PARENT AND ADOLESCENT REPORTS OF RISKY BEHAVIOR AND THEIR RELATIONSHIP WITH PARENTAL MONITORING IN BLACK SOUTHERN FAMILIES

The purpose of this study was to explore the relationship between perceived parental knowledge, perceived parental monitoring and risky behaviors among rural Black adolescents in the United States. The health-risk behaviors of concern were sexual behavior, drug and alcohol usage, and violence. Using a sample of 62 Black parent and adolescents from rural communities, parents' perceptions of adolescent risk behaviors were compared with adolescent reports of risky behaviors. Additionally, the relationship between parental monitoring and knowledge, relative to adolescent self-reported risk was examined. Results indicated that parents possessed a high accuracy regarding their adolescent’s engagement in sexual activity, violent behaviors and drug and alcohol use. Parental monitoring however did not predict adolescent engagement in sexual intercourse, violence, drugs, and alcohol use or combined risk.


Statement of the Problem
The developmental period of adolescence is marked by a rapid change in cognitive development, parental and peer relationships, and emerging sexuality (Hill & Tyson, 2009;Santrock, 2012). Adolescence and middle school provides new opportunities to engage in risky behaviors. The initiation of risk behaviors during this developmental period can have critical effects on the future of adolescents. For example, early initiation of sexual behaviors often leads to: increased likelihood of having multiple sex partners in within the last year, using alcohol/drugs during sexual intercourse, unprotected sex during most recent sexual experience, and unintended pregnancy (Sandfort, Orr, Hirsch, & Santelli, 2008;Kaplan, Jones, Olson, & Yunzal-Butler, 2013).
Notably, the consequences of engagement in risky behaviors are different for Black adolescents as compared to White adolescents engagement. For example, Black females are more likely than White females to contract gonorrhea and chlamydia (CDC, 2009). There also are racial differences in the use of alcohol and drugs. African American adolescents engage in less alcohol use but higher marijuana use (Lewis et al., 2011).
Additionally, African American adolescents appear to experience bullying and violent behaviors at rates that are different from their White adolescent counterparts. One study suggests that African American adolescents report bullying at rates that were almost three times than some national studies (Fitzpatrick, Dulin & Piko, 2007). In addition to differences in rates of risky behavior among youth of different backgrounds, it also is important to consider potential differences as a function of geographic contexts. Rural America has often been stereotyped as a place free from urban problems such as drug abuse, crime, and poverty (Brown & Waite, 2005). Some recent studies have challenged that perception. Geographic differences are observed in risky sexual behaviors and substance use. For example, teen birth rates are higher in rural counties compared to urban and suburban areas (The National Campaign, 2013). Other studies show an increase in substance use among adolescents living in rural areas (Lambert, Gale, & Hartley, 2008).
In addition to recognizing risky adolescent behavior it also is important to recognize the role that parents may play in prevention of such behavior. For example, parental monitoring has been shown to be a protective factor against engagement in risky behaviors (Crouter & Head, 2002;Li, Feigelman, & Stanton, 2000;Lippold, Coffman, & Greenberg 2013;Lippold, Greenberg, & Feinberg, 2011). However most studies examining parental monitoring have been conducted with youth who live in urban areas.
It is less clear if parental monitoring can be viewed as a protective factor against engagement in risky behaviors for minority youth living in rural communities.

Adolescence and adolescent development
Adolescence is a transitional period of development that begins at approximately 10 to 12 years of age and concludes around 18 to 22 years of age (Santrock, 2012).
Adolescents encounter changes in biological and cognitive development, relationships with parents and friends, and the emergence of sexuality (Hill & Tyson, 2009;Santrock, 2012). Puberty, which is a rapid period of physical maturation that involves hormonal and bodily changes, signals the beginning of adolescence (Santrock, 2012). The average pubertal sequence for males begins as early as age 10 or as late as age 13 ½ and may end at age 13 through 17 (Santrock, 2012). For females, puberty can begin between the ages of 9 and 15 (Santrock, 2012). The developmental period of adolescence typically alters the parent-child relationship (Bakken & Brown, 2010;Santrock, 2010), as adolescents push for autonomy or independence away from their parents, which can lead to parentadolescent conflict (Santrock, 2012). Parent-adolescent conflict escalates during early adolescence and remains moderately stable during high school years (Santrock, 2012).

Adolescents and participation in middle school
Participation in middle school is a critical stage in development for adolescents.
The transition from elementary to middle school is abrupt and dramatic. Adolescents transition from being the oldest age group in elementary school to becoming the youngest group in middle school, which is known as the top-dog phenomenon (Santrock, 2012).
Perceived social support from teachers, peers, and parents has a major impact on early adolescents. And, perceived parental support has been linked to school-related interest and academic goal orientation for middle school students (Wentzel, 1998). Adolescent perceptions of teacher support in middle school has been linked to class interest and the pursuit of social responsibility (Wentzel, 1998). And finally, perceived peer support has been shown to positively predict prosocial goal pursuit (Wentzel, 1998). Unfortunately, research has found that perceived social and teacher support has been found to decline during the transition to middle school (Martínez, Aricak, Graves, Peters-Myszak, & Nellis, 2011).

