Parental Monitoring and Risk Behaviors and Experiences Among High School Students — Youth Risk Behavior Survey, United States, 2021

Parents have an important role in the promotion of healthy adolescent behaviors that can influence positive developmental trajectories and health outcomes. Parental monitoring is a central component of the parent-child relationship with the potential to reduce adolescent risk behaviors. Data from CDC’s 2021 nationally representative Youth Risk Behavior Survey were used to describe the prevalence of parental monitoring reported by U.S. high school students and examine associations between parental monitoring and adolescent behaviors and experiences. Behaviors and experiences included sexual behaviors, substance use, violence, and indicators of poor mental health. This report marks the first national assessment of parental monitoring among U.S. high school students. Point prevalence estimates and corresponding 95% CIs were generated in the bivariate analyses between parental monitoring and the outcomes, stratified by demographic characteristics (sex, race and ethnicity, sexual identity, and grade). Multivariable logistic regression analyses were conducted to estimate the main effects of parental monitoring (categorized as high = always or most of the time and low = never, rarely, or sometimes) for each outcome, controlling for all demographics. Overall, 86.4% of students reported that their parents or other adults in their family know where they are going or with whom they will be all or most of the time. Reports of high parental monitoring were protective for all risk behaviors and experiences, with models controlling for sex, race and ethnicity, sexual identity, and grade. Results highlight the need for public health professionals who develop public health interventions and programs to conduct further research on the relation between parental monitoring and student health outcomes.


Introduction
Parents have an important role in the promotion of healthy adolescent behaviors that can influence developmental trajectories and health outcomes. Parental monitoring is an active, multidimensional process that includes setting boundaries and establishing an open exchange of information or knowledge related to a child's whereabouts, companions, and activities (1). Parental monitoring has been identified as a central component of the parent-child relationship, with the potential to reduce risk behaviors, reduce involvement in situations that might involve high risk or negative behavior, and promote environmental contexts that support positive behavior and decision-making (1)(2)(3).
Previous studies have found protective associations between parental monitoring and multiple adolescent behaviors and experiences across race, ethnicity, and gender. For example, associations have been found between increased parental Corresponding author: Patricia J. Dittus, PhD, Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC. Telephone: 404-639-8299; Email: pdd6@cdc.gov. monitoring and adolescents' decreased prevalence of ever having engaged in sexual intercourse as well as increased use of contraception or condoms if they do (4,5). Parental monitoring also has been associated with reduced intention to engage in risk behaviors such as drinking alcohol, using marijuana, and misusing prescription drugs (3,6). In addition, parental monitoring has been inversely associated with multiple violencerelated outcomes, including reductions in bullying perpetration and victimization (e.g., school-based bullying, electronic or cyber-bullying), dating violence, and sexual violence (7,8).
Less is known about the relations between parental monitoring and indicators of poor mental health. However, less parental monitoring has been associated with a greater likelihood of selfinjury attempts, including suicide attempts (9,10). In addition, the role of parental monitoring in supporting adolescent health behaviors, reducing risk, and encouraging positive, healthy decision-making has not been studied comprehensively across adolescent subgroups. For example, additional research is needed to understand the protective role of parental monitoring for sexual minority adolescents.
One question assessing adolescents' perceptions of parental knowledge of whereabouts and companions was included on the 2021 Youth Risk Behavior Survey (YRBS). This inclusion marks the first national, school-based assessment of student-reported parental monitoring and its association with adolescent behaviors and experiences. YRBS data from 2021 were used to both describe the prevalence of parental monitoring reported by youths and examine associations between high and low levels of parental monitoring and youth behaviors and experiences, including sexual behaviors, substance use, violence, and indicators of poor mental health. Findings from this report can be used to better understand the potential influence of parental monitoring and shape public health initiatives designed to improve adolescent health and well-being.

Measures
The main exposure of interest, parental monitoring, is derived from the question, "How often do your parents or other adults in your family know where you are going or with whom you will be?" Responses were combined to create two categories: high parental monitoring (always or most of the time) and low parental monitoring (never, rarely, or sometimes). The nine student health behaviors and experiences included sexual behaviors, substance use, violence, and mental health and suicide-related behaviors. Outcome variables were dichotomized (Table 1)

Analysis
Point prevalence estimates and corresponding 95% CIs were generated in the bivariate analyses between parental monitoring and the outcomes, stratified by demographic characteristics. Multivariable logistic regression analyses were conducted to estimate the main effects of parental monitoring for each outcome, controlling for all demographic characteristics. Estimates were considered statistically significant if the 95% CIs did not include 1.0 or if p was <0.05. Prevalence estimates with a denominator <30 were considered statistically unreliable and therefore were suppressed (11). All analyses were conducted in SAS-callable SUDAAN (version 11.0.3; RTI International) using sample weights to account for complex survey design and nonresponse.

