A narrow view: The conceptualization of sexual problems in human sexuality textbooks

This study examined the ways in which the meaning of 'sexual problems' is constructed and defined in undergraduate human sexuality textbooks. Drawing on feminist and critical discourse frameworks, the dominant as well as the absent/marginalized discourses were identified using critical discourse analysis. Sexual difficulties were largely framed by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Thus, medical discourse was privileged. Alternative conceptualizations and frameworks, such as the New View of Women's Sexual Problems, were included marginally and peripherally. We argue that current constructions of sexuality knowledge reinforce, rather than challenge, existing hegemonic discourses of sexuality.

"Girls need to behave like girls you know": the complexities of applying a gender justice goal within sexuality education in South African schools

Sexuality education, as a component within the Life Orientation (LO) programme in South African schools, is intended to provide young people with knowledge and skills to make informed choices about their sexuality, their own health and that of others. Key to the programme are outcomes relating to power, power relations and gender. In this paper, we apply a critical gender lens to explore the ways in which the teaching of sexuality education engages with larger goals of gender justice. The paper draws from a number of ethnographic studies conducted at 12 South African schools. We focus here on the data collected from focus group discussions with learners, and semi-structured interviews with individual learners, principals and Life Orientation (LO) teachers. The paper highlights the complexities of having gender justice as a central goal of LO sexuality education. Teaching sexuality education is reported to contradict dominant community values and norms. Although some principals and school authorities support gender equity and problematize hegemonic masculinities, learners experience sexuality education as upholding normative gender roles and male power, rather than challenging it. Teachers rely heavily on cautionary messages that put more responsibility for reproductive health on female learners, and use didactic, authoritative pedagogical techniques, which do not acknowledge young people's experience nor facilitate their sexual agency. These complexities need to be foregrounded and worked with systematically if the goal of gender justice within LO is to be realised.

Implementation in Practice: Adaptations to Sexuality Education Curricula in California

BACKGROUND

Local implementation of evidence-based curricula, including sex education, has received increasing attention. Although there are expectations that practitioners will implement evidence-based programs with fidelity, little is known regarding the experiences of instructors in meeting such standards. During 2005 to 2009, the California Department of Public Health funded local agencies through its Teen Pregnancy Prevention Programs (TPP) to provide comprehensive sex education.

METHODS

To improve understanding of how agencies implemented curricula, in-depth telephone interviews with 128 coordinators were conducted in 2008 to 2009. Qualitative data were analyzed for content and themes. Selected data were quantified and analyzed to examine differences in curriculum adaptations across settings and curricula type.

RESULTS

Whereas over half of the TPP agencies (59%) implemented evidence-based curricula, most agencies (95%) reported adapting the curriculum, with the majority (83%) adding content. Reasons for adaptations included ensuring that the material was accurate and appropriate; responding to logistical or time constraints; and other factors, such as parental and institutional support.

CONCLUSION

These adaptations reflected agencies' efforts to balance state and local requirements, maintain curriculum fidelity, and provide more up-to-date and accessible information. These experiences highlight the need for guidelines that enable appropriate adaptations, while maintaining fidelity to the core components of the original curriculum.

Support for Offering Sexual Health Services Through School-Based Health Clinics

BACKGROUND

Numerous studies document support for sexuality education in the schools. However, there is a dearth of research assessing support for sexual health services offered through school-based health clinics (SBHCs). The purpose of this study was to assess voter support for offering 3 sexual health services (STI/HIV testing, STI/HIV treatment, condom distribution) through SBHCs.

METHODS

The survey was developed after review of existing surveys on support for sexuality education and sexual health services. The university's Public Opinion Research Laboratory used random-digit-dialing to administer the survey to participants (N = 311) including residential and cell phone numbers.

RESULTS

Most participants were supportive of offering sexual health services at both middle schools (MS) and high schools (HS): testing for STIs/HIV (61% MS, 76% HS), treatment for STIs/HIV (60% MS, 75% HS), and provision of condoms (44% MS, 63% HS). Analyses showed significant differences in support for sexual health services by a few demographic variables, opinions about sexuality education, and the percentage of students perceived to have had sexual intercourse.