Adolescents and risky behaviors
According to the Centers for Disease Control and Prevention (2015), six healthrisk behaviors contribute to the leading causes of death, disability, and social problems among adolescents in the United States. These six health-risk behaviors are: unintentional injuries and violence, sexual behaviors, alcohol and other drug use, tobacco use, unhealthy dietary behaviors, and inadequate physical activity. For the present project, the health-risk behaviors of concern are sexual behavior, drug and alcohol usage, and violence, which are discussed in turn in the following sections.

Sexual behavior
One risk factor associated with poor adolescent outcomes is early sexual behavior.
Early sexual behavior is defined as having sexual intercourse before the age of 14 (Kaplan et al., 2013). Youth who engage in early sexual behavior are more likely to engage in other risky sexual behaviors (Kaplan et al., 2013;Sandfort et al., 2008). Early sex is associated with having multiple sex partners in within the year, using alcohol/drugs during sexual intercourse, not using a condom during last sexual experience, unintended pregnancy, having a sexual partners that was over 21 years old, being forced to have sex and physical dating violence (Sandfort et al., 2008;Kaplan et al., 2013).
Black adolescents appear to be affected by the negative consequences of risky sexual behaviors more than their White counterparts. Urban Black and Hispanic adolescents who engaged in sexual intercourse before the age of 15 are more likely to: not use contraceptives, have multiple sexual partners, higher frequency of sexual intercourse, have been pregnant or impregnated someone and have a child (Smith, 1997).
Black females are more likely than White females to contract gonorrhea and chlamydia (CDC, 2009). In 2015, birth rates of Hispanic and Black teens were more than twice as high as White teens (Martin, Hamilton, Osterman, Driscoll & Mathews, 2015). Literature additionally suggests that young black males are disproportionately more likely to become infected with HIV (CDC, 2011) and STIs (CDC, 2014). Variations in risky sexual behavior have additionally been noted across different geographic regions.
Research indicates that risky sexual behavior is increasing in rural communities (Milhausen et al., 2003). The CDC (2000) reported outbreaks of HIV in a small rural town in Mississippi where the median age for HIV-infected females was 16 years old. In New York (1999), a similar outbreak was observed in a rural part of the state. Geographic differences can additionally be observed in teen pregnancy. Teen birth rates are higher in rural counties compared to urban and suburban areas (The National Campaign, 2013).
The southern United States currently contains the highest number of teen pregnancy (Kost & Henshaw, 2014).

Drug and Alcohol Use Among Adolescents
A second critical risk factor among adolescents is drug and alcohol use.
According to Johnston, O'Malley, Bachman & Schulenberg (2011), substance use among US adolescents is a public health concern because rates remain high and substance initiation, or the introduction of substances, occurs early. Research has found that adolescents can be initiated to substances as early as 13 years old (Johnston et al., 2011).
In 2011, Johnston and colleagues found that 16% of 8th graders reported used marijuana at least once, 13% in the prior year, 7% in the prior month, and 1.3% reported daily usage. This study additionally found that 33% of 8th-grade students reported using alcohol in their lifetime and roughly 13% reported being current consumers of alcohol (Johnston et al., 2011).
Early alcohol initiation is linked to risky sexual behaviors in adolescents. Stueve and O'Donnell (2005) found that those who were initiated to alcohol early were more likely to report alcohol problems, multiple sexual partners, unprotected sexual intercourse, being under the influence of drugs or alcohol during sexual intercourse, and pregnancy. Increased peer alcohol use and alcohol offers are associated with an increase of drinking and drinking-related activities (Schwinn & Schinke, 2014).
Previous research also has found that African American adolescents report lower substance use rates than their non-African American counterparts (Gil, Wagner, & Tubman, 2004). In a study that examined the prevalence of substance use among adolescents researchers found that 60.6 percent of White adolescents reported a prevalence of lifetime alcohol use compared to 46.5 percent of Blacks (Goings, Buttler-Bente, McGovern & Howard, 2016). With that being said, literature suggests that across all racial and ethnic groups substance use increases during adolescence (Harris, Gordon-Larsen, Chantala & Udry, 2006). Lewis et al., (2011), studied substance use among African American adolescents and found lower alcohol use but higher marijuana use in the sample versus a nationwide sample of youth.
As seen with risky sexual behavior, the literature suggests that there are variations in substances use across geographic regions. Lambert, Gale, and Hartley (2008) conducted a study that examined substance use among adolescents and young adults across four geographic regions. The researchers found that rural youth ages 12 to 17 reported higher rates of alcohol, cocaine, inhalants and methamphetamine use than urban youth in the past year. The study also found that rates of binge drinking increased with the degree of rurality. It was also found that rural youth were more likely to have driven under the influence of alcohol or drugs in the past years.

