Article

Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy

May 2008
Journal of Adolescent Health 42(4):344-51

DOI:10.1016/j.jadohealth.2007.08.026

Source
PubMed

Authors:

Pamela K Kohler

University of Washington Seattle

Lisa E Manhart

University of Washington Seattle

The role that sex education plays in the initiation of sexual activity and risk of teen pregnancy and sexually transmitted disease (STD) is controversial in the United States. Despite several systematic reviews, few epidemiologic evaluations of the effectiveness of these programs on a population level have been conducted. Among never-married heterosexual adolescents, aged 15-19 years, who participated in Cycle 6 (2002) of the National Survey of Family Growth and reported on formal sex education received before their first sexual intercourse (n = 1719), we compared the sexual health risks of adolescents who received abstinence-only and comprehensive sex education to those of adolescents who received no formal sex education. Weighted multivariate logistic regression generated population-based estimates. Adolescents who received comprehensive sex education were significantly less likely to report teen pregnancy (OR(adj) = .4, 95% CI = .22- .69, p = .001) than those who received no formal sex education, whereas there was no significant effect of abstinence-only education (OR(adj) = .7, 95% CI = .38-1.45, p = .38). Abstinence-only education did not reduce the likelihood of engaging in vaginal intercourse (OR(adj) = .8, 95% CI = .51-1.31, p = .40), but comprehensive sex education was marginally associated with a lower likelihood of reporting having engaged in vaginal intercourse (OR(adj) = .7, 95% CI = .49-1.02, p = .06). Neither abstinence-only nor comprehensive sex education significantly reduced the likelihood of reported STD diagnoses (OR(adj) = 1.7, 95% CI = .57-34.76, p = .36 and OR(adj) = 1.8, 95% CI = .67-5.00, p = .24 respectively). Teaching about contraception was not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education.

The Need for Earlier Implementation of Comprehensive Sexual Education Within a Formal Classroom Setting and Beyond Based on the Influences of Technology

Article

Full-text available

Aug 2022

Abstinence-only education taught predominately via formal classroom instruction has continuously been emphasized throughout history and in classrooms today. Although abstinence-only methods are often stressed, contraceptive education is occasionally but not consistently implemented in school curricula. A variety of other instructional delivery methods include student-peer education, education outside of the formal classroom setting, community youth service programs, education via telehealth, educational videos, self-study websites and social media. Providing comprehensive sexual education utilizing multiple instructional delivery methods could close the gap in sexual education for adolescents. The age at which sexual education instruction is introduced has remained relatively unchanged throughout history. Adolescents are being formally educated within classrooms as early as grade five, although they are often exposed to informal and potentially misleading information regarding sexual education much earlier than this. In part, this is due to the relatively recent emergence and subsequent influence of technology such as social media. Thus, given the influence of technology such as social media in recent history we need to reevaluate the age of formal sexual education and increase comprehensive sexual education resources. Additionally, it is important to note that sexual education instruction provided solely in formal classroom settings may not provide sufficient information for youth to make informed decisions. Thus, sexual education information including abstinence and contraceptive methods should be provided through additional means via utilizing differing instructional delivery methods in conjunction with formal classroom instruction. For example, comprehensive sexual education should also be provided in healthcare offices including pediatric and obstetrics and gynecology (OBGYN) offices. Sexual education could include discussing/providing external resources such as pamphlets that incorporate social media and other links to online resources that provide a more inclusive, accurate educational experience within a safe environment. This would allow healthcare professionals to provide a better targeted and engaging educational experience to adolescents as well as proactively allow for exposure of younger adolescents to helpful educational resources.

Maternal Communication About Sexual Content and Ease of Access to Contraceptives

Article

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Nov 2022
ARCH SEX BEHAV

Previous literature has emphasized the role of mothers in sexual health communication with their adolescents. However, the extant literature lacks exploration of the importance of parental communication in association to specific risk-reduction behaviors, such as access to contraceptives. Therefore, the purpose of the current study was to explore the roles of parental attachment, the mother–daughter relationship, and communication about sexual content during adolescence in relation to women’s recalled access to contraceptives during their teen years. Cisgender female participants aged between 18 and 35 (N = 582) were retrospectively assessed on maternal and paternal attachment, the mother–daughter relationship, mother–daughter communication about sexual content, and their own access to contraceptives during their teen years. After controlling for socioeconomic status, participant race, and history of pregnancy, only maternal communication about sexual content significantly related to access to contraceptives and ease of access to contraceptives. These results demonstrated that specific communication about sexual content was associated with greater access and ease of access to contraceptives, whereas more general relationship factors and communication did not.

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Barriers to sexual and reproductive care among cisgender, heterosexual and LGBTQIA + adolescents in the border region: provider and adolescent perspectives

Article

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Apr 2022
Reprod Health

Introduction The United States (U.S.) has higher rates of sexually transmitted infections (STIs) and adolescent pregnancy than most other industrialized countries. Furthermore, health disparities persist among racial and ethnic minority adolescents (e.g., African American and Latinx) and in counties located along the U.S.–Mexico border region—they demonstrate the highest rates of STIs and unintended pregnancy among adolescents. Methods Qualitative data were collected as part of formative research for the development of a mobile app that provides gender-inclusive sexual education to adolescents living in the U.S.—Mexico border region. From August 2019 to March 2020, the study team conducted 11 in-depth interviews with healthcare providers and three focus groups with cisgender, heterosexual, and SGM adolescents ages 15–18 (n = 20). Results Providers and adolescents reported similar barriers to accessing SRH in this region such as transportation, lack of insurance and cost of services or accessing services without their parent’s knowledge. However, providers shared that some adolescents in this region face extreme poverty, family separation (i.e., parent has been deported), have a mixed family legal status or are binational and have to travel every day from Mexico to the U.S. for school. These challenges further limit their ability to access SRH. Conclusions Adolescents in the U.S.-Mexico border region face unique economic and social challenges that further limit their access to SRH care, making them uniquely vulnerable to STIs and unintended pregnancy. The prototype of the app was developed based on the needs expressed by providers and adolescents, including providing comprehensive Sex Ed and mapping of free comprehensive and confidencial SRH services available in the region and is being pilot tested. Our findings provide further evidence for the need for interventions and service delivery, programs tailored for residents in the border region.

Dose Matters in Evaluation of a School‐Based Adolescent Sexual Health Education Program

Article

Full-text available

Mar 2022

Background: Research on the effects of intervention dose on outcomes within adolescent sexual health education programming is lacking. Existing research on dose typically utilizes the number of sessions as a variable. In a school setting, there are scheduling limitations, student absences, and other logistical barriers that have the potential to affect the number of sessions for an intervention and, in turn, impact the efficacy of programming. Methods: This article evaluates the effectiveness of a school-based, peer-led adolescent comprehensive sexual health education program, with a focus on dose. A repeated measures MANOVA was used to evaluate the effects of individual difference variables and intervention variables on changes in participants' knowledge and attitudes across 2 time points. Additionally, paired t-tests were used to evaluate changes in specific behaviors. Results: Results indicated that knowledge improved following the intervention, and specifically larger doses, measured in minutes, of the intervention were associated with larger improvements in knowledge. There were no significant effects related to attitudes or behavioral outcomes. Conclusions: This study adds to the knowledge base by including analysis of how the dose of intervention may impact youth outcomes. Implications for school health practices and research are discussed.

Sex Education for LGBTQ+ Adolescents

Article

Full-text available

May 2023
Curr Sex Health Rep

Purpose of Review This paper summarizes the current research on the impact of abstinence-only sex education programs on LGBTQ+ adolescent health in the USA. We also seek to explore the current barriers to implementing comprehensive sex education, as well as discuss the future of LGBTQ+ adolescent health by outlining crucial components of LGBTQ+-inclusive sex education. Recent Findings The US sex education debate is centered on two approaches: abstinence-only and comprehensive. Abstinence-only sex education emphasizes risk reduction through abstaining from sexual behavior and has been found to be ineffective in promoting healthy sexual behavior among adolescents, compared to comprehensive sex education which centers on disseminating inclusive and medically accurate information. Abstinence-only sex education is taught through a heteronormative framework that excludes and devalues the experiences of LGBTQ+ adolescents. LGBTQ+ individuals are at increased risk for negative health outcomes as compared to their cisgender heterosexual counterparts. Lack of knowledge regarding safe sexual practices and consent, coupled with the shame and fear-based messaging promoted by abstinence-only sex education, further contributes to the health disparities experienced by LGBTQ+ youth. Summary The content and inclusivity of sex education has important implications for the health of LGBTQ+ youth. Abstinence-only sex education further compounds the health disparities experienced by LGBTQ+ adolescents by erasing LGBTQ+ representation and leaving out crucial information on diverse, non-heterosexual sex practices. Numerous barriers exist to implementing comprehensive, inclusive sex education including funding, policies, teacher training, and attitudes toward sex and LGBTQ+ individuals. To address these health disparities, we must listen to and amplify the voices of LGBTQ+ youth to promote safe, comprehensive, and LGBTQ+-inclusive content within our sex education system in the USA.

Attitudes of Fathers Who Have Children in Preschool Period Towards Their Children's Sexual DevelopmentOkul Öncesi Dönemde Çocuğu Olan Babaların Çocuklarının Cinsel Gelişimlerine Yönelik Tutumları

Article

Jun 2022

Sexual development begins in the mother's womb and is affected by other environmental factors, especially parental attitude, with birth. This research aims to reveal fathers' attitudes on sexual development and the demographic variables (child’s age, child’s sex, number of children, father's age, father's education level, socioeconomic level) that affect these attitudes. This study is in the quantitative research approach and the descriptive model. The study group consists of 190 fathers who have children aged 3-6. The data were collected on the internet by using the 'Information Form' and the 'Parental Attitude Scale'. While analyzing the data, independent sample t-test, one-way ANOVA, and Tukey test analysis were used. According to the findings, it is seen that there is a significant relationship between the variables of child’s sex, number of children, father's education level, socioeconomic level, and fathers' attitudes towards sexual development. There was no significant relationship between the age of the father, the age of the child, and the father's attitude. It is seen that the mean scores of the fathers' attitudes towards sexual development are in the range of neutral-positive attitudes. While fathers generally had a positive attitude towards children's sexual questions and sexual behaviors, they had a negative attitude towards social norms.