Results
Overall, 86.4% of students reported that their parents or other adults in their family know where they are going or with whom they will be all or most of the time ( Table 2). High parental monitoring was more prevalent among females compared with males (89.3% versus 84.1%), more prevalent among Asian students compared with Black students (91.3% versus 79.8%), and less prevalent among students who selfidentify as lesbian, gay, or bisexual compared with heterosexual or questioning or other students (84.2% versus 87.6% and 88.9%, respectively). By grade, no differences occurred in reports of parental monitoring.
The prevalences of nine health risk behaviors and experiences, stratified by level of parental monitoring and demographic characteristics, were calculated (Tables 3 and 4). Differences occurred in the prevalence of each outcome by sex, race and ethnicity, sexual identity, and grade. Compared with students who reported low levels of parental monitoring, students who reported high parental monitoring experienced more positive health outcomes (e.g., fewer sexual risk behaviors, less substance use, fewer experiences of violence, fewer mental health challenges, and fewer suicide attempts) and engaged in more protective behaviors (e.g., condom use). This pattern was particularly pronounced for lesbian, gay, or bisexual students with high parental monitoring. In the multivariable logistic regression analyses, reports of high parental monitoring were protective for all risk behaviors and experiences, with models controlling for sex, race and ethnicity, sexual identity, and grade (Table 5). For instance, prevalence of ever having had sex among high school students who reported high levels of parental monitoring was 54% lower compared with those who reported low levels of parental monitoring. Compared with low levels of parental monitoring, high levels of parental monitoring were associated with higher prevalence of using a condom at last sex and lower prevalence of reporting multiple lifetime sex partners. Similarly, high levels of parental monitoring were associated with lower prevalence of both current prescription opioid misuse and current marijuana use. In regard to experiences of violence, students who reported high levels of parental monitoring were less likely to have experienced forced sex in their lifetime and electronic bullying during the past 12 months than students who reported low levels of parental monitoring. Finally, high school students who reported high levels of parental monitoring were less likely to report persistent feelings of sadness and hopelessness and to have attempted suicide in the past 12 months than students who reported low levels of monitoring.