Violence/Bullying
A third significant risk factor among adolescents is violence. Nansel, Overpeck, Haynie, Ruan, and Scheidt (2003) found that being bullied or bullying was consistently related to carrying a weapon, carrying a weapon in school, fighting and being injured in a fight. In schools, adolescents face interpersonal conflicts that include physical violence or the more subtle form of interpersonal conflict that elicits psychological and emotional harm (Batsche, 1997). Relational aggression is defined as, "behaviors that harm others through damage to relationships or feelings of acceptance, friendship or group inclusion" (Crick, Casas, & Ku, 1999). Physical aggression involves behaviors that result in bodily injuries.
Research indicates that school bullying is becoming a major issue for youth, especially in middle school. In 2011 it was estimated that 28% of students in grades sixth through twelfth experienced bullying (Lessne & Harmalkar, 2011). Bullying has been found to occur with greater frequency among middle school students (6th -8th grade) than high school (9th-10th grade) aged youth (Nansel et al., 2001). Males typically experience verbal and physical bullying while females typically experience verbal bullying (taunts and rumors) (Horowitz et al., 2004). Horowitz et al. (2004) found that students are typically teased and bullied in regards to four categories: physical appearance, personality and behavior, family and environment, and school-related factors. Across all four categories, "Being different in any way" was a common theme for being bullied (Horowitz et al., 2004).
In terms of ethnic and racial differences in bullying and violent behaviors the research is less clear. For example, Fitzpatrick and colleagues (2007) examined the prevalence of bullying among urban African American adolescents and found that African Americans reported bullying at rates that were almost three times higher than some national studies. Conversely, research by Koo, Peguero, and Shekarkhar (2011) found that African American female adolescents were more likely to be victimized at school than White female adolescents. Examining bullying and violent behaviors among African American adolescents is vital because homicide was the leading cause of death for African American males (48.6%) and the second cause of death among African American females (19.1%) ages 15 to 19 in 2014 (CDC, 2014).
In summary, there are several areas of risky behavior that heighten the likelihood of poor adolescent adjustment and outcomes. These include early sexual behavior, drug, and alcohol use, and violent and bullying behaviors. Such concerns warrant careful examination of potential protective factors relating to the risky behaviors previously discussed.

Parent-adolescent-agreement
Few studies have examined parent-adolescent agreement in evaluations concerning health risk behaviors. Gersh and colleagues (2017) examined adolescent and parent perspectives on the engagement in health risk behaviors and found no significant differences between parent and adolescent reports of sexual behavior and alcohol use.
However, O'Donnell et al., (2008) found that fewer than 1% of parents reported that their adolescent daughters had consumed alcohol while 22.3% of the female adolescents reported consuming alcohol once or more. Similarly, Berge, Sundell, Öjehagen, Höglund, and Håkansson (2015) found that parents had poor knowledge of their adolescent's drug and alcohol use.

Parental Monitoring /Knowledge
According to Dishion and McMahon (1998), parental monitoring is, "a set of correlated parenting behaviors involving attention to and tracking of the child's whereabouts, activities, and adaptations." Dishion and McMahon (1998) additionally noted that the parent-child relationship is at the foundation of parental monitoring: "a positive parent-child relationship enhances parents' motivation to monitor their child and to use healthy behavior management practices." Unfortunately, measures of parental knowledge have been combined with measures of behavior control and efforts to solicit information. As a result, it has become difficult to determine the singular effects of parent knowledge on adolescent's behavior (Lippold et al., 2013). Research suggests that parental knowledge links parent monitoring behaviors and adolescent outcomes (Lippold. Greenberg, Graham, Feinberg, 2013).
Adolescents whose parents possess high levels of knowledge about the activities of their adolescents are less likely to engage in risky behaviors (Crouter and Head, 2002;Li et al., 2000;Lippold et al., 2013;Lippold et al., 2011). For example, Lippold et al., (2013) conducted a longitudinal study that aimed to explore the relationship between parent knowledge and youth risk behaviors among rural youth. The risky behaviors examined in this study were: youth delinquency, substance abuse, attitudes towards substance use, and antisocial peer relationships. Researchers found that parental knowledge had a significant dampening effect on substance abuse, delinquency, and attitudes towards substance use. Lippold et al., (2013) additionally explored the concordance between mothers' and youths' perceptions of maternal knowledge among rural adolescents and its association with adolescent risk behaviors. The researchers assembled four dyads based on mothers' and youths' perspectives on maternal knowledge.
Adolescents in dyads with high youth and mother perceived knowledge experienced fewer substances use and healthier drug attitudes compared to any other group.
Adolescents in dyads with lower perceived maternal knowledge but higher maternal reported knowledge experienced significantly higher levels of delinquency and substance use. Cottrell et al., (2003) compared parent and youth reports of parent monitoring to examine which perceptions were more predictable of adolescent risk behavior. Parent perceptions' of monitoring were found to be inversely related to adolescents drinking, smoking, and sexual involvement.
Parental Monitoring/Knowledge in Black Families. Li et al., (2000) conducted a study that examined the association between perceived parental monitoring, health risk behaviors, and risk perception for urban low-income African American children and adolescents. These researchers found that low levels of youth rated perceived parental monitoring was associated with several health risk behaviors such as: sexual behavior, substance/drug use, drug trafficking, and violent behaviors. Similarly, Yang et al., (2007) explored the relationship between parental monitoring, communication and adolescent involvement in risky behaviors among a sample of low-income urban African Americans adolescents and their parents. For African American males, perceived parental monitoring was negatively associated with "beating someone up," vaginal sex and alcohol use (Yang et al., 2007). For African American females, perceived parental monitoring was negatively associated with fighting, vaginal sex, cigarette, alcohol and drug use (Yang et al., 2007). Results also suggest that African American females who perceived consistent parental monitoring were less likely to have engaged in vaginal sex at follow up (Yang et al., 2007).