The long-term effects of reproductive health education among primary and secondary school students: A longitudinal quasi-experimental study in rural Tanzania

Preprint

Full-text available

Feb 2023

Background: Adolescent pregnancy remains a major global health issue, increasing the risk of complications during pregnancy and childbirth in mothers and babies. In Tanzania, adolescent pregnancy threatens girls’ education and makes it difficult for them to obtain a proper job; hence, the majority fall into poverty. Previous studies have developed and conducted reproductive health education for adolescent students; however, they evaluated only the effect immediately after education. Therefore, this study investigated the effects of reproductive health education on attitudes and behaviors toward reproductive health among adolescent girls and boys one year after the intervention in rural Tanzania. Methods: A longitudinal quasi-experimental study was conducted with 3295 primary and secondary students (2123 in the intervention group, 1172 in the control group) from three purposefully selected wards in Korogwe District. In the intervention group, the students received reproductive health education. We used paper-based questionnaires to evaluate the effect of the adolescent education program on attitudes and behaviors toward reproductive health education. To analyze the association between the intervention and each outcome, mixed-effect multiple regression analyses was conducted. Results: The mean age, primary school proportion, and female proportion of the intervention and the control group was 13.05 (standard deviation (SD) 1.59), 14.14 (SD 1.7), 77.9% and 34.3%, and 54.2% and 52.6%, respectively. There was no statistically significant effect of reproductive health education on adolescent health attitudes and behaviors in the multiple regression analyses (coefficient: -0.24 (95% confidence interval (CI): -0.98-0.50), coefficient: 0.01 (95%CI: -0.42-0.43)). Conclusion: A statistically significant effect of reproductive health education on adolescent health attitudes and behaviors was not found. An effective reproductive health education intervention to improve the attitude and behaviors of reproductive health among Tanzania adolescents in the long term remain to be determined, particularly in real-world settings. Trial registration: the National Institute for Medical Research, Tanzania (NIMR/HQ/R.8a/Vol. IX988)

Healthy and Respectful Relationship Education: Differences by Disability Status and Associations With Sexual Abuse

Article

Feb 2023
J SCHOOL HEALTH

Background: Education about healthy and respectful relationships (HRR) is a key component of comprehensive sexual health curricula and is supposed to be universally provided in Oregon. This study: (1) assesses the extent to which high school students with disabilities received HRR education, and (2) examines associations between HRR education and experiences of sexual abuse. Methods: Using data from the 2019 Oregon Healthy Teens survey, we conducted multivariable Poisson regression to compare 11th grade students with and without disabilities on self-reported receipt of school based HRR instruction (N = 10,992), and to measure associations between HRR education and sexual abuse experiences among teens with (N = 3736) and without (N = 7256) disabilities. Results: Students with disabilities were 41% more likely than students without disabilities to say they had never been taught in school about HRR (adjusted prevalence ratio 1.41, 95% confidence interval: 1.25-156). Experiences of sexual abuse victimization were more common for all students who did not receive HRR education (34.1% vs 21.6% among students with disabilities; 16.2% vs 7.5% among students without disabilities). Conclusions: Students with disabilities are less likely to have received school-based HRR education than their peers without disabilities. Providing inclusive HRR education may help reduce risk of sexual abuse and is essential for addressing health disparities affecting youth with disabilities.

Influence of Selected Sociodemographic and Cultural Factors on the Age of Sexual Initiation of Students from Polish Universities

Article

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Feb 2023
Int J Environ Res Publ Health

Sexuality is the one of the most important parts of human life. The aim of our study was to identify the factors influencing the onset and age of sexual initiation in students and drawing attention to the need to improve access to sexual education in Polish schools at a sufficiently high level. An original questionnaire with 31 questions was used for the study. Data were collected using the Google Forms tool. A total of 7528 students participated in the study and 5824 underwent sexual initiation. The mean age at sexual initiation was 18.1 years. Logistic regression analysis was performed to show factors influencing the onset of sexual activity, while linear regression analysis was used for factors influencing the age of sexual initiation. Religion, drug use, smoking, alcohol consumption, type of housing, and conversations with parents about contraception or sex affect the onset of sexual activity. The age of sexual initiation is affected by religion, the age of the first viewing of pornography, quality of life, the size of the city of residence, smoking and drug use.

The Impact of Sex Education on the Status of Women in the United States

Article

Full-text available

Feb 2023

Jing Tian

As social identities are more and more developed and people’s awareness of self-identity is blooming, sexual-related topics are frequently becoming the most highlighted topic in nowadays social topics. Sexual minorities and women as two relatively disadvantaged groups in social structure, LGBTQ+ and women’s rights, and status occupied greater weight in motions and social norms. Self-identification and self-protection are where sex education is involved. Sex education is an important part for an individual to form a sane identity, and it does not merely exist in school but (should) exist in society outside of schools’ high walls. Sex education is an important step to equip the educated with the essential knowledge to protect themselves away from sexual problems, conduct safe, healthy, and responsible sexual behavior and enhance reproductive health. This article will use a case study to examine how sex education relates to women’s status or social identities by comparing the sex education curriculum and social situation in two major American states, Texas and New York. Analyze how different pedagogical, curricular, and instructional approach greatly impacts the status of women in these states, exploring the laws and the regulation that govern these practices. This article will show how they impact women´s physical and mental health, their income levels, and their professional advancement. It will argue how systematical sex education affects the status of women in New York and Texas and conclude the effective measure to improve the women’s status, which would be helpful to present the importance of sex education, and provide feminism and also sexual minorities a new key effective point to sustain their rights.

The Implementation of Sex Education for Secondary School Students in China

Article

Full-text available

Feb 2023

In this study, 200 questionnaires and structured interview samples were collected nationwide from students, parents, and teachers in three perspectives: personal identification information, personal experience of sex education and the level of knowledge about sex education. The data from the questionnaires and the results of the structured interviews were combined to analyze and summaries the general characteristics of the current situation of sex education among high school students: high school students, their parents and teachers are to a large extent aware of the importance of sex education and are eager to obtain relevant knowledge through the school, but the knowledge provided by the school is often limited and does not fully meet the needs of high school students; the sources of sex knowledge for high school students are mainly The attitude of high school students towards sex-related topics has changed considerably from the previous surveys conducted by scholars, with most of them being able to face up to their own physiological demands and discuss sex-related topics with others openly; however, even so, the vast majority of respondents still think that sex education is not being implemented, and the sex education curriculum is far from the national standard. Even so, most respondents still believe that sex education is not being implemented and that the curriculum is nowhere near the level required by the state. The reasons for the current situation of sex education include: school reasons, the concept of sex education has not kept pace with the quality of education, the lack of professional resources for sex education teachers and sex education materials in schools; family reasons, some parents have old-fashioned ideas, lack of correct understanding of sex education, do not attach enough importance to sex education, parents generally lack comprehensive scientific knowledge of sex, parents and children lack of communication; social reasons, the government lacks regulation of undesirable cultural factors and the relevant policies are not comprehensive.

Outcomes and Factors Associated with Adolescent Pregnancies at the University Teaching Hospital, Lusaka, Zambia

Article

Dec 2017
Med J Zambia

Objectives: These were to determine obstetric outcomes associated with adolescent pregnancies and those of older women at the UTH, identify factors associated with and compare the obstetric outcomes between the two age groups with determining the scale of adolescent pregnancy. Materials and methods: This was a comparative prospective cross sectional study with a purposeful sample of 200 pregnant adolescents and women aged between 20 and 30 years in a ratio of 1:1. Results: 3,456 women delivered between September and October, 2015 out of which 480 (13.9%) were adolescents. Of the 100 adolescents studied, 62(62%) had dropped out of school due to pregnancy and 81(81%) of the pregnancies were unplanned. Factors associated with adolescent pregnancies noted included mean age at coitarche (p <0.001), early marriages (p <0.001; AOR 14.6, 95% CI: 4.642 - 45.99), primary education (p 0.002; AOR 4.522, 95% CI: 1.758 – 11.634), having a boyfriend (p<0.001; AOR 12.70, 95% CI: 4.04 – 39.91) and contraceptive use. There were 95(95%) adolescents who had never used a contraceptive before compared to 40(40%) older women (p <0.001). Adolescents were also significantly associated with first degree perineal tears (p<0.001; AOR 3.46, 95% CI: 1.83 - 6.56) and preterm deliveries (p 0.026, AOR 2.60, 95% CI: 1.16 - 5.78). Furthermore, although not statistically significant, more adolescents 22(22%) had low birth weight babies compared to 14(14% older women and 11(11%) had pregnancy induced hypertension versus 7(7%) older mothers. In addition, out of the 10 documented caesarean sections among the study participants, 8(80%) were done among adolescents (p 0.052). Conclusion: Several factors and adverse obstetric outcomes are associated with adolescent pregnancies seen at the UTH. Although adolescent pregnancy is reducing, it remains high and contributing significantly to discontinuation of school. Key stakeholders need to continue targeting adolescents with appropriate health messages including an emphasis on increased access to and utilization of effective contraceptives.

Importance attributed by adolescents to sexual education: correlation with their attitudes, knowledge, and sexual behavior

Article

Jan 2023

Introduction: Sexual education plays an important role in the prevention of risk-taking sexual behaviors. The objective of this study was to evaluate the importance attributed to sexual education by adolescents, correlating it with the assessment they make of their attitudes and with their knowledge towards sexuality. Methods: This observational study included adolescents who attended elementary or high school in the central region of Portugal. A characterization of sociodemographic and sexual data was made and the Adolescent Students’ Attitudes Scale towards Sexuality (E3AS) was applied. Results: We included 394 adolescents with a mean age of 14.9 ± 1.4 years. The majority (89.3%) attributed importance to sexual education. Adolescents that gave more importance to sexual education were the ones that ranked higher the information they learned about sexuality (r = 0.236), had less unprotected sex due to lack of information (r = -0.363) or because they were under the effect of alcohol and/or drugs (r = -0.365) and had a superior classification in F2 (r = 0.380), F5 (r = 0.402) and in the total scale (r = 0.531). Discussion and conclusion: Adolescents that attributed greater importance to sexual education were the ones that ranked higher the information they possessed about sexuality. After initiating sexual activity, a greater importance attributed to sexual education seems to have a protective effect on risk-taking sexual behaviors.

