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Lassi ZS, Rahim KA, Stavropoulos AM, Ryan LM, Tyagi J, Adewale B, Kurji J, Bhaumik S, Meherali S, Ali M. Use of contraceptives, empowerment and agency of adolescent girls and young women: a systematic review and meta-analysis. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:195-211. [PMID: 38479786 PMCID: PMC11287556 DOI: 10.1136/bmjsrh-2023-202151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The evidence on adolescent empowerment, which involves access to personal and material resources for reproductive autonomy and economic equity, is limited. This systematic review assesses the use of contraceptives in empowering and strengthening the agency and vice versa among adolescents and young women. METHODS We ran the searches in six electronic databases: Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), The Campbell Library, MEDLINE (PubMed), EMBASE, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The methodological quality of studies was assessed using ROBINS-I and ROB-II tools as appropriate. Meta-analysis was performed using Review Manager 5.4. RESULTS Forty studies that assessed the impact of empowerment on contraceptive use were included. Of these, 14 were non-randomised studies for intervention (NRSIs), and the remaining 26 were randomised controlled trials (RCTs). The results from RCTs show a significant effect of the sexual and reproductive health empowerment in increasing ever use of contraception (RR 1.22; 95% CI 1.02, 1.45; n=9; I²=77%; GRADE: Very Low), and insignificant effect on unprotected sex (RR 0.97; 95% CI 0.74, 1.26; n=5; I²=86%; GRADE: Very Low) and adolescent pregnancy (RR 1.07; 95% CI 0.61, 1.87; n=3; I²=36%; GRADE: Very Low). None of the studies assessed impact of contraceptive use on empowerment. CONCLUSIONS Empowerment of adolescents and young women certainly improves contraceptive use in the immediate or short-term period. However, more robust studies with low risk of bias, longer-term outcomes, and impact of contraceptive use on empowerment and agency-strengthening are required. To increase contraceptive use uptake, tailored policies and delivery platforms are necessary for youth in low- and middle-income countries.
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Affiliation(s)
- Zohra S Lassi
- School of public health, Faculty of health and medical sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Komal Abdul Rahim
- Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan
- Center of Excellence in Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | | | - Lareesa Marie Ryan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jyoti Tyagi
- George Institute of Global Health, New Delhi, India
| | - Bisi Adewale
- University of Alberta, Edmonton, Alberta, Canada
| | - Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Soumyadeep Bhaumik
- Meta-Research and Evidence Synthesis Unit, Health Systems Science, George Institute of Global Health, New Delhi, India
- George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia
| | | | - Moazzam Ali
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
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Koh MCY, Ngiam JN, Tambyah PA, Archuleta S. ChatGPT as a tool to improve access to knowledge on sexually transmitted infections. Sex Transm Infect 2024:sextrans-2024-056217. [PMID: 38925936 DOI: 10.1136/sextrans-2024-056217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVES Specific to sexual health, individuals in need of information may be adolescents who have limited ability to formally access healthcare. These digital natives may turn to ChatGPT to address their concerns on sexually transmitted infections (STI). We sought to evaluate the veracity of ChatGPT's responses to commonly asked questions on STIs. METHODS We instructed ChatGPT (GPT 3.5) to answer STI questions from three domains, namely, (1) general risk factors for STIs, (2) access to care and diagnosis of STIs and (3) management of STIs and postexposure prophylaxis. The responses were recorded and checked against the US Centers for Disease Control and Prevention STI Treatment Guidelines 2021. RESULTS Overall, the responses were concise and accurate. In terms of prevention, ChatGPT could also recommend measures like safe sex practices and human papillomavirus vaccination. However, it failed to recommend HIV pre-exposure prophylaxis. When an individual expressed a symptom that could potentially represent STI (eg, dyspareunia) ChatGPT appropriately provided reassurance that other possibilities exist, but advocated for testing. In terms of treatment, ChatGPT consistently communicated the importance of partner testing and follow-up testing, but at times, failed to highlight the importance of testing for other STIs. Overall, the advice given was not tailored to the specific individual's circumstances. CONCLUSIONS ChatGPT can provide helpful information regarding STIs, but the advice lacks specificity and requires a human physician to fine-tune. Its ubiquity may make it a useful adjunct to sexual health clinics, to improve knowledge and access to care.
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Affiliation(s)
- Matthew Chung Yi Koh
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Jinghao Nicholas Ngiam
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sophia Archuleta
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Jayne PE, Szucs LE, Lesesne CA, Grose RG, Johns MM. "I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:158-170. [PMID: 38623631 DOI: 10.1111/psrh.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. METHODS We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences. RESULTS Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender. CONCLUSION There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways.
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Affiliation(s)
- Paula E Jayne
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Atlanta, Georgia, USA
| | - Leigh E Szucs
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Chamblee, Georgia, USA
| | | | - Rose Grace Grose
- Colorado School of Public Health, Community Health Education, University of Northern Colorado, Greeley, Colorado, USA
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Chipako I, Singhal S, Hollingsworth B. Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2024; 5:1344135. [PMID: 38699461 PMCID: PMC11063325 DOI: 10.3389/fgwh.2024.1344135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives The aim of this scoping review was to identify and provide an overview of the impact of sexual and reproductive health (SRH) interventions on reproductive health outcomes among young people in sub-Saharan Africa. Methods Searches were carried out in five data bases. The databases were searched using variations and combinations of the following keywords: contraception, family planning, birth control, young people and adolescents. The Cochrane risk-of-bias 2 and Risk of Bias in Non-Randomized Studies-of-Interventions tools were used to assess risk of bias for articles included. Results Community-based programs, mHealth, SRH education, counselling, community health workers, youth friendly health services, economic support and mass media interventions generally had a positive effect on childbirth spacing, modern contraceptive knowledge, modern contraceptive use/uptake, adolescent sexual abstinence, pregnancy and myths and misperceptions about modern contraception. Conclusion Sexual and reproductive health interventions have a positive impact on sexual and reproductive health outcomes. With the increasing popularity of mHealth coupled with the effectiveness of youth friendly health services, future youth SRH interventions could integrate both strategies to improve SRH services access and utilization.
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Affiliation(s)
- Isaac Chipako
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
| | - Saurabh Singhal
- Economics Department, Lancaster University, Lancaster, United Kingdom
| | - Bruce Hollingsworth
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
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Schieber E, Deveaux L, Cotrell L, Li X, Lemon SC, Ash AS, MacDonell K, Ghosh S, Poitier M, Rolle G, Naar S, Wang B. Maintaining Program Fidelity in a Changing World: National Implementation of a School-Based HIV Prevention Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:436-447. [PMID: 37979069 PMCID: PMC11093787 DOI: 10.1007/s11121-023-01614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
Large-scale, evidence-based interventions face challenges to program fidelity of implementation. We developed implementation strategies to support teachers implementing an evidence-based HIV prevention program in schools, Focus on Youth in The Caribbean (FOYC) and Caribbean Informed Parents and Children Together (CImPACT) in The Bahamas. We examined the effects of these implementation strategies on teachers' implementation in the subsequent year after the initial implementation during the COVID-19 pandemic. Data were collected from 79 Grade 6 teachers in 24 government elementary schools. Teachers completed training workshops and a pre-implementation questionnaire to record their characteristics and perceptions that might affect their program fidelity. School coordinators and peer mentors provided teachers with monitoring, feedback, and mentoring. In Year 1, teachers on average taught 79.3% of the sessions and 80.8% of core activities; teachers in Year 2 covered 84.2% of sessions and 72.9% of the core activities. Teachers with "good" or "excellent" school coordinators in the second year taught significantly more sessions on average (7.8 vs. 7.0, t = 2.04, P < 0.05) and more core activities (26.3 vs. 23.0, t = 2.41, P < 0.05) than teachers with "satisfactory" coordinators. Teachers who had a "good" or "satisfactory" mentor taught more sessions than teachers who did not have a mentor (7.9 vs. 7.3; t = 2.22; P = 0.03). Two-level mixed-effects model analysis indicated that teachers' program fidelity in Year 1, confidence in the execution of core activities, and school coordinators' performance were significantly associated with Year 2 implementation dose. Implementation of FOYC + CImPACT was significantly associated with improved student outcomes. Teachers maintained high fidelity to a comprehensive HIV prevention program over 2 years during the COVID-19 pandemic. Future program implementers should consider additional implementation support to improve the implementation of school-based programs.
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Affiliation(s)
- Elizabeth Schieber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Lynette Deveaux
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Lesley Cotrell
- Department of Pediatrics, West Virginia University, 959 Hartman Run Road, Morgantown, WV, 26506, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Arlene S Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Karen MacDonell
- Center for Translational Behavioral Science, Florida State University College of Medicine, 2010 Levy Ave. Building B, Tallahassee, FL, 32310, USA
| | - Samiran Ghosh
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Maxwell Poitier
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Glenda Rolle
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University College of Medicine, 2010 Levy Ave. Building B, Tallahassee, FL, 32310, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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Tirone A, Maule L, Huang J, Higgins J, Walsh T, Filingeri D, Songveera A, Poh C, Henderson AN. A retrospective review of the rate of sexually transmitted infections in adolescents after universal screening protocol implementation in an urban United States clinic. Prev Med Rep 2024; 40:102672. [PMID: 38464418 PMCID: PMC10920956 DOI: 10.1016/j.pmedr.2024.102672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Despite expanded guidelines, adolescent gonorrhea and chlamydia (GC/CT) screening rates remain low due to multiple psychosocial barriers and biases. This intervention aimed to improve screening and diagnosis rates at adolescent well visits by establishing a streamlined universal screening protocol for all patients ages 13-18 years old. Methods A universal sexually transmitted infection (STI) screening approach was introduced at an urban clinic affiliated with an academic medical center near Philadelphia, Pennsylvania (PA) in September 2018 for all adolescent well-visits. GC/CT screening and diagnosis rates were compared two years prior to and two years after implementation, deemed the baseline and intervention groups, respectively. Results In total, 1,168 encounters were included for analysis. The patient cohort consisted of 47% females, with an average age of 15, and were predominantly publicly insured (79%). STI screening rates increased significantly from 16.7% (89/534) to 83.6% (530/634) of adolescents with implementation of the universal screening protocol. Furthermore, there was a 1.6-fold increase in total positive cases detected after implementation of ok universal screening. Conclusion This study demonstrates improved adolescent GC/CT capture rates by establishing a universal screening protocol and highlights a streamlined means of implementation in virtually any pediatric clinic. Limitations include sample size, as this is a single academic practice, as well as any issues with lab collection and results reporting.