"Black"
In the present study, the term "Black" is used to describe individuals who selfidentify as Black or having African descent. The current study is focused on risky behaviors and parental monitoring for the Black race, regardless of ethnicity.

Purpose of the Study
As previously indicated, research has shown that parental monitoring has been found to reduce the likelihood of engagement in risky behaviors. However, it is less clear if parental monitoring could serve as a protective factor against the engagement of risky behaviors for Black adolescents living in rural communities. The purpose of this study was to explore the relationship between perceived parental knowledge, perceived parental monitoring and risky behaviors among rural Black adolescents in the United States. First, parents' perceptions of adolescent risk behaviors were compared with adolescent reports of risky behaviors. Additionally, the relationship between parental monitoring and knowledge, relative to adolescent self-reported risk was examined. Two primary research questions were investigated Research Questions: 1. To what extent do Black parents assess their adolescent children's engagement in specified risky behaviors in a manner that is consistent with the adolescent's assessments, as indicated by parent and adolescent reports using the Youth Risk Behavior Surveillance System (YRBSS)?
Hypotheses #1: Assessment concordance of adolescent risk by Black parents will vary by degree of adolescent-reported risk.
Hypotheses 1a. Black parents with adolescents whose scores fall into the no-risk category will be most concordant.
Hypotheses 1b. Black parents with adolescents whose scores fall into the some risk category will be moderately concordant.
Hypotheses 1c. Black parents with adolescents whose scores fall into the elevated risk category will be least concordant.
2. Is there a significant relationship between parental monitoring and adolescent risk behaviors, in terms of both (a) combined risk behaviors, and (b) specific risk behavior types, in Black youth?
Hypotheses #2a. High parent monitoring scores will predict lower adolescent risk scores; Low parent monitoring scores will predict high adolescent risk scores.
Hypotheses #2b: Level of parent monitoring will not be differentially related to type of risk behavior.

Participants
The sample consisted of 31 dyads, each consisting of one adolescent and her/his parent, for a total of 62 participants who also self-identified as Black or African American. Parents ranged in age from 30 to 60 years (M=40, SD=7.37) and included females (n=27, 87.1%) and males (n=4, 12.9%). Adolescents ranged in age from 11 to 14 years (M=12.93, SD=.96) and included females (n= 17, 56.7%) and males (n=13, 43.3%).
One adolescent did not report their sex. All participants were living in a rural county in the southern United States.

Measures
Parent-adolescent dyads responded to questions regarding risk behavior from the Youth Risk Behavior Surveillance System (YRBSS). Parents additionally completed questions regarding demographic information and parent monitoring. Below is a description of each measure used.

Demographic questions.
Parents were asked to indicate various demographic characteristics including age, gender, martial status, highest educational level, religion, household income, disciplinary practices and current occupation (see Appendix A).

System (YRBSS) was developed in 1990 by the Centers for Disease Control and
Prevention as a way to monitor risky behaviors that contribute to the leading causes of death, disability, and social problems among youth. According to the CDC website, the YRBSS helps, "determine the prevalence of health risk behaviors, and assess whether health risk behavior increases or decreases over time." The YRBB has six subscales:

unintentional injuries and violence, sexual behaviors (unintended pregnancy, STD/STI's, HIV), alcohol and other drug use, tobacco use, unhealthy dietary behaviors and
inadequate physical activity. The CDC conducted two test-retest reliability studies for this measure in 1992 and 2000. The first study consisted of 1,679 students who were in grades 7-12 (Brener, Collins, Kann, Warren, & Williams, 1995). The YRBSS was administered on two different occasions, which were 14 days apart. Approximately threefourths of the questions were rated as having moderate to high reliability (kappa-61-100%; Brener, Collins, Kann, Warren, & Williams, 1995). There was no statistically significant difference observed between prevalence estimates from the 1 st and 2 nd time the questionnaire was administered.
The second test-retest reliability study was conducted from 1991-1994 and included 619 high school students (Brener et al., 2002) . The YRBSS was administered on two different occasions, which were two weeks apart. The researchers found that 10 questions had a kappa of <. 61 % and, "significant differences in the prevalence estimates between time-1 and time-2" (Brener et al., 2002). This indicated that the reliability of these questions was questionable. These questions were either revised or deleted. To date, there are no studies on the validity of self-reported behaviors of the YRBSS, but in 2003 the CDC did review existing literature to explore cognitive and situational factors that might influence the validity of adolescent self-reporting (Brener, Billy, & Grady, 2003).
The CDC concluded that although adolescent self-report is affected by both cognitive and situational factors, these factors do not threaten the validity of the YRBSS (Brener, Billy, For this study, the middle school version of the YRBSS was administered to both parents and adolescents (See Appendix B). The YRBSS given to parents was a modified version of the adolescent YRBSS survey (See Appendix C). This version of the YRBSS obtained knowledge of the parent's perception of their adolescent's risky health behaviors. Parent-adolescent dyads completed the entire (49 questions) questionnaire, however, only the subsections regarding violence, sexual behaviors and drugs and alcohol use were examined for this study. The YRBSS contains questions that require a yes/no answer and questions that offer a range of ages for answers, for these questions the youngest age option (8 years old) was coded as a six while the oldest age option (13 years old or older) was scored as one (See Appendix E). Higher parent ratings indicated greater perceived engagement in risky behaviors while higher adolescent ratings indicated greater engagement in risky behaviors. Cronbach's alpha was found to be .77 for the paternal monitoring scale. This indicates that the items on this scale are internally consistent. To complete this questionnaire each parent responded to questions on a four-point Likert scale (0= don' t know at all/never to 3=know everything/always). Questions ranged from "I know who my child spends time with" to "do you tell your child what time he/she has to be home on a school night." Higher scores on this measure reflect higher monitoring/knowledge while lower scores reflect low monitoring/knowledge.