Knowledge, attitudes, and practices on comprehensive sexuality education among adolescent males and influential factors: A Cross-sectional study

Preprint

Full-text available

Dec 2022

Introduction: Information and services relating to Sexual and Reproductive Health (SRH) are limited particularly to unmarried adolescents who often turn to friends and family for guidance. The purpose of this study was to analyze adolescent males' knowledge, attitude, and practice (KAP) on Comprehensive Sexuality Education (CSE) and the influencing factors in Bangladesh. Methods: A cross-sectional study was undertaken. Quantitative data were collected from July to November 2021 using a pre-tested semi-structured questionnaire. Participants (n=192) were adolescent males studying at secondary and higher secondary levels. Results: Data analysis revealed a significant gap in KAP among adolescent males with regard to CSE. Factors such as age, education level, socioeconomic status, the primary source of knowledge, use of Facebook and watching TV were influential. Most of the respondents relied on their mothers to be their key informants of SRH while 61% of adolescent males said teachers were not interested in teaching sexuality education in the classroom. A majority had poor knowledge (84.4%); over half had negative attitudes (58.3%) and improper practices (58.9%) on CSE. Respondents who completed Secondary School or above level of education, had more correct knowledge, positive attitude, and appropriate practice. Family monthly income was another significant factor that had an association with respondents’ KAP on CSE (p<0.001). More access to the use of Facebook and watching television were the preeminent factors affecting positive attitude and appropriate SRH practices (p<0.01). Conclusion: To promote curriculum-based CSE, all key stakeholders including government authorities need to realize the value and influence of CSE on adolescent development. Keywords: knowledge, attitude, practice, comprehensive sexuality education, adolescent male

Sexual Education Experiences and Curriculum Recommendations from Survivors of Sexual Violence: A Mixed Method Study

Article

Nov 2022

The current study sought to describe the experiences and curriculum recommendations from survivors of sexual violence (SV), as lived experiences may inform education targets that improve sexual education curriculum, especially as it relates to SV. Women (N = 51) at a mid-size university completed a measure of SV and engaged in focus groups. Participant responses were transcribed and coded to identify themes related to curriculum recommendation and barriers to sexual education. Participant responses were then compared based on SV status (i.e., survivors compared to participants without histories of SV) to identify thematic differences. Results indicate that survivors of SV were twice as likely to suggest sexual education curriculum that includes topics like pornography literacy and community issues (e.g., intimate partner violence, local sexual health resources, and LGBTQ+ issues). Survivors of sexual violence were also more likely to have received sexual education for an inadequate duration and identified more barriers to sexual education. In sum, these findings demonstrate that participants’ recommendations are analogous to the core components of comprehensive sexuality education and provide clear direction for future curriculum development that has potential to reduce SV and its sequelae. Furthermore, these findings highlight the value of lived experiences in informing SV prevention.

Assessing a touchy subject: The problem of evaluating sex education then and now

Article

Nov 2022

Assessment is a necessary task in all areas of education, but there is no agreement on how to assess the impacts of different approaches to sex education, both on an individual level and on a population level over time. The history of mid‐20th Century Family Life Education in the United States illuminates some of the obstacles that have made assessing sex education programmes so difficult: control groups, access to large numbers of research subjects and the means to verify self‐reporting are elusive. These persistent challenges have to do with the nature of the subject, which is, in contrast to most subjects, not supposed to be practised at school. Standards of reliability, validity and classroom authenticity, therefore, apply partially at best. We argue that some approaches to sex education are valuable whether or not they are assessable, and that some things that are assessable may not be valuable in the way they are thought to be.

Indonesia mixed contraception method skewness background 1997-2012: A mixed method study

Article

Full-text available

Nov 2022

Dyah Utari

Background: Indonesia's decentralization policy adopted in 1999 had implications for the programs of national ministries and agencies, including the family planning program. Since 1999, there has been a "relaxation in family planning program effort" since many districts have a low commitment to family planning. The trend of contraceptive mix in Indonesia leading to hormonal methods, especially injections, has occurred since 2007. This study aimed to describe the mixed conditions of contraception in Indonesia from 1997 to 2012 and explore the link between the availability of facilities and infrastructure with this plan. Methods: The quantitative research used was a cross-sectional design using secondary data from the Indonesian Demographic and Health Survey (IDHS), and In-depth interviews were employed as the qualitative approach in this study. It was found based on the results of the quantitative analysis that the trend of contraceptive mix tilted to the injection method. Results: The qualitative study results indicate that the contraceptive mix is affected by infrastructure as the main factor. Conclusion: In conclusion, there is a close relationship between the decentralization policy and the condition of the contraceptive mix. Thus, it is recommended that the central and local governments re-prioritize family planning programs and assure the availability of supporting facilities and infrastructure.

The Impact of State Policy on Adverse Teen Sexual Health Outcomes in the United States: A Scoping Review

Article

Full-text available

Nov 2022
Sex Res Soc Pol

Introduction Adolescent sexually transmitted infections (STIs) and unintended birth are critical public health issues, with a need for continued prevention and an essential focus on health equity. This scoping review systematically examines the existing literature on the impact of state policies in the USA on both teen pregnancy/birth and STIs, including the impact of policy on racial disparities. Methods A comprehensive scoping review approach was used to systematically identify relevant studies. Articles were assessed by three reviewers for relevance based on predetermined inclusion criteria. Results Thirty-two peer-reviewed articles met all inclusion criteria. Years of publication ranged from 1986 to 2022. Broadly, policies evaluated can be grouped into seven categories: abortion access/restrictions; sex education; welfare reform and public assistance policies; family planning expenditures; contraception access/restrictions; state public education expenditures; and child support enforcement. Nine articles discussed multiple policies and their association with the selected outcomes. Conclusions State policies supporting family planning, including contraceptive access, were consistently associated with lower rates of teen pregnancy/birth. Evidence related to abortion, sex education, and public assistance policies was inconclusive. Few studies examined state policy’s impact on STIs, or the association with minority health disparities, illustrating critical gaps in the literature. Policy Implications Evidence on policy effectiveness is a vital tool in health promotion and may be particularly influential in promoting improved health behaviors and outcomes among adolescents. Collectively, this study offers a comprehensive summary of existing evidence on the association between state-level policies and adolescent sexual health outcomes, highlighting essential areas for future research in policy and adolescent sexual health.

Unwanted Teenage Pregnancies: Sociological Model Based on Agents

Article

Nov 2017

This study used new methodologies embedded in agent-based modeling to generate specific characteristic phenomena and core dynamics in unwanted teenage pregnancies. A NetLogo software was used to simulate data exhibiting the pattern of unwanted teenage pregnancy. The simulation revealed four agents contributing to the number of unwanted pregnancies: number of multiple partners, commitment, birth control method/s used and frequency of sex education. Among the four agents, the number of sexual partners significantly influenced the rate of unwanted pregnancies. However, commitment was not observed to be a contributory factor for the number of unwanted teenage pregnancies; rather it was more sensitive to the interactions among different agents. The Multiple Linear Regression model was generated from the interactions of the four predictor-variables and it illustrated prediction of unwanted teenage pregnancies in a given community.

A Culturally Relevant Sexuality Education Programme in Guyanese schools -What would it look like?

Thesis

Full-text available

Aug 2022

Jairo Rodrigues

The purpose of this study was to contribute to the analysis of sexuality education in Caribbean societies, and study the effects of culture on education policies and programmes. The prime objective of the research was to understand what a “culturally relevant” sexuality education programme for Guyana would look like since "culturally relevant" was never defined, nor was it clearly understood. It is in this researcher’s hope that the outcomes of the research would be used to inform decision-making and policy changes regarding sexuality education in Guyana. Methodology: The research was a qualitative study. Primary data from interviews and surveys on the experiences, knowledge, attitude, and practices of education and social development technocrats, parents/guardians and teachers of students in Guyanese Secondary schools were collected, and analysed to frame an understanding of what a comprehensive sex education programme specific to Guyanese culture and society would look like. Findings: The research has found that a "Culturally relevant" sexuality programme consists of themes on religiosity and conservatism, western scholarship in contrast to indigenous cultures, and acknowledgments that sensitive topics need to be addressed for positive social and cultural change. Though the research found a liberal value-shift when compared to previous studies in Guyana, there are still major rejections from high level technocrats, parents, and teachers to what topics children are exposed to. Conclusion: Sex Education in Guyanese schools may conform to the existing hesitancy, discomfort, and rejection of introducing students to sensitive subjects teachers themselves find ill-equipped to cover; or it may be an integrated, inter-cultural programme that encompasses all attitudes, theories, and perspectives from every aspect of Guyanese society, seeking to understand differences, and address social issues. The majority of respondents support the latter. While this shows a liberal cultural shift from conservatism, more research would need to be done with the use of mixed methodologies and a wider target audience to further study culture and its influence on sexuality education, and to theoretically design a Comprehensive Sexuality Education programme for Guyana.

English Education

Article

Full-text available

Jul 2020
J ADOLESC ADULT LIT

John Wesley White

It is critical to engage today's students in the realities of the world--and the realities depicted in quality literature--in our ELA classrooms. This includes explorations of sex, sexuality, and gender dynamics. To do this, however, teachers need to be adequately prepared so as to avoid inadvertently reproducing their own cultural norms and biases onto students.

Psychosocial Determinants of Premarital Sexual Practices among University Students in Sudan

Article

Full-text available

Aug 2022
Sex Cult

Sudan is one of the Islamic countries where extramarital sex is religiously forbidden and socially unacceptable. However, increasing numbers of university students become engaged in premarital sex practices, which increases their risk of contracting STIs, including HIV, and puts them into conflicts with their religious beliefs. As little is known about the motivations for abstinence from premarital sex, this study aimed to identify these psychosocial determinants. Using a cross-sectional design, a sample of 257 students between18 and 27 years old was recruited from randomly selected public and private universities in Khartoum. The participants filled out an online questionnaire based on the Integrated Change Model (ICM) to assess their beliefs and practices about abstinence from premarital sex. The analysis of variances (MANOVA) showed that the students who reported being sexually active differed significantly from abstainers in having more knowledge about HIV/AIDS, higher perception of susceptibility to HIV, more exposure to cues that made them think about sex and a more positive attitude towards premarital sex. The abstainers had a significantly more negative attitude towards premarital sex, higher self-efficacy to abstain from sex until marriage and perceived more peer support and norms favouring abstinence from sex until marriage. These findings suggest that promoting abstinence from sex until marriage among university students in Sudan, which aligns with the Sudanese religious values and social norms, requires health communication messages addressing these potential determinants. However, given that sexual encounters still may occur, health communication messages may profit from a more comprehensive approach by also addressing the need for condom use for those unwilling to refrain from sex.

