This exploratory study examined links between health communication and other constructs affecting health promotion and disease prevention among Haitian mother-daughter dyads living in West Central Florida, and the risk or protective factors for HIV. Risky sexual behaviors can be reduced with accurate and effective information provided through parent-adolescent communication (Coetzee et al, 2014; Ogle, Glasier & Riley, 2008; Hadley et al., 2009). In Haiti, a country that bears a disproportionate burden of HIV/AIDS, women are the most vulnerable (UNAIDS, 2016a); In the United States (U.S.), foreign-born Haitian women in the state of Florida experience health disparities in many areas and bear a disproportionate burden of HIV/AIDS relative to their non-Haitian peers but little is known about (Florida Department of Health [FLDOH], 2017; U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion [ODPHP], 2017). Indeed, the state of Florida recently reported that newly diagnosed cases of HIV increased for foreign-born Haitian women and in 2016, the latter represented 3.64% of all cases (Florida Department of Health, Bureau of Communicable Diseases, HIV/AIDS Section, 2017a). Recognizing that Haitian mothers traditionally bear the primary responsibility for transmitting traditional norms, values, health beliefs and practices, a concept referred to as poto mitan, this qualitative study examined risks and protective factors for HIV that may emerge in health and sexual health communication among Haitian mothers and daughters. This study comprised a two-phase process in which purposive sampling was first used to recruit and interview a focus group of seven health care providers and Haitian-descendant community leaders who engage Haitian-descendant clients in West Central Florida, after which findings from the focus group were used to strengthen a semi-structured interview guide that would be used to interview 10 Haitian mother/daughter dyads in the area. This study addressed a gap in the scientific literature related to health and sexual health promotion and disease prevention communication among Haitian immigrant women in the U.S., particularly surrounding HIV risk. Specifically, it sought to discover what constitutes specific methods that Haitian mothers use to communicate health and sexual health and the contents of such conversations, as well as the intention of daughters to transmit information that they received from their mothers, even here in the U.S. This study applied a constructivist grounded theory approach, in which Symbolic Interactionism (SI) and the Information-Motivation-Behavioral Skills Model (IMB) were triangulated as a framework. ATLAS.ti® 7.0, a software that supports analysis of textual data, was used to analyze transcripts from the focus group and from the interviews. Findings indicate that (a) Haitian mothers intentionally transmit specific and valued traditional knowledge about health and sexual health to their daughters, specifically in the areas of vaginal health, post-partum rituals, and abstinence as the acceptable mode of HIV prevention; (b) Haitian mothers in the study sample lack adequate and accurate knowledge about HIV/AIDS as well as the time to learn more that they can share with daughters; (c) Haitian mothers in the study sample do engage in direct communication about HIV prevention, taking advantage of teachable moments, using popular music and television programs; (d) there is a strong reliance on religious leaders and school systems to address health and sexual health instruction; (e) Haitian mothers in the sample reported and daughters confirmed that there is extremely limited conversation between the mothers and daughters surrounding sex, HIV risk reduction methods outside of abstinence. (f) Symbolic Interactionism is a useful framework for understanding the process of communication between Haitian mothers and daughters in this study; (g) IMB is useful to understand that the information being provided by Haitian mothers in this sample is at times insufficient and inaccurate, thereby limiting the ability of daughters to effectively and intentionally engage in conduct that protects their sexual health and reduces HIV risk. This study has several implications for social work education, research, practice, and policy. First, social work students must be taught to conduct comprehensive assessments of Haitian women in the context of valued Haitian family dynamics, and to engage in life-long learning regarding protective as well as risk factors for Haitian mothers and daughters. Second, Haitian and non-Haitian health providers who serve Haitian clientele could be surveyed regarding knowledge of health beliefs and practices and its potential impact on the health of their constituents. their Haitian patients. Third, researchers may use this study’s findings as a foundation for developing interventions that enhance strategies aimed at establishing rapport with Haitian clients and for assessing potential interactions between hidden health practices and prescribed medications. Fourth, findings suggest the need to develop interventions that empower trusted religious leaders to gain accurate HIV knowledge and to deliver empowering information effectively to their congregants. Fifth, findings suggest a need to develop outreach programs aimed at heightening HIV awareness and increasing HIV testing for Haitian women who are similar to this study’s sample. Sixth, social workers engaging Haitian female clients can make intentional efforts to include Haitian mothers in treatment. Seventh, this study’s findings underscore a need for social workers to advocate on behalf of Haitian immigrants’ efforts to be properly counted in the census, and to be counted as a culturally distinct group in other surveillance data. Social workers can benefit from understanding the strengths of relationships between Haitian mothers and daughters and to enhance their awareness of the heterogeneity among Haitians in general when working with Haitian clients. To work effectively with Haitian immigrant females overall requires cultural humility to mitigate the likelihood of bias towards them based on known or hidden traditional health beliefs and practices and gender roles.

