Society for Adolescent Health and Medicine. Abstinence-Only-Until-Marriage Policies and Programs: An Updated Position Paper of the Society for Adolescent Health and Medicine

Promoting sexual health in schools: a systematic review of the European evidence

Introduction

Sexual ill-health is an urgent public health issue with subsequent social and economic costs. There is, therefore, a need for more effective sexual health promotion interventions in an early stage of life. Previous research has focused on preventive sexual health interventions applying a risk perspective, and the limited and scattered evidence concerning school-based sexual health promotion interventions employing a health-resource perspective has not been compiled and synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in schools in Europe.

Method

A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and included information on study characteristics, intervention content, methods, and outcomes relevant to the current review. A narrative synthesis of the included studies was performed, highlighting the collective results.

Result

Seventeen records were included in the review, reporting on 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All three studies with a qualitative research design described positive effects experienced by the participants. Six of thirteen quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. The outcomes of interest were grouped into five areas, and most studies focused on the area of attitudes toward sexual health.

Conclusion

The findings indicate promising evidence of effect for interventions with a health promotion approach, highlighting the importance of strengthening sexual health resources related to respect, communication skills, attitudes, and other positive psycho-social aspects of sexual health. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas a comprehensive focus on the multi-dimensional sexual health literacy concept is less common and can be recommended to be included in future intervention research.

Prevalência de indicadores de saúde sexual e reprodutiva dos adolescentes brasileiros

Objetivo: comparar as estimativas de prevalência de indicadores de saúde sexual e reprodutiva dos adolescentes brasileiros que participaram das edições 2015 e 2019 da Pesquisa Nacional de Saúde do Escolar (PeNSE). Método: estudo transversal que analisou dados de adolescentes escolares de 13 a 17 anos respondentes da PeNSE 2015 e 2019. Estimou-se a prevalência para nove indicadores com intervalos de 95% de confiança de acordo com o sexo, faixa etária, dependência administrativa da escola e região do país. Resultados: observou-se manutenção da maior parte dos indicadores analisados. Destaca-se aumento da prevalência de iniciação sexual precoce, entre os mais novos, 171,2% entre os meninos e 425,2% entre as meninas. Também houve aumento da prevalência de gravidez na adolescência nas regiões Nordeste (376,9%) e Sudeste (416,6%), entre as mais jovens. Entre os adolescentes de 16 e 17 anos, houve redução do uso de preservativo na última relação e aumento na prevalência de recebimento de orientações sobre prevenção de gravidez e sobre HIV/Infecções Sexualmente Transmissíveis, entre os estudantes de escolas públicas. Houve redução na prevalência de acesso a essas orientações nas escolas privadas entre os mais jovens. Em 2019, observou-se redução no uso de pílulas anticoncepcionais entre as adolescentes mais novas das regiões Norte, Sudeste e Centro-Oeste. Conclusão: houve estabilidade para a maioria dos indicadores, porém, com aumento da iniciação sexual precoce, da história de gravidez na adolescência e das orientações recebidas nas escolas, apontando maior risco entre jovens que frequentam as escolas públicas, e que vivem no Nordeste e Norte do país.

SART CORS IVF registry: looking to the past to shape future perspectives

PURPOSE

The SART CORS database is an informative source of IVF clinic-specific linked data that provides cumulative live birth rates from medically assisted reproduction in the United States (US). These data are used to develop best practice guidelines, for research, quality assurance, and post-market surveillance of assisted reproductive technologies. Here, we sought to investigate the key areas of current research focus (higher-order categories), discover gaps or underserved areas of ART research, and examine the potential application and impact of newer ART adjuvants, future data collection, and analysis needs.

METHODS

We conducted a systematic review (PRISMA guidelines) to quantify unique output metrics of the SART CORS database. Included were SART member reporting clinics: full-length publications from 2004 to 2021 and conference abstracts from 2015 to 2021, the two key timepoints when the SART CORS database underwent transformative shifts in data collection.

RESULTS

We found 206 abstracts presented from 2015 to 2021, 189 full-length peer-reviewed publications since 2004, with 654 unique authors listed on these publications. A total of 19 publications have been highly impactful, garnering over 100 citations at the time of writing. Several higher-order categories, such as endometriosis and tubal infertility, have few publications. The conversion of conference abstracts to full-length papers ranged from 15 to 35% from 2015 to 2021.

CONCLUSIONS

A substantial body of literature has been generated by analyzing the SART CORS database. Full-length publications have increased year over year. Some topic areas, such as endometriosis and tubal infertility, may be underrepresented. Conversion of conference abstracts to full-length publications has been low, indicating that more organizational support may be needed to ensure that research is methodologically sound and researchers supported to reach full publication status.

Caregiver reports of physician risk counseling for adolescents with special health care needs

BACKGROUND

Research has indicated disagreement between physicians, caregivers, and adolescents with special health care needs regarding appropriate risk counseling.

OBJECTIVE

The study examines caregivers' perceptions of adolescent risk counseling. We hypothesize caregivers of adolescents with special healthcare needs will perceive a lower rate of risk counseling.