CONCLUSIONS

Results document support for offering sexual health services through SBHCs. These findings may benefit other communities looking to implement similar clinics. Such services have great potential for positively impacting the sexual health of youth.

Fertility knowledge and intentions to have children in a national study of Australian secondary school students

OBJECTIVE

This paper reports on fertility knowledge and intentions to have children among a national sample of students in years 10-12.

METHOD

Data were from the Fifth National Survey of Australian Secondary Students and Sexual Health. Students identified factors that could affect fertility, if they wanted children and at what age.

RESULTS

Most students wanted to have children (77%). Of those who wanted children or were unsure (n=1,780), 54% were able to identify six of eight factors that could affect fertility. Male students had poorer knowledge than females. Poorer knowledge was also reported by male students who were born overseas or used marijuana and by female students who were sexually active or religious. More than half the students (59%) wanted their first child aged 25-29, while 19% wanted their first child after 30. Intentions to have children at an earlier age were associated with being religious, sexually active (females), and using marijuana (males). Students not exclusively attracted to the opposite sex were more likely to want children at an older age.

CONCLUSIONS AND IMPLICATIONS

Most students typically want children in their late 20s. Many were unaware of factors that could affect their fertility and there was a mismatch between intentions and likely behaviour. These factors could be addressed as part of relationship education.

'You need to have some guts to teach': Teacher preparation and characteristics for the teaching of sexuality and HIV/AIDS education in South African schools

Using in-depth interviews, we asked sexuality educators in South Africa about their own professional preparation and what they believed were necessary educator characteristics for teaching Sexuality Education. Our findings show that our teachers taught Sexuality Education without any appropriate qualification or preparation, but because they had a lighter teaching load and had room to take on more teaching hours. Nevertheless, they all mention that 'not anybody can teach Sexuality Education'. Drawing on Shulman's taxonomy of knowledge and Freire's concept of critical consciousness, we attempt to make meaning of the teachers' responses and their relevance for the teaching of Sexuality Education.

Sexuality Education Intervention for Parents of Children with Disabilities: A Pilot Training Program

The purpose of the study is to evaluate pilot sexuality education intervention for parents of children with disabilities between ages of 6 and 25 years old. A within subjects design was utilized and 15 parents of children with disabilities were recruited to receive a two-week sexuality education without a control group. A paired-samples t-test results showed that there was a significant difference between the participants' pre-test and post intervention scores in their: attitude and beliefs, sexual communication, knowledge, and self-efficacy of sexuality education among children with disabilities (all p<.001). The intervention change the participants sexual communication behavior and increased knowledge about sexuality education with children with disabilities.

Facing negative reactions to sexuality education through a Multicultural Human Rights framework

Sexuality education, its protocols and planning are contingent on an ever-changing political environment that characterizes the field of sexuality in most countries. In Brazil, human rights perspectives shaped the country's response to the AIDS epidemic, and indirectly influenced the public acceptability of sexuality education in schools. Since 2011, however, as multiple fundamentalist movements emerged in the region, leading to recurrent waves of backlashes in all matters related to sexuality, both health and educational policies have begun to crawl backwards. This article explores human rights-based approaches to health, focusing on a multicultural rights-based framework and on productive approaches to broadening the dialogue about sustained consent to sexuality education. Multicultural human rights (MHR) approaches are dialogical in two domains: the communication process that guarantees consent and community agreements and the constructionist psychosocial-educational methodologies. In its continuous process of consent, the MHR approach allowed for distinct values translation and diffused the resistance to sexuality education in the participant schools/cities, successfully sustaining notions of equality and protection of the right to a comprehensive sexuality education that does not break group solidarity and guarantees acceptability of differences.

