Chapter 1-Adolescents

1.1 Adolescents

The demographic profile of Malaysia is that of a country in transition from

developing to developed status, with adolescents (aged 10-19) making up about one-fifth of
the total population. Adolescence, the second decade of life, is increasingly recognized as a
critical phase in the life course, especially from the health and social perspectives. The health
of adolescents is a key element and an investment for social and economic progress in the
Region. The most challenging aspect of adolescence is sexual and reproductive health. Many
of the problems adolescents experience are inter-related and should be regarded in a
comprehensive manner. However, adjusting to sexual development and protecting their
reproductive health are the major challenges for adolescents (WHO, 2007).
Adolescence is a period in life when significant biological and social changes occur.
Youth may encounter difficulties in adjusting to new situations. The majority of the social
problems are related to behaviour, life style or sexuality. Promiscuity, teenage pregnancy,
running away from home, delinquency and substance abuse are problems that often occur
among youth (United Nations, 2002).
Le Vay and Valente (2003), described adolescence as a key period of sexual
exploration and development. During this time, individuals begin to consider which sexual
behaviours are enjoyable, moral, and appropriate for their age group. Many teens become
sexually active during this period (Collins, et al., 2004). Sex is occurring before youths are
prepared for its consequences because according to NCTPP (2002), most sexually active
teens wish they had waited longer to have sex. According to Branstad (2007), adolescent
sexual behaviour is cause for societal concern. Understanding the messages sent to
adolescents about sex may increase awareness of this concern and lead to improved
adolescent sexual health.

1.2 Knowledge of Sex

Knowledge on matters related to sexual and reproductive health varies according to

several studies, but it is clear that in some areas knowledge is still limited in Malaysia. In
areas where knowledge appears adequate, it does not generally translate into behaviour. For
puberty changes and similar matters, the usual sources of information are parents and
teachers. For sexual relationships, however, the main sources are friends and peers. There is

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little information on sexual development of Malaysian adolescents, and what is available is
limited to menarche for girls and wet dreams for boys. Information on sexual behaviour,
including dating behaviour, indicates that young people are involved in various types of
specific sexual behaviour, including some considered unacceptable according to religious and
cultural norms of Malaysia (WHO, 2007).
Adolescents are vulnerable because they lack knowledge and skills to avoid risky
behaviour and lack access to acceptable, affordable and appropriate reproductive health
information and services. This is often compounded with environmental disadvantages such
as poverty and unemployment. Social norms of sexuality in Malaysia have also changed in
the past 2 decades and puberty comes 2-3 years earlier over one century, but the environment
to support adolescents has not changed. Also families and communities are still unprepared to
provide accurate reproductive health information and services necessary for adolescents
(WHO, 2007).

1.3 Sexual Relationships

Males began masturbating at the mean age of 14.4 years, compared to girls who began
at mean age 15.5 (Zulkifli, et al., 1995). As in most studies of this nature, more boys than
girls reported having sexual intercourse, confirming the belief that there is less pressure for
boys to remain virgins or that they are more aggressive when it comes to having sex. The
same study showed that the incidence of having engaged in sexual intercourse went up with
age: from 15% among the ages 15-16, to 23.3% among the 17-19, and to 32.8% among the
20-21(Huang, 1999). According to the National Population and Family Development
Board, a survey among secondary school students showed that, although only 2.4%
admitted to have had sex, 20.7% of the respondents said they know of friends who
have had premarital sex (NPFDB, 1998).
In the household survey, 1% admitted to have had sexual intercourse, while 24% had
confirmed in the media survey. Of these, 18.4% had their first sexual intercourse between 15
and 18 years, when most of them would have completed their formal schooling and have
been away from parental guidance (NPFDB, 1997). An earlier study conducted nationwide
by the Ministry of Health in 1992, found that 52% of the youth aged 17-24 had had more than
one sex partner, and half of them had engaged in premarital sex (Huang, 1999).
A study conducted among 1,200 Malaysian adolescent aged 15-21, with 1, 181
unmarried respondents, found that among the unmarried respondents, 9% reported having

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had sexual intercourse; males were significantly more experienced compared to females.
Older age groups were also found to be more sexually active than the younger ones. Among
the 45% who had experience dating, 20% have experienced sexual intercourse, 44% have
kissed and necked, and 35% have experienced petting, while 24% have had no physical
intimacies. Among those who had dated, 26% of the boys and 5% of the girls had had sexual
intercourse (Zulkifli, et al., 1995).
Another study carried out nationwide at the end of 1996 among 30,233 secondary
level students (aged 13-18) in 881 classes, from 708 schools, revealed that 1.8% were
engaged in sexual activities (Second National Health and Morbidity Survey, Ministry of
Health, 1997). Of these, 63.2% were heterosexual, 19.9% homosexual (male and male), 6.2%
lesbian, and 8.4% had sex with both male and female sex workers (Huang, 1999).
It is also reported that among the youth “lazing” in various places of entertainment,
18% of them have friends who have engaged in premarital sex (Samsudin, 1994). A study on
reproductive health of adolescents (ages 13-19) revealed that 40% of respondents had begun
dating from ages 13 to 15. By 13 to 18 years, 84% had started holding hands, 85% kissing
and necking, and 83% petting (Huang, 1999).
According to the statistics posted in the official website of the Sultan Abdul Hamid
Hospital, Sungai Petani, Kedah, 261 cases of unmarried pregnancies of adolescent have been
reported since January 2010. It shows an increase of 23 of cases compared to the same period
last year (NA, 2010). This statistics shows precisely why the topic of adolescent sex is
becoming more prevalent in current research and gaining media attention.
There is no specific finding on oral sex among Malaysia adolescents. In America,
although nearly fifty percent admit to having intercourse, the percent increases when
considering participation in oral sex (Kaiser Family Foundation, 2003). Adolescents often
view oral sex as safe because the public does not teach them the dangers involved; instead the
public concentrates on basic discussion of intercourse or no discussion at all (Haffner, 2002).
Consequently, the media and peer networks are left to influence adolescents on more
controversial topics such as oral sex.