High School Sex Education in the Context of State Mandates and Policies in New Jersey: a Qualitative Retrospective Study of Student Experiences

Article

Full-text available

Jun 2022
Sex Res Soc Pol

Introduction Historically in the USA, divergent views about sex education have led to inconsistency in implementation. While state standards and mandates convey the wishes of legislatures and voters, understanding the impact of these state policies on the actual delivery of sex education is critical to planning, implementing, and evaluating the effectiveness of school-based sex education efforts. Methods This retrospective investigation used in-depth focus groups, as part of a broader study focused on first sex experiences conducted between 2011 and 2014. Researchers explored high school sex education experiences of seventy-four first- and second-year college students at a state University in New Jersey, a state with a sex education mandate, and strong comprehensive sex education state learning standards. Results Despite being educated in a state which, through its policies and learning standards, is better than most at promoting comprehensive sex education, participants reported largely negative experiences of school-based sex education, characterized as too little too late and with a fear-based, abstinence, sex-negative, and heterocentric focus. Results describe a missed opportunity to provide young people with the knowledge and skills to grow into sexually healthy adults. Conclusions Strong policies and solid public support for a comprehensive approach to sex education are vitally important, but without accountability and enforcement mechanisms, may not be enough. Policy Implications This study suggests that in addition to a requirement that sex education be medically accurate, state legislatures and boards of education must adopt and strengthen provisions to make sure that high-quality sex education is actually being delivered.

Sexual Health Education for Youth with Disabilities: An Unmet Need

Chapter

Full-text available

May 2022

Individuals with disabilities experience higher rates of mental, emotional, physical, and sexual abuse than those without disabilities. Children with disabilities are 3.4 times more likely to experience sexual abuse than their peers without disabilities. Although a variety of resources have been created to help improve the sexual health of people with disabilities, one area that is seriously lacking is access to sexual health information and education. Previous work has identified several barriers to providing sexual health education to adolescents and youth with disabilities, including lack of teacher preparation, lack of teacher knowledge that leads to fear, concern, and anxiety, parental anxiety and fear, the lack of valid and reliable sexual health education materials for students with disabilities, and the sexuality of students with disabilities viewed as deviant. This chapter will review those issues and discuss methods to improve sexual health education for youth with disabilities.

Sex Education and Sexual Risk Behavior among Adolescents and Youth in the Deep South: Implications for Youth HIV Prevention

Article

May 2022
SOUTH MED J

Objectives: Adolescents and young adults represent the largest group of new human immunodeficiency virus (HIV) infections in the United States, especially in the South. We wanted to determine whether abstinence only until marriage (AOUM) sex education programs were effective in reducing HIV vulnerability among youth in Mississippi. Methods: Using the 2015 Mississippi Youth Risk Behavior Surveillance System, we examined the effect of AOUM sex education among a sample of youth ages 12 to 18 years on 4 HIV-related sexual risk behaviors. Results: Compared with youth not enrolled in AOUM sex education, we found no statistically significant differences on sexual risk behaviors. Race, age, and gender were significant risk factors in predicting sexual risk behavior. Conclusions: AOUM sex education programs are ineffective in reducing HIV vulnerability among youth in Mississippi. There is an urgent need to implement comprehensive sex education if we are to reduce the numbers of new HIV infections among youth and achieve our goals of ending the HIV epidemic by 2030.

Intervention-based Puberty Program: A Study on the Tendency of Afghan female youths to Engage in High-risk Behaviours in Iran

Article

Full-text available

Dec 2021

Intervention-based Puberty Program: A Study on the Tendency of Afghan female youths to Engage in High-risk Behaviours in Iran. Abstract: Risky behaviours are one of the major problems for adolescents. These behaviours are rooted in physical, sexual, mental, and social changes. This study aims at designing a puberty training program for Afghan female youths in Iran and assesses its effectiveness in reducing their tendency to high-risk behaviour. The aim of this study is in line with the fifth goal of Sustainable Development Goals which is "Gender equality". This study provides Afghan girls with easy access to information on puberty and its issues. Forty-three Afghan adolescent girls were selected through a random sampling method and organized into three intervention groups. The participants were given trainings on the physical symptoms of puberty, early/late puberty, genital anatomy, menstruation and hygiene, psychological changes symptoms, sexual relationships, sexually transmitted diseases, peer pressure, and addiction. The intervention consisted of seven sessions. Thirty-eight participants in the control group received no intervention. The Iranian adolescents' risk-taking scale was used to measure the dependent variable at baseline and completion of the program. The results showed that there were significant decreases in the tendency to smoke, substance abuse, alcohol consumption, and unprotected sexual relationships in the intervention groups (P < 0.01). However, the tendency to violence had no significant differences among the control nor in the intervention groups. This study provides evidence on the effectiveness of puberty training among Afghan adolescent girls with a tendency to engage in high-risk behaviours. Further research on the the immigrant adolescent's tendency towards violence are recommended. Longitudinal follow-ups are suggested to support the generalization of these kinds of interventions.

Gender Differences In Sex-Related Education, Knowledge, And Attitudes Among Chinese Adolescents

Preprint

Full-text available

Feb 2022

Background: Gender equality in sex education is important to protect adolescents from unexpected pregnancies and sexually transmitted infections. The aim of this study was to examine gender differences in sex-related education, knowledge, and attitudes, and to identify factors that may contribute to these gender differences. Methods：A cross-sectional survey was distributed to 191 adolescents from four high schools in Fuzhou, China. Multivariable regression analyses were used to determine the associations between individual factors and their knowledge, attitudes. Results: Over 80% the responding adolescents lacked knowledge about contraception, and half of them cannot recognize all the AIDS transmitted routes. Boys got a lower level sex-related knowledge score than girls. However, parents were more likely to answer girls’ questions about sex than boys (p<0.001), and sex education courses were delivered later to boys (p=0.003). Gender difference of knowledge score was not identified in the multivariable linear regression model, while education from parents/school and sex education need score were found to be positive factors. In the multivariable logistic regression models, parents’ positive responses to adolescents’ questions and need score were associated with respondents’ attitudes with adolescence. Conclusions: Our findings indicated that Chinese high school students had a low level sex-related knowledge and education needs. Several individual factors may explain gender differences in adolescents’ sexual knowledge and attitudes. Designation of targeted sex education programs should consider these individual factors in the future.

Unmet need for family planning and sexual and reproductive health and rights among adolescents in Bangladesh

Article

May 2023

Every individual has the right to make their own choices about their sexual and reproductive health. Family planning, including contraceptive information and services, is fundamental to all individuals’ health and human rights, including adolescents. Bangladesh made a commitment at the Nairobi summit (ICPD+25) in 2019 to address three zeros, including the unmet need for family planning by 2030—a big challenge where unmarried adolescents are excluded from most Sexual and Reproductive Health and Rights (SRHR) information and services. However, unmet need for family planning amongst adolescents in the country is high. A literature review of relevant research papers, survey reports, and policy documents has been conducted (i) to demonstrate the current situation of unmet need and SRHR-FP for adolescents in Bangladesh; (ii) to identify unique barriers and challenges faced by adolescents in accessing SRHR-FP information and using services in Bangladesh; (iii) to analyze and identify gaps in the current policies, strategies, and plans to address unmet need and SRHR in Bangladesh; and to provide recommendations for adapting policies and improving best practices. This paper demonstrates that although Bangladesh has policies designed to support youth rights and access to comprehensive sexuality education and relevant services, there are immense implementation gaps. Social stigma and taboos are overpowering the implementation of policies that need critical attention. Also, interventions are needed to address the significant gap in data on unmarried adolescents and their use of family planning services, which limits the analysis of the current situation of unmarried adolescents.

What are the research opportunities on strategies for delaying sexual activity onset to prevent pregnancy in the adolescence? An evidence gap map

Chapter

Full-text available

Apr 2023

Evidence Gap Maps can be defined as thematic collections of evidence structured around a framework that graphically and schematically represents the types of interventions and outcomes relevant to a particular issue. They are useful inputs for defining the agenda and funding of future research and supporting the creation of evidence-based policies. The objective of this Evidence Gap Map is providing a visual overview of health outcomes affected by strategies for delaying sexual activity onset to prevent pregnancy in the adolescence. The findings showed that most intervention components had indifferent effect on delaying or intention to delay sexual intercourse and on reduction of pregnancy between the compared groups, or presented limited data. In addition, most studies included in this Evidence Gap Map presented high risk of bias. In this sense, more well-designed studies assessing pregnancy prevention as a primary outcome are needed to fill the gap in the evidence on effectiveness of interventions and their components to delay sexual activity to prevent pregnancy in adolescence.

Determinantes del uso de preservativo en estudiantes adolescentes en Huiramba, Michoacán

Book

Full-text available

Oct 2020

Determinantes del uso de preservativo en estudiantes adolescentes en Huiramba, Michoacán

PREGNANCY IN ADOLESCENCE: A PUBLIC HEALTH ISSUE

Chapter

Full-text available

Apr 2023

Pregnancy in adolescence is a global public health issue that remains in need of addressing. Although its prevalence has declined in some countries and regions in recent years, it remains high. Some factors may predict pregnancy in adolescence, such as age, marital status, healthcare system, family structure, mental health, educational and socioeconomic status. In addition, in this chapter, we briefly discuss its health, social, and economic impacts. Adolescent mothers and their babies are likely to face a variety of negative health-related outcomes, including consequences related to mental and physical health, such as depression, increased risks of anemia, preeclampsia, preterm birth, low birth weight babies, and miscarriages. The socioeconomic impact, on the other hand, may include academic failure, substance abuse, poverty, unemployment, and intimate partner violence. Thus, intervention programs or public health initiatives should be adopted to implement effective strategies to prevent unwanted adolescent pregnancy worldwide.

Implementation science in health education

Chapter

Full-text available

Apr 2023

Educational strategies to promote health and prevent disease face the same challenges as any other Evidence-Based Practice (EBP): becoming implementable in the real world and promoting the benefits achieved in clinical trials. In this context, Implementation Science (IS) emerges to promote the absorption of innovations into routine practice, impacting the effectiveness of interventions and health care. Discussing the main aspects related to health education in IS is essential to complement the approaches in this book and empower decisionmakers and researchers on the main tools in the area. Different methodological approaches, such as experimental, observational, and qualitative designs, are used in IS to address problems ranging from evaluating the effectiveness of implementation strategies to understanding the phenomenon and stakeholders' perceptions. The use of optimization and effectiveness-implementation hybrid trials and mixed methods in the evaluation of implementation outcomes is increasing, reducing the time between the production of evidence and the "implementability" of innovations. Regardless of the design and methods used, research must be guided by implementation frameworks, models, and theories. There are more than 60 theories, models, and frameworks in IS identified in the literature, although no approach has been demonstrated to be superior or more consistently useful. In addition, the definition of the implementation outcome to be evaluated is important, since it differs from the clinical research outcomes and indicates the effectiveness of implementation strategies. Finally, some implementation research initiatives applied to health education interventions were summarized and presented as examples of implementation methods, strategies, and outcomes.