"Sexuality? A million things come to mind": reflections on gender and sexuality by Chilean adolescents

Although Chile is a traditionally conservative country, considerable legal advances in sexual and reproductive rights over the past decade have brought discourses on sexuality into mainstream political, social and media agendas. In light of these changes it is important to explore how adolescents conceptualize sexuality, which in turn influences their understanding of sexual rights. This study is based on four focus group discussions and 20 semi-structured interviews with adolescents, and seven interviews with key informants in Santiago, Chile. Findings indicate that adolescent conceptualizations of sexuality are diverse, often expressed as attitudes or observations of their social context, and primarily shaped by peers, parents and teachers. Attitudes towards individuals with non-heterosexual orientations ranged from support to rejection, and conceptualizations of sexual diversity were also influenced by media, medicalization and biological explanations. Gender differences in sexual expression were described through gendered language and behaviour, in particular observations of gender stereotypes, censored female sexuality and discourses highlighting female risk. Many adolescents described social change towards greater equality regarding gender and sexuality. To optimize this change and help bridge the gap between legal and social recognition of sexual rights, adolescents should be encouraged to reflect critically on issues of gender equality and sexual diversity in Chile.

AB133. The Directors of Japanese Society for Sexual Medicine have a positive attitude for sexuality education in Japanese medical schools

Objective

The purpose of the present study was to investigate the current state of sexuality education in Japanese medical schools and the association of the position title of Japanese Society for Sexual Medicine (JSSM).

Methods

We surveyed the four factors, the number of lecture components, the time of curriculum hours, the degree of sufficiency level of the components, and the degree of sufficiency level of the curriculum hours in medical schools in Japan. Also, we have investigated the four factors difference among three groups, Directors, Council, and Non-member of JSSM.

Results

Of the 80 medical schools, the faculties of the Urological department of 69 medical schools (86%) responded. The mean number of lecture components was 7.8. The number of lecture components of Directors (10.2) had significantly higher than Council (4.7) and Non-member (7.3). There is no significant difference the number of lecture components between Council and Non-member. The mean curriculum hour was 113 minutes. The curriculum hour of Directors (152.6) was significantly longer than Non-member (95.9). There is no significant difference the curriculum hour between Council (106.7) and Non-member. The satisfactory degree of the components was very satisfied (1.5%), satisfied (26.5%), not satisfied (55.9%), and dissatisfied (16.5%) for the faculties. The satisfactory degree of the curriculum hours was very long (0%), long (0%), moderate (50%), short (45.6%), and very short (4.4%) for the faculties. There is no significant difference the satisfactory degree of the components and the curriculum hours among three groups.

Conclusions

The Directors of JSSM have a positive attitude for sexuality education in Japanese medical schools. While curriculum hour is insufficient for the faculties in half of medical schools, over 70% medical schools answered that the lecture components are insufficient, too. Now we should make every effort to achieve sufficient components for sexuality education. We need the standardized syllabus and materials for sexual medicine in medical schools. These syllabus and materials should to be mainly made by Directors. This is the first Japanese study on sexuality education in medical schools.

Short-term effects of a rights-based sexuality education curriculum for high-school students: a cluster-randomized trial

BACKGROUND

An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior.

METHODS

A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors.

RESULTS

Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms.

CONCLUSIONS

Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02009046.

Thoughts about conceptual models of nursing and health policies

In this essay, we present a conceptual framework for analysis and evaluation of sexuality education health policies based on the conceptual model of nursing and health policy and the Neuman systems model. The framework is intended to facilitate understanding of sexuality education policies promulgated by the governments of any country in the world.

Protective effects of middle school comprehensive sex education with family involvement

BACKGROUND

School-based comprehensive sex education programs can reduce early adolescents' risky sexual behavior. The purpose of this study was to assess the effectiveness of a 3-year comprehensive sex education program in delaying vaginal sex for middle school students and whether the family component of the intervention contributes to its effectiveness.

METHODS

This longitudinal evaluation followed a cohort of 6th graders (N = 2453) through the end of 8th grade. The design used random assignment of 24 schools into treatment and comparison conditions. The analysis included multiple-group logistic regression to assess differences in delay of sex between intervention and comparison groups.

RESULTS

In schools where the program was taught, 16% fewer boys and 15% fewer girls had had sex by the end of 8th grade compared to boys and girls at comparison schools. Completing family activities during the first year of the program predicted delayed sexual debut for boys.

CONCLUSIONS

Theory-based, developmentally appropriate, comprehensive sex education programs that include parent involvement can be effective in delaying vaginal sex for middle school students. Parent involvement is particularly important for boys, as family activities may encourage parents to talk with their sons earlier and more frequently.