Parent-child sexual health communication (PCSHC) can have a positive impact on adolescents’ sexual health choices, outcomes, and capabilities for communicating with others about sexual health. Many parents are hesitant and feel unprepared for and uncomfortable with communicating about sexual health with their children. Other parental factors as well as child factors can impact the quality, frequency, coverage, and effectiveness of PCSHC. Some adolescent sexual health outcomes have improved, however, teen birth rates in the United States are elevated compared to other developed countries and half of all sexually transmitted infection (STI) diagnoses are made to adolescents and emerging adults. This emphasizes the importance of PCSHC as a protective factor for children and opportunity for them to develop understanding and skills for good sexual health decision-making. While challenging to recruit and retain participants, parent sex education programming designed to promote PCSHC can instill a sense of parental necessity and responsibility, and equip parents with knowledge and skills to confidently and successfully engage their children. The theory of planned behavior (TPB) provided the framework for this mixed methods study designed to learn more about PCSHC, differences in PCSHC based on gender of children, parental beliefs about PCSHC, intentions for and actual engagement in PCSHC. Included in the literature review for this study is a systematic review of literature focused on parent education programming designed to improve PCSHC. Parents of children in grades 4 – 11 completed a pencil/paper or an electronic Qualtrics baseline survey containing questions about their perceptions of and engagement in PCSHC. The quantitative data collection instrument included items measuring TPB constructs of behavioral, normative, and control beliefs, intentions for and actual engagement in PCSHC and condom use instruction delivery, communication openness, communication ability, sexual health topics discussed with children, and respondents’ demographics Many of the respondents (N = 205) were residents of the program target community, Winchester/Clark County, Kentucky, and were eligible to participate in parent programming, as were all residents that were parents of children in grades 4 – 11. The program, I’ll Have a Side of Sex Education, was designed as a six-week series of 50 minute lunch time sessions with the intention to improve parents’ sense of comfort, confidence, and skills in communicating with their children in general, and particularly about sexual health. Of the 205 parents who completed the baseline survey, 50 enrolled in and attended some or all of one of five offerings of the six-week parent education series and were invited to complete a post-program and six-week follow up surveys. Post-program data were collected with a paper- pencil survey and six-week follow up data were collected with a Qualtrics survey. The systematic review of parent sex education literature provided insight into components of programming related to successful program delivery and positive parental outcomes. The systematic analysis of the baseline data including examining PCSHC factors from the parental perspective and how these related to the gender of children and determining the usefulness of the TPB constructs for understanding PCSHC Results of Chi-square tests of mean differences showed a significant difference in parents actually providing their children with instructions for correct condom usage, χ2(2, N = 203) = 6.96, p = 0.03, and MANOVA results revealed the degree to which parents address certain sexual health topics with their children related to the gender of their children. Results of logistic regression showed behavioral beliefs having the greatest predictive power of parents’ intentions to give condom use instructions (p < 0.01) and actual delivery of condom use instructions (p = 0.04) and engagement in PCSHC, generally (p = 0.03). The current study contributes to the greater body of literature addressing parental and child factors related the promotion, delivery, and effectiveness of PCSHC and parent education programming designed to improve the quality, frequency, and impact of PCSHC. Its findings expand our understanding of how gender of children and parental beliefs relate to PCSHC and lend themselves to the consideration of the greater social influences impacting parents’ ability and motivation to engage their children in communication about sexual health. Differences in communication based on gender of children signal to a double standard in the messaging about sexual health and behaviors related to gender and these discrepancies leave adolescents and emerging adults, both males and females, vulnerable at worst to poor sexual health choices and outcomes and at least to being undereducated about sexual health topics. Although these findings give little support for the overall TPB model contributing to the understanding of parental intentions and behavior related PCSHC, the relationship between behavioral beliefs informed by attitudes about the value of PCSHC and parental intentions and behaviors does provide insight to health promoters and educators. Assessing parental attitudes toward PCSHC and tailoring messages and educational opportunities that may improve these attitudes and motivate parents to engage in and seek support for effective PCSHC holds promise. The piloting of a parent education program adapted from a previously evaluated parent sex education programming and the summative evaluation offered by participants gives support for efforts on the part of health promotion and education professionals to invest time, energy, and resources into program design and delivery and recruitment and retention of parents.