Effectiveness of strategies to delay sexual activity onset to prevent pregnancy in the adolescence: a systematic review

Chapter

Full-text available

Apr 2023

Adolescent pregnancy is associated with health, social and economic burdens. Different strategies have been implemented to prevent this outcome; yet few updated data on their effectiveness exist. We aim to synthetize the available evidence on the impact of interventions to delay sexual activity onset in adolescents by means of a broader systematic review. A literature search to gather interventional and observational analytical studies published since 2010 was conducted in PubMed, Scopus, PsycINFO, CINAHL Plus, ERIC and LILACS, being complemented by grey literature and manual searches. A total of 57 studies were identified reporting data on 60 comprehensive and 9 abstinenceonly interventions. The interventions were predominantly provided in schools (69.6%), in person (82.6%), and in groups (66.7%), by trained facilitators or educators (43.5%). The recipient of the intervention was exclusively the adolescent in 85.5% of the studies. Five out of 9 abstinence-only interventions presented a statistically favorable result towards the use of the intervention for any of the evaluated outcomes (delay/intention to delay sexual intercourse and pregnancy; this rate was of 22 from the 60 comprehensive interventions. Most intervention components had similar effect as the comparator group (no statistical differences) or data was limited to reach any conclusion. This review showed a scarcity and low-quality evidence on the effectiveness of abstinenceonly interventions, and the absence of robust evidence for comprehensive strategies aiming at delaying sexual practice by adolescents to avoid early pregnancy. Further well-designed and well-reported studies are needed to help stakeholders to understand this scenario and enable decision-making process within public policies for this population.

Promoting Healthy Sexual Behaviours through Comprehensive Sexuality Education

Article

Full-text available

Apr 2023

Unlabelled: Comprehensive sexuality education is a scientifically accurate global program that encompasses the variable aspects necessary for achieving healthy sexual and reproductive health in children of schoolgoing age. It provides a holistic approach to developing sound knowledge and a positive attitude in a manner that does not blatantly refute the established sociocultural norms but rather delicately treads around them to bust unhealthy practices through age-appropriate measures. It is deemed necessary for health professionals to be appropriately trained to better convey sensitive information regarding sexual and reproductive well-being in a manner that is acceptable and effective, especially in the context of orthodox communities. Keywords: adolescent; medical students; sexual health; sexuality education.

Louisiana Parents Support Sex Education for their Children: Results of a Statewide Survey

Article

Feb 2023

This paper presents results from a survey of parents of school age children in Louisiana to understand their knowledge of and attitudes toward sex education. Louisiana adolescents rank amongst the highest in the nation for teen births and sexually transmitted infections. Louisiana does not require instruction in sex education at any grade level. Survey results provide clear evidence that the majority of Louisiana parents support sex education in school curricula that emphasizes abstinence but also provides broad information on sexual health. With continued efforts to engage local communities statewide, these data stand to redirect state and local level policy making.

Religiousness and Sexual Values Predict Sexual Incongruence: Results from a U.S. Nationally Representative Study

Article

Nov 2022

The present work aimed to clarify commonly endorsed sexual values in the general U.S. population as well as the association between sexual values and incongruence. Study 1 recruited adults (N = 923; 51.8% women; Mage = 35.5, SD = 10.8) to answer a free response question about sexual values via Amazon’s Mechanical Turk, while Study 2 posed the same question to a weighted, nationally representative U.S. sample (N = 2,519; 51.4% women; Mage = 48.2, SD = 17.8). Data collection was completed in 2017 and 2019, respectively. Results from these cross-sectional studies demonstrated that, although religiousness predicted sexual incongruence, conservative sexual values predicted variance in sexual incongruence, over and above the effects of religiousness.

Inequitable Access, Information & Support: A Social Analysis of America’s Sex Education Programs

Article

Dec 2022

Ann Jenkin LaVanway

Sex education has long been a controversial topic in the United States in terms of both policy and practice. A lack of consensus on the implementation of sex education, its content, and its participants continues to be a concern for equitable inclusion of all young people and their sexual and emotional health as a result. Current policy guidance and implementation fall short in developing and sustaining equitable access to medically accurate and socially meaningful curriculum. Analyzed through a sociological framework of functionalist theory, feminist theory, and queer theory, this sociological analysis examines the following questions: (1) Should sex education programs even exist?, (2) What should be taught in sex education courses?, and (3) Who should be represented in sex education content? Through a review of existing literature and available data on the experiences of young people, this scholarly commentary posits that current sex education practices in the United States are inequitable and insufficient based on their variability and lack of policy guidance. To address these shortcomings, the United States must implement comprehensive sex education in all schools to ensure equitable access, information, and support for all students.

Leveraging Comprehensive Sexuality Education as a Tool for Knowledge, Equity, and Inclusion

Article

Nov 2022

Background: Sexual education programs in the United States are rooted in inequitable structures and are often inadequate at educating marginalized student groups such as students of color, Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), women, and disabled students. Contributions to theory: Current sexual education is irregularly implemented and often excludes or misrepresents the experiences of students with marginalized identities. This theoretical paper specifically discusses ways that sexual education has been harmful or exclusionary for marginalized student groups and how a shift toward making sexual education inclusive and equitable will improve outcomes for students of all identities. Implications for school health policy, practice, and equity: This paper discusses several recommendations on improving access to equitable sexual health education for all students including reviewing and improving sexual education curriculum and delivery, as well as the need for additional research focused on this topic. Conclusions: This article provides an overview on the current sexual education system, its inadequacies, and how comprehensive sexuality education programs can be leveraged as a tool for equity for students of all backgrounds, but particularly those who are underrepresented in sexual education curricula.

Vulnerabilities and strengths of Lesbian and Homosexual Mexican Adolescents to dating violence

Article

Full-text available

Sep 2022

Irene Casique

This paper explores dating violence among same-sex adolescent couples and compares the prevalence’s of the different expressions of this violence (emotional, physical, and sexual) between heterosexual couples and same-sex couples. Additionally, we identify those characteristics of homosexual adolescents that reduce or increase their vulnerability to dating violence, examining the role played by various elements of empowerment, such as self-esteem, agency, gender role attitudes, social power, and adolescent sexual power. Descriptive analysis as well as bivariate and multivariate logistic regression models were developed using data from the Survey on Dating, Empowerment and Sexual and Reproductive Health in Adolescent in High School in Mexico (ENESSAEP 2014 in Spanish), a survey representative of three Mexican states in México: Morelos, Jalisco and Puebla. The findings confirm that the prevalence’s of the three types of dating violence (emotional, physical, and sexual) are significantly higher for adolescents with same-sex partners than for heterosexual adolescents. The experiences of emotional violence received and witnessed at home are more frequent in the lives of gay and lesbian adolescents, and these experiences in turn show significant and larger associations with the risk of all three types of dating violence for them. Except for sexual empowerment, most indicators of empowerment showed significant and negative associations with the risk of the three types of dating violence for heterosexual adolescents, and in some cases for gay or lesbian youths too. It is necessary further research on the role of adolescent's empowerment as a relevant process to prevent dating violence and to provide young people with key resources to identify and deal with violent relationships, and particularly in the case of youth from the sexual diversity groups.

County-Level School Sex Education Policy: A Single State Analysis of the Association with Adolescent Birth and Sexually Transmitted Infections

Article

Jun 2022

Substantial evidence supports comprehensive sex education programs as effective means of promoting adolescent sexual health, but evidence on the effect of state-level sex education policy is inconclusive. Multiple states in the U.S. afford local authority in school policy, and existing literature calls for investigation of the impact of local interpretation and implementation of sex education policy. This study is the first to assess the association between stated county policy and select adolescent sexual health outcomes. In this single state multivariate analysis, stated county policy was not significantly associated with adolescent birth or sexually transmitted infections. The incongruity of evidence between the impacts of sex education programs and policies on teen birth and STIs in Florida suggests that implementation of policy and delivery of sex education at the district or school level may not align with stated county policy and may be a critical mediating factor, confirming an area of essential future research in sex education.

Perception of Students & Teachers on Reproductive Health Education

Article

Full-text available

Jan 2022

John Nyarko

Increased Parent Support for Comprehensive Sexuality Education Over 15 Years

Article

Oct 2022
J ADOLESCENT HEALTH

Purpose Comprehensive sexuality education (CSE) has been shown to reduce sexual risk-taking behaviors and promote healthy sexual development, and studies have shown high support for this approach. However, the past decade has seen many changes in the political landscape and social controversies. The present study reports on an updated survey and analysis of changes in support from 2006 to 2021. Methods Survey data were collected by telephone in 2006 (N = 1,605) and online and in-person in 2021 (N = 719) from separate samples of Minnesota parents of school-age children. Parents responded to items regarding preferences for CSE, support for teaching numerous specific sexuality education topics, and the grade level at which topics should be introduced. Chi-square tests and logistic regression (with weighted 2021 data) were used to detect differences in support between survey years and across demographic and personal characteristics. Results At both time points, approximately 90% of parents thought that CSE should be taught in schools, with significant increases in support within several demographic categories. Support for including all specific topics was high, including for topics typically considered highly controversial (e.g., gender identity, 68.7%; abortion, 77.7% in 2021). Parents endorsed introducing most topics in elementary or middle school years. Discussion Findings suggest that policy makers and educators in Minnesota can be confident of strong parental support for CSE covering a wide range of content to meet students’ needs. Advocacy and action to advance the use of national sexuality education standards are in keeping with the views of the overwhelming majority of parents of school-age children.

Sex Ed in the Post- Roe World: Implications for Public Health Education

Article

Sep 2022

The overturning of Roe v. Wade and the increasing assaults on lesbian, gay, bisexual, transgender, queer (LGBTQ+) rights in legislatures across the country have put our sexual and reproductive health in peril. They are likely also bellwethers of more to come. While a full reckoning of the repercussions from these attacks will not be known for a long time, the field of public health must act now with a strong and cohesive plan to mitigate the harms, fight these threats to our well-being, and lead the way forward.

What Explains Socioeconomic Disparities in Early Pregnancy Rates?

Article

Sep 2022

In this study, we integrate diverse structural, social psychological, and relational perspectives to develop and test a comprehensive framework of the processes that make early pregnancy a socially stratified phenomenon. Drawing on rich panel data collected among a sample of 940 18- to 20-year-old women from a county in Michigan, we estimate nested hazard models and formal mediation analyses to simultaneously elucidate the extent to which different mechanisms explain disparities in early pregnancy rates across maternal education levels—a key indicator of socioeconomic status. Together, our distal mechanisms explain 53 and 31 percent of the difference in pregnancy rates between young women whose mothers graduated college and young women whose mothers graduated and did not graduate high school, respectively. Reproductive desires, norms, and attitudes, relationship contexts, and educational opportunities and environment each link maternal education to young women’s odds of pregnancy. Self-efficacy, however, plays only a modest role; while contraceptive affordability and knowledge are not significant pathways. These findings bring into focus the most prominent intervening mechanisms through which socioeconomic circumstances shape young women’s likelihood of becoming pregnant during the transition to adulthood.