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1.4 Pregnancies and Abortions

Adolescents are not ready to start a family, from both a biological and a social
perspective. Pregnancy and childbirth are high-risk events for young women because they are
not physiologically or psychologically mature. Therefore abortion becomes an alternative
when an unwanted pregnancy happens. According to the National Population and Family
Development Board, a survey among secondary school students showed that 21.2%
know of friends who have had illegitimate pregnancies and 10% have friends who have
undergone abortions (NPFDB, 1998). In another recent study of 4,500 respondents in seven
districts in Negeri Sembilan, 5.4% has had sexual intercourse and 17.8% of the
respondents reported they had been pregnant or had made his partner pregnant (Lee, et al.,
2006).
Unplanned pregnancies are more common among those who begin sexual activity
earlier (Collins, et al., 2004). In the Youth Sexuality Survey, when sexually active females
were asked about “precautions to prevent pregnancy,” 90% of the in-school females
questioned admitted to not taking any measures, but 60% of the out-of-school females said
that they did. On the other hand, about 30% of in-school males and 15% of out-of-school
males said they took precautions to prevent pregnancy.
In another study, conducted in Kuala Lumpur, only 37% of the sexually active
teenage respondents said they used some form of birth control, even although the majority
knew about birth control methods. By far the most common method used was the condom
(51%), followed by oral contraceptives (18%) and withdrawal (15%). Among those who did
not use any contraceptives, about half explained that sex was not much fun with
contraceptives or that they found contraceptives too difficult to use (WHO, 2007).
There is a paucity of data on abortions in the country, especially for the unmarried and
adolescent population. Of the 3866 women surveyed in 1984, 16.3% had experienced at least
one spontaneous abortion and 5.8% at least one induced abortion. Lack of information is a
major barrier to making any meaningful situational analysis. However, whether more data
would lead to more meaningful interventions is questionable, given the religious and cultural
sanctions against abortion. Even though “hard” data are not available on rates of abortion,
observations and anecdotal reports suggest that the rates are not as low as might be expected
(WHO, 2007). World Health Organization found that 4.4 million adolescents around the
world have had induced abortion (Hashim, et al., 2008).

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 Abortion could not be done at all time times depending on the duration of pregnancy,
financial and lack of sources, and when this situation arises, some unmarried mothers resort
to abandoning their babies. Cases of abandoned babies in Malaysia rise from time to time.
From anecdotal and media reports on the incidence of abandoned babies, it is reasonable to
postulate that many of those mothers of “unknown” age are unmarried young women who
have no recourse to family and other institutional support, and therefore abandon their babies
hoping that someone will take better care of them. Inherent in this phenomenon is the deep
sense of shame related to the societal sanction placed upon illegitimate births. As, in almost
all cases, the identity of a woman who has given birth and abandoned her baby is not known,
such events take place under clandestine circumstances (WHO, 2007).
In a period of two years until 2006, Social Welfare Department has received
information that 145 babies born out of wedlock were abandoned (Hashim, et al., 2008). A
report in 2007 stated that one baby is abandoned every ten days in Kuala Lumpur. From
2001 to 2004, the Social Welfare Department recorded 315 cases of abandoned babies,
while police statistics revealed about 100 cases a year (Ang, 2007). Clearly, there are still
gaps in the provision of, or access to, reproductive health services, including unmet
needs for contraception, emergency contraception and abortion.

1.5 Sex-Related Activities

Pornography is so widely available in various forms via protocols such as Usenet,

World Wide Web and Bulletin Board Service which is being commercially operated. There
are also websites that has been exclusively created to portray the sexual acts of the Malays,
with columns for sharing of sexual experiences and “real-time sex-chatting”. All this could be
easily accessed by anyone with a cheap subscribing fee (Alim, 2000).
In Huang (1999), it was reported that among Malaysian adolescents aged 14-15, 50%
have read pornographic materials, 44% have seen pornographic images from magazines or
videos, and some have done so as early as the age of nine (NFPDB,1998). It is also reported
that among the youth “lazing” in various places of entertainment, 40% knew of friends who
have watched “blue films”, 39% knew of friends who have read pornographic magazines
(Samsudin, 1994). Over two-thirds of youth aged 13 to 19 years have had at least some
exposure to materials such as magazines, films and videos containing explicit or implied
sexual connotations (United Nations, 2002).

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 The advent of the Internet has profound effects on youth’s lives. Online sexual
activities have become the next sexual revolution. The fact that the changing attitudes of
today’s youth has made cybersex palatable to the young net citizens. The American
Psychological Association has demonstrated that those who do spend large amount of
time in the Net in sexual pursuits may be at risk for developing psychological
difficulties. It is also known to be a major contributing factor to separation and divorce
of couples. Negative consequences are shown for those hooked on cybersex. Thus,
understanding the common use of the Internet can help mental healthcare professionals
develop guidance to prevent, diagnose, intervene and treat sexual compulsivity and
related disorders. As Malaysia is highly wired, there is a need for research in this area as
pornography and other forms of online sexuality activities is known to be rampant as
reported in the media (Low, 2009).

1.6 Sexually Transmitted Diseases

Sexual and reproductive health care is a central health issue among youth. There is a
need for sex education and counselling as there is evidence that many of the youth in
Malaysia are sexually active and lack accurate information to protect them. This seems to be
particularly true among young males. Although not the major cause of the spread of
HIV/AIDS in Malaysia, unprotected sex has become an increasing concern as a large number
of heterosexuals continue to mistakenly believe that they are at little risk of contracting the
virus (United Nations, 2002). Half of all new sexually transmitted disease cases each year are
adolescents ages 15-24 (Weinstock, et al., 2004). Each year, 1 case of a sexually transmitted
disease (STD) is diagnosed for every 4 sexually active teens in the United States and STDs
are more common among those who begin sexual activity earlier (Collins, et al., 2004).