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Affiliation(s)
- Anthony Tirone
- Drexel University College of Medicine, 60 N 36th Street, Philadelphia, PA 19104, USA
| | - Laura Maule
- Drexel University College of Medicine, 60 N 36th Street, Philadelphia, PA 19104, USA
| | - Jessie Huang
- Drexel University College of Medicine, 60 N 36th Street, Philadelphia, PA 19104, USA
| | - Jenna Higgins
- Department of Pediatrics, Drexel University College of Medicine and Crozer Health, 30 Medical Center Boulevard POB1 Suite 205, Upland, PA 19013, USA
| | - Tanner Walsh
- Department of Pediatrics, Drexel University College of Medicine and Crozer Health, 30 Medical Center Boulevard POB1 Suite 205, Upland, PA 19013, USA
| | - Domenic Filingeri
- Department of Pediatric Endocrinology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave., Pittsburgh, PA, USA
| | - Alyssa Songveera
- Department of Pediatrics, Stanford University School of Medicine, 750 Welch Road, Suite 220, Palo Alto, CA 94304, USA
| | - Christina Poh
- Meritus Medical Center, 11110 Medical Campus Rd, Hagerstown, MD 21742, USA
| | - Ashley N. Henderson
- Department of Pediatrics, Drexel University College of Medicine and Crozer Health, 30 Medical Center Boulevard POB1 Suite 205, Upland, PA 19013, USA
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Balén Z, Pliskin E, Cook E, Manlove J, Steiner R, Cervantes M, Garrido M, Nuñez-Eddy C, Day M. Strategies to develop an LGBTQIA+-inclusive adolescent sexual health program evaluation. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1327980. [PMID: 38590517 PMCID: PMC11000634 DOI: 10.3389/frph.2024.1327980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Adolescent sexual health interventions are increasingly incorporating content that is inclusive of LGBTQIA+ youth (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other marginalized sexualities and genders). Evaluations of such programs must also be inclusive to enhance the validity of evaluation results and avoid further marginalization. We present strategies for increasing LGBTQIA+-inclusivity based on our evaluation of SafeSpace, a sexual health curriculum. Methods To design an LGBTQIA+-inclusive program evaluation, we leveraged LGBTQIA+ research staff's insights, pursued a parental consent waiver, developed an inclusive recruitment plan, and crafted demographic and sexual behavior survey measures with input from youth and equity experts. We conducted a pilot study with 42 youth ages 14-17 to assess the feasibility and efficacy of our strategies. Results We obtained a parental consent waiver and recruited a majority LGBTQIA+ pilot study sample (62%). Using themes from cognitive interviews with youth and experts regarding inclusive framing and use of plain language, we refined demographic measures and expanded sexual behavior measures. Conclusion Findings suggest that the strategies used to enhance LGBTQIA+-inclusivity in our evaluation of SafeSpace were effective in respectfully and more accurately capturing a fuller range of experiences and identities of LGBTQIA+ and cis-straight youth. The strategies and survey measures developed for this study can be applied to increase LGBTQIA+-inclusivity in other adolescent sexual health program evaluations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maeve Day
- Child Trends, Rockville, MD, United States
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Diana P, Esposito S. Epidemiology, risk factors, and prevention strategies of HIV, HPV, and other sexually transmitted infections among cisgender and transgender youth: a narrative review. Front Public Health 2024; 12:1342532. [PMID: 38515602 PMCID: PMC10955097 DOI: 10.3389/fpubh.2024.1342532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers regarding the influence of their gender identity (GI) and sexual orientation on the risk of STIs. This narrative review aims to analyse the available data to provide a comprehensive overview of STIs incidence and risk factors among adolescents, taking into account the unique circumstances related to various sexual orientations and GIs. Transgender and gender minority (TGM) youth experience more challenges accessing health services compared to cisgender youth. This is often attributed to non-inclusive health environments, barriers to obtaining medical gender affirmation, and an underestimation of sexual risk perception. Literature analysis has revealed that the majority of adolescents, both cisgender and TGM, have limited awareness regarding the risks associated with their sexual behaviors, the most common sexually transmitted diseases, and strategies for prevention, such as PrEP and HPV vaccination. Moreover, a significant portion of pediatricians possess limited knowledge and comfort in addressing various aspects of sexual health, particularly when it involves discussing topics such as sexual orientation, gender identity, and sexual behaviors with sexually active adolescents. This underscores the pressing need for enhanced education for pediatricians, specifically focusing on STIs diagnosis, prevention, and screening.
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Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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Wolford LL, Jansen KL. Who Helps Children With Communication Disorders Access Sex Education? Practice Patterns of Speech-Language Pathologists and Psychologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:848-865. [PMID: 38118453 DOI: 10.1044/2023_ajslp-23-00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
PURPOSE Children with communication disorders are often systematically excluded from sex education curricula. They may also have difficulty accessing the curricula because of the materials' linguistic and pragmatic complexity. Even curricula written for children with intellectual disabilities do not typically include considerations for communication disorders. This places them at risk for sexually transmitted infections, sexual health misinformation, and sexual assault. Yet, it is unclear which professionals are assisting children with communication disorders to access sex education. METHOD North American speech-language pathologists (SLPs) and clinical psychologists (N = 112) completed a survey that asked about their practice patterns in helping children access sex education, as well as their beliefs about the importance of sex education, how disabilities affect sex education, perceived barriers, and their self-efficacy and role in addressing sex education. RESULTS Although SLPs and clinical psychologists believed that communication disorders could affect sex education and consent and felt they had some responsibility for helping their clients in accessing sex education, they did not regularly assist their clients in this area. Both groups of clinicians were divided in their views of their own roles and responsibility. SLPs were especially polarized; every question about their role in addressing sex education included SLPs who fully agreed and some who fully disagreed with the statement. CONCLUSIONS Children with communication disorders do not consistently receive assistance accessing sex education curricula from either SLPs or clinical psychologists. Clinicians need education to support them addressing sex education and clear guidance about their roles in this area.
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Affiliation(s)
- Laura L Wolford
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Kate L Jansen
- Department of Clinical Psychology, Midwestern University, Glendale, AZ
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Wetzel GM, Sanchez DT. "What's Something You've Heard About Sex, But Are Unsure If It's True?": Assessing Middle and High School Students' Sex Education Questions. J Adolesc Health 2024; 74:327-339. [PMID: 37804300 DOI: 10.1016/j.jadohealth.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Comprehensive sex education (CSE) encourages safer sex behavior for teens and young adults. However, young people recognize a gap between sex education as taught in the classroom and the reality of their sexual experiences. Thus, CSE should take into account the perspectives of its target population. METHODS The current project assesses young people's sexual uncertainties by analyzing open-ended responses that were anonymously submitted during in-person sex education sessions. These education programs were administered in middle and high schools in New York State by facilitators from Planned Parenthood Hudson Peconic, Inc. The authors analyzed 1,335 responses from a racially diverse sample of students between the ages of 10 and 21, with 75% of participants between 15 and 17 years old. RESULTS Using content analysis, the authors identified 49 recurring content codes in participants' responses, which were organized into 16 categories. Most responses centered around pregnancy, sexually transmitted infections, and how to prevent these outcomes. However, responses also highlighted topics that are not always covered with nuance and transparency, if at all, in sex education (e.g., withdrawal, effectiveness of condoms and other contraception, anal and oral sex). Additionally, gender analyses indicated that girls made greater reference to pain, while boys made greater reference to pleasure, which has implications for girls' development of a positive sexuality. DISCUSSION These results should be interpreted with a social equity lens to inform the development of needs-driven, target-based CSE programming.
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Affiliation(s)
- Grace M Wetzel
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey.
| | - Diana T Sanchez
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Hawkins SS. Expansion of Comprehensive Sexuality Education. J Obstet Gynecol Neonatal Nurs 2024; 53:14-25. [PMID: 38072008 DOI: 10.1016/j.jogn.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
School-based sex education has always been and continues to be controversial and mired in politics, and gaps persist in the content and skills that children and adolescents receive about sexual health. State policies dictate whether sex and HIV education are mandated, medically accurate, or include life skills such as providing consent to sexual activity, and these policies have important implications for population health. In this column, I review research findings about abstinence only versus sex education or comprehensive sexuality education, identify gaps in research and content related to sex education programs, review state sex education policies, and provide recommendations from professional organizations on expanding school-based programming to include comprehensive sexuality education.
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GAMELIA ELVIERA, ANIES, WIDJANARKO BAGOES, SHALUHIYAH ZAHROH. Systematic review: risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions. J Public Health Afr 2023; 14:2672. [PMID: 38204809 PMCID: PMC10774857 DOI: 10.4081/jphia.2023.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 01/12/2024] Open
Abstract
In many countries, there is a high number of teenage pregnancies, Sexually Transmitted Infections (STIs), and unsafe sexual behavior, so there is a need for adolescent health intervention programs to change behavior. The effectiveness of comprehensive interventions in various contexts to reduce teenage pregnancy, STIs, and related sexual risk behaviors is reviewed in this systematic. This study aimed to identify risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions. Literature search strategy from January 2008 to December 2022 through electronic databases. Key words 'teenage prenancy' OR 'teen pregnancy' OR 'pregnancy adolescence', AND 'maternal education', AND 'randomised clinical trial', AND 'risk behavior'. Articles that were deemed worthy of following the PRISMA guidelines were 28 articles. Most studies looked at school-based, individual, community, clinic, and family-based care. Most studies were followed up after intervention at intervals from one month to seven years, and the majority of the population and sample were adolescents with ages ranging from 13 to 18 years. Implementation of research in urban, suburban, and rural areas. This program has proven successful in preventing pregnancy, contraceptive use, STI and HIV, sexual behavior, dropping out of school, knowledge about pregnancy, sexuality, attitudes towards sexuality, intention to change risky sexual behavior, self-efficacy, and increasing parent-children. This article describes some basic trends in adolescent pregnancy prevention interventions in several countries that can be used as a reference for health programs. Unproven effectiveness can be implemented in conjunction with other interventions that have a high-quality impact.
