Parental Interactions Associated with Adolescent Health Risk Behavior: Premarital Sexual and Aggressive Behavior

Introduction: Interactions within the family will determine the behavior of adolescents. Lack of interaction in adolescents is a risk factor for adolescent behaving deviant, among others, unmerried sexual and aggressive behaviors. The purpose of this study was to analyze the relationship between parental interaction and the premarital sexual and aggressive behavior among adolescents.Methods: A cross-sectional approach was taken. The sample consisted of 744 adolescents from junior high school and senior high school in Java Island aged 13 - 19 years old who had completed a Google form. The independent variable was parent interaction while the dependent variable was premarital sexual and aggressive behaviors. The PACHIQ-R questionnaire was used for measuring parent interaction. While the dependent variable was using checklist questionnaire. The data was analyzed using Spearman Rank correlation with a level of significance α=0.05.Results: The results show that there is a correlation between the parent interactions and premarital sexual (p=0.007; r=0.100) and aggressive behavior among adolescents (p=<0.001;r=0.156). Parental interaction has an association on the adolescent’s behavior, especially in terms of premarital sexual and aggressive behavior.Conclusion:Nurses need to provide education not only to parents, but also for adolescents to prevent premarital sexual and aggressive behaviors among adolescents in any media that available.


INTRODUCTION
Chemotherapy Risky behaviors in adolescents greatly affect their health (Achhab et al., 2016). The behaviors include fighting, drug use and extortion. One of the behaviors that is less often in the spotlight is sexual behavior when dating (Catur, 2015). It is also supported that the factors that influence adolescent sexual behavior include the adolescent's parental relationships, negative peer pressure, an understanding of religion (religiosity) and exposure to pornographic media (Arista, 2015;Murdiningsih, Rosnani, & Arifin, 2016;Yusuf, Bahiyah, Nihayati, & Wiyono, 2017). Parental interactions have been shown to be associated with risky behavior in adolescents (Kurnia et al., 2019) (Krisnana, Diyan, Yuni, Arief, & Dwi, 2019). The impact of aggressive behavior can be seen from the impact on both the perpetrators and victims. The impact of the perpetrators is that they will be shunned and not liked by others. The impact of the victim includes physical and psychological pain and losses due to aggressive behavior (Restu & Yusri, 2013).
Based on a reproductive health survey conducted by the National Family Planning Board (BKKBN) 2017, 67% of adolescents were dating, 18,6% boys had kissed each other and 5% of adolescent (male) teens who were dating had had sexual intercourse before marriage (BKKBN, 2017). Based on the data from WHO (2018) stated that nearly one in three adolescent girls aged 15 -19 years (84 million) has been a victim of emotional, physical and/or sexual violence perpetrated by their husband or partner (WHO, 2018). Based on the data from the National Commission on Child Protection 2016, there were 41 brawls between students, while childhood violence (bullies) totaled 93 cases (Komisi Perlindungan Anak, 2016).
Child relationship with family becomes an important factor in the prevention and management of juvenile delinquency (Doly Purba, 2014). The parent-child interactions are a mutually beneficial process because the parental behavior will affect the child and vice versa. The child will affect the parents so then both experience change (Adah & Arisna, 2015). Various theories of nursing have been introduced by nursing experts, one of which is the theory of Kathry E. Barnard. This theory discusses the interaction between children and their parents. The reason for taking this theory into account is because it is in accordance with the problems that are to be explored, namely the interaction between the parents and the evidence of pre-marital sexual and aggressive behavior in adolescents. The focus of Barnard's theory is to view the parents and children as an interactive system (Alligood, 2014). The parent-child system is influenced by the individual characteristics of each member involved and the individual characteristics are modified to meet the needs of the interactive system in turn. The identification of the parent interactions as it relates to the premarital sexual behavior of adolescents is very important. This is because Indonesia is a country that still adheres to norms of Eastern behavior and customs. There is still only a small amount of research that explains the relationship between parental interactions, aggressive behavior and premarital sexual behavior in adolescents. The researchers are interested in conducting an analytical study of the relationship between parental interactions, aggressive behavior and premarital sexual behavior in adolescents. Study on parental interaction with premarital sexual behavior and aggressive behavior in adolescents on the island of Java has not been carried out. Therefore, the purpose of this study is to analyze the relationship between parental interactions with pre-marital sexual behavior and aggressive behavior among adolescents on the Java Island.

