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 >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.