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Affiliation(s)
| | - ANIES
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
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VanTreeck K, Elnakib S, Chandra-Mouli V. A reanalysis of the Institute for Research and Evaluation report that challenges non-US, school-based comprehensive sexuality education evidence base. Sex Reprod Health Matters 2023; 31:2237791. [PMID: 37548507 PMCID: PMC10408562 DOI: 10.1080/26410397.2023.2237791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Comprehensive sexuality education (CSE) prepares young people to make informed decisions about their sexuality. A review by the Institute of Research and Evaluation that analysed 43 CSE studies in non-US settings found the majority to be ineffective and concluded that there was little evidence of the effectiveness of CSE. We reanalysed the review to investigate its validity. We found several weaknesses with the review's methodology and analysis: (1) there was an absence of a clearly articulated search strategy and specific eligibility criteria; (2) the authors put forth criteria for programme effectiveness but included studies that did not collect the data needed to show programme effectiveness and thus several studies were determined to be ineffective by default; (3) the analytical framework minimised positive intervention effects and privileged negative intervention effects; and (4) there were errors in the data extracted, with 74% of studies containing one or more discrepancies. Overall, our reanalysis reveals that the IRE review suffers from significant methodological flaws and contains many errors which compromise its conclusions about CSE. Our reanalysis is a tool for the international community to refute CSE opposition campaigns based on poor science.
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Affiliation(s)
- Kelly VanTreeck
- Consultant, Department of Sexual and Reproductive Health and Research, World Health Organization, Av. Appia 20, 1202Geneva, Switzerland
| | - Shatha Elnakib
- Consultant, Department of Sexual and Reproductive Health and Research, World Health Organization, Av. Appia 20, 1202Geneva, Switzerland
- Full-time faculty, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Venkatraman Chandra-Mouli
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Harms MB, Garrett-Ruffin SD. Disrupting links between poverty, chronic stress, and educational inequality. NPJ SCIENCE OF LEARNING 2023; 8:50. [PMID: 37985671 PMCID: PMC10662171 DOI: 10.1038/s41539-023-00199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/20/2023] [Indexed: 11/22/2023]
Abstract
The income-achievement gap is a significant and stubborn problem in the United States, which has been exacerbated by the Covid-19 pandemic. In this article, we link two emerging literatures that have historically been disparate: the neurobiology of poverty as a form of early life stress, and research on educational policies with the potential to reduce SES-based disparities in academic achievement. In doing so, we (1) integrate the literature on poverty-related mechanisms that contribute to early life stress, alter neurobiology, and lead to educational inequities, and (2) based on this research, highlight policies and practices at the school/classroom level and broader structural level that have the potential to address the problem of inequity in our educational systems. We emphasize that educational inequity is a systemic issue, and its resolution will require coordination of local, state, and national policies.
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Affiliation(s)
- Madeline B Harms
- Department of Psychology, University of Minnesota Duluth, Duluth, USA.
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15
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Vasilenko SA, Wang X, Liu Q. Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2881-2896. [PMID: 37154880 PMCID: PMC10630535 DOI: 10.1007/s10508-023-02607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/02/2023] [Accepted: 04/16/2023] [Indexed: 05/10/2023]
Abstract
Early sexual intercourse is associated with sexually transmitted infections, pregnancy, and depressive symptoms, and delay of intercourse allows adolescents opportunities to practice relationship skills (Coker et al., 1994; Harden, 2012; Kugler et al., 2017; Spriggs & Halpern, 2008). Thus, understanding predictors of early sexual intercourse is crucial. Prior research has suggested that violence exposure is associated with early initiation of sexual intercourse in adolescence (Abajobir et al., 2018; Orihuela et al., 2020). However, most studies have looked only at a single type of violence exposure. In addition, little research has examined longitudinal patterns of violence exposure in order to determine whether there are particular periods when the violence exposure may have the strongest impact on sexual behavior. Guided by life history and cumulative disadvantage theories, we use longitudinal latent class analysis and data from the Future of Families and Child Well-being Study (N = 3,396; 51.1% female, 48.9% male) to examine how longitudinal patterns of multiple types of violence exposures across ages 3 to 15 are associated with early sexual initiation in adolescence. Findings suggest that experiencing persistent physical and emotional abuse across childhood was associated with the greatest prevalence of early sexual initiation. Early exposure to violence was not consistently associated with greater likelihood of sexual initiation; instead, early abuse was more strongly associated with sexual initiation for boys, while late childhood abuse was more strongly associated for girls. These findings suggest that gender-sensitive programs are highly needed to address unique risk factors for boys' and girls' sexual behaviors.
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Affiliation(s)
- Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University, 144 White Hall, Syracuse, NY, 13244, USA.
| | - Xiafei Wang
- Department of Social Work, Syracuse University, Syracuse, NY, USA
| | - Qingyang Liu
- Department of Human Development and Family Science, Syracuse University, Syracuse, NY, USA
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16
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Bai H, Wang Y, Li X, Guo J. Electrochemical nucleic acid sensors: Competent pathways for mobile molecular diagnostics. Biosens Bioelectron 2023; 237:115407. [PMID: 37295136 DOI: 10.1016/j.bios.2023.115407] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Electrochemical nucleic acid biosensor has demonstrated great promise in clinical diagnostic tests, mainly because of its flexibility, high efficiency, low cost, and easy integration for analytical applications. Numerous nucleic acid hybridization-based strategies have been developed for the design and construction of novel electrochemical biosensors for diagnosing genetic-related diseases. This review describes the advances, challenges, and prospects of electrochemical nucleic acid biosensors for mobile molecular diagnosis. Specifically, the basic principles, sensing elements, applications in diagnosis of cancer and infectious diseases, integration with microfluidic technology and commercialization are mainly included in this review, aiming to provide new insights and directions for the future development of electrochemical nucleic acid biosensors.
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Affiliation(s)
- Huijie Bai
- Key Laboratory of Clinical Laboratory Diagnostics (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Yong Wang
- Key Laboratory of Clinical Laboratory Diagnostics (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Xiaosong Li
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China.
| | - Jinhong Guo
- Key Laboratory of Clinical Laboratory Diagnostics (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China; School of Sensing Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
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17
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Lohan M, Gillespie K, Aventin Á, Gough A, Warren E, Lewis R, Buckley K, McShane T, Brennan-Wilson A, Lagdon S, Adara L, McDaid L, French R, Young H, McDowell C, Logan D, Toase S, Hunter RM, Gabrio A, Clarke M, O'Hare L, Bonell C, Bailey JV, White J. School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-139. [PMID: 37795864 DOI: 10.3310/ywxq8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design A cluster randomised trial, incorporating health economics and process evaluations. Setting Sixty-six schools across the four nations of the UK. Participants Students aged 13-14 years. Intervention A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). Limitations The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration This trial is registered as ISRCTN10751359. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kathryn Gillespie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Lewis
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kelly Buckley
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Susan Lagdon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Adara
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca French
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Honor Young
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | | | | | - Sorcha Toase
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rachael M Hunter
- Health Economics Analysis and Research Methods Team, University College London, London, UK
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Liam O'Hare
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - James White
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
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18
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Poix S, Elmusharaf K. Investigating the pathways from preconception care to preventing maternal, perinatal and child mortality: A scoping review and causal loop diagram. Prev Med Rep 2023; 34:102274. [PMID: 37387730 PMCID: PMC10302151 DOI: 10.1016/j.pmedr.2023.102274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
In recent years, there has been a growing recognition that developing preconception care provides an opportunity to significantly reduce maternal and child mortality and morbidity. This involves targeting multiple risk factors through a large array of medical, behavioural and social interventions. In this study, we created a Causal Loop Diagram (CLD) to describe several pathways by which a set of preconception interventions may lead to women's improved health and better pregnancy outcomes. The CLD was informed by a scoping review of meta-analyses. It summarises evidence on the outcomes and interventions related to eight preconception risk factors. The authors reviewed literature from two databases (PubMed and Embase) and used the framework developed by Arksey and O'Malley. The CLD includes 29 constructs categorised into five different levels (mortality, causes of death, preconception risk factors, intermediate factors, interventions or policies). The model indicates interconnections between five sub-systems and highlights the role of preventing early and rapidly repeated pregnancies, as well as optimising women's nutritional status in the preconception period. It also shows the prevention of preterm birth as a privileged route for lowering child mortality and morbidity. The CLD demonstrates the potential benefits of strategies that address multiple preconception risk factors simultaneously and can be used as a tool to promote the integration of preconception care into efforts to prevent maternal and child mortality. With further improvements, this model could serve as a basis for future research on the costs and benefits of preconception care.
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Affiliation(s)
- Sébastien Poix
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Khalifa Elmusharaf
- Applied Health Research, University of Birmingham Dubai, Dubai, United Arab Emirates
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19
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Dickson E, Brakey HR, Wilson P, Hackett JM, McWethy M. Classroom Voices: Youth Perspectives to Direct School-based Sexual Health Education. SEX EDUCATION 2023; 24:479-496. [PMID: 38947913 PMCID: PMC11213557 DOI: 10.1080/14681811.2023.2218267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 07/02/2024]
Abstract
Sexual health education is a well-known, evidence-based intervention that can improve adolescent health outcomes, increase protective health behaviours, and decrease risky health behaviours. Providing sexual health education in school settings offers opportunities for discussion of critical health topics and can improve the school environment for all students. However, not all sexual health education is taught equitably across classroom environments. As part of a mixed-methods study to describe school-based sexual health education, we conducted focus groups and interviews with recently graduated high school students in New Mexico, a geographically and ethnically diverse state in the US Southwest. Thirty-one young people shared their experiences, explored the sexual health education content they had been taught, and offered recommendations to improve sexual health education. Three key themes were developed: young people wanted and needed sexual health education taught in school settings; the sexual health education currently taught in school is not helpful and sometimes harmful; and the individuals who teach sexual health education are critically important. These findings can inform and support school staff and administrators addressing barriers to school-based sexual health education delivery, particularly in schools within marginalised communities with limited resources. The results support including youth as stakeholders in the planning, delivery and evaluation of school-based sexual health education; and the development of sexual health education training for teachers, with the goal of improving health outcomes for all youth populations.
