A randomly selected nationally representative sample of 508 practicing pediatricians was surveyed in order to identify factors associated with physician delivery of primary prevention to parents about sexual risk reduction (SRR). A full 86% (n=435) reported that provision of SRR guidance is equally or more important than other guidance provided to parents. Among the 435, only 121 (28%) provided SRR guidance to greater than 75% of parents of their adolescent patients. Multivariate analyses revealed barriers of: lack of training, lack of request from parents, and awkwardness. To promote parent-child communication, physicians suggested high-quality brochures for parents (84%); a list of resources (74%); and tools to facilitate parent-child discussions (63%). Pediatricians and parents are important components of sexual risk prevention efforts for adolescents. Editors' Strategic Implications: The findings related to the perceived importance but infrequent delivery of SRR communication between pediatricians and parents of adolescents have implications for training and information dissemination in pediatric practices, as well as other health and reproductive health settings.