Improving sexuality education: the development of teacher-preparation standards

BACKGROUND

Teaching sexuality education to support young people's sexual development and overall sexual health is both needed and supported. Data continue to highlight the high rates of teen pregnancy, sexually transmitted disease, including human immunodeficiency virus (HIV) infections, among young people in the United States as well as the overwhelming public support for sexuality education instruction. In support of the implementation of the National Sexuality Education Standards, the current effort focuses on better preparing teachers to deliver sexuality education.

METHODS

An expert panel was convened by the Future of Sex Education Initiative to develop teacher-preparation standards for sexuality education. Their task was to develop standards and indicators that addressed the unique elements intrinsic to sexuality education instruction.

RESULTS

Seven standards and associated indicators were developed that address professional disposition, diversity and equity, content knowledge, legal and professional ethics, planning, implementation, and assessment.

CONCLUSIONS

The National Teacher-Preparation Standards for Sexuality Education represent an unprecedented unified effort to enable prospective health education teachers to become competent in teaching methodology, theory, practice of pedagogy, content, and skills, specific to sexuality education. Higher education will play a key role in ensuring the success of these standards.

New evidence: data documenting parental support for earlier sexuality education

BACKGROUND

Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools.

METHODS

As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715).

RESULTS

Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education.

CONCLUSIONS

Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education.

Cost analysis of school-based sexuality education programs in six countries

BACKGROUND

Policy-makers who are making decisions on sexuality education programs face important economic questions: what are the costs of developing sexuality education programs; and what are the costs of implementing and scaling them up? This study responds to these questions by assessing the costs of six school-based sexuality education programs (Nigeria, Kenya, Indonesia, India, Estonia and the Netherlands).

METHODS

Cost analyses were carried out in schools that were fully implementing a SE program, as this best reflects the resources needed to run an effective program. The costs were analyzed from the program perspective, meaning that all costs borne by the governmental and (international) non-governmental organizations supporting the program were included. Cost analyses were based on financial records, interviews and school surveys.We distinguished costs in three consecutive program phases: development, update and implementation. Recommendations on the most efficient program characteristics and scale-up pathways were drawn from results of three fully scaled up programs (Estonia, Nigeria and the Netherlands), scale-up scenarios of two pilot programs (Kenya and Indonesia), and an implementation plan (India), The costs of the programs were compared by converting cost per student reached in US dollars (US$) to international dollars (I$).

RESULTS

Findings revealed a range of costs and coverage of sexuality education programs. Costs per student reached were; US$7 in Nigeria, US$13.50 in India, US$33 in Estonia and the Netherlands, US$50 in Kenya, and US$160 in Indonesia.

CONCLUSIONS

Intra-curricular sexuality education programs have, because of their compulsory nature, the most potential to be scaled up and are therefore most efficient. Extra-curricular sexuality education programs have lower potential to be scaled up and are therefore less efficient. In terms of class size and number of lessons, countries need to strike a balance between the quality (demanding smaller classes and many lessons) and the costs (demanding larger classes and fewer lessons). Advocacy was a significant cost component.

'I make sure I am safe and I make sure I have myself in every way possible': African-American youth perspectives on sexuality education

High rates of youth pregnancy and STIs play a major role in the physical, mental, and emotional health of young people. Despite efforts to provide sexuality education through diverse channels, we know little about the ways in which young people perceive school- and community-based efforts to educate them about sexual health. Forty-eight African-American young people participated in six focus groups to discuss their sexuality education experiences. Three major themes emerged that highlight experiences and perspectives on optimal strategies for promoting sexual health. These themes were: 1) experiences with school-based sexuality education (SBSE); 2) seeking information outside of schools; and 3) general principles of youth-centered sexuality education. Young people in the focus groups expressed their varying satisfaction with SBSE due to the restricted content covered and lack of comfort with the instruction methods. Participants described how they reached outside of SBSE for sexuality education, turning to those in the community, including local organisations, health care providers, and peers, also expressing variability in satisfaction with these sources. Finally, participants identified three important principles for youth-centred sexuality education: trust and confidentiality, credibility, and self-determination. These findings give voice to the often-unheard perspectives of African-American young people. Based on their responses, it is possible to gain a better understanding of the optimal combination of school, family, peer and community-based efforts to support them as they move towards adulthood.