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Affiliation(s)
- Elizabeth Dickson
- College of Nursing, Albuquerque, University of New Mexico, New Mexico, USA
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Persephone Wilson
- Planned Parenthood of the Rocky Mountains, Albuquerque, New Mexico, USA
| | - Janna M. Hackett
- College of Nursing, Albuquerque, University of New Mexico, New Mexico, USA
| | - Magdalena McWethy
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
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20
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Robbins T, Szucs LE, Trujillo L, Young E. AIDS or HIV Education and Sexual Behaviors Among Adolescent Sexual Minority Males: National HIV Behavioral Surveillance, 3 U.S. Cities, 2015. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:201-212. [PMID: 37410370 PMCID: PMC11057022 DOI: 10.1521/aeap.2023.35.3.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
In the U.S., HIV transmission rates have increased among male-male sexual contacts. Sex education reduces HIV-related risks; yet impacts for adolescent sexual minority males (ASMM) are less known. Data from a sample (n = 556) of ASMM (aged 13-18) in three U.S cities were used to examined associations between HIV education in school and sexual behaviors. Outcomes of interest included: sexually transmitted infection (STI), multiple sex partners, and condomless anal intercourse (CAI) with a male (all past 12 months). Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were calculated. Of 556 ASMM, 84% reported received HIV education. Among sexually active ASMM (n = 440) who received HIV education, fewer reported an STI (10% vs. 21%, aPR: 0.45, CI [0.26, 0.76]) and CAI (48% vs. 64%, aPR: 0.71, CI [0.58, 0.87]) than ASMM who did not receive HIV education. Protective effects of school HIV education on sexual behaviors are promising and suggest prevention education is vital to reducing HIV- and STI-related risks among ASMM.
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Affiliation(s)
- Taylor Robbins
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leigh E Szucs
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta
| | - Lindsay Trujillo
- ICF International, Fairfax, Virginia. Emily Young is also affiliated with the Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Emily Young
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta
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21
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Munshi I, Ishaq JK, Liebhardt B, Goncy EA. Maternal Communication About Sexual Content and Ease of Access to Contraceptives. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1607-1616. [PMID: 36385683 DOI: 10.1007/s10508-022-02476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
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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Affiliation(s)
- Ishita Munshi
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Jennifer K Ishaq
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Briana Liebhardt
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Elizabeth A Goncy
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA.
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22
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Torres-Cortés B, Leiva L, Canenguez K, Olhaberry M, Méndez E. Shared Components of Worldwide Successful Sexuality Education Interventions for Adolescents: A Systematic Review of Randomized Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4170. [PMID: 36901181 PMCID: PMC10002383 DOI: 10.3390/ijerph20054170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
A crucial aspect of human development is sexuality which has implications for health, particularly in adolescence, since unfavorable sexual experiences may result in physical and mental problems. Sexuality education interventions (SEI) are one of the most used actions to promote sexual health in adolescents. Nevertheless, there is variability across their components; therefore, key elements for an effective SEI targeted at adolescents (A-SEI) are not well known. Based on this background, this study aims to identify the shared components of successful A-SEI through a systematic review of randomized controlled trials (RCT). This study followed the preferred reporting items for systematic reviews and meta-analyses statement. A search was conducted in CINAHL, PsycInfo, PubMed, and Web of Science between November and December 2021. A total of 21 studies passed the inclusion test after the review of 8318 reports. A total of 18 A-SEIs were identified in these studies. The components analyzed were the intervention's approach, dose, type of intervention, theoretical framework, facilitators' training, and intervention methodology. The results established that components that should be present in the design of an effective A-SEI are behavior change theoretical models, the use of participatory methodology, be targeted at mixed-sex groups, facilitators' training, and at least ten hours of weekly intervention.
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Affiliation(s)
- Betzabé Torres-Cortés
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Avenida Capitán Ignacio Carrera Pinto 1045, Ñuñoa 7800284, Chile
- Millennium Institute for Research on Depression and Personality (MIDAP), Av. Vicuña Mackenna 4860, Macul 7820436, Chile
| | - Loreto Leiva
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Avenida Capitán Ignacio Carrera Pinto 1045, Ñuñoa 7800284, Chile
| | - Katia Canenguez
- Department of Psychiatry, Massachusetts General Hospital, Yawkey 6A, 55 Fruit Street, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Marcia Olhaberry
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Millennium Institute for Research on Depression and Personality (MIDAP), Av. Vicuña Mackenna 4860, Macul 7820436, Chile
| | - Emmanuel Méndez
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Department of Psychiatry, Faculty of Medicine, Universidad de Chile, Gran Av. José Miguel Carrera 3100, San Miguel 8900085, Chile
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23
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Appiah R. Facilitating change processes in group-based behaviour change interventions in rural African contexts: practical lessons from Ghana. Int J Ment Health Syst 2023; 17:3. [PMID: 36747199 PMCID: PMC9900900 DOI: 10.1186/s13033-023-00571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Evidence from implementation research suggests that group-based behaviour change interventions (GBCIs) can encourage the development of peer support, promote psychosocial skills, and facilitate collaborative therapeutic relationships. However, although the mechanisms of action that mediate the behaviour change process have been extensively described in other settings, less is known about the implementation strategies and contextual factors that actuate the reported behaviour changes among programme participants in Ghana and sub-Saharan Africa, more generally. We draw on insights from the literature and field experiences from designing, implementing, and evaluating GBCIs across several rural and peri-urban communities in Ghana to discuss a range of theoretical, methodological, and contextual factors that facilitate the behaviour change process in programme participants. We offer suggestions to guide researchers to envision and manage potential challenges with the programme development and implementation processes. We propose that intervention programmes designed to facilitate health behaviour change in the defined context should (i) have a context-relevant focus, (ii) be coherent and well-structured, (iii) have explicit techniques to facilitate inter-personal and intra-personal change processes, (iv) include appropriate mechanisms to monitor and assess the progress of the interventional sessions; and (v) be implemented by trained facilitators with a deep knowledge of the sociocultural values and norms of the target group and of the principles and theories underlying the intervention programme. We envisage that these insights could serve to guide the design, implementation, and evaluation of contextually-tailored and potentially effective GBCIs that align with the needs, capacities, and circumstances of the local population.
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Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Accra, Ghana. .,Center for African Studies, Harvard University, Cambridge, MA, USA. .,Department of Psychology, University of Johannesburg, Johannesburg, South Africa.
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24
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Benjamin SN, Crandall AL, Hirsch JS. Sex 101: A Rapid Review of Research in the United States on the Impacts of College Sexual Health Curricula. SEX EDUCATION 2023; 24:272-289. [PMID: 38390516 PMCID: PMC10881205 DOI: 10.1080/14681811.2023.2171001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/18/2023] [Indexed: 02/24/2024]
Abstract
Comprehensive sexuality education (CSE) has been shown to have a wide range of positive impacts for K-12 students. Despite its demonstrated benefits, many K-12 students in the USA do not receive CSE. Because of this, college may be an opportune time to teach this information. However, little is known about the impact of CSE at institutions of higher education. To synthesise knowledge about the impacts of college-level sexual health courses in the USA, a review of the topic was conducted. A review searching Ebscohost, ProQuest, PubMed, and Google Scholar was undertaken. Following the search, a second coder reviewed the articles to confirm eligibility. 13 articles, published between 2001 and 2020, met the inclusion criteria and were included in the review. A wide range of outcomes were reported. These included increased health promoting behaviours, less homophobic and judgemental attitudes around sexuality, improved communication and relationships, and increased understanding of sexual violence. College sexual health courses have high potential efficacy to provide CSE and fill gaps in US students' sexual health knowledge. Future research should corroborate the existing outcomes using randomisation and more diverse samples and examine whether these courses are effective in preventing sexual assault.
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Affiliation(s)
- Shoshana N. Benjamin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University New York, NY, USA
| | - Amy L. Crandall
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University New York, NY, USA
| | - Jennifer S. Hirsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University New York, NY, USA
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Epps B, Markowski M, Cleaver K. A Rapid Review and Narrative Synthesis of the Consequences of Non-Inclusive Sex Education in UK Schools on Lesbian, Gay, Bisexual, Transgender and Questioning Young People. J Sch Nurs 2023; 39:87-97. [PMID: 34605714 PMCID: PMC9841814 DOI: 10.1177/10598405211043394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Relationships and Sex Education (RSE) in schools are predominantly heterocentric. Consequently, lesbian, gay, bisexual, transgender, and questioning young people have reported feeling excluded. This exclusion results in feelings of being "different" and "other," which in turn leads to further disengagement in the sex education classroom, contributing to poor sexual health literacy, greater risk of abusive relationships, and higher rates of sexually transmitted infections. A rapid review was undertaken to identify the impact of non-inclusive sex education. The review makes recommendations for policy and practice, which includes the provision of training courses to school teaching staff with an emphasis on inclusive RSE, appropriate online resources for lesbian, gay, bisexual transgender, and questioning (LGBTQ) young people, as well as offering 1:1 emotional health support for LGBTQ young people as they begin to question their sexual orientation.
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Affiliation(s)
- Beth Epps
- Kent School Health Team, Children and Young People's Directorate, Kent Community Health NHS Foundation Trust, Maidstone, UK
| | - Marianne Markowski
- Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK,Marianne Markowski, Research Fellow, Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK.
| | - Karen Cleaver
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
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Szucs LE, Demissie Z, Steiner RJ, Brener ND, Lindberg L, Young E, Rasberry CN. Trends in the teaching of sexual and reproductive health topics and skills in required courses in secondary schools, in 38 US states between 2008 and 2018. HEALTH EDUCATION RESEARCH 2023; 38:84-94. [PMID: 36315469 PMCID: PMC11002834 DOI: 10.1093/her/cyac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/01/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Information about state and local education policies regarding sexually transmitted infections, including human immunodeficiency virus, and unintended pregnancy prevention is available, yet less is known about school-level implementation of such policies. We examine trends in the percentage of US secondary schools teaching sexual and reproductive health (SRH) topics in a required course in Grades 6-8 and 9-12, including healthy relationships, sexual abstinence, condoms and condoms with other contraceptive methods. We analyze representative data from 38 states across six cycles of School Health Profiles (2008-18) assessed through self-administered questionnaires completed by lead health teachers. Logistic regression models examined linear trends in the percentages of schools teaching topics for Grades 6-8 and 9-12, separately. Trends were calculated for states having representative data for at least three cycles, including 2018. During 2008-18, it was more common to have increases in teaching how to obtain condoms, correct condom use and use condoms with other contraceptive methods in Grades 6-12 than decreases. More states showed decreases in teaching abstinence in Grades 6-12 than increases. Most states had no change in teaching SRH topics across grades. Findings suggest some improvement in school-based SRH education, yet efforts are needed to improve comprehensive, developmentally appropriate content.