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Chapter 2-Parents
2.1 Role of Parents

Family plays a vital role in the development of the personality and morality of an
individual. From a family, an individual will learn the religion of his/her parents. Education
at home gives a strong impact on the growth of the children. Wrong and unplanned education
would result in wrong behaviours of the children (Mohd Azhar, 2001). There is a need to
strengthen the family institution in order to foster an environment that is supportive to youth.
This entails encouraging improved family relations, open communication, and increased
interaction and time spent between parents and children (United Nations, 2002).
Comprehensive information on reproductive health among youth was provided by the
National Study on Reproductive Health of Adolescents conducted by the National Population
and Family Development Board in 1994. A total of 2,366 adolescents aged 10 to 19 years
from every state and all ethnic groups were surveyed during the two-year study. According to
this study, most youth are not provided with information, counselling or support when they
experience stress owing to biological changes that affect their behaviour, attitude, personality
and lifestyle. Parents are often unprepared or unable to give sufficient advice and reassurance
to their children or are reluctant to discuss the issues. Therefore, youth often share
experiences of biological changes and sexual relationships among themselves (United
Nations, 2002).
With the growing numbers of adolescents engaging in at-risk behaviours, many
researchers have begun to study adolescent influences. One of the initial places to examine is
the relationship between parents and adolescents; more so, the communication between
parents and adolescents. The majority of parents believe it is their responsibility to be the
primary source of sex education (Jordan, et al., 2002). Communicating about sex and
sexuality is sure to increase adolescents’ understanding of the world around them, as well as
the merger of their personal values, family values, religious values, and societal values. With
many sources wanting to influence adolescent sexual behaviour, parents continue to be a
consistent source of forming beliefs and representing the values they wish to teach their
children (Branstad, 2007).
A large body of literature suggests that parents can be key agents in shaping
adolescents’ sexual attitudes and behaviours and influencing them in a positive way (Guo &
Nathanson, 2009).

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The role of the family in reducing risk-taking sexual behaviour has been extensively studied.
Important aspects of parental influence on adolescent risk taking behaviour are: monitoring,
communication and sexual conservatism (Majumdar, 2003).
Parental influences are important determinants of adolescent behaviour including
sexual behaviour. However, the literature indicates a general absence of consistent findings
regarding the effects of parents and peers on adolescent sexual activity. It seems that parental
monitoring decreases sexual activity in studies where peer conformity was not considered. n
prior research, parental influence on adolescent sexual behaviour has been overwhelmingly
represented by their supervision or monitoring. However, other aspects of parental influence
not restricted only to monitoring, need to be explored, e.g., communication with adolescents,
and conservatism / disapproval towards sexual activity. This will provide a holistic view of
the manner in which parental socialization affects adolescent sexual behaviour (Majumdar,
2003).
Research suggests that parents have an important influence on adolescents’ sexual
behaviour. Two aspects of the parent-child relationship that have received considerable
attention in the literature are (1) parental monitoring (or supervision) of children’s activities
and friendships and (2) parent-child communication about sex. While parental monitoring is
generally associated with delayed sexual initiation and safe sex behaviours, the research on
parent-child communication is much less consistent (Chernin, et al., 2007).
Results indicate that, for both males and females, quality of parenting and family
structure are indirectly related to risky sexual behaviour through their influence on mediating
variables. Family structure and quality of parenting influence adolescents’ commitment to the
institution of marriage and the importance of value similarity in a partner (versus sexual
compatibility) (Simon & Murphy, 2003).

2.2 Parental Communication on Sex

Increasing the understanding of parent-child communication is vital in improving

adolescents’ sexual health. Parents “are a key resource for adolescents and can have a major
impact on their lives” (Branstad, 2007). Parents can play an important role in the sexual
socialization of their children by educating and talking to youth about sexuality. Talking
about sex is not an all-or-nothing event. The content of parent–adolescent sexual discussions
can cover a range of topics, including biological and developmental issues (e.g., puberty),
values, healthy relationships, and pregnancy and STD prevention (Beckett, et al., 2009).

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 As cited in Branstad (2007), understanding of adolescent sexuality is fairly limited;
improving that understanding assures progress toward creating sexually healthier youth and a
sexually healthier nation. Parent-child sexual communication allows parents to ultimately
convey the messages they find consistent with their family’s beliefs, values, and lifestyle
(Jaccard, Dodge, & Dittus, 2002). Helping adolescents understand their own sexuality,
preparing them for potential consequences and helping them create healthy perspectives is
vital in improving adolescent sexual health (Jaccard, et al., 2002).
Understanding communication prior to sexual activity is vital in understanding which
types of communication delay or encourage sexual behaviour. With high rates of teen
pregnancy and sexually transmitted diseases, it is now more important than ever to begin
conversations about sex with adolescents. It is crucial to look at ways in which
communication can help adolescents better understand the topic of sex and engage in
healthier sexual behaviours (Branstad, 2007). Adolescents are swayed by these sources so it
is important to supply adolescents with educational resources. With adolescents’ sexual
health at risk, it is crucial to look at ways in which communication can help adolescents
better understand the topic of sex. Though teen sexual health is becoming more discussed and
the public is more aware of teen sexual behaviour, there are few effective and reliable sources
to improve the rising statistics.
Rosenthal, et al., (1998) found most parents cover at least some aspect of puberty,
physical development and reproduction. Furthermore, sexually transmitted diseases,
specifically HIV and AIDS, are also commonly discussed. The discussions of such topics are
not necessarily related to the individual, but perhaps merely mentioned as a general risk of
sexual activity and a reason not to engage in sexual intercourse (Jordan et al., 2000). Studies
also found more personal issues, or private matters, such as sexual development,
masturbation, oral sex, pornography, and so forth are rarely discussed among parents and
their children (Branstad, 2007).
It is apparent; parents affect sexually active and inactive teenagers differently
compared to peers. Both parents and peers influence adolescents who are inactive to a much
greater extent than those who are sexually active. Parental influence was primarily affected
teenagers who became sexually active for the first time between the interview waves. For
adolescents who were already sexually active, parents influences largely did not matter. This
perhaps indicates that parents and peers play very important role in the transition of an
adolescent to non virgin status. Adolescents regard both their influences very intently before
taking the plunge. However, once they become sexually active, the same factors that

9
predicted their sexual initiation does not play very important role anymore. This could
possibly imply that after being sexually active adolescents make decisions about their sexual
behaviour themselves. This could be due to parental and peer input on such matters may not
appear to be that critical to an adolescent once they have ‘learned the ropes.’ (Majumdar,
2003).