Emergency Contraception: Access and Challenges at Times of Uncertainty

Article

Aug 2022
Am J Therapeut

Background: The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. Areas of uncertainty: Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. Data sources: PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations. Therapeutic advances: A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. Conclusions: EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.

Online Sexual Health Information Seeking of Adolescents: A Content Analysis

Article

Aug 2022

Internet-based platforms present vital new venues for sex education. However, research is limited on the ways adolescents utilize these resources, particularly within user-generated content contexts. This study assesses the sexual health content adolescents seek online through a qualitative, directed content analysis of 365 user-generated posts in an open sexual health community forum. An adapted version of the National Sex Education Standards, a comprehensive, evidence-based sexual health framework, was used as the schema for this data analysis. Collectively, our results highlight and confirm the importance of providing comprehensive, medically accurate sexual health information to adolescents. Our analysis further supports the need to provide information on pleasure in sexual health and well-being, as well as guidance on social and emotional aspects of sexual health, and for education to be supportive and inclusive of all individuals. Ultimately, our results can help guide effective public health interventions, including sex education efforts, aimed at promotion of adolescent sexual health by offering direct insight into adolescents’ perceived information needs.

Colombian Youth Express Interest in Receiving Sex Education from their Parents

Article

Full-text available

Aug 2022
Sex Cult

Despite having essential health needs regarding sexual and reproductive health services (SRHS), young people (e.g., adolescents) in many countries show low use of such services. The World Health Organization advocates fostering young people’s autonomy to access health services to address this global health problem. However, there are gaps in the literature to understand how young people’s autonomy can be fostered to access SRHS. In 2019–2020, we conducted semi-structured interviews with 45 young people aged 14–23 years old in Colombia to explore how they might wish to have their autonomy fostered in accessing SRHS. Research in different cultural contexts has shown that young people generally do not wish to discuss sex with their parents. By contrast, most of our participants expressed a strong wish for the ability to talk openly with their parents about their sexual and reproductive health. One of the main complaints of these young people was that their parents lacked the necessary knowledge to help them make informed decisions related to their sexual and reproductive health (e.g., choosing a contraceptive option). As a potential solution, participants were enthusiastic about initiatives that could provide parents with comprehensive sex education to assist young people in making informed choices for their sexual and reproductive health, including how to access SRHS.

The Ethics of Medical Sexual Health Education and Its Provision

Article

Full-text available

Jul 2022
Curr Sex Health Rep

Elisabeth Gordon

Purpose of Review The purpose of this paper is to open a discussion of the ethics of medical sexual health education (SHE) and its provision in medical education. The paper utilizes a qualitative analysis of currently available literature on medical SHE and a medical ethics framework of the four prima facie principles of (1) respect for autonomy, (2) beneficence, (3) non-maleficence, and (4) justice, together with expert opinion. The result is a review of the ethics of medical SHE as well as the ethics of the decision to provide, or not to provide, comprehensive SHE. Recent Findings Recent literature has underscored the many ways in which comprehensive medical SHE supports trainees’ ability to provide sexual health care and improve their delivery of general health care, as well as the many ways sexual health is correlated with systemic health. The literature also provides evidence that the provision of comprehensive SHE is limited in undergraduate and graduate medical education. There is a dearth of literature specifically examining the ethics of medical SHE provision. Summary This analysis demonstrates the ways in which comprehensive medical SHE and its provision conforms with the principles of the ethical practice of medicine. The analysis also supports that a lack of inclusion of SHE in medical education programs may be a violation of these principles and increases the risk of future unethical practice by medical professionals. MESH Headings: Ethics, Medical, Social justice, Sexual health, Sexuality, Human, Education, Medical, Undergraduate, Education, Medical, Graduate

Origen del embarazo temprano en adolescentes mexicanas: contextos, significados y experiencias

Article

Full-text available

Dec 2021
PAPELES POBLAC

Se han abordado las causas y consecuencias del embarazo adolescente, pero no su origen psico-social. Pretendemos analizar su génesis paulatina. La investigación fue cualitativa. Siete mujeres de la Ciudad de México, y zona conurbada, que vivieron un embarazo a sus 14 o 15 años de edad, fueron entrevistadas. Se realizaron categorías para clasificar la información. El embarazo fue precedido por: noviazgos, de contacto corporal cada vez más íntimo; menarquia; permisopaterno; renuencia masculina y connivencia femenina a usar condón post debut sexual; métodos anticonceptivos inaccesibles por minoría de edad; débil resistencia a la incitación masculina respecto del cortejo, contacto erótico y coito; relación bidireccional unión conyugal-embarazo; y secuencia (sexo no protegido-fecundación inadvertida-síntomas de embarazo-incertidumbre del embarazo-pruebas de embarazo confiables-certitud del embarazo-descarte del aborto). El emba-razo temprano ocurrió tras una secuencia de hechos dentro de la trayectoria de vida, bajo normas de género inequitativas sobre sexualidad, reproducción y unión conyugal.

Impacts of Four Title V, Section 510 Abstinence Education Programs. Princeton, NJ: Mathematica Policy Research

Article

Full-text available

Jan 2007

Since fiscal year 1998, the Title V, Section 510 program has allocated $50 million annually in federal funding for programs that teach abstinence form sexual activity outside of marriage as the expected standard for school-age children. A new impact report from Mathematicaâ€™s congressionally mandated multi-year evaluation of four abstinence education programs finds that the programs had no effect on the sexual abstinence of youth. But it also finds that youth in these programs were no more likely to have unprotected sex, a concern that has been raised by some critics of these programs.

Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries

Article

Full-text available

Jan 2000
Fam Plann Perspect

Adolescent pregnancy occurs in all societies, but the level of teenage pregnancy and childbearing varies from country to country. A cross-country analysis of birth and abortion measures is valuable for understanding trends, for identifying countries that are exceptional and for seeing where further in-depth studies are needed to understand observed patterns. Birth, abortion and population data were obtained from various sources, such as national vital statistics reports, official statistics, published national and international sources, and government statistical offices. Trend data on adolescent birthrates were compiled for 46 countries over the period 1970-1995. Abortion rates for a recent year were available for 33 of the 46 countries, and data on trends in abortion rates could be gathered for 25 of the 46 countries. The level of adolescent pregnancy varies by a factor of almost 10 across the developed countries, from a very low rate in the Netherlands (12 pregnancies per 1,000 adolescents per year) to an extremely high rate in the Russian Federation (more than 100 per 1,000). Japan and most western European countries have very low or low pregnancy rates (under 40 per 1,000); moderate rates (40-69 per 1,000) occur in Australia, Canada, New Zealand and a number of European countries. A group of five countries--Belarus, Bulgaria, Romania, the Russian Federation and the United States--have pregnancy rates of 70 or more per 1,000. The adolescent birthrate has declined in the majority of industrialized countries over the past 25 years, and in some cases has been more than halved. Similarly, pregnancy rates in 12 of the 18 countries with accurate abortion reporting showed declines. Decreases in the adolescent abortion rate, however, were less prevalent. The trend toward lower adolescent birthrates and pregnancy rates over the past 25 years is widespread and is occurring across the industrialized world, suggesting that the reasons for this general trend are broader than factors limited to any one country: increased importance of education, increased motivation of young people to achieve higher levels of education and training, and greater centrality of goals other than motherhood and family formation for young women.

Prevalence of Chlamydial and Gonococcal Infections Among Young Adults in the United States

Article

Full-text available

Jun 2004
J Am Med Assoc

Chlamydial and gonococcal infections are important causes of pelvic inflammatory disease, ectopic pregnancy, and infertility. Although screening for Chlamydia trachomatis is widely recommended among young adult women, little information is available regarding the prevalence of chlamydial and gonococcal infections in the general young adult population. To determine the prevalence of chlamydial and gonococcal infections in a nationally representative sample of young adults living in the United States. Cross-sectional analyses of a prospective cohort study of a nationally representative sample of 14,322 young adults aged 18 to 26 years. In-home interviews were conducted across the United States for Wave III of The National Longitudinal Study of Adolescent Health (Add Health) from April 2, 2001, to May 9, 2002. This study sample represented 66.3% of the original 18,924 participants in Wave I of Add Health. First-void urine specimens using ligase chain reaction assay were available for 12,548 (87.6%) of the Wave III participants. Prevalences of chlamydial and gonococcal infections in the general young adult population, and by age, self-reported race/ethnicity, and geographic region of current residence. Overall prevalence of chlamydial infection was 4.19% (95% confidence interval [CI], 3.48%-4.90%). Women (4.74%; 95% CI, 3.93%-5.71%) were more likely to be infected than men (3.67%; 95% CI, 2.93%-4.58%; prevalence ratio, 1.29; 95% CI, 1.03-1.63). The prevalence of chlamydial infection was highest among black women (13.95%; 95% CI, 11.25%-17.18%) and black men (11.12%; 95% CI, 8.51%-14.42%); lowest prevalences were among Asian men (1.14%; 95% CI, 0.40%-3.21%), white men (1.38%; 95% CI, 0.93%-2.03%), and white women (2.52%; 95% CI, 1.90%-3.34%). Prevalence of chlamydial infection was highest in the south (5.39%; 95% CI, 4.24%-6.83%) and lowest in the northeast (2.39%; 95% CI, 1.56%-3.65%). Overall prevalence of gonorrhea was 0.43% (95% CI, 0.29%-0.63%). Among black men and women, the prevalence was 2.13% (95% CI, 1.46%-3.10%) and among white young adults, 0.10% (95% CI, 0.03%-0.27%). Prevalence of coinfection with both chlamydial and gonococcal infections was 0.030% (95% CI, 0.18%-0.49%). The prevalence of chlamydial infection is high among young adults in the United States. Substantial racial/ethnic disparities are present in the prevalence of both chlamydial and gonococcal infections.