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Affiliation(s)
- Leigh E. Szucs
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
| | - Zewditu Demissie
- Division of Violence Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS S106-10, Atlanta, GA 30333, USA\
- U.S. Public Health Service Commissioned Corps, 1101 Wootton Pkwy, Rockville, MD 20852, USA
| | - Riley J. Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS S107-2, Atlanta, GA 30333, USA
| | - Nancy D. Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
| | - Laura Lindberg
- The Guttmacher Institute, 125 Maiden Lane, New York, NY 10038, USA
| | - Emily Young
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830, USA
| | - Catherine N. Rasberry
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
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Hurst JL, Widman L, Brasileiro J, Maheux AJ, Evans-Paulson R, Choukas-Bradley S. Parents' attitudes towards the content of sex education in the USA: Associations with religiosity and political orientation. SEX EDUCATION 2023; 24:108-124. [PMID: 38464814 PMCID: PMC10923385 DOI: 10.1080/14681811.2022.2162871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/22/2022] [Indexed: 03/12/2024]
Abstract
While most parents support their adolescents receiving school-based sex education, there is variability in which sex education topics receive the most support from parents. Conservative political orientation and greater religiosity have been independently associated with parents' lack of support for school-based sex education; however, no studies have examined the intersection of these two factors. The three goals of this study were to: 1) identify how specific sexual education topics cluster together to form content areas; 2) examine if religiosity and political orientation are uniquely associated with these content areas; and 3) examine if political orientation moderates the relationship between parents' religiosity and their perceived importance for the specific sex education content areas. Participants were a national sample of 881 US parents. The sex education topics clustered into three content areas: Factual Knowledge (e.g., STI transmission), Practical Skills (e.g., how to access condoms), and Pleasure and Identity (e.g., pleasurable aspects of sex). Politically conservative and more religious parents reported the lowest perceived importance for each content area. Importantly, these main effects were qualified by a significant interaction: parents who reported both political conservativism and high levels of religiosity reported the lowest perceived importance for these three content areas being taught.
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Affiliation(s)
- Jeffrey L Hurst
- Department of Psychology, North Carolina State University, Raleigh, USA
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh, USA
| | - Julia Brasileiro
- Department of Psychology, North Carolina State University, Raleigh, USA
| | - Anne J Maheux
- Department of Psychology, University of Pittsburgh, USA
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Improving Adolescent Perceptions of Barriers and Facilitators to Sexual and Reproductive Health Services Through Sexual Health Education. J Adolesc Health 2023; 72:138-146. [PMID: 36289042 DOI: 10.1016/j.jadohealth.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examines whether comprehensive sexual health education that provides information on clinical services can change adolescents' perceptions of barriers, facilitators, and intention to use services and whether changes in perceptions differ by participant characteristics. METHODS Adolescent participants in a statewide sexual health education program in California were surveyed at baseline and at exit about their perceptions of barriers, facilitators, and intention to use clinical services. Linked baseline and exit surveys (n = 7,460) assessed change in perceptions after program completion. Logistic regression analyses that accounted for the clustered data structure assessed associations between participant characteristics and improvement in perceptions. RESULTS After the program, there were significant reductions in two perceived barriers (worry about cost and judgment by staff), but there were also small but significant increases in perceptions of two barriers (worry about confidentiality of services and test results). There were significant increases in all three perceived facilitators and intention to use sexual and reproductive health services, which rose from 90.6% at baseline to 96.2% at exit. Younger youth were more likely than older youth to show improvement in all perceived facilitators and intentions. Girls and Black youth were more likely than boys and Hispanic youth to show improvement in two facilitators (knowing what to expect and access). No sociodemographic characteristics were consistently associated with reductions in perceived barriers. DISCUSSION Comprehensive sexual health education that addresses adolescents' questions and concerns regarding clinical services can help to reduce perceived barriers, increase facilitators, and increase intention to use services if needed.
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Seewald LA, Myers M, Zimmerman MA, Walton MA, Cunningham RM, Rupp LA, Haasz M, Carter PM. Firearm safety counseling among caregivers of high-school age teens: Results from a National Survey. Prev Med 2022; 165:107285. [PMID: 36183798 PMCID: PMC9900740 DOI: 10.1016/j.ypmed.2022.107285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/08/2023]
Abstract
Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020-7/22/2020) was conducted among caregivers (n = 2924) of teens (age:14-18). Weights were applied to generate nationally representative estimates. Bivariate analyses and multivariate regressions were examined. Among respondents, 56.0% were women, 75.1% were non-Hispanic White, and mean (SD) age was 47.4. Firearm safety was the least discussed topic among caregivers reporting their teen received HCP preventative counseling (14.9%). For caregivers receiving counseling, the most common issues discussed were household firearms screening (75.7%); storing firearms locked (66.8%); and storing firearms unloaded (53.0%). Only 24.6% of caregivers indicated firearm safety was an important issue for teen HCPs to discuss and only 21.9% trusted teen HCPs to counsel about firearm safety. Female caregivers (aOR = 1.86;95%CI = 1.25-2.78), those trusting their teen's HCP to counsel on firearm safety (aOR = 9.63;95%CI = 6.37-14.56), and those who received teen HCP firearm safety counseling (aOR = 5.14;95%CI = 3.02-8.72) were more likely to favor firearm safety counseling. Caregivers of teens with prior firearm safety training (aOR = 0.50;95%CI = 0.31-0.80) were less likely to agree that firearm safety was an important preventative health topic. In conclusion, few caregivers receive preventive counseling on firearm safety from their teen's HCP, with trust a key barrier to effective intervention delivery. Future research, in addition to understanding barriers and establishing effective strategies to increase safety practices, should focus on increasing provider counseling competency.
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Affiliation(s)
- Laura A Seewald
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, United States of America.
| | - Matthew Myers
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Marc A Zimmerman
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maureen A Walton
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Addiction Center, Dept of Psychiatry, Univ of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America
| | - Rebecca M Cunningham
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Laney A Rupp
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maya Haasz
- Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America
| | - Patrick M Carter
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
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Eisenberg ME, Oliphant JA, Plowman S, Forstie M, Sieving RE. Increased Parent Support for Comprehensive Sexuality Education Over 15 Years. J Adolesc Health 2022; 71:744-750. [PMID: 36220687 DOI: 10.1016/j.jadohealth.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Jennifer A Oliphant
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Shari Plowman
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Melanie Forstie
- Office of Measurement Services, University of Minnesota, Minneapolis, Minnesota
| | - Renee E Sieving
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; School of Nursing, University of Minnesota, Minneapolis, Minnesota
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Gross G, Ling R, Richardson B. Improving curriculum delivery: Using a results informed quality improvement model for teen behavioral health education. Front Public Health 2022; 10:965534. [PMID: 36466477 PMCID: PMC9709193 DOI: 10.3389/fpubh.2022.965534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
Adolescence is a critical developmental stage to establish healthy decision-making processes and behavior patterns. Many interventions such as evidence-based curricula have been implemented to guide adolescents to avoid risk-taking behaviors and improve health and medical knowledge and outcomes. This study presents a participatory approach informed by the three-stage (3S) quality improvement process model to improve the quality of curriculum delivery, based on the results indicating outcomes achieved, needs for improvement, and quality assurance for maintaining the expected outcomes of an evidence-based curricula. Tests were conducted before and after the intervention. Using threshold levels and measures of change in the tests, instructors participated in guided discussion and analysis of the data to identify where and how instructional improvements should be made and where outcomes were being achieved as expected. This method was used to diagnose variation in the results and delivery and identify root causes informing actions to improve curriculum delivery and outcomes. After the facilitated discussions, pre- and post-tests from subsequent classes were analyzed. The results showed improved test item scores ranging from 2 to 69.5% and seven of 18 items obtained statistical significance following the implementation of the model described. Overall, an increase in the mean percent correct of 17.1% was found.
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Affiliation(s)
- Gregory Gross
- National Resource Center for Family Centered Practice, University of Iowa School of Social Work, Des Moines, IA, United States,Brown School, Washington University, St. Louis, MO, United States
| | - Rui Ling
- National Resource Center for Family Centered Practice, University of Iowa School of Social Work, Des Moines, IA, United States
| | - Brad Richardson
- National Resource Center for Family Centered Practice, University of Iowa School of Social Work, Des Moines, IA, United States,*Correspondence: Brad Richardson
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Brasileiro J, Widman L, Norwalk K, McCrimmon J, Mullins L. National trends and disparate access to formal and informal sex education among youth involved with the child welfare system in the USA. SEX EDUCATION 2022; 23:723-739. [PMID: 37849527 PMCID: PMC10578646 DOI: 10.1080/14681811.2022.2134102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 10/19/2023]
Abstract
This study aimed to understand whether youth involved with the child welfare system in the USA are receiving formal and informal sex education. Data come from the Second National Survey of Child and Adolescent Wellbeing, a nationally representative sample of children and adolescents in contact with child protective services. Participants included young people (n=1093, aged 11-21) involved with the child welfare system. Participants reported whether they had received formal sex education about a) abstinence only; b) contraceptives/condoms only; c) abstinence and contraceptives/condoms; or d) none. They also reported whether they knew where to access family planning services. We examined the prevalence of sex education experiences and differences in sex education access and knowledge based on participants' pregnancy history and sociodemographic characteristics. Only half (49%) of participants had received any form of formal sex education. Pregnant youth were less likely to have received any sex education compared to non-pregnant youth (p=.045). 72% of adolescents who had received sex education about contraceptives/condoms reported knowing where to access family planning services compared to only 46% of adolescents who had not received sex education about contraceptives/condoms (p=.014). There is a pressing need for comprehensive sex education among young people involved with the child welfare system in the USA.