Recall, relevance and application of an in-school sexual and reproductive health intervention 7-9 years later: perspectives of rural Tanzanian young people

Many adolescent sexual and reproductive health (ASRH) interventions have improved knowledge and reduced reported sexual risk behaviours, but found no impact on HIV. We explored potential reasons for this in 23 in-depth interviews, conducted 7-9 years after exposure to ASRH intervention. We discussed participants' memories and views of the relevance of the in-school intervention, and their subsequent ability to apply what they had learned. While most participants had favourable memories of the intervention, few recalled specific details. Most reported that the intervention had been relevant, although few reported being able to apply the teachings. Men found it easier to apply lessons about condoms than women. Inability to apply the intervention teachings was often linked to cultural norms around fertility and/or gender power relations. ASRH interventions should address structural factors such as the quality of parenting and explicitly link interventions to young peoples' future aspiration.

BDSM Disclosure and Stigma Management: Identifying Opportunities for Sex Education

While participation in the activities like bondage, domination, submission/sadism, masochism that fall under the umbrella term BDSM is widespread, stigma surrounding BDSM poses risks to practitioners who wish to disclose their interest. We examined risk factors involved with disclosure to posit how sex education might diffuse stigma and warn of risks. Semi-structured interviews asked 20 adults reporting an interest in BDSM about their disclosure experiences. Most respondents reported their BDSM interests starting before age 15, sometimes creating a phase of anxiety and shame in the absence of reassuring information. As adults, respondents often considered BDSM central to their sexuality, thus disclosure was integral to dating. Disclosure decisions in nondating situations were often complex considerations balancing desire for appropriateness with a desire for connection and honesty. Some respondents wondered whether their interests being found out would jeopardize their jobs. Experiences with stigma varied widely.

Understanding adolescent parenthood from a multisystemic perspective

PURPOSE

This study examined the associations between social, behavioral, and environmental factors and adolescent parenthood.

METHODS

We analyzed data from a subsample of participants, 18-30 years of age (n=7,937), who took part in the 2001-2002 National Epidemiologic Study on Alcohol and Related Conditions, a nationally representative survey of adults. An extended Cox proportional hazards model was used to model time until becoming an adolescent parent (i.e., age at which first child was born if < or =18 years). Predictor variables of interest included initiation of alcohol, marijuana, cocaine, and daily cigarette use, age of earliest conduct disorder symptom, having a parent with alcohol and/or drug problems, parental death, divorce and/or separation, race/ethnicity, and gender.

RESULTS

Several variables were associated with adolescent parenthood, including initiation of daily cigarette smoking, age of first antisocial/conduct disorder symptom, and race/ethnicity. Parental alcohol/drug problems and parental death were also associated with adolescent parenthood for women. A significant interaction between initiation of daily cigarette smoking and ethnicity was present for women. Daily cigarette smoking was associated with adolescent parenthood to a greater degree than nondaily cigarette smoking for white and Hispanic women but not African American women. No significant associations were found between adolescent parenthood and initiation of drinking, marijuana, or cocaine and parental divorce/separation.

CONCLUSIONS

Prevention efforts should focus on adolescents who are at highest risk of adolescent parenthood.

Metaphors we love by: Conceptualizations of sex among young people in Malawi

This paper explores how young people in Malawi conceptualize sex and sexual relations through an analysis of their personal narratives about these phenomena. Eleven focus group discussions were conducted with 114 youth aged 14-19 years. Participants were asked to describe behaviors, attitudes, and motivations to reduce unplanned pregnancies and the spread of HIV/AIDS, with appropriate probes to illuminate their sexual world-views. The various metaphors that emanated from the discussions suggest that young people in this study take a utilitarian approach to sex, and conceive it as a natural and routine activity of which pleasure and passion are essential components. Future research and prevention efforts (around sexuality education in particular) would do well to incorporate adolescents' language in programming as this can enhance understanding of the world of young people as well as the effectiveness of interventions addressing problems related to early sexual behavior.