Effectiveness of condoms in preventing sexually transmitted infections

Article

Full-text available

Jul 2004
B WORLD HEALTH ORGAN

In June 2000, the United States National Institutes of Health (NIH) organized a review of the scientific evidence on the effectiveness of condoms in preventing sexually transmitted infections (STIs). The review concluded that condoms were effective in protecting against transmission of HIV to women and men and in reducing the risk of men becoming infected with gonorrhoea. Evidence for the effectiveness of condoms in preventing other STIs was considered to be insufficient. We review the findings of prospective studies published after June 2000 that evaluated the effectiveness of condoms in preventing STIs. We searched Medline for publications in English and included other articles, reports, and abstracts of which we were aware. These prospective studies, published since June 2000, show that condom use is associated with statistically significant protection of men and women against several other types of STIs, including chlamydial infection, gonorrhoea, herpes simplex virus type 2, and syphilis. Condoms may also be associated with protecting women against trichomoniasis. While no published prospective study has found protection against genital human papillomavirus (HPV) infection, two studies reported that condom use was associated with higher rates of regression of cervical intraepithelial neoplasia and clearance of cervical HPV infection in women and with regression of HPV-associated penile lesions in men. Research findings available since the NIH review add considerably to the evidence of the effectiveness of condoms against STIs. Although condoms are not 100% effective, partial protection can substantially reduce the spread of STIs within populations.

Reborn a Virgin: Adolescents’ Retracting of Virginity Pledges and Sexual Histories

Article

Full-text available

Jul 2006

Janet E Rosenbaum

We examined retractions of virginity pledges and of sexual histories among adolescents taking part in waves 1 and 2 of the National Longitudinal Study of Adolescent Health. Logistic regression analyses were used to compare respondents' reports of virginity pledges and sexual histories at waves 1 and 2.Results. Among wave 1 virginity pledgers, 53% denied having made a pledge at wave 2; after control for confounders, pledgers who subsequently initiated sexual activity were 3 times as likely to deny having made a pledge as those who did not initiate sexual activity (odds ratio [OR] = 3.21; 95% confidence interval [CI] = 2.04, 5.04). Among wave 1 nonvirgins who subsequently took virginity pledges, 28% retracted their sexual histories at wave 2; respondents who took virginity pledges were almost 4 times as likely as those who did not to retract reports of sexual experience (OR=3.88; 95% CI=1.87, 8.07). Adolescents who initiate sexual activity are likely to recant virginity pledges, whereas those who take pledges are likely to recant their sexual histories. Thus, evaluations of sexual abstinence programs are vulnerable to unreliable data. In addition, virginity pledgers may incorrectly assess the sexually transmitted disease risks associated with their prepledge sexual behavior.

Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women

Article

Full-text available

Jul 2006
NEW ENGL J MED

To evaluate whether the use of male condoms reduces the risk of male-to-female transmission of human papillomavirus (HPV) infection, longitudinal studies explicitly designed to evaluate the temporal relationship between condom use and HPV infection are needed. We followed 82 female university students who reported their first intercourse with a male partner either during the study period or within two weeks before enrollment. Cervical and vulvovaginal samples for HPV DNA testing and Papanicolaou testing were collected at gynecologic examinations every four months. Every two weeks, women used electronic diaries to record information about their daily sexual behavior. Cox proportional-hazards models were used to evaluate risk factors for HPV infection. The incidence of genital HPV infection was 37.8 per 100 patient-years at risk among women whose partners used condoms for all instances of intercourse during the eight months before testing, as compared with 89.3 per 100 patient-years at risk in women whose partners used condoms less than 5 percent of the time (adjusted hazard ratio, 0.3; 95 percent confidence interval, 0.1 to 0.6, adjusted for the number of new partners and the number of previous partners of the male partner). Similar associations were observed when the analysis was restricted to high-risk and low-risk types of HPV and HPV types 6, 11, 16, and 18. In women reporting 100 percent condom use by their partners, no cervical squamous intraepithelial lesions were detected in 32 patient-years at risk, whereas 14 incident lesions were detected during 97 patient-years at risk among women whose partners did not use condoms or used them less consistently. Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection.

Sexual abstinence only programmes to prevent HIV infection in high income countries: Systematic review

Article

Full-text available

Sep 2007
Br Med J

To assess the effects of sexual abstinence only programmes for HIV prevention among participants in high income countries. Systematic review. 30 electronic databases without linguistic or geographical restrictions to February 2007, contacts with experts, hand searching, and cross referencing. Two reviewers independently applied inclusion criteria and extracted data, resolving disagreements by consensus and referral to a third reviewer. Randomised and quasirandomised controlled trials of abstinence only programmes in any high income country were included. Programmes aimed to prevent HIV only or both pregnancy and HIV. Trials evaluated biological outcomes (incidence of HIV, sexually transmitted infection, pregnancy) or behavioural outcomes (incidence or frequency of unprotected vaginal, anal, or oral sex; incidence or frequency of any vaginal, anal, or oral sex; number of partners; condom use; sexual initiation). The search identified 13 trials enrolling about 15,940 US youths. All outcomes were self reported. Compared with various controls, no programme affected incidence of unprotected vaginal sex, number of partners, condom use, or sexual initiation. One trial observed adverse effects at short term follow-up (sexually transmitted infections, frequency of sex) and long term follow-up (sexually transmitted infections, pregnancy) compared with usual care, but findings were offset by trials with non-significant results. Another trial observed a protective effect on incidence of vaginal sex compared with usual care, but this was limited to short term follow-up and countered by trials with non-significant findings. Heterogeneity prevented meta-analysis. Programmes that exclusively encourage abstinence from sex do not seem to affect the risk of HIV infection in high income countries, as measured by self reported biological and behavioural outcomes.

Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000

Article

Jan 2000

Prevalence of Chlamydial and Gonococcal Infections Among Young Adults—Reply

Article

Aug 2004

Do sexual risk reduction interventions inadvertently increase the overall frequency of sexual behavior? Answers from a meta-analysis of 174 studies with 116,735 participants

Article

Jan 2005

A meta-analytic review of the influence of HIV risk reduction interventions on sexual occasions, number of partners, and abstinence was conducted to assess whether condom-related interventions inadvertently undermine sexual risk reduction efforts by increasing the frequency of sexual behavior. Included studies examined sexual risk reduction strategies and used a controlled design. Data from 174 studies (206 interventions, N = 116,735 participants) were included. In general, HIV risk reduction interventions neither increased nor decreased sexual occasions or number of partners reported. Participants in intervention conditions were less likely to be sexually active than those in control conditions. When samples included more black participants, interventions reduced the number of sexual occasions; interventions were more successful at reducing the number of partners in samples that included more men who have sex with men (MSM) or individuals engaged in sex trading. Samples that included more MSM were more likely to adopt abstinence as a risk reduction strategy. Interventions that included more information, motivational enhancement, and skills training also led to greater risk reduction. HIV risk reduction interventions do not increase the overall frequency of sexual activity. To the contrary, for some subgroups, interventions that include components recommended by behavioral science theory reduce the frequency of sexual events and partners.

The Relationship between Condom Use and Herpes Simplex Virus Acquisition

Article

Nov 2005

Anna Wald

Changes in formal sex education: 1995–2002

Article

Aug 2006
CONTRACEPTION

Sexually Transmitted Diseases among Adolescents in Developed Countries

Article

Jan 2000
Fam Plann Perspect

Sexually transmitted diseases (STDs) are responsible for a variety of health problems, and can have especially serious consequences for adolescents and young adults. An international comparison of levels and trends in STDs would be useful to identify countries that are relatively successful in controlling the incidence of STDs, as a first step toward improving policies and programs in countries with high or growing STD incidence. Incidence data for the past decade on three common bacterial STDs--syphilis, gonorrhea and chlamydia--were obtained for as many as 16 developed countries from official statistics, published national sources or scientific articles, and unpublished government data. Rates of incidence per 100,000 were calculated for adolescents, for young adults and for the total population. (These estimates should be considered conservative, because STDs commonly are underreported.) The incidence of these three STDs has generally decreased over the last decade, both in the general population and among adolescents. However, the Russian Federation is an important exception: Syphilis has risen dramatically in the 1990s. Except in the Russian Federation and Romania, the syphilis rate in the mid-1990s was quite low, with rates of less than seven reported cases per 100,000 teenagers in most developed countries. Gonorrhea incidence is many times higher than that of syphilis in several countries, and this disease disproportionately affects adolescents and young adults. Gonorrhea rates among adolescents can be as high as 600 per 100,000 (in the Russian Federation and the United States), although in many countries the reported rate among teenagers is below 10 per 100,000. In all countries with good reporting, chlamydia incidence is extremely high among adolescents (between 563 and 1,081 cases per 100,000). The reported incidence of all three STDs is generally higher among female teenagers than among males of the same age; this is especially true for chlamydia. Prevention programs, active screening strategies and better access to STD diagnosis and treatment services, especially for adolescents and young adults, are necessary to reduce the incidence and the burden of STDs among young people.

Factors Associated with the Content of Sex Education In U.S. Public Secondary Schools

Article

Sep 2003

While sex education is almost universal in U.S. schools, its content varies considerably. Topics such as abstinence, and basic information on HIV and other sexually transmitted diseases (STDs), are commonly taught; birth control and how to access STD and contraceptive services are taught less often. Factors potentially associated with these variations need to be examined. Data on 1,657 respondents to a 1999 national survey of teachers providing sex education in grades 7-12 were assessed for variation in topics covered. Logistic regression was used to ascertain factors associated with instruction on selected topics. The content of sex education varied by region and by instructors' approach to teaching about abstinence and contraception. For example, teaching abstinence as the only means of pregnancy and STD prevention was more common in the South than in the Northeast (30% vs. 17%). Emphasizing the ineffectiveness of contraceptives was less common in the Northeast (17%) than in other regions (27-32%). Instructors teaching that methods are ineffective and presenting abstinence as teenagers' only option had significantly reduced odds of teaching various skills and topics (odds ratios, 0.1-0.5). Instructors' approach to teaching about methods is a very powerful indicator of the content of sex education. Given the well-documented relationship between what teenagers learn about safer sexual behavior and their use of methods when they initiate sexual activity, sex education in all U.S. high schools should include accurate information about condoms and other contraceptives.

Sexual possibility situations and sexual behaviors among young adolescents: The moderating role of protective factors

Article

Jan 2005

To examine sexual possibility situations (SPS) and protective practices associated with involvement in intimate sexual behaviors and the initiation of sexual intercourse among young adolescents and to determine if protective factors moderate the relationship between SPS and sexual behaviors. Data for these analyses were obtained from the baseline assessment for adolescents conducted as part of an HIV prevention study called "Keepin' it R.E.A.L.!" The study was conducted with a community-based organization (CBO) in an urban area serving a predominantly African-American population. In addition to items assessing SPS, intimate sexual behaviors, and initiation of sexual intercourse, adolescents provided information on the following protective factors: educational goals, self-concept, future time perspective, orientation to health, self-efficacy, outcome expectations, parenting, communication, values, and prosocial activities. Background personal information, including age and gender, was also collected. The analyses were conducted on data from 491 predominantly African-American adolescents, 61% of whom were boys. Variables were combined to form SPS and protective indices that were used in the first set of regression analyses. In a second set of analyses, the indices were unbundled and individual variables were entered into regression analyses. Both SPS and protective indices explained significant portions of variance in intimate sexual behaviors, and the SPS index explained a significant portion of variance in the initiation of sexual intercourse. The regression analysis using the unbundled SPS and protective factors revealed the following statistically significant predictors for intimate sexual behaviors: age, gender, time alone with groups of peers, time alone with a member of the opposite sex, behavior self-concept, popularity self-concept, self-efficacy for abstinence, outcome expectations for abstinence, parental control, personal values, and parental values. A similar regression analysis revealed that age, time alone with a member of the opposite sex, and personal values were significant predictors of initiation of sexual intercourse. These results provide evidence for the important role of protective factors in explaining early involvement in sexual behaviors and show that protective factors extend beyond personal characteristics to include both familial and peer factors.