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Affiliation(s)
| | - Laura Widman
- Department of Psychology, North Carolina State University, USA
| | - Kate Norwalk
- Department of Psychology, North Carolina State University, USA
| | | | - Lily Mullins
- Department of Psychology, North Carolina State University, USA
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Ghazi HF, Taher TMJ, Hassan MR. Systematic review on effectiveness of prevention programs for sexually transmitted diseases (STD). J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wang B, Deveaux L, Herbert C, Li X, Cottrell L, Adderley R, Poitier M, Mortimer A, Rolle G, Marshall S, Forbes N, Stanton B. Comparing standard versus enhanced implementation of an evidence-based HIV prevention program among Bahamian sixth grade students: findings from nationwide implementation trials. BMC Public Health 2022; 22:1442. [PMID: 35906572 PMCID: PMC9334549 DOI: 10.1186/s12889-022-13848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Effective implementation strategies are needed to address the challenges encountered by teachers in implementation of evidence-based HV prevention programs in schools. The current study: 1) compares implementation fidelity of Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT) intervention using enhanced implementation strategies (including biweekly monitoring/feedback and site-based mentoring) to those using more traditional approach (teacher training only); and 2) evaluates the impact of school coordinators’ and mentors’ performance on teachers’ implementation fidelity and student outcomes. Methods Data from an enhanced implementation trial in 2019–2020, involving 24 government primary schools, 79 teachers, and 2252 students, were compared to data from a standard implementation trial in 2011–2012, involving 35 government primary schools, 110 teachers and 2811 students using mixed-effects modeling and structural equation modeling. Findings Teachers in the 2019–2020 trial taught more core activities (28.3 vs. 16.3, t = 10.80, P < 0.001) and sessions (7.2 vs. 4.4, t = 9.14, P < 0.001) than those participating in the 2011–2012 trial. Teachers taught > 80% of the intervention curriculum in 2019–2020 compared to 50% curriculum delivery in 2011–2012. Teachers who had a “very good” or “excellent” school coordinator in their schools taught more core activities than those who had a “satisfactory” school coordinator (30.4 vs. 29.6 vs. 22.3, F = 18.54, P < 0.001). Teachers who worked in a school which had a “very good” mentor, taught more core activities than those teachers who did not have a mentor or had only a “satisfactory” mentor (30.4 vs. 27.6; t = 2.96; p = 0.004). Teachers’ confidence in implementing core activities, comfort level with the curriculum, attitudes towards sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers’ implementation fidelity. The degree of implementation was significantly associated with improved student outcomes. Implications/conclusion An evidence-based HIV prevention intervention can achieve a high degree of implementation when delivered with enhanced implementation strategies and implementation monitoring. Future program implementers should consider the purposeful selection and training of school coordinators and mentors to support low-implementing teachers as a potentially important strategy when attempting to achieve high-quality implementation of school-based interventions.
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Affiliation(s)
- Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Lynette Deveaux
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Carly Herbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, 915 Greene Street, Suite 408, Columbia, SC, 29208, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, 959 Hartman Run Road., Morgantown, WV, 26506, USA
| | - Richard Adderley
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Maxwell Poitier
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Arvis Mortimer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Glenda Rolle
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Sharon Marshall
- Department of Pediatrics, Wayne State University School of Medicine, 400 Mack Avenue, Detroit, MI, 48201, USA
| | - Nikkiah Forbes
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Bonita Stanton
- Hackensack Meridian School of Medicine, 340 Kingsland, St., Nutley, NJ, 07110, USA
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Walker R, Fields J, Gilbert J, Leahy D. School-Based Education: An Opportunity to Promote Equitable Access to Sexual and Reproductive Health Knowledge. Semin Reprod Med 2022; 40:193-198. [PMID: 35830868 DOI: 10.1055/s-0042-1742336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
All young people are entitled to knowledge and support that protects their sexual and reproductive health. School-based education is the most opportune setting for young people to have equitable access to sexual and reproductive health education. However, there is room for significant improvements in the provision of sexual and reproductive health education globally, and a range of barriers to be addressed. The Global Standards for Health Promoting Schools is a framework for governments, policy-makers, and schools to ensure that all students receive sexual and reproductive health education and support that promotes their sexual and reproductive health and overall health and well-being. The Global Standards for Health Promoting Schools acknowledges that school environments, partnerships, governance, policies, and resources are ultimately influenced by government resources and policy, and that advocacy and meaningful action across each standard is required.
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Affiliation(s)
- Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash, Australia
| | - Jessica Fields
- Department of Health and Society, University of Toronto, Toronto, Canada
| | - Jen Gilbert
- Faculty of Education, York University, York, Canada
| | - Deana Leahy
- Faculty of Education, Monash University, Monash, Australia
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LGBTQ+ Youth Health: An Unmet Need in Pediatrics. CHILDREN 2022; 9:children9071027. [PMID: 35884011 PMCID: PMC9325167 DOI: 10.3390/children9071027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
Abstract
At present, lesbian, gay, bisexual, transgender, queer and intersex people (LGBTQ+) are increasingly being empowered to freely express themselves, particularly young people and rising generations. Although data underline the trend of more open expression of different sexual orientations and gender identities, LGBTQ+ adolescents still suffer discrimination in the health care framework. Inclusive care by providers to look after the health of LGBTQ+ indiviuals is needed. Pediatricians are often the first health care providers for LGBTQ+ youth facing their sexual and gender identities. Unfortunately, pediatricians have limited knowledge about LGBTQ+ issues, which keeps them from fulfilling the specific needs of LGBTQ+ youth. The purpose of this review is to frame the most important aspects of LGBTQ+ youths’ lives, including risks, difficulties and needs, that pediatricians should investigate and meet to provide these youth with better and more individualizedassistance regarding their health. A literature analysis showed that pediatricians have insufficient knowledge of and comfort with several items regarding the management of LGBTQ+ youths. Increased awareness and knowledge of the specific and exclusive needs of LGBTQ+ adolescents are mandatory, including dedicated pediatric LGBTQ+ health care training. This would give them the opportunity to forward an inclusive health care system, thus reducing the risks related to stigma, bullying and family rejection and promoting sex education. Further studies are needed to better evaluate the prevalence of LGBTQ+ youths, gender-based medicine in pediatrics and the effects of COVID-19 on the LGBTQ+ younth population due to increased risks of psychosocial suffering, isolation and mental diseases.
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Lohan M, Brennan-Wilson A, Hunter R, Gabrio A, McDaid L, Young H, French R, Aventin Á, Clarke M, McDowell C, Logan D, Toase S, O’Hare L, Bonell C, Gillespie K, Gough A, Lagdon S, Warren E, Buckley K, Lewis R, Adara L, McShane T, Bailey J, White J. Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial. THE LANCET PUBLIC HEALTH 2022; 7:e626-e637. [DOI: 10.1016/s2468-2667(22)00117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
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Young E, Demissie Z, Brener ND, Benes S, Szucs LE. Trends in Teaching Sexual and Reproductive Health Skills in US Secondary Schools in 35 States, 2008 to 2018. THE JOURNAL OF SCHOOL HEALTH 2022; 92:711-719. [PMID: 35322428 PMCID: PMC9307078 DOI: 10.1111/josh.13179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Little is known about trends in implementing skills-based instruction in US schools, specifically for sexual and reproductive health (SRH). We examined state-level trends in the percentage of US secondary schools teaching SRH skills in a required course in grades 6 to 8 and 9 to 12. METHODS Representative data from 35 states participating across 6 cycles of School Health Profiles (2008-2018) was analyzed. The prevalence of teaching four SRH skills was assessed through lead health education teacher self-administered questionnaires. Logistic regression models examined linear trends in the percentages of schools teaching SRH skills in grades 6 to 8 and 9 to 12. Trends were calculated for states with weighted data (response rates ≥70%) for at least 3 cycles, including 2018. RESULTS During 2008 to 2018, the median percentage of schools addressing each SRH skill ranged from 63.5% to 69.7% (grades 6-8) and 88.2% to 92.0% (grades 9-12). Linear decreases in SRH skills instruction were more common for grades 6 to 8 than grades 9 to 12; linear increases were comparable for both groups. Most states demonstrated no change in the percentage of schools teaching SRH skills in grades 6 to 8 and 9 to 12. CONCLUSIONS Limited changes and decreases in SRH skills instruction in US secondary schools suggest efforts to strengthen SRH education are needed.
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Affiliation(s)
- Emily Young
- Oak Ridge Associated Universities, 1299 Bethel Valley Road, Oak Ridge, TN 37830; The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027
| | - Zewditu Demissie
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027; U.S. Public Health Service Commissioned Corps 1101 Wootton Pkwy, Rockville, MD 20852
| | - Nancy D. Brener
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027
| | - Sarah Benes
- Merrimack College 315 Turnpike Street, North Andover, MA 01845
| | - Leigh E. Szucs
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027
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Tabaac AR, Johns MM, Zubizarreta D, Haneuse S, Tan AS, Austin SB, Potter J, Lindberg L, Charlton BM. Associations between sexual orientation, sex education curriculum, and exposure to affirming/disaffirming LGB content in two US-based cohorts of adolescents. SEX EDUCATION 2022; 23:506-523. [PMID: 37771517 PMCID: PMC10530727 DOI: 10.1080/14681811.2022.2072286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/27/2022] [Indexed: 09/30/2023]
Abstract
Sexual health education experienced by lesbian, gay, and bisexual (LGB) youth varies widely in relevancy and representation. However, associations among sexual orientation, type of sex education, and exposure to affirming or disaffirming content have yet to be examined. Understanding these patterns can help to address gaps in LGB-sensitive sex education. Our goal in this study was to examine the prevalence and associations among abstinence-only until marriage (AOUM) and comprehensive sex education with LGB-affirming and -disaffirming content sought/received before age 18 (from 1999-2014) by sexual orientation (completely heterosexual with same-sex contact, completely heterosexual with no same-sex contact, mostly heterosexual, bisexual, gay/lesbian) in a sample of 12,876 US young adults from the Growing Up Today Study. Compared to completely heterosexual referents, LGB participants who received AOUM sex education were more likely to encounter LGB-disaffirming content, and this effect was largest among sexual minority participants. Conversely, exposure to comprehensive sex education was associated with receipt of LGB-affirming information. Overall, participants commonly reported receiving AOUM sex education, which may lead to deficits and potential harm to sexual minorities.
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Affiliation(s)
- Ariella R. Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michelle M. Johns
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andy S.L. Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jennifer Potter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Fenway Institute, Boston, MA, USA
| | | | - Brittany M. Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA, USA
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Hegdahl HK, Musonda P, Svanemyr J, Zulu JM, Grønvik T, Jacobs C, Sandøy IF. Effects of economic support, comprehensive sexuality education and community dialogue on sexual behaviour: Findings from a cluster-RCT among adolescent girls in rural Zambia. Soc Sci Med 2022; 306:115125. [PMID: 35724585 DOI: 10.1016/j.socscimed.2022.115125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/14/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Abstract
Adolescent girls in Sub-Saharan Africa are at high risk of poor sexual and reproductive health outcomes. We present findings from a cluster-randomised trial in rural Zambia on the effects of economic support, comprehensive sexuality education (CSE) and community dialogue on sexual activity, contraceptive use and beliefs among adolescent girls. We recruited 157 schools in 2016, and all girls in grade 7 were invited to participate. Schools were randomised to either economic support, combined economic support, CSE and community dialogue, or control. Economic support consisted of unconditional cash transfers to girls and their guardians, and payment of school fees for girls continuing to grades eight and nine. CSE and community dialogue meetings focused on practices around girls' fertility, marriage and education. The interventions lasted two years from 2016 to 2018, with follow-up for another two years. The effects on outcomes were measured in 2018 and 2019 and compared using generalised estimating equations. We found that economic support lowered sexual activity (risk ratio (RR) 0.70; 95% C.I. 0.54 to 0.91), with a small added benefit of CSE and community dialogue. Economic support and the additional CSE and community dialogue were effective in lowering unprotected sexual activity (RR 0.53 for combined support vs. control; 95% C.I. 0.37 to 0.75). There was no evidence of intervention effects on contraceptive use among those ever sexually active, but the addition of CSE and community dialogue improved contraceptive use among those recently sexually active (RR 1.26; 95% C.I. 1.06 to 1.50) and knowledge regarding contraceptives (RR 1.18; 95% C.I. 1.01 to 1.38) compared to economic support alone. Perceived community support regarding contraceptives was lower in both intervention arms compared to the control. These findings indicate that economic support in combination with CSE and community dialogue can improve the sexual and reproductive health of adolescent girls.