2.3 Positive Link on Adolescents Sexual Behaviours

A recent study found that repetition of sexual discussions (talking about topics more
than once) was associated with adolescents’ feeling closer to the parent and having a sense of
open communication. Consistently, parent-child communication about sex has proven to
decrease adolescent sexual risk behaviors (Branstad 2007).The link between parent-child
communication about sex and adolescent sexual behaviour is to a large degree unclear.
Numerous studies have found that frequent parent-child communication about sex is
associated with delayed sexual initiation and, among sexually active adolescents, consistent
condom use and having fewer sexual partners (Chernin, et al., 2007).
In the case of a positive association between parent-child communication about sex
and sexual activity, Miller et al. (2001) suggested that parents may initiate conversations with
their teenagers about sex only after they suspect that their child has become sexually active.
Parent-child communication about sex was positively associated with sexual initiation, and
this result persisted after controls were added to the model. A one-point increase in the
communication scale was associated with a 38% increase in the odds of sexual initiation
(Chernin, et al., 2007).

2.4 Negative Link on Adolescents Sexual Behaviours

It seems that sexual information is not always transmitted in a positive environment

by parents to their adolescents. DiIorio’s (1997) research found that parent-adolescent
discourse dwelled more on the negative outcomes associated with sexual intercourse rather
than transmission of information about their biological developments and physical changes.
This could be a response to sexual activity that has already been initiated. Yet, the effects
differ according to both gender and race (Majumdar, 2003). Several researchers have reported
that parent-child communication about sex is associated with earlier sexual initiation and
more frequent sexual activity (Chernin, et al., 2007).

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 Many studies have also found no association between parent-child communication
about sex and adolescent sexual behaviour. One possible explanation for the inconsistent
findings lies in methodological limitations (Chernin, et al., 2007). Almost all of the studies
that examine parent-child communication are cross-sectional surveys, and, as a result, the
temporal order of the variables is unclear.
Additionally, attention needs to be paid to the nature of parental influence. Different
elements of parental socialization may affect teenage sexual activity differently. Parental
communication, counter intuitively, appears to facilitate risk taking behaviours among
teenagers. Teenagers may consider free communication with parents as a sign of latent
approval of sexual activity. Approachable and communicative parents could also be parents
who are lenient and compassionate. This could lead to risk taking among their adolescent
offspring as observed in this research. Parental conservativeness, on the other hand,
decreases the chances of risky sexual behaviour. Thus, parents having traditional values
about sexuality does thwart their adolescent’s sexual risk taking propensities (Majumdar,
2003).
Thus, it can be concluded that although parents play salient roles in an adolescent’s
sexual career, their impact is most profound in the area of sexual commencement and when
they are newly active. The longer adolescents’ have had sex, the less is the influence of
parents. Thus, social factors play a salient role in postponement of sex and reduction of
sexual risk among those who have recently started having sexual intercourse (Majumdar,
2003).

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Chapter 3-Problems in Parental Communication on Sex
3.1 Avoidance of Discussion by Adolescents

Zuria, et al., (2001), in a research done among 388 secondary school students on self-
disclosure, found that matters related to sexual activities are the least shared with parents by
adolescents. Adolescents may be excluding parents from this aspect of their life by avoiding
discussions about it; allowing influence from outside sources. Consequently, teenagers and
even younger children are receiving mixed messages regarding sexuality. They are confused
about what to think, what to abstain from and what to engage in, and how to communicate
about the questions they have (Branstad, 2007).
Many adolescents fear the topic of sex being discussed with their parents for some of
the same reasons. Adolescents suggest a fear of embarrassment when talking to their parents
about sex. Adolescents’ experience with sexual behaviours or lack of sexual knowledge may
create a sense of embarrassment. Many adolescents go so far to claim it is not important for
their parents to talk to them about sexual issues. If parents are going to talk about sex, many
adolescents believe it only needs to be about sexual safety. Adolescents are so uncomfortable
with such a seemingly private topic they ignore their need to be knowledgeable about sexual
matters (Rosenthal & Feldman, 1999).

3.2 Pseudo-Communication by Parents

Most adolescents recalled little or no sexual communication with their parents, similar
to existing research. This is interesting since most parents believed they had communicated
with their own adolescent about sex, and believed they did so in an open manner. In fact,
many parents believed their communication was not just open but also successful and unique
and different from all other parents. This supports the idea that parents believe the way in
which they communicate with their own children is different from that of other parents. One
study found many parents believe they have had successful sexual communication with their
children but only 9% of parents believe other parents talk to their own children about sex
(Branstad, 2007).
This study suggests parents think they have a different approach than other parents.
Perhaps this stems from the need to be believe they are “good” and “making a difference”
through communication about sex. Parents may also want to believe they are better than other
parents or that their children are better than others. Parents often use of catalysts to discuss

12
sex with their adolescents and some parents recalled their use of other people’s experiences to
bring up sexual communication with their children (Branstad, 2007).
The problem with parents wanting to be primary sex educators is the discrepancy over
if the education actually occurs. Most parents report talking to their adolescents about sex,
but few adolescents recalls having these conversations. Somewhere in this communication,
an agreement of what is actually discussed is not attained. It is possible parents may report
communicating about sex to their children at an age when the child may not have been old
enough to retain the information, therefore, the child does not remember having such
conversations. It is also possible parents are not explicitly talking about sex, leading to a lack
of understanding by the adolescent (Branstad, 2007).