Procedure
Prior to study implementation, the University of Rhode Island Institutional Review Board reviewed and approved the study. Participants were recruited using a combination of snowball methods and targeted sampling. Announcements at community centers, phone calls, emails, and professional networks were used to recruit participants.
Once participants expressed interest, they were sent a packet that included parent and adolescent instructions, and two copies of consent, assent and parent permission forms that detailed the study goals, and the risks and benefits associated with participation. A resource guide was additionally included in the packet.
Parents were asked to complete both the parent permission and parent consent forms. Then, in a separate room from their child, they completed the Parental Monitoring Survey. Once finished, parents were asked to complete the YRBSS. When completed, parents placed their packet in a large envelope. Parents were then asked to review the "Resource Materials" packet. The "Resource Materials" package provided handouts to assist in a discussion about the topics covered on the survey.
The adolescents were asked to complete the assent form. Then, in a separate room from their parent, they completed the adolescent YRBSS. When completed, adolescents were instructed to place their survey in the large envelope along with their parents.

RESULTS
To begin, participants' demographic information is presented and discussed. Next, correlations among the variables are described. Lastly, the research questions are examined based on the analyzed data.

Participant Demographics
Parents provided personal background information regarding: (a) their highest level of education, (b) household income, and (c) religion. As summarized in Table 1, there was variability in the education level of parents. The majority of parents had completed some level of education including one of the following: General Equivalency Diploma (GED), some college experience or a bachelor's degree. Three parents had completed a master's degree, while none had completed a doctorate. Finally, one parent had a professional certification. Parents reported their household incomes during the past 12 months. There was variability in their incomes, ranging from below the poverty line to what is considered middle class (Table 2). An examination of income level shows that twelve parents report making less than $34,999 per year. There was little variability in regards to religion, a majority (93.55%) of the parents reported to be Christian (see Table   3).   presented for parent and adolescent reports of each risky behavior (see Table 4). The data were reviewed to examine whether the necessary assumptions for parametric analyses were met. The skewness and kurtosis of each variable can be seen in Table 4    conducted for income, highest degree earned by parent and parent-adolescent reported health risk behaviors (see Table 5). Significant positive correlations were found for parent ratings of violence and adolescent ratings of violence (r=.79, p<.05). Higher parent ratings of adolescent engagement in violent behavior were associated with higher ratings of adolescents of violent behavior. Adolescent ratings of drug and alcohol use also produced significantly positive correlations with adolescent ratings of violent behaviors (r=.35, p<.01) and parent ratings of violent behavior (r=.30, p<.05).
In addition to examining relationships between individual behaviors, a combined adolescent risk score was constructed and analyzed statistically. The combined score consisted of adding all of the adolescent health risk behaviors across the three health risk categories and combining them into a combined score. For example, an adolescent whose score of zero on sexual behavior, two on drugs and alcohol, and one on violent behaviors was combined to be a score of three. This combined risk score was found to be significantly correlated with adolescent ratings of sexual behavior (r=.62, p<.01). This indicates there was a positive relationship between total combined risky behavior and adolescent reported sexual behavior. The combined risk score also was significantly  This question examined the concordance between parent ratings of their adolescent's health risk behaviors and the ratings of the adolescents themselves. The researcher proposed to conduct a chi-squared test of independence and three chi-square goodness of fit tests to examine research question 1 and its hypotheses. However, these analyses were not appropriate because the data did not meet the necessary assumptions of normality (see Table 4). Therefore, results for this question are examined on a descriptive level, and reported in the following separate sections for each of three risky behaviors.
Sexual intercourse. Two (6.5%) of the thirty-one adolescent participants reported engaging in sexual intercourse. Both of these adolescent participants reported having sexual intercourse at 13 years or older, having one sexual partner and using a condom during their last sexual encounter. However, every parent (100%) reported believing that her/his adolescent was not engaging in sexual intercourse (see Figure 2).
The concordance rate, or the agreement between parent and adolescent reports, was 93.5%.