Discussion
This report provides the first national prevalence estimates of adolescents' experience of parental monitoring among U.S. high school students. Analyses of data collected in fall 2021 estimated that most students reported high levels of parental monitoring, defined in this report as parent knowledge of where a student was going and with whom. Although differences occurred in experience of parental monitoring by sex, race and ethnicity, sexual identity, and grade, overall 86% of students across all groups said their parents knew where they were and with whom they would be.
Associations between levels of students' experience of parental monitoring and behaviors and experiences that affect the health and well-being of adolescents, including sexual behaviors, substance use, violence, mental health, and suiciderelated behaviors, also were examined. For all behaviors and experiences included in this report, high parental monitoring was associated with lower risk for negative outcomes. Of note, the measure of parental monitoring used in this report reflects students' perceptions of whether their parents know where they are and with whom. This measure might indicate various interrelated factors, including parental behaviors (e.g., positive * N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction, students in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering each question varied. Percentages in each category are calculated on the known data. † High parental monitoring is defined by a response of "most of the time, always" to the question, "How often do your parents or other adults in your family know where you are going or with whom you will be?" § p value is based on chi-square tests (p<0.05). ¶ Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic. ** Significantly different from Black or African American students, on the basis of t-test analysis with Taylor series linearization (p<0.05). † † Significantly different from Hispanic students, on the basis of t-test analysis with Taylor series linearization (p<0.05). § § Significantly different from White students, on the basis of t-test analysis with Taylor series linearization (p<0.05). ¶ ¶ Significantly different from Asian students, on the basis of t-test analysis with Taylor series linearization (p<0.05). *** Significantly different from American Indian or Alaska Native students, on the basis of t-test analysis with Taylor series linearization (p<0.05). † † † Significantly different from multiracial students, on the basis of t-test analysis with Taylor series linearization (p<0.05). § § § Dash indicates cell data are suppressed because the denominator is <30 and therefore considered to be statistically unreliable.
communication and inquiry) and adolescent disclosure, and might reflect positive parent-child relationships and family connectedness. Previous research has found that adolescents' perceptions of parents' knowledge of their whereabouts and companions are influenced by both solicitation of information by parents and relationship satisfaction reported by adolescents (5). The multidimensional nature of the construct indicates that it is related to a broad set of behaviors (i.e., activities in which adolescents engage, such as sex and substance use) and experiences (i.e., things that happen to adolescents). The multiple factors likely influencing whether students disclose their whereabouts and companions to their parents might be related in different ways to the outcomes of interest and might lead to different promotion strategies. For instance, parental knowledge of students' whereabouts can prevent opportunities for engaging in risk behaviors or for spending time with peers who might promote such behaviors (1,3,6). In this report, high parental monitoring was inversely related to student reports of ever having sex, multiple sex partners, and for male students, increased prevalence of condom use. These findings support previous research demonstrating that parental monitoring positively affects decisions about sexual activity among young persons (4)(5)(6)(7). Similarly, observed relations between parental monitoring and decreased substance use in this report are congruent with analyses from the National Survey on Drug Use and Health, other longitudinal studies (12), and parenting interventions targeting adolescent substance use (3).
High parental monitoring also was related to lower prevalence of electronic bullying victimization and forced sex. Previous studies have found that collaborative parental monitoring strategies (e.g., those focused on communication) are associated with lower cyber-bullying victimization and perpetration, and family connectedness is associated with decreased experience of violence victimization and perpetration (2,7,8). Building strong relationships with parents and other prosocial adults might be an especially important protection for students at increased risk for violence (7,8). CDC's youth violence and adverse childhood experiences (ACEs) technical packages provide examples of the best available evidence for the prevention of youth violence and ACEs, including parenting skills and family relationship programs that support caregivers and teach communication, problem-solving, and behavior monitoring and management skills (13,14).
In this report, a strong relation was found between students' perceptions of parental monitoring and improved mental health and decreased suicidality. High parental monitoring was associated with lower likelihood of reporting symptoms of poor mental health, including feeling sad and hopeless and having attempted suicide. This finding adds to studies that have found a weak negative association between parental monitoring and depression (9). In another study, parental monitoring also was negatively correlated with suicidality, self-injury, and depression, such that increased monitoring was associated with decreased poor outcomes (10). The link between parental knowledge of companions and whereabouts and students' mental health and suicidality is less direct. This link aligns, however, with other research on family relationships and connectedness (15), suggesting that monitoring knowledge expressed by students is likely the result of positive relationships rather than parental control of activities. In fact, parental  Therefore, the total number (N) of students answering each question varied. Percentages in each category are calculated on the known data. † Refer to Table 1 for variable definitions. § Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic. ¶ Dashes indicate cell data are suppressed because the denominator is <30 and therefore considered to be statistically unreliable. monitoring strategies that facilitate involvement, information sharing, and parental warmth and support have demonstrated potential for reducing risks for poor mental health outcomes (https://www.cdc.gov/suicide/pdf/preventionresource.pdf ).
Overall, parental monitoring had universal positive effects across all domains of risk behavior and experiences investigated in this report. Systematic reviews of parental monitoring literature have found similar protective associations between parental monitoring and youth risk behaviors, including substance use and risky sexual activity (2)(3)(4)6). However, among students with a history of social isolation and societal marginalization, including those who identify as lesbian, gay, bisexual, questioning, or other, effectiveness of parental monitoring has been tied to strategies that focus on the establishment of positive home environments and family relationships where students are comfortable disclosing information and feel accepted, rather than just focus on limiting opportunities for sexual activity (16). The findings discussed in this report warrant further exploration and research on specific aspects of parental monitoring and engagement that are most strongly tied to positive youth health behaviors and outcomes.

Future Directions
Parental monitoring is a broad construct that encompasses a range of interrelated actions that include information exchange between parents and students. Measurements of parental monitoring vary, with certain measures attending more to parental actions and parental sense of control and others incorporating adolescents' willingness to disclose information to parents (1). The student perspective of parental monitoring represented by the YRBS measure considers adolescent information sharing, representing student perceptions of parental knowledge. Further research is needed to assess measurement quality and explore the relation between other dimensions of parental monitoring and student health outcomes. Additional research also is needed to explore factors that might affect parental monitoring practices (e.g., neighborhood social cohesion, parent-adolescent relational quality, and cultural values) that might support increased parental monitoring and engagement. Such research is needed for the design of public health interventions and programming. Future work could explore protective qualities of parental monitoring across intersecting student and parent identities (e.g., race and ethnicity and sexual identity) and attributes of interventions to improve parental monitoring and adolescent outcomes.

Limitations
General limitations for the YRBS are available in the overview report of this supplement (11). The findings in this report are subject to at least three additional limitations. First, causality between parental monitoring and student behaviors and experiences cannot be inferred by these cross-sectional data. Second, the single-item measure of perceived parental monitoring might not capture the complexity of this construct because parental monitoring knowledge might be gained through a combination of voluntary youth disclosure of information, parental solicitation of information, and parental control strategies such as rule enforcement (17). Finally, although the examples provided are only of opioid-containing prescription medications, the assessment of prescription opioid misuse might be overestimated because the questions refer to prescription pain medication more generally.