MATERIALS AND METHODS
The design in this study was cross-sectional. This research was conducted in one time data collection on the subject. The population of this study consisted of 13 -19 year old adolescents attending junior and senior high school in Indonesia, particularly in Java Island. The inclusion criteria in this study were 1) adolescents living in Java, aged 13-19 years old, 2) adolescents who can access Google Forms. The determination of the sample size in this study was done using the Gpower 3.1.9.2 application and statistical test Correlations: Two dependent Pearson r's (common index). The results of the calculation using power analysis obtained 744 samples as the ideal size. Sampling based on quota sampling according to the results of the sample size formula.
The independent variable was parent interaction and the dependent variable was pre-marital sexual behavior and aggressive behavior.
The researcher made an online questionnaire using Google forms https://goo.gl/forms/49lv8TrN2D3qzFcs1. The form contained the informed consent sheet, the respondent's demographic data, the PACHIQ-R questionnaire, the premarital sexual behavior questionnaire and the aggressive behavior questionnaire. The questionnaires were distributed through social media such as Line, Whatsapp, Facebook and Instagram to be filled in by the respondents on 3 months period (September-November 2017). The respondents fill out the informed consent form first. After agreeing, the respondents filled in the biodata and PACHIQ-R questionnaire, in addition to the premarital sexual behavior questionnaire and the aggressive behavior questionnaire that was used in the Google form. The PACHIQ-R questionnaire (The Parent-Child Interaction Questionnaire-Revised) was made by  and it was filled in by the adolescents (Lange, Evers, Jensen, & Dolan, 2002) . The PACHIQ-R questionnaire was translated from English into Indonesian and it was tested for validity and reliability . All of the items in the questionnaire had good validity scores. The reliability testing had a Cronbach's Alpha score = .854. The questionnaire was divided into 2 measurements, namely the measurement of the interactions of the parent and the measurement of the interactions of the adolescent. The adolescent version had 25 questions. The 2 subscales were conflict resolution (certain behaviors) and acceptance (certain feelings). There were both positive and negative questions in the PACHIQ-R questionnaire: (6, 8, 9, 11, 14, 16, 17, 18, 19, 20, 21, 23, 24, and 25) and (1, 2, 3, 4, 5, 7, 10, 12, 13, 15, and 22) respectively. PACHIQ-R used five response categories: "never", "hardly ever", "sometimes", "almost always", and "always". The higher the score, the higher the level of interaction between the adolescents and their parents. The questionnaire was completed by those with the means who had understood the instructions for filling it in. Meanwhile, the dependent variable data is in the form of descriptive data, namely the percentage of adolescents who did and did not engage in premarital sexual behavior and aggressive behavior. The researcher gave the participants a cellphone number that they could be contacted on if there were questions related to the questionnaire. The completion of the questionnaire took approximately 20 minutes. For the completed questionnaire, the researcher checked Google forms directly to find out the number of questionnaires that had been filled in. Once they met the target, the researcher turned off the link that allowed access to the Google form. The data was analyzed using Spearman Rank correlation with a level of significance of α=0.05.
This study has passed the review and certification of the Ethical Agreement with no. 566 -KEPK issued by the Faculty of Nursing University of Airlangga. This study follow the princip of ethic are anonymity, justice, informed concent, confidentially, beneficience.