3.3 Selective On Topics

There are many reasons parents may choose to discuss some sexual topics with their
children and avoid others. One leading reason is parents feel uncomfortable talking with their
adolescents about certain topics (Rosenthal et al., 1998). In examining why parents do not
initiate sex conversations, or limit the topics when they do, it is evident many parents fear
they lack knowledge on the topic. Parents feel a need to do better than their own parents did
in terms of talking about sex, but fear they do not know the most effective ways to do so
(Geasler et al., 1995).

3.5 Communication Vs. Commands

Perhaps when parents believe they are communicating with their children about sex,
they are in fact sending cautioning or reprimanding statements, rather than discussions of
sexuality. Parents may be sending messages of “don’t get pregnant” or “you better not do
that” when they believe are merely talking informatively about sex. Adolescents may not
consider those remarks to be discussion about sex and therefore report not talking with their
parents about the topic (Branstad, 2007).

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Chapter 4-Television
4.1 Content of Television Programmes

One factor commonly cited by parents and policy makers as promoting sex among
teens has received little systematic scientific investigation, namely, television (TV). The
flooding of hedonistic lifestyle is due to the influence of printed media, satellite television,
television, movies, videos and laser disc (DVD and VCD). In Malaysia, there are more than
30 local channels, Indonesia, Thailand, Brunei, Philippine, Singapore and satellite television
such as Astro and Mega TV (Mohd Azhar, 2001). According to Shahrom (2001), “…a
communication expert quoted that television is the religion of the industrial society. As a
“new religion”, television has pushed aside conventional religions.”
There is good scientific reason to think that TV may be a key contributor to early
sexual activity. There, sexual messages are commonplace, according to a scientific content
analysis of a representative sample of programming from the 2001–2002 TV seasons. Sexual
content appears in 64% of all TV programs; those programs with sexual content average 4.4
scenes with sexually related material per hour. Talk about sex is found more frequently (61%
of all programs) than overt portrayals of any sexual behaviour (32% of programs).
Approximately 1 of every 7 programs (14%) includes a portrayal of sexual intercourse,
depicted or strongly implied (Kunkel, et al., 2003).
This high-dose exposure to portrayals of sex may affect adolescents’ developing
beliefs about cultural norms. TV may create the illusion that sex is more central to daily life
than it truly is and may promote sexual initiation as a result, a process known as media
cultivation. Exposure to the social models provided by TV also may alter beliefs about the
likely outcome of engaging in sexual activity (Collins, et al., 2004)
Although televised sexual portrayals can theoretically inhibit sexual activity when
they include depictions of sexual risks (such as the possibility of contracting an STD or
becoming pregnant), abstinence, or the need for sexual safety, this type of depiction occurs in
only 15% of shows with sexual content. In other words, only 1 of every 7 TV shows that
include sexual content includes any safe sex messages and nearly two-thirds of these
instances (63%) are minor or inconsequential in their degree of emphasis within the scene
(Collins, et al., et al., 2004).

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4.2 Learning Theories of Albert Bandura

Social learning theory predicts that teens that see characters having casual sex without
experiencing negative consequences will be more likely to adopt the behaviours portrayed.
As a result, sexual content on TV is far more likely to promote sexual activity among US
adolescents than it is to discourage it. TV has already been shown to influence violent and
aggressive behaviour among youths and, although extension of the principles involved to the
realm of sexual behaviour is not a foregone conclusion, the hypothesis that TV promotes early
sexual initiation logically follows from previous media effects theory and several existing
studies (Collins, et al., 2004).
Although TV producers and the general public have expressed concern regarding both
sexual talk and sexual behaviour, portrayals of behaviour have typically been the focus of
such attention. Social learning theory predicts that observation of either sexual talk or sexual
behaviour will influence teens to have sex, as long as the portrayed consequences are not
negative, but the theory does not address whether the magnitudes of these effects will differ.
Finally, we examined the effects of hours spent viewing TV, independent of content. Some
theory and research argue that any time spent watching TV affects sexual behaviour, whereas
other research suggests that only programs with known sexual content have an influence. The
issue warrants examination, because the implications of the 2 results, with respect to theory,
programming, policy, and parenting, are quite different (Collins, et al., 2004).
This is further reinforced by Bandura’s (1986) social cognitive theory can account for
the behavioural effects of exposure to sexual content. According to this theory, viewers learn
which behaviours are appropriate through observation of media models. Seeing characters on
TV get rewarded for certain behaviours helps viewers learn and imitate those behaviours,
whereas seeing characters get punished for certain behaviours inhibits them from adopting
those behaviours. Therefore, observing characters enjoying sexual intercourse with few
negative consequences should lead adolescents to perceive this behaviour as appropriate and
then try to imitate what they observe on television (Guo & Nathanson, 2009).
There are several possible explanations for why exposure to sexual television is
related to undesirable sexual knowledge, attitudes, and behaviors. According to Ward (2003),
cultivation theory is the most heavily relied on theory to account for the effects of sexual
content on attitudes, even despite criticism of the theory’s underlying assumptions. This
theory proposes that television consistently presents viewers with a world that is different
from reality, and as viewers watch more television, they gradually come to adopt the beliefs

15
about the world that coincide with the media’s depiction. Since content analyses indicate that
sex on TV is spontaneous, glamorous, recreational, and risk-free, the cultivation model
predicts that heavy viewers will be more likely to endorse this perspective than will light
viewers (Guo & Nathanson, 2009).