Drugs and Alcohol.
No adolescent participants reported using drugs but several reported using alcohol. Of the 31 parent participants, only one reported believing that their adolescent was using drugs or alcohol (see Figure 3). The concordance rate or the agreement between parent and adolescent ratings of alcohol use was 64.5%. As seen in Figure 3, eleven parent-adolescent dyads were not concordant. One parent overestimated their adolescent's alcohol use while 30 parents underestimated their adolescents reported alcohol use. The parent participant with the adolescent whose score fell in the highest alcohol risk believed that their adolescent was not engaging in this risky behavior.  Thus, the rates of parent-adolescent concordance ranged from 93.5% regarding sexual behavior to 64.5% regarding drug and alcohol use to 61.3% regarding violent behavior. These rates suggest that parents may be more accurate and/or sensitive to sexual behavior and alcohol use in their adolescent children.
The second research question was "Is there a significant relationship between parental monitoring and adolescent risk behaviors, in terms of both (a) combined risk behaviors, and (b) specific risk behavior types, in Black youth?" This question explored the relationship between adolescent ratings of health risk behaviors and parental monitoring. The researcher proposed to conduct four multiple regression analyses to examine question two and its hypotheses. However, as noted above, the data did not meet the necessary assumptions (see Table 4 and Figures 1.1-1.6).
Thus, as an alternative to the multiple regression analyses, data were analyzed using negative binomial regressions because they account for over-dispersion in count data (Cohen, Cohen, West, & Aiken, 2003). Negative binomial regressions carry out a log transformation on dependent variables, which for this study are risk health behaviors. A one-unit increase in the predictor variable (e.g., parental monitoring) represents a log (x) increase in the dependent variable, which is indicated by the regression coefficient estimate. Negative binomial regressions also produce odds ratios 1 , which can be used as an index of effect size. Negative binomial regressions were conducted to examine the predictive nature of parental monitoring on adolescent alcohol and drug use, sexual behavior, violence and combined risk.
Parental monitoring and combined risk.  Note. SE= standard error; CI= confidence interval; OR= odds ratio.

DISCUSSION
In this section, the results of the study will be discussed in relation to the research questions. Next, implications for research and practice will be explored. Limitations of the study will be presented and lastly, future directions for research will be highlighted.
The current study examined parents' knowledge of their adolescents' engagement in risky behaviors. In addition, this study aimed to explore the interaction between parental monitoring and the engagement in health risk behaviors for Black adolescents residing in rural areas. The first research question examined the concordance rate, or the agreement between adolescent and parent participant's ratings of health risk behaviors.
Results did demonstrate that parents possessed a high accuracy regarding their adolescent's engagement in sexual activity, violent behaviors and drug and alcohol use.
These results are similar to those in a study conducted by Gersh et al., (2017) who found no significant differences between parent and adolescent reports of sexual behavior and alcohol use.
However, these results are dissimilar to many previous findings. For example, Young and Zimmerman (1998) Yang et al., 2007) and alcohol use (Yang et al., 2007).
In both of these latter studies, the focus was on Black adolescents living in urban areas and researchers examined parental monitoring from the adolescents perspective.
Similarly, Lippiod et al., (2010) found that with rural adolescents and parents higher levels of maternal knowledge were only associated with positive adolescent outcomes when both youth and mothers reported high levels of maternal knowledge. In the present study, it is possible that only examining parental monitoring from the parent perspective lead to an overestimation of parental monitoring.
The current results may have been influenced by multiple factors. Neighborhood types may affect the relationship between parental knowledge and engagement in health risk behaviors. For example, Jones and colleagues found that parental monitoring increased in families that lived in neighborhoods that were characterized as urban versus rural neighborhoods. Neighborhood characteristics could have an impact on just how protective parental knowledge is against the engagement in health risk behaviors possibly explaining why in the present work parental monitoring was not found to be significant against the engagement in health risk behaviors.
Research also suggests that rurality could have an effect on parental knowledge.
In many rural areas there are rich social networks where adolescents are known by many adults and many non-relative adults may have a sense of responsibility for youth in the community (Lippiod et al., 2010), or "it takes a village to raise a child" mentality. This rich social network can potentially lead to sharing of information among adults about adolescents/children, and could help explain the high rates of accuracy between parent and adolescent reports of engagement in health risk behaviors.
Another factor, parental religiosity, could have affected the results of this study as well. Brody and Flor (1998) found that parental religiosity had an effect on parenting.
These researchers found that greater maternal religiosity among rural African American mothers was directly linked to increased maternal involvement in school activities, higher quality mother-child relationships and more use of "no non-sense parenting." Brody and Flor (1998) characterized "no non-sense parenting" as parenting with high levels of control and affection. Higher involvement and "no non-sense parenting" could account for lower adolescent reported engagement in risky behaviors than what is typically found.
It is important to note that some of the questions on the YRBSS may have been more difficult for parents and adolescents to answer truthfully. For example, answering questions regarding bullying may have carried less stigma than answering questions about sexual behavior.