RESULTS
The results show that the majority of respondents were their mid adolescents, in the range of 15 -17 years old (as many as 374 people; 50.2%). The majority of respondents (606) had a high school level of education (81.3%). The majority of the respondents' parent's education was high school for the father and mother, totaling 328 people (44.1%) and 314 people (42.2%) respectively. The majority of the respondents resided with their parents (672 people; 90.3%). Most of the respondents used motorbikes as their medium of transportation to get to school (as many as 462 people; 62.1%). The majority of respondents were given pocket money by their parents, totaling as much as < 50,000 IDR (as many as 626 people; 84.1%) ( Table 1).
The parent interactions with the adolescents had a minimum score of 55. This score indicates that there were no adolescents who had never interacted with their parents. The maximum score was 121. This score shows that none of the adolescents had a perfect score. The mean value was 95 which means that the adolescent interactions were in the range of 'sometimes' and 'almost always' ( Table 2).
Most of the adolescents had never engaged in premarital sexual behavior (96.1%) and they had not engaged in aggressive behavior either (73.1%). The parent interactions with the adolescents consist of a very weak positive relationship. These results indicate that the higher the level of interactions, the higher the tendency of the adolescents to not engage in premarital sexual behavior (p = .007; r = .100) and aggressive behavior (p = <. 001; r = .156) ( Table 3).

DISCUSSION
Table The results showed that there was a relationship between parental interactions with premarital sexual behavior and aggressive behavior in adolescents. Interaction refers to contact and communication which is interpreted as the mutual influence on various aspects of a shared life (Lange, Evers, Jansen, & Dolan, 2002). There were 2 subscales used to measure the interaction between parents and adolescents, namely conflict resolution and acceptance. For the conflict resolution subscale, most adolescents call their parents directly by their names. For the acceptance subscale, the acceptance of a small proportion of teenagers is related to always being told by their parents to do everything. Good family interactions will provide happiness in the family which can provide protection various problems and minimize the occurrence of negative things in the children (Adah & Arisna, 2015). Adolescents, while developing, need love, attention and a sense of security from their parents (Saputri, 2014). This is consistent with the research conducted by (Rogi, 2015) where the results showed that juvenile delinquency occurred due to the lack of intense family communication where the power related t the control and guidance of the parents towards adolescent behavior was very limited.
Adolescence is a period of rapid physical, cognitive, emotional and social maturity in both males and females (Wong, Hockenberry, Wilson, Winkelstein, & Schwartz, 2009). Adolescents who actively communicate with their parents have risky sexual behavior that is in the mild category. The respondents who passively communicate with their parents have risky sexual behavior in the severe category (Sekarrini, 2012) . The research conducted by (Gustina, 2017) showed the same result, that there is a relationship between parental communication and sexual risk behavior. Poor communication between parents and adolescents results in the adolescents engaging in risky sexual behavior.
Interactions between the teenagers and their parents can delay and even reduce the level of sexual intercourse behavior in adolescents (Hidayah & Maryatun, 2013). The impact of free sexual behavior is that it puts the adolescents at risk of developing STDs, Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). The risk of unplanned pregnancy can lead to the action of abortion which can result in death (Arista, 2015). Some of the factors that can cause the teenagers to behave freely include puberty, poor communication with their parents and friends, other social factors and media exposure (Sekarrini, 2012). Adolescent health risk behavior includes casual sex, brawling and alcoholism (Hartono & Gianawati, 2013). Children from harmonious families have more of a stronghold when it comes to the prevention of aggressive behavior(Gómez-Ortiz, Romera, & Ortega-Ruiz, 2016). The interactions in a harmonious family can have a positive influence on adolescents. . Physical punishment and strict disciplinary practices on part of the parents will result in negative impacts, one of which is the emergence of aggressive behavior in the children (Hidayah & Maryatun, 2013). The level of parental interaction related to adolescent health risk behavior includes free sex and aggressive behavior. Efforts to minimize the increase in adolescent health risk behavior can be applied by increasing the understanding of the parents about the importance of maintaining open communication and interactions with adolescents. Based on the results of this study showed that parental interaction has a relationship with premarital sex behavior and violent behavior in adolescents. the school and the government need to provide education and empowerment for parents so that they can monitor adolescents in order to prevent health risk behaviors.
The limitation of this study was that the researchers could not directly observe the process of the questionnaires being filled out by the adolescents via a Google form.

CONCLUSION
Parental interaction has an impact on the adolescent's behavior, especially in terms of premarital sexual and aggressive behavior.
Nurses need to provide education not only to parents, but also to teenagers to prevent premarital sexual and aggressive behaviors among adolescents in any media that available. For futher study need to explore the parents perspective of premarital sexual and aggressive behavior of adolescents.