4.3 Influences on Adolescents Sexual Behaviours

Previous work demonstrated links between viewing of sexual content on TV and

attitudes toward sex, endorsement of gender stereotypes likely to promote sexual initiation,
and dissatisfaction with virginity, as well as a wide range of perceptions regarding normative
sexual behaviour. In addition to these studies, 2 groundbreaking articles published in the early
1990s examined the question of whether exposure to sex on TV influences adolescent sexual
behaviour. The studies found positive associations between any lifetime intercourse and TV
viewing among adolescents, but methodological limitations rendered the results inconclusive.
Higher levels of exposure to sex on TV might have led to sexual initiation in that research,
but a plausible alternative interpretation was that, because sexual content more closely
reflects their identities and interests, sexually active adolescents choose to watch more of it
than their inactive peers (Collins, et al., 2004).
According to Guo & Nathanson, (2009), television plays an important role in the
sexual socialization of adolescents. Studies have found that adolescents who watch a lot of
sexual content are more likely to hold gender stereotyped attitudes toward sex (Ward, 2002),
perceive less serious consequences of sexual behaviour (Farrar, 2006), and become sexually
active. However, relatively little research has examined parents’ role in mitigating these
negative effects. And yet, the work on parental mediation has shown that parents can play a
significant role in reducing their youngsters’ susceptibility to undesirable outcomes
(Nathanson, 1999).
Ward’s (2003) meta-analysis of the research on sexual content in media revealed
several features that are prevalent across various genres of sexual television programs. For
example, sexual programs often depict women as sexual objects, including presenting them in
provocative and revealing clothing and as objects of sexual harassment. In addition, sexual
content often lacks discussion and depiction of sexual planning and consequences, with few
references to sexually-transmitted disease, contraception, and abortion. In addition, sex is
usually depicted in a spontaneous and glamorous way. Moreover, the bulk of sexual action
and language occurs outside of marital relationships (Guo & Nathanson, 2009).

16
Chapter 5-Parental Mediation
5.1 Mediation as a Tool

Although there is a great number of studies on the relationship between parent-child

communication about sex and adolescents’ sexual attitudes and behaviours, researchers have
not studied parental mediation of sexual content in television. And yet, adolescents are very
interested in sexual media content and gain much of their information about sex from the
media. It is important to understand whether parents can reduce the negative effects of
exposure to sexual material. In addition, given that parents are typically reluctant and
uncomfortable discussing sex with their adolescents, it is useful to explore whether
discussions about sex in the safer, less threatening context of television stories and characters
could be effective in transmitting knowledge and healthy attitudes and encourage responsible
sexual behaviours among adolescents. Perhaps parents can use television as a means of
opening up a dialogue about sex with their adolescents that they could not have accomplished
otherwise (Guo & Nathanson, 2009).

5.2 Co-Viewing

Co-viewing refers to parents and children watching television together. Though

parents do not convey verbal information to their children during this process, the mere
action of viewing could communicate that parents hold positive attitudes toward the material.
Under such circumstances, it is probable that co-viewing sends a message about the
importance and value of the material and therefore children pay closer attention to and learn
more from programs that are co-viewed (Guo & Nathanson, 2009).
Depending on the television content, we can expect either positive or negative effects
of co-viewing. Positive effects include enhanced learning from educational television, and
negative effects include increased aggression after co-viewing violent TV, endorsement of
stereotyped sex roles due to co-viewing of gender-stereotyped TV, and perceived realism of
TV character. It seems as though co-viewing facilitates media effects on children (Guo &
Nathanson, 2009).
Based on previous research, it is likely that parents’ co-viewing sexual content with
adolescents would strengthen adolescents’ perceived importance of the content. Therefore,
co-viewing of sexual content may lead adolescents to pay more attention to the material and
learn more from it. Adolescents are more likely to develop stereotyped and casual attitudes

17
toward sex that are consistent with the way that sex is portrayed on television. In addition,
adolescents may infer from their parents’ co-viewing behaviour that their parents have
favourable attitudes toward sex, which could lead to risky sexual behaviours (Guo &
Nathanson, 2009).
Consistent with prior work, research found that parent-adolescent co-viewing of
sexual television content has negative effects. Co-viewing was related to engaging in sex at a
younger age and having more sexual partners. It is noteworthy that this effect was found even
when the adolescents’ own exposure to sexual media content was controlled. As a result,
viewing sexual content with parents made an independent contribution to adolescents’ sexual
behaviours even above and beyond the influence of their own media habits. It is likely that
parents who co-view sexual television with their adolescents unintentionally send a subtle
endorsement of the content and the characters, thereby making the behaviours more
acceptable to the adolescents. With this study, there is now strong and consistent evidence
that co-viewing of objectionable television content is related to undesirable outcomes among
children and adolescents (Guo & Nathanson, 2009).

5.3 Restrictive Mediation

Restrictive mediation occurs when parents set rules about children’s television
viewing, such as rules about the amount and timing of viewing as well as rules pertaining to
permissible and unacceptable content. The existence of viewing rules in the house can
decrease the importance of television for children however, it can backfire. Research found
that the relationship between restrictive mediation and children’s co-viewing was curvilinear,
such that too low and too high levels of restrictive mediation triggered more aggression in
children, with moderate amounts of restrictions resulting in optimal effects (Nathanson,
1999). Similarly, Nathanson (2002) found that adolescents whose parents restricted their
viewing of violent and sexual television were more likely to seek it out in other contexts,
such as when viewing with friends.
Restrictive mediation of sexual content may generate unintended effects, especially
the “forbidden fruit” response in adolescents. This effect may be heightened in the case of
sexual television since adolescents are particularly interested in learning about sex.
Moreover, adolescents often question their parents’ values and rules as they seek to build
their own identities. As a result, restricting access to sexual content can increase its
attractiveness among adolescents. This could, in turn, lead them to watch more sexual content

18
when parents are absent (Nathanson, 2002) which could lead to more acceptance of the
stereotyped and recreational views of sex portrayed on television (Guo & Nathanson, 2009).
Parents should use restrictive mediation with caution, especially when their children
enter adolescence. Setting limits on viewing is effective in moderate doses; however, very
low levels or very high levels of restrictions are related to undesirable outcomes. This finding
underscores the importance of examining the ways in which parents communicate rules and
expectations. Nathanson (2002) also found that restrictive mediation of violent television had
negative effects on adolescents; however, adolescents whose parents paired restrictive
mediation with active mediation experienced positive outcomes. Similarly, Nathanson (1999)
found that the relationship between restrictive mediation of antisocial television and
children’s antisocial behaviour was curvilinear (Guo & Nathanson, 2009).
It is likely that moderate amounts of rules are tolerable to adolescents and leave open
the possibility of negotiation and discussion of restrictions. However, too few rules or too
many rules (or rules that are very harsh) leave adolescents more vulnerable to the negative
influence of television. Moderate amounts of restrictive mediation send a message of caring
and concern to adolescents while simultaneously communicating trust and respect for the
adolescents’ decisions and preferences (Guo & Nathanson, 2009).