Limitations
The study is not without limitations. The sample size for this study was relatively small. After approximately 18 months of data collection, only half of the projected number of participants had been recruited. Researchers consider certain populations "hard-to-reach" meaning the population is "difficult for researchers to access" (Sydor, 2013). In this regard, individuals and families that are African American are considered to be a "hard-to-reach" population in research. Further information regarding the meaning of "hard-to-reach" can be gleaned from Bonevski et al., (2014), who conducted a systematic review exploring strategies to improve research with diverse groups. The authors discussed some common barriers that "hard-to-reach" individuals face. For example, some common barriers to the engagement in research by diverse groups are lack of trust, fear of authority, perceived harm of research, mistreatment, cultural beliefs, low health literacy and no benefits for participation.
To reach these individuals and populations, Bonevski and colleagues (2014) suggest using variations in recruitment efforts and incorporating community groups and organizations throughout the study. For the current study, the researcher worked with local churches to recruit participants. Prior to recruiting data at churches, the researcher spoke with church leaders to gain their support. Once church leaders agreed to support the project, the researcher worked with a member of the church to plan recruitment.
Having community partnerships and working with peer recruiters has been suggested to combat the barriers of lack of trust and fear of authority (Bonevski et al., 2014).
Bonevski and colleagues (2014) systematic review also suggests that "hard-toreach" individuals can often believe that there are no benefit participations. To help eliminate this belief, a "commitment to give back" is suggested. While there were no monetary rewards parent participants did receive a resource packet with handouts to assist in a discussion about the topics covered on the survey.
Because the data did not meet the necessary assumptions of normality, the first research question and hypotheses were examined on a descriptive level. The researcher was not able to fully examine the relationship between concordance rate of adolescentparent dyads and the degree of adolescent-reported risk.
It is important to note that a large majority of the adolescent sample did not endorse engagement in sexual activity, violent behaviors or alcohol use. It is unclear how these low levels of risky behavior affected parent accuracy. The high levels of parent accuracy found in this study could truly be parent knowledge or luck.
As stated above, this study examined parental monitoring from the perception of the parent. Parental monitoring as reported by the parent was relatively high among all parents. Research by Li et al., (2000) and Yang and colleagues (2007) found that parental monitoring had an effect on the engagement in risky behaviors but examined parental monitoring from the adolescent perspective. Furthermore, Lippiod and colleagues (2010) found parental knowledge to only be associated with less risky behaviors when both adolescents and mothers reported high levels of maternal knowledge. These studies suggest that adolescents and parents may have different perceptions of the monitoring that is occurring. Future research should seek to incorporate both adolescent and parent reports of monitoring.
When examining the questions on the YRBSS, it was found that the questions regarding sexual intercourse did not specifically mention participation in oral sex.

Implications
Despite the study's limitations, the work conducted and its results provide some insight on rural Black parents perceptions of their adolescent's engagement in health risk behaviors. Also, the work provides information on parental monitoring and the engagement of health risk behaviors among this population. Results suggest that rural Black adolescents are engaging in health risk behaviors at an early age. Creating more awareness of the early onset of these risk behaviors among rural Black adolescents is important for parents and school staff. This is because awareness of the emergence of health risk behaviors at an early age can lead to better prevention efforts.
Results did not show that parental monitoring predicted lower engagement in health risk behaviors. However, results did show that rural Black parents are relatively aware of their adolescent's engagement in risky behaviors. Extrapolating these results to a sample of 1,000 parents we would see that 935 of 1000 parents would be found to accurately report their adolescents engaged in sexual behaviors, 645 of 1000 parents would be found to accurately report engagement in drugs and alcohol and 631 of 1000 parents who would accurately reported engagement in violent behaviors. This extrapolation implies that in a rural middle school with 1000 Black students more than half of their parents would be knowledgeable of their adolescents engagement in risky behaviors.
Conversely, the extrapolations provided above can be interpreted from the "other side of the coin" so to speak. It is concerning that 65 of 1000 parents would inaccurately estimate adolescent engagement in risky sexual behavior. And, 355 would inaccurately predict drug and alcohol use. Finally 369 of 1000 would inaccurately report adolescent engagement in violent behavior. Taken from this perspective, then, there is a need for prevention and intervention methods in schools and communities to support parent practices that could lead to increased knowledge, prevention, and safety efforts.
Parents are typically the ones identifying and providing access to health services so, it is critical that they are aware of their adolescent's participation in risky behaviors.
Generally speaking, medical professionals and clinicians tend to rely on parent reports when assessing the engagement in risky health behaviors. While this study did show a high concordance rate between parents and adolescents professionals should rely on adolescent report over parent report.

Future Directions
The present study adds to our information base about parent's knowledge of their adolescent's engagement in risky behaviors and the interaction between parental monitoring and the engagement in health risk behaviors for Black adolescents residing in rural areas. Black adolescents who reside in rural communities are frequently left out of studies that examine parental monitoring and Black adolescents.
This study is among the first to explore parental perceptions of adolescent engagement in health risk behaviors among a rural Black sample. Furthermore, the study contributes to the limited knowledge of parental monitoring and the engagement in health risk behaviors among Black youth who reside in rural America. Future research should examine the role that rurality and religion play in parental practices among rural Black parents. Given that the current study did not find a relationship between parental perceptions of parental monitoring and health risk behaviors, future studies should examine perceived parental monitoring from the adolescents perspective or both the parent and adolescent perspective.
The mistreatment of African American's in research studies has long been documented. Historical events coupled with current health care issues have aided in distrust among the African American community and researchers. When working with African American participants researchers should be aware of the mistrust and other barriers that might affect African American's participation in research. It is also suggested that researches be aware of their biases and actively work to ensure that these biases do not affect their research. To increase participation of African American participants, it is suggested that researchers work with leaders in the community and becoming as immersed in the community as possible. It could also be useful for researchers to explain the importance of their study and why African American participation is critical.