School-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials

Article

Feb 2005

We compared school-based abstinence-only programs with those including contraceptive information (abstinence-plus) to determine which has the greatest impact on teen pregnancy. The United States has one of the highest rates of teen pregnancy in the industrialized world. Programs aimed at reducing the rate of teen pregnancy include a myriad of approaches including encouraging abstinence, providing education about birth control, promoting community service activities, and teaching skills to cope with peer pressure. We systematically reviewed all published randomized controlled trials of secondary-school-based teen pregnancy prevention programs in the United States that used sexual behavior, contraceptive knowledge, contraceptive use, and pregnancy rates as outcomes.

After the promise: The STD consequences of adolescent virginity pledges

Article

May 2005

To examine the effectiveness of virginity pledges in reducing STD infection rates among young adults (ages 18-24). Data are drawn from the National Longitudinal Study of Adolescent Health, a nationally representative study of students enrolled in grades 7-12 in 1995. During a follow-up survey in 2001-2002, respondents provided urine samples, which were tested for Human Papilloma Virus, Chlamydia, Gonorrhea, and Trichomoniasis. We report descriptive results for the relationship of pledge status and sexually transmitted disease (STD) rates as well as health behaviors commonly associated with STD infection. Pledgers are consistently less likely to be exposed to risk factors across a wide range of indicators, but their STD infection rate does not differ from nonpledgers. Possible explanations are that pledgers are less likely than others to use condoms at sexual debut and to be tested and diagnosed with STDs. Adopting virginity pledges as intervention may not be the optimal approach to preventing STD acquisition among young adults.

AIDS Education, Condom Demand, and the Sexual Activity of American Youth

Article

Aug 2005

This paper examines the effects of AIDS education at school and at home on the sexual behavior of American youth. Multinomial logit equations of the probabilities of abstinence, sexual intercourse with a condom, and intercourse without a condom are estimated using data from the Youth Risk Behavior Supplement of the 1992 National Health Interview Survey. We find no significant effects of AIDS education on the probability of abstinence, but we do find that AIDS education significantly raises the likelihood of condom-protected relative to unprotected intercourse. These results indicate that risk-altering and risk-revealing AIDS education dominate any utility-altering effects favoring intercourse over abstinence. We also find that young women are influenced by AIDS education to a greater extent than young men. Overall, our results suggest that educating young people about AIDS does not promote sex and encourages safer sex, reducing the likelihood of HIV transmission and lowering the subsequent social costs.

The relationship between condom use and herpes simplex virus acquisition

Article

Dec 2005
ANN INTERN MED

Few studies have evaluated the relationship between condom use and herpes simplex virus type 2 (HSV-2) and HSV type 1 (HSV-1) acquisition. To assess the relationship between condom use and acquisition of HSV-2 and HSV-1 among men and women. Analysis of data collected as part of a clinical trial of an ineffective candidate vaccine for HSV-2. Sexually transmitted disease clinics. Men and women at risk for HSV-2 acquisition, defined as having 4 or more sexual partners or having a sexually transmitted disease in the past year. Acquisition of HSV-2 and HSV-1 as measured by viral culture or change to positive HSV serostatus. Of 1843 participants, 118 (6.4%) became infected with HSV-2. In multivariate analyses, participants reporting more frequent use of condoms were at lower risk for acquiring HSV-2 than participants who used condoms less frequently (hazard ratio, 0.74 [95% CI, 0.59 to 0.95]); categories of increasing condom use were 0% to 25%, 25% to 75%, and greater than 75% of sexual acts. Nineteen (2.9%) of 659 participants at risk for infection with HSV-1 became infected. No statistically significant association between condom use and infection with HSV-1 was found (hazard ratio, 0.79 [CI, 0.48 to 1.31]). Use of condoms was measured by self-report, and persons who used condoms may have differed from those who did not. Consistent use of condoms is associated with lower rates of infection with HSV-2 and should be routinely recommended.

Sexual Risk Reduction Interventions Do Not Inadvertently Increase the Overall Frequency of Sexual Behavior

Article

Apr 2006
JAIDS-J ACQ IMM DEF

Does sex education affect adolescent sexual behaviors and health?

Article

Feb 2006

Joseph J. Sabia

This study examines whether offering sex education to young teenagers affects several measures of adolescent sexual behavior and health: virginity status, contraceptive use, frequency of intercourse, likelihood of pregnancy, and probability of contracting a sexually transmitted disease. Using data from the National Longitudinal Study of Adolescent Health, I find that while sex education is associated with adverse health outcomes, there is little evidence of a causal link after controlling for unobserved heterogeneity via fixed effects and instrumental variables. These findings suggest that those on each side of the ideological debate over sex education are, in a sense, both correct and mistaken. Opponents are correct in observing that sex education is associated with adverse health outcomes, but are generally incorrect in interpreting this relationship causally. Proponents are generally correct in claiming that sex education does not encourage risky sexual activity, but are incorrect in asserting that investments in typical school-based sex education programs produce measurable health benefits.

Changes in Formal Sex Education: 1995–2002

Article

Jan 2007

Although comprehensive sex education is broadly supported by health professionals, funding for abstinence-only education has increased. Using data from the 1995 National Survey of Adolescent Males, the 1995 National Survey of Family Growth (NSFG) and the 2002 NSFG, changes in male and female adolescents' reports of the sex education they have received from formal sources were examined. Life-table methods were used to measure the timing of instruction, and t tests were used for changes over time. From 1995 to 2002, reports of formal instruction about birth control methods declined among both genders (males, from 81% to 66%; females, from 87% to 70%). This, combined with increases in reports of abstinence education among males (from 74% to 83%), resulted in a lower proportion of teenagers' overall receiving formal instruction about both abstinence and birth control methods (males, 65% to 59%; females, 84% to 65%), and a higher proportion of teenagers' receiving instruction only about abstinence (males, 9% to 24%; females, 8% to 21%). Teenagers in 2002 had received abstinence education about two years earlier (median age, 11.4 for males, 11.8 for females) than they had received birth control instruction (median age, 13.5 for both males and females). Among sexually experienced adolescents, 62% of females and 54% of males had received instruction about birth control methods prior to first sex. A substantial retreat from formal instruction about birth control methods has left increasing proportions of adolescents receiving only abstinence education. Efforts are needed to expand teenagers' access to medically accurate and comprehensive reproductive health information.

Sexually Transmitted Diseases Among American Youth: Incidence and Prevalence Estimates, 2000

Article

Jan 2004

In the United States, young people aged 15-24 represent 25% of the sexually experienced population. However, the incidence and prevalence of sexually transmitted diseases (STDs) among this age-group are unknown. Data from a variety of sources were used to estimate the incidence and prevalence of STDs among 15-24-year-olds in the United States in 2000. The quality and reliability of the estimates were categorized as good, fair or poor, depending on the quality of the data source. Approximately 18.9 million new cases of STD occurred in 2000, of which 9.1 million (48%) were among persons aged 15-24. Three STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15-24-year-olds. These estimates emphasize the toll that STDs have on American youth. More representative data are needed to help monitor efforts at lowering the burden of these infections.

Budget of the United States Government, Fiscal Year 2005; Department of Health and Human Service [Online] Available at: www.whitehouse.gov/omb

Dec 2005

Office
Management
Budget

Office of Management and Budget, Budget of the United States Government, Fiscal Year 2005; Department of Health and Human Service [Online]. Available at: www.whitehouse.gov/omb/budget/ fy2005/pdf/budget/hhs.pdf. Accessed November 23, 2005.

Research Findings on Programs to Reduce Teen Pregnancy (Summary) Washington, DC: National Campaign to Prevent Teen Pregnancy

May 2001

Kirby D Emerging Answers

Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (Summary). Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001 [Online]. Available at: http://www.teenpregnancy.org/resources/data/pdr/emerganswsum.pdf. Accessed April 4, 2007.

Budget of the United States Government, Fiscal Year 2008; Department of Health and Human Services

May 2007

Office
Management
Budget

Office of Management and Budget, Budget of the United States Government, Fiscal Year 2008; Department of Health and Human Services [Online]. Available at: http://www.gpoaccess.gov/usbudget/ fy08/pdf/budget/hhs.pdf. Accessed April 4, 2007.

Adolescents and Youth

Apr 2005

Disease Control
Prevention
Std
Surveillance

Centers for Disease Control and Prevention. STD Surveillance 2005: Adolescents and Youth [Online]. Available at: http://www.cdc.gov/ std/stats05/adol.htm. Accessed May 18, 2006.

Teenagers' Sexual and Reproductive Health: Developed Countries

May 2007

Alan Guttmacher

Alan Guttmacher Institute. Teenagers' Sexual and Reproductive Health: Developed Countries [Online]. Available at: http://www. guttmacher.org/pubs/fb_teens.pdf. Accessed April 5, 2007.

Teenagers' Sexual and Reproductive Health: Developed Countries [Online] Available at: http://www. guttmacher.org/pubs/fb_teens.pdf

May 2007

Alan Guttmacher Institute

Alan Guttmacher Institute. Teenagers' Sexual and Reproductive Health: Developed Countries [Online]. Available at: http://www. guttmacher.org/pubs/fb_teens.pdf. Accessed April 5, 2007.

Section 510 [42 U.S.C. 710] [Online] Available at: http://www.ssa.gov/OP_Home

May 2007

Social Security Act

Social Security Act. Section 510 [42 U.S.C. 710] [Online]. Available at: http://www.ssa.gov/OP_Home/ssact/title05/0510.htm#fn019. Accessed April 9, 2007.

Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (Summary). Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001.

Kirby D.

Changes in formal sex education: 1995–2002

Jan 2006
182

Lindberg

Factors associated with the content of sex education in US public secondary schools

Jan 2003
261

Landry

Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy

Abstract

No full-text available

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