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Affiliation(s)
- Hanne Keyser Hegdahl
- Centre for International Health, University of Bergen, Årstadveien 21 (Overlege Danielsens Hus), 5006, Bergen, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, NO-5020, Bergen, Norway.
| | - Patrick Musonda
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Joar Svanemyr
- Chr. Michelsen Institute, P.O. Box 6033, N-5892, Bergen, Norway
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Taran Grønvik
- Centre for International Health, University of Bergen, Årstadveien 21 (Overlege Danielsens Hus), 5006, Bergen, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, NO-5020, Bergen, Norway
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Ingvild Fossgard Sandøy
- Centre for International Health, University of Bergen, Årstadveien 21 (Overlege Danielsens Hus), 5006, Bergen, Norway; Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, NO-5020, Bergen, Norway
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Rusley JC, Tao J, Koinis-Mitchell D, Rosenthal AE, Montgomery MC, Nunez H, Chan PA. Trends in risk behaviors and sexually transmitted infections among youth presenting to a sexually transmitted infection clinic in the United States, 2013-2017. Int J STD AIDS 2022; 33:634-640. [PMID: 35387518 DOI: 10.1177/09564624221077785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sexually transmitted infections (STIs) are increasing among adolescents and young adults (AYA) across the United States. However, data are scarce on trends in condom use, number of partners, and other STI risk factors among AYA. The present study evaluated associations between sexual behaviors and STI diagnoses over time among AYA. Methods: We evaluated linked encounters of AYA aged 13-26 attending an urban Northeast public STI clinic from 2013-2017. Demographics, risk behaviors, self-reported past year and lifetime STI, and STI diagnosis during clinic encounter (positive test for urine, oral, or anal chlamydia; urine, oral, or anal gonorrhea; urine trichomonas; HIV; and syphilis) were extracted from electronic health records. We estimated prevalence and performed trend analyses of the repeated cross-sectional data. Cochran-Armitage and Kruskal-Wallis trend test were conducted for categorical and continuous variables, respectively. Results: Among 3822 encounters, clinical STIs demonstrated statistically significant increases including chlamydia (+9%, p = 0.001), gonorrhea (+5%, p = 0.008), and syphilis (+3%, p = 0.006) all of which significantly increased over time, as did any STI (+10%, p < 0.001). HIV and trichomonas rates remained low and unchanged. Self-reported STI increased as well, both past year (+9%) and lifetime (+14%). Greater proportions of AYA reported multiple partners (+9%, p < 0.001), and condomless oral (+12%, p = 0.001) and vaginal/anal (+7%, p = 0.001) sex. Conclusion: Among AYA presenting to a STI clinic, the proportion who engaged in condomless sex and had multiple partners increased over a 5 year period, which corresponded to increased STI prevalence during this period. Preventions efforts for AYA should continue to emphasize the importance of condoms and partner selection.
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Affiliation(s)
- Jack C Rusley
- Department of Pediatrics, Division of Adolescent Medicine, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA.,Department of Health Services, Policy, and Practice, RinggoldID:12321Brown University School of Public Health, Providence RI
| | - Jun Tao
- Department of Pediatrics, Division of Adolescent Medicine, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Department of Psychiatry and Human Behavior, 174610Alpert Medical School of Brown University, Providence, RI, USA
| | - Alex E Rosenthal
- Department of Pediatrics, Division of Adolescent Medicine, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Madeline C Montgomery
- Department of Medicine, Division of Infectious Diseases, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, 12321Brown University School of Public Health, Providence RI
| | - Hector Nunez
- Department of Medicine, Division of Infectious Diseases, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Division of Infectious Diseases, RinggoldID:12321Alpert Medical School of Brown University, Providence, RI, USA
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Mata D, Korpak AK, Sorensen B, Dodge B, Mustanski B, Feinstein BA. A mixed methods study of sexuality education experiences and preferences among bisexual, pansexual, and queer (bi+) male youth. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:806-821. [PMID: 35756362 PMCID: PMC9230504 DOI: 10.1007/s13178-021-00593-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 06/03/2023]
Abstract
Introduction Bisexual male youth are more likely to engage in certain behaviors that contribute to HIV/STI transmission (e.g., substance use) than are heterosexual and gay male youth. However, sexuality education rarely addresses the unique needs of sexual minority youth, especially bisexual, pansexual, and queer (bi+) youth, and little is known about their sexuality education experiences and preferences. As such, the goal of this study was to examine bi+ male youth's experiences learning about sex and their preferences for sexuality education. Methods In 2019, 56 bi+ male youth ages 14-17 were surveyed and interviewed about their sexuality education experiences and preferences. Participants identified as bisexual (64%), pansexual (27%), and queer (9%), were racially/ethnically diverse (39% white, 32% Latinx, 20% Black, 9% other races), and included cisgender (79%) and transgender (21%) male youth. Results Participants described varied experiences with school-based sexuality education (e.g., none, abstinence only, covered sexual health in some way), but it rarely addressed their unique needs. They typically learned about sex by searching for information online and from sexually explicit media. Participants identified several topics they wanted to learn more about (e.g., sex with same-gender partners, anal sex, consent), but they typically believed they were prepared to have sex. Finally, some participants described benefits of tailoring sexuality education to their unique needs, while others described benefits of more inclusive programs. Conclusions and Policy Implications Findings suggest that bi+ male youth do not receive adequate sexuality education to make informed decisions about safer sex, highlighting the critical need for reform.
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Affiliation(s)
- David Mata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Aaron K. Korpak
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Feinberg School of Medicine, Northwestern University
| | | | - Brian Dodge
- Center for Sexual Health Promotion, Indiana University Bloomington
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
- Feinberg School of Medicine, Northwestern University
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Wilkins NJ, Rasberry C, Liddon N, Szucs LE, Johns M, Leonard S, Goss SJ, Oglesby H. Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being. J Adolesc Health 2022; 70:540-549. [PMID: 35305791 PMCID: PMC9260911 DOI: 10.1016/j.jadohealth.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 05/04/2021] [Indexed: 10/18/2022]
Abstract
Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being.
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Affiliation(s)
- Natalie J. Wilkins
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329,b Corresponding author: , 770-488-1392
| | - Catherine Rasberry
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Nicole Liddon
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Leigh E. Szucs
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Michelle Johns
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Sandra Leonard
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Sally J. Goss
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Heather Oglesby
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
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Szucs LE, Harper CR, Andrzejewski J, Barrios LC, Robin L, Hunt P. Overwhelming Support for Sexual Health Education in U.S. Schools: A Meta-Analysis of 23 Surveys Conducted Between 2000 and 2016. J Adolesc Health 2022; 70:598-606. [PMID: 35305795 PMCID: PMC10904928 DOI: 10.1016/j.jadohealth.2021.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/19/2020] [Accepted: 05/04/2021] [Indexed: 10/18/2022]
Abstract
PURPOSE Surveys suggest that the general public (i.e., adults or parents) supports sexual health education in schools. However, the number of schools providing sex education continues to decline in the United States. The purpose of this study is to conduct a meta-analysis of U.S.-based representative surveys to provide a pooled estimate of public support for sexual health education delivered in schools. METHODS A systematic search of three databases (Medline, PsycInfo, and ERIC) was conducted to identify survey measuring adult and parent attitudes toward sexual health education in school between 2000 and 2016. Meta-analyses were conducted in OpenMetaAnalyst via the metaphor package in R using a DerSimonian-Laird random effect models to account for heterogeneity between surveys. RESULTS A total of 23 citations met study inclusion and exclusion criteria, representing 15 unique probability surveys conducted with the public. Among the included surveys, 14 were nationwide and 11 included parents or an overrepresentation of parents. Across all survey findings, 88.7% (95% confidence interval = 86.2-91.2) of respondents supported sexual health education. Among surveys that only included parents or oversampled for parents, 90.0% (95% confidence interval = 86.5-93.4) supported sexual health education, and among nationally representative surveys, 87.7% (95% confidence interval = 85.1-90.6) of respondents supported sexual health education. CONCLUSION These findings demonstrate overwhelming support for sexual health education delivered in schools. Additional research is needed to determine individual differences in support for specific sexual health education topics and skills delivered through classroom-based instruction.
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Affiliation(s)
- Leigh E Szucs
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia.
| | - Christopher R Harper
- The Centers for Disease Control and Prevention, Division of Violence Prevention, Atlanta, Georgia
| | - Jack Andrzejewski
- San Diego State University-University of California, San Diego Joint Doctoral Program in Public Health, Health Behavior Track, La Jolla, California
| | - Lisa C Barrios
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Leah Robin
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Pete Hunt
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
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Rasberry CN, Young E, Szucs LE, Murray C, Sheremenko G, Parker JT, Roberts G, Lesesne CA. Increases in Student Knowledge and Protective Behaviors Following Enhanced Supports for Sexual Health Education in a Large, Urban School District. J Adolesc Health 2022; 70:588-597. [PMID: 35305794 PMCID: PMC9237957 DOI: 10.1016/j.jadohealth.2021.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/17/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE School-based sexual health education (SHE) can teach students critical knowledge and skills. For effective SHE, school districts can offer support, including strong curricula and professional development. This study assessed changes in students' sexual health knowledge and sexual behaviors following implementation of enhanced support for SHE delivery in one school district. METHODS Sexual health knowledge was assessed at the beginning and end of middle and high school health education classes in a large, urban district (n = 7,555 students). Sexual behaviors were assessed using Youth Risk Behavior Survey data from the district (2015 and 2017) and state (2017). Analyses explored differences in behavior from 2015 (n = 2,596) to 2017 (n = 3,371) among intervention district students and compared intervention district students (n = 3,371) to other students in the same state (n = 1,978). RESULTS Hierarchical linear model regression analyses revealed significant knowledge gains among students. Logistic regression results revealed that among students in the intervention district, 6 of 16 examined behaviors moved in the intended direction from 2015 to 2017; 1 moved in the unintended direction. Logistic regression results of 2017 data revealed that in comparison of intervention district students to other students in the state, intervention district students had significantly higher odds of reporting condom use at last sex (adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.07-1.72) and significantly lower odds of reporting having had sex with 4+ persons (AOR = .72, 95% CI = .55-.94) or alcohol or drug use before last sex (AOR = .63, 95% CI = .42-.94). CONCLUSIONS Findings suggest potential effects of the district's SHE in increasing knowledge and improving behaviors and experiences among youth.