5.4 Active Mediation

Active mediation refers to talking with children about television. It can be further
divided into negative, positive, and neutral mediation according to whether the statements
condemn, endorse, or do neither, such as when parents ask questions or provide more
information. Although there is a large body of research on parent-adolescent communication
about sex, we know very little about whether and how parents talk with their adolescents
about the sexual activity and situations which appear on television (Guo & Nathanson, 2009).
Research suggests that active mediation should promote desirable outcomes among
children and adolescents. Using Messaris’ conceptualization of active mediation, we can
speculate that parents can engage in validating mediation by expressing their positive or
negative attitudes toward sexual content. However, because studies show that the effects of
positive (endorsement) messages differ from the effects of negative (condemning) messages,
we make separate predictions about each type of mediation. Hence, we reserve the term
“validation” for positive messages about sexual content and offer the term “contradiction” for
negative messages about sexual content. In our view, categorization mediation also would be

19
a form of either validation or contradiction mediation, depending on whether statements
support or refute the accuracy of TV reality (Guo & Nathanson, 2009).
In addition, the style that parents use when delivering these messages can have a
significant role in the message’s effectiveness. Research indicates that people respond
differently to the same type of content when they are asked to think about the content
compared to when they are given a statement about the content. Asking questions enhances
learning among adults and older children (Guo). Some surprising main effects of active
mediation in the form of contradiction emerged but were qualified by more sensible
interactions with parents’ delivery style. Specifically, parents’ who contradict sexual media
content are most effective when they deliver their messages in the form of an open dialogue.
It is likely, especially among adolescents, that these messages are more palatable when they
are delivered in a context in which the adolescents’ opinions are valued and sought. On the
other hand, when parents contradict what is shown in sexual television in a way that
resembles a lecture or speech, with little opportunity for an exchange of ideas, these messages
backfire and produce more undesirable outcomes among adolescents (Guo & Nathanson,
2009).

Chapter 6-Conclusions

Understanding how youths make decisions to engage in early sexual activities is

critical for intervention efforts. Efforts that can be aimed at fostering positive youth
development and decreasing the negative outcomes of youth sexual behaviour. This is
because, healthy youths are fundamental to the prevention initiatives. Promoting the sexual
and reproductive needs and rights of youths are socially and politically sensitive topics. There
has been a paucity of research in these issues. Hence, there is a lack of data on what
strategies work best in different settings that can cater to young people’s needs for
information, life skills and services. Research in this area needs to incorporate
multidisciplinary personnel to cater to the needs of our youths today.
It is clear that parent as the root of the family plays a major role in influencing sexual
behaviours of adolescents. Parental communication on sex related issues and mediation in
viewing television by all means concluded to decrease unwanted sexual behaviours among
adolescents. It should be taken as a guide to educate parents to better enable them in playing
their roles effectively as a catalyst in their adolescents’ life.

20
 As for Malaysia, this is an area where, more research has to be done in order to
establish a concrete foundation in curbing risky and unwanted sexual behaviour among
adolescents. The statistics of Malaysia on this issue is very poor and no major statistics are
available on national level as compared to countries like America.
There are several gaps in current knowledge on adolescents’ sexual and reproductive
health in Malaysia. There is little information about abortion, teenage pregnancies and STD
among teenagers. Such knowledge could be useful in making relative policies and designing
effective intervention strategies. It could also highlight the impact of current policies. There
is no information about sexual development, except concerning wet dreams and onset of
menarche which is also minimal with almost only the traditionally inherited information.
Research is needed to identify the best approaches for adolescents’ sexual and reproductive
health education, and to evaluate the impact of such education. There is also a need to
improve and standardize research methods to obtain reliable information. Almost of all the
researches done, it covers only certain areas, limited group of adolescents and small number
of adolescents compared to the actual number. Non-threatening approaches should be used to
gather information from and about adolescents. It is also recommended that all agencies
should coordinate their research, so that important areas are covered and duplication is
avoided.

References:
Alim Mujahid. (2000). Cybersex Melayu. dalam Tamadun. Bil. 71: 59.

Ang ES.(2007). Adolescent health. Paper presented at the National Population

Conference, 3-5 July 2007, Kuala Lumpur, Malaysia.

Beckett, M. K., Elliott, M. N., Martina, S., Karouse, D. E., Corona, R. Klein, D. J.,
Schuster, M. A. (2009). Timing of Parent and Child Communication About Sexuality Relative
to Children’s Sexual Behavior, 125, 34-42

Branstad, H. S. (2007). Parents vs. Adolescents: Parent - Adolescent Communication

About Sex.   Paper presented at the annual meeting of the NCA 93rd Annual Convention,
TBA, Chicago, IL Online <PDF>. Retrieved 24-01-2010 from
http://www.allacademic.com/meta/p188250_index.html

Chernin, A. R., Fishbein, M. , Hennessy, M. and Bleakley, A. (2007). The Effects of

Parental Monitoring and Parent-Child Communication About Sex on Adolescents' Sexual

21
Behavior. Paper presented at the annual meeting of the International Communication
Association, TBA, San Francisco, CA Online <PDF>. Retrieved 24-01-2010 from
http://www.allacademic.com/meta/p172744_index.html

Collins, R. L., Elliott, M. N., Beery, S. H., et al., (2004). Watching Sex On Television
Predicts Adoloescents Initiatioon of Sexual Behavior. Journal of Pediatrics, 114, e280-e289,
Retrieved 24-01-2010 from http://www.pediatrics.org/cgi/content/full/114/3/e280

Farrar, K. M. (2006). Sexual intercourse on television: Do safe sex message matter?

Journal of Broadcasting and Electronic Media, 50, 635-650.

Geasler, M. J., Dannison, L. L., & Edlund, C. J. (1995). Sexuality education of young
children: Parental Concerns. Family Relations, 44, 184-188.