Conclusion
According to the U.S. Census Bureau, more than six million adolescents live in rural areas (2014). Rural America has as long been stereotyped as a place free from drug abuse, crime, and poverty (Brown and Waite, 2005). We are now becoming aware that the same issues that plague urban communities can be seen in rural communities as well.
Black youth living in rural areas often face chronic poverty, parental employment status change, limited educational opportunities, interpersonal and institutional racism, and difficulty in accessing medical care. The current study sought to assess the influence of parental monitoring on the impact of three health risk behaviors, which included sexual intercourse, violence/bullying and drug and alcohol use. While results did not show that parental monitoring predicted the engagement in health risk behaviors results did show that rural Black parents are relatively aware of their adolescent's reported engagement in health risk behaviors.

How many hours per week do you USUALLY work at your job?
A. 35 hours a week or more B. Less than 35 hours a week C. I am not currently employed If you suspected that your child had a mental heath issue who would you seek for help and why?

Appendix B 2015 Middle School Youth Risk Behavior Survey
This survey is about health behavior. It has been developed so you can tell us what you do that may affect your health. The information you give will be used to improve health education for young people like yourself.
DO NOT write your name on this survey. The answers you give will be kept private. No one will know what you write. Answer the questions based on what you really do.
Completing the survey is voluntary. Whether or not you answer the questions will not affect your grade in this class. If you are not comfortable answering a question, just leave it blank.
The questions that ask about your background will be used only to describe the types of students completing this survey. The information will not be used to find out your name. No names will ever be reported.
Make sure to read every question. Fill in the ovals completely. When you are finished, follow the instructions of the person giving you the survey.
Thank you very much for your help. The next 2 questions ask about bullying. Bullying is when 1 or more students tease, threaten, spread rumors about, hit, shove, or hurt another student over and over again. It is not bullying when 2 students of about the same strength or power argue or fight or tease each other in a friendly way.

Appendix C Youth Risk Behavior Survey (YRBSS) Parent Version
DO NOT write your name on this survey. The answers you give will be kept private. No one will know what you write. Answer the questions based on what you really do.
Completing the survey is voluntary. Whether or not you answer the questions will not affect you or your child. If you are not comfortable answering a question, just leave it blank.
The questions that ask about your background will be used only to describe the types of people completing this survey. The information will not be used to find out your name. No names will ever be reported.
Make sure to read every question. Circle your answer completely. When you are finished, follow the instructions of the person giving you the survey. (Select only one response.) A. They did not smoke cigarettes during the past 30 days B. They bought them in a store such as a convenience store, supermarket, discount store, or gas station C. They got them on the Internet D. They gave someone else money to buy them for me E. They borrowed (or bummed) them from someone else F. A person 18 years old or older gave them to them G. They took them from a store or family member H. They got them some other way 23. During the past 30 days, on how many days did your child use chewing tobacco, snuff, or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen? A. 0 days B. 1 or 2 days C. 3 to 5 days D. 6 to 9 days E. 10 to 19 days F. 20 to 29 days G. All 30 days 24. During the past 30 days, on how many days did your child smoke cigars, cigarillos, or little cigars? A. 0 days B. 1 or 2 days C. 3 to 5 days D. 6 to 9 days E. 10 to 19 days F. 20 to 29 days G. All 30 days The next 2 questions ask about electronic vapor products, such as blu, NJOY, or Starbuzz. Electronic vapor products include e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens. 25. Has your child ever used an electronic vapor product? A. Yes B. No 26. During the past 30 days, on how many days did your child use an electronic vapor product? A. 0 days B. 1 or 2 days C. 3 to 5 days D. 6 to 9 days E. 10 to 19 days F. 20 to 29 days G. All 30 days The next 2 questions ask about drinking alcohol. This includes drinking beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey. For these questions, drinking alcohol does not include drinking a few sips of wine for religious purposes. 27. Has your child ever had a drink of alcohol, other than a few sips? A. Yes B. No 28. How old was your child when they had their first drink of alcohol other than a few sips? A. They have never had a drink of alcohol other than a few sips B. 8 years old or younger C. 9 years old D. 10 years old E. 11 years old F. 12 years old G. 13 years old or older The next 2 questions ask about marijuana use. Marijuana also is called grass or pot.

Appendix E
For questions that produce yes or no answers the answer choice of yes will be coded as one while the answer choice no will be coded as zero. For example:

Have you ever had sexual intercourse?
A. Yes (1)

B. No (0)
The YRBSS additionally contains questions that offer a range of ages for answers, for these questions the youngest age option (8 years old) was coded as a six while the oldest age option (13 years old or older) was scored as one. For example: 36. How old were you when you had sexual intercourse for the first time?