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Affiliation(s)
- Catherine N. Rasberry
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road NE, MS US 8-1, Atlanta, GA 30329
| | - Emily Young
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN
| | - Leigh E. Szucs
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road NE, MS US 8-1, Atlanta, GA 30329
| | - Colleen Murray
- Formerly with ICF, 2635 Century Center Pkwy, Suite 1000, Atlanta, GA 30329
| | | | - J. Terry Parker
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road NE, MS US 8-1, Atlanta, GA 30329
| | - Georgi Roberts
- Fort Worth Independent School District, Department of Health and Physical Education, 100 N. University Dr., Suite 241A, Fort Worth, TX
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Dunn M, Yannessa J. The Relationship Between Sexual Intercourse Before the age of 13 and Alcohol, Tobacco, and Other Drug use among High School Students. JOURNAL OF DRUG EDUCATION 2022; 51:3-9. [PMID: 35769035 DOI: 10.1177/00472379221111548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research has indicated that early sexual intercourse in high school is associated with poor health outcomes such as unintentional pregnancy and sexually transmitted infections (STIs). What is lacking in the research is an understanding of the relationship between even earlier sexual initiation (i.e., before the age of 13) and alcohol, tobacco, and other drug (ATOD) use behaviors. As such, the purpose of this study was to assess whether sexual intercourse younger than 13 years of age was predictive of ATOD use among students currently in high school. Data was derived from the 2015 Youth Risk Behavior Survey (n = 15,624). This national study is conducted every odd year, and is a representative sample of high school students in the United States. Logistic regression was used to determine the relationship between sexual initiation younger than 13 years of age and current ATOD use among high school students. The results of this study found that early sexual initiation was predictive of current high school ATOD use with students who had initiated early sexual intercourse having significantly higher prevalence rates among all variables measured. The results of this study indicates health education regarding ATOD use, as well as sexual health education should be introduced to US student at an earlier age. These results indicate that continued education is needed in the pre-teen years to prevent early health risk behaviors in our youth.
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Affiliation(s)
- Michael Dunn
- Health Sciences, 2672Coastal Carolina University, Conway, SC, USA
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Chan CT, Olivieri-Mui BL, Mayer KH. Associations between State-Level High School HIV Education Policies and Adolescent HIV Risk Behaviors. THE JOURNAL OF SCHOOL HEALTH 2022; 92:316-324. [PMID: 34951018 PMCID: PMC10069761 DOI: 10.1111/josh.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND School-based human immunodeficiency virus (HIV) education can reach most adolescents, but inconsistencies exist in state-level content policies. The purpose of this study was to evaluate the associations between state-level high school HIV education policies and adolescent HIV risk behaviors. METHODS This was a cross-sectional analysis of the 2019 Youth Risk Behavior Survey linked to the Guttmacher Institute Sex and HIV Education report. Logistic regression models examined the associations of state-level HIV education mandates and content policies with 3 HIV risk behaviors: (1) 4 or more lifetime sexual partners; (2) substance use before last sex; (3) condomless last sex. RESULTS Across 33 states, 128,986 high school students were included. Multivariable adjusted models demonstrated no associations between mandated HIV education and risk behaviors. Covering abstinence along with other safe sex options was associated with lower odds, whereas stressing abstinence was associated with higher odds of at least 4 lifetime sexual partners and condomless last sex. Discriminatory sexual orientation content was associated with increased condomless last sex; associations for all HIV risk behaviors were stronger among sexual minority youth. CONCLUSIONS Increased HIV risk behaviors associated with state policies stressing abstinence or requiring discriminatory sexual orientation content support the need for comprehensive and inclusive HIV education.
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Affiliation(s)
- Carrie T Chan
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115
- Stanford Children's Health, 750 Welch Road Suite 212, Palo Alto, CA, 94304
- Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94131
| | - Brianne L Olivieri-Mui
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, 1200 Centre Street, Roslindale, MA, 02131
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 7 Haviland Street, Boston, MA, 02215
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215
- Department of Global Health and Population, Harvard School of Public Health, 9 Bow Street, Cambridge, MA, 02138
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More comprehensive sex education reduced teen births: Quasi-experimental evidence. Proc Natl Acad Sci U S A 2022; 119:2113144119. [PMID: 35165192 PMCID: PMC8872707 DOI: 10.1073/pnas.2113144119] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
Sex education for youth in the United States has been the topic of considerable debate among researchers, policy makers, and the public at large. In this study, we focus attention on federal funding for more comprehensive sex education that was received by a mix of public and private organizations in 55 US counties. Our analyses provide population-level causal evidence that funding for more comprehensive sex education led to an overall reduction in the teen birth rate at the county level of more than 3%. This study thus contributes causal evidence relevant to ongoing debates on the potential role more comprehensive sex education may play in reducing teen births in the United States. Women in the United States are much more likely to become mothers as teens than those in other rich countries. Teen births are particularly likely to be reported as unintended, leading to debate over whether better information on sex and contraception might lead to reductions in teen births. We contribute to this debate by providing causal evidence at the population level. Our causal identification strategy exploits county-level variation in the timing and receipt of federal funding for more comprehensive sex education and data on age-specific teen birth rates at the county level constructed from birth certificate natality data covering all births in the United States. Our results show that federal funding for more comprehensive sex education reduced county-level teen birth rates by more than 3%. Our findings thus complement the mixed evidence to date from randomized control trials on teen pregnancies and births by providing population-level causal evidence that federal funding for more comprehensive sex education led to reductions in teen births.
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Szucs LE, Barrios LC, Young E, Robin L, Hunt P, Jayne PE. The CDC's Division of Adolescent and School Health Approach to Sexual Health Education in Schools: 3 Decades in Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:223-234. [PMID: 34964130 PMCID: PMC10924689 DOI: 10.1111/josh.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND School health education, including sexual health education, plays a crucial role in shaping adolescents' protective health behaviors, experiences, and outcomes. Adolescents need functional knowledge and skills to practice, adopt, and maintain healthy behaviors for preventing sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), and unintended pregnancy. METHODS The US Centers for Disease Control and Prevention's Division of Adolescent and School Health (CDC/DASH) has advanced school-based approaches to STI/HIV and pregnancy prevention through surveillance, research and evaluation, and program partnership and collaboration for over 3 decades. RESULTS CDC/DASH uses systematic and innovative strategies to identify the breadth of adolescent sexual health evidence; characterize key elements of effective educational curricula; and provide practical guidance to support school-based delivery. CDC/DASH's approach to effective health and sexual health education in schools has changed dramatically over the past 30 years and must continue to progress. CONCLUSION This paper describes how and why that approach has evolved and outlines directions for the future.
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Affiliation(s)
- Leigh E. Szucs
- Research Application and Evaluation Branch, Division of Adolescent and School Health, The US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, US8-1, Atlanta, GA, 30329-4027
| | - Lisa C. Barrios
- Research Application and Evaluation Branch, Division of Adolescent and School Health, The US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, US8-1, Atlanta, GA, 30329-4027
| | - Emily Young
- Research Application and Evaluation Branch, Division of Adolescent and School Health, The US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, US8-1, Atlanta, GA 30329-4027; Oak Ridge Institute of Science and Education, 1299 Bethel Valley Road, TN, Oak Ridge, TN, 37830
| | - Leah Robin
- Research Application and Evaluation Branch, Division of Adolescent and School Health, The US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, US8-1, Atlanta, GA 30329-4027
| | - Pete Hunt
- Research Application and Evaluation Branch, Division of Adolescent and School Health (Retired), The US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US8-1, Atlanta, GA, 30329-4027
| | - Paula E. Jayne
- Research Application and Evaluation Branch, Division of Adolescent and School Health (Retired); ICF, The US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, US8-1; ICF, 2635 Corporate Blvd NE Suite 1000, Atlanta, GA, 30345
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Robin L, Timpe Z, Suarez NA, Li J, Barrios L, Ethier KA. Local Education Agency Impact on School Environments to Reduce Health Risk Behaviors and Experiences Among High School Students. J Adolesc Health 2022; 70:313-321. [PMID: 34531096 PMCID: PMC8792165 DOI: 10.1016/j.jadohealth.2021.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study is to assess associations between exposure to a multilevel, socio-ecological health program administered by local education agencies and changes in health behaviors among high school students. METHODS This analysis used a multilevel difference-in-differences approach to compare student health experiences and outcomes between schools selected by local education agencies nationwide to implement the program (exposed schools) and schools that were not (unexposed schools). We measured repeated cross-sectional outcomes using the 2015 and 2017 Youth Risk Behaviors Surveys. The final analytic sample comprised 638 schools in total (N = 64,838 students), with 237 exposed schools (n = 30,336 students) and 401 unexposed schools (n = 34,502 students). RESULTS Students in exposed schools demonstrated significant reduction in odds compared with those in unexposed schools in ever having sex (adjusted odds ratio [aOR] = .88, 95% confidence interval [CI]: .81-.96), having four or more lifetime sexual partners (aOR = .84, 95% CI: .72-.97), being currently sexually active (aOR = .78, 95% CI: .78-.96), and using effective hormonal birth control (aOR = .7, 95% CI: .56-.88). Exposure to the program was associated with significant reduction in odds of not going to school because of safety concerns (aOR = .87, 95% CI: .78-.97), having experienced forced sex (aOR = .76, 95% CI: .68-.86), ever used marijuana (aOR = .89, 95% CI: .81-.98), and currently using marijuana (aOR = .77, 95% CI: .64-.93). CONCLUSIONS Exposure to the program was associated with significant decreases in sexual risk behaviors, experience of violence, and substance use.
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Affiliation(s)
- Leah Robin
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia.
| | - Zachary Timpe
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Nicolas A Suarez
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Jingjing Li
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Lisa Barrios
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Kathleen A Ethier
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
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