Guo, W. and Nathanson, A. , (2009). The Effects of Parental Mediation of Sexual Content
on Adolescents’ Sexual Knowledge, Attitudes, and Behaviors.  Paper presented at the
annual meeting of the International Communication Association, Marriott, Chicago, IL
Online <PDF>. Retrieved (22-01-2010) from
http://www.allacademic.com/meta/p299790_index.html

Haffner, D. H. (2002). Beyond the big talk: Every parent’s guide to raising sexually
healthy teens- from middle school to high school and beyond. New York: New Market Press.

Hashim B., Khairulhelmi K, Mohd Fahmi M S, Syed Mohamed Syafeq S M. Keruntuhan

Akhlak Dan Gejala Sosial Dalam Keluarga; Isu Dan Cabaran. Paper Presented at Seminar
Kaunseling 2008.

Huang, S. L. M. (1999). Case study, Malaysia: Communication and Advocacy Strategies

Adolescent Reproductive and Sexual Health. Bangkok: UNESCO PROAP, 1999.

Jordan, T. R., Price, J. H., & Fitzgerald, S. (2000). Rural parents’ communication with
their teenagers about sexual issues. Journal of School Health, 70, 338-345.

Kaiser Family Foundation. (2003).National survey of adolescents and young adults:

Sexual health knowledge, attitudes and experiences.

Kunkel D., Eyal K., Biely E., et al. Sex on TV3: A Biennial Report to the Kaiser Family
Foundation. Menlo Park, CA: The Henry J. Kaiser Foundation; 2003.

22
 Lee L.K., Chen P.C.Y., Lee K.K., Jagmohni K. (2006). Premarital Sexual Intercourse
Among Adolescents in Malaysia: A Cross-Sectional Malaysian School Survey. Singapore
Med Journal; 47(6): 476-481.

LeVay S, Valente S. Human Sexuality. Sunderland, MA: Sinauer Associates; 2003

Low WY.(2009). Malaysian Youth Sexuality: Issues And Challenges. JUMMEC 2009; 12
(1):3-14.

Majumdar, D. (2003). Understanding the Dimensions of Parental and Peer Influence on

Risky Sexual Behavior Among Adolescents.   Paper presented at the annual meeting of the
American Sociological Association, Atlanta Hilton Hotel, Atlanta, GA, Aug 16, 2003 Online
<.PDF>. Retrieved 24-01-2010 from http://www.allacademic.com/meta/p106523_index.html

Ministry of Health, Malaysia. Report of the Second National Health and Morbidity
Survey Conference. Public Health Institute, Ministry of Health, 1997.

Mohd Azhar A.H., Azmi S.S., Muhamad Fauzi O. (2001). Senario Pendidikan Moral
Masyarakat Melayu Zaman Teknologi Komunikasi Maklumat (ICT): Trend, Hala Tuju Dan
Model Pendidikan Moral Keluarga Islam. Jurnal Teknologi, 35 (E): 45-70.

NA. (2010). Berzina Ketika Keluarga Tidur. Retrieved 24-01-2010 from

http://hsah.moh.gov.my/modules/xt_conteudo/index.php?id=82&sel_lang=malay

National Population and Family Development Board. Report of the National Study
on Reproductive Health and Sexuality 1994/1995. Kuala Lumpur: National Population
and Family Development Board; 1998.

Nathanson, A. I. (1999). Identifying and explaining the relationship between parental

mediation and children’s aggression. Communication Research, 26, 124-143.

Nathanson, A. I. (2002). The unintended effects of parental mediation of television on

adolescents. Media Psychology, 4, 207-230.

Rosenthal, D. A., & Feldman, S. S. (1999). The importance of importance: Adolescents’

perceptions of parental communication about sexuality. Journal of Adolescence, 22, 835-
851.

23
 Rosenthal, D. A., Feldman, S. S., & Edwards, D. (1998). Mum’s the word: Mothers’
perspectives on communication about sexuality with adolescents. Journal of Adolescence,
21, 727-743.

Samsudin A. Rahim et. al. (1994). Tingkah laku lepak di kalangan remaja. Laporan
kajian kepada Kementerian Belia dan Sukan Malaysia.

Shahrom TM Sulaiman. 2001. Realiti dan Ilusi Kehidupan Maya dalam Era Siber.
Selangor: Mahzum Book Services.

Simons, L., & Murphy, D. (2003). Identifying Mechanisms Whereby Family Processes
Influence Adolescent Sexual Behavior. Paper presented at the annual meeting of the
American Sociological Association, Atlanta Hilton Hotel, Atlanta, GA, Aug 16, 2003 Online
<.PDF>. Retrieved 24-01-2010 from http://www.allacademic.com/meta/p107046_index.html

United Nations (2002). Youth In Malaysia: A Review of the Youth Situation and National
Policies and Programmes. New York: United Nations.

Ward L.(2002). Does television exposure affect emerging adults’ attitudes and assumptions
about sexual relationships? Correlational and experimental confirmation. Journal of Youth
Adolescence;31:1–15.

Ward, L. M. (2003). Understanding the role of entertainment media in the sexual

socialization of American youth: A review of empirical research. Developmental Review, 23,
347–388.

Weinstock H., Berman S., & Cates W. (2004). Sexually transmitted diseases among
American youth: Incidence and Prevalence Estimates, 2000. Perspectives on Sexual and
Reproductive Health 36, 6-10.

World Health Organization. Sexual And Reproductive Health Of Adolescents And Youths
In Malaysia: A Review Of Literature And Projects 2005. Western Pacific Region, World
Health Organization, 2007.

Zulkifli SN, Low WY, Yusof K.(1995) Sexual activities of Malaysian adolesecents.
Med J Malaysia; 50(1): 4-10.

Zuria M, Abdul Razak H, Salleh A. (2001) Pendedahan Kendiri: Perkara yang

diceritakan oleh Remaja kepada Ibu Bapa. Jurnal Pendidikan 26: 81-92.

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