METHODS

Data come from the 2016 National Survey of Children's Health. The sample included 13,542 adolescents. Analysis completed using logistic regression with odds ratios.

RESULTS

The results indicate no difference in caregiver perceptions of risk counseling for adolescents with special healthcare needs. Gender, race/ethnicity, and relationship between caregiver and provider influenced perception of receipt of risk counseling, regardless of health status.

CONCLUSIONS

Although adolescents with special healthcare needs perceive their risk behavior counseling to be lacking in quantity/quality, caregivers perceive such counseling does occur. These results highlight the need for comprehensive risk counseling for groups at risk of known health disparities.

PRACTICE IMPLICATIONS

Physicians and providers should be provided with the training and resources needed to be comfortable to engage in risk counseling. Adolescents need the opportunity to see their provider privately, and education to advocate for information risky behaviors. Parents, providers, and adolescents should be included in future risk counseling intervention plans.

Adolescents' Receipt of Sex Education in a Nationally Representative Sample, 2011-2019

PURPOSE

Updated estimates of adolescents' receipt of sex education are needed to monitor trends and potential inequities.

METHODS

Using nationally representative data from the 2011-2015 and 2015-2019 National Survey of Family Growth, we use logistic regression to examine changes in the receipt of formal sex education by gender. For 2015-2019, we estimate patterns by gender and race/ethnicity for content, timing, and location of instruction.

RESULTS

Between 2011-2015 and 2015-2019, there were few significant changes in adolescents' receipt of formal sex education. Between these periods, instruction on waiting until marriage to have sex declined (73%-67% female [F.], p = .005; 70%-58% males [M.], p < .001). In both the periods, about half of the adolescents received sex education that meets the minimum standard articulated in national goals. In 2015-2019, there were significant gender differences in the instruction about waiting until marriage to have sex (67% F., 58% M., p < 001) and condom skills (55% F., 60% M., p = .003). Non-Hispanic Black and Hispanic males were less likely than non-Hispanic White males to receive formal instruction before the first sex on sexually transmitted infection/HIV, birth control, or where to get birth control. Many adolescents reported religious settings as the sources of instruction about waiting until marriage to have sex (56% F. and 49% M.), but almost none received instruction about birth control from those settings.

CONCLUSIONS

Differences in the receipt of sex education, by gender, race/ethnicity, and the location of instruction, leave many adolescents without critical information. Gaps in meeting national objectives indicate the need to expand the provision of sex education.

Who attends a crisis pregnancy center in Ohio?

OBJECTIVES

We sought to quantify the prevalence of ever attendance at a crisis pregnancy center (CPC) among adult, reproductive-age women in Ohio and identify demographic factors associated with ever attendance.

STUDY DESIGN

We analyzed data from the Ohio Survey of Women, a survey of adult, reproductive-age women (N = 2529) conducted in 2018 to 2019. We calculated unadjusted and adjusted prevalence ratios (PRs) to evaluate the possible associations between demographic factors and ever CPC attendance. Analyses used statistical weights to be population-representative.

RESULTS

Analyses are based on women reporting ever (n = 291) or never CPC attendance (n = 2151). Prevalence of ever CPC attendance was 13.5%. Ever CPC attendance was higher among women of Black, non-Hispanic race/ethnicity (adjusted PR, 2.1; 95% confidence interval [CI], 1.4-3.2) and currently in the lowest socioeconomic status (SES) stratum (defined as less than a college degree and annual household income less than $75,000) (aPR, 1.6; 95% CI, 1.1-2.3) compared to those of other race/ethnicity and in the highest SES stratum.

CONCLUSIONS

Disparities exist among adult women in Ohio regarding their ever use of CPCs. Because CPCs typically are not medical facilities and may provide inaccurate information, future studies should evaluate a wider range of correlates of recent CPC attendance.

IMPLICATIONS

Findings from a population-based survey of adult, reproductive-age women in Ohio indicate that ever attendance to a CPC for pregnancy-related care is not rare, and this attendance is higher among Black/non-Hispanic women and those of low SES compared to other women.

Sexual Partner Accumulation From Adolescence to Early Adulthood in Populations With Physical Disabilities in the U.S

PURPOSE

This study aimed to examine the lifetime and pre-18 sexual partnering patterns of populations with physical disabilities from adolescence to early adulthood and how these patterns further vary by biological sex, race/ethnicity, and sexual orientation.

METHODS

Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Poisson regression models were used to assess differences in pre-18 and lifetime sexual partner counts among populations with physical disabilities compared with those without disabilities. Moderation analyses by biological sex, race/ethnicity, and sexual orientation were used to consider further differences among minority subgroups.

RESULTS

The results indicated more similarities than differences in sexual partnering patterns across disability severity groups. Specifically, populations with disabilities had just as many pre-18 and lifetime sexual partners as peers without disabilities. There was variation by biological sex, race/ethnicity, and sexual orientation, although this was not tied to disability status.

CONCLUSIONS

These results fill an important gap in the literature by considering the sexual partnering behaviors of populations with physical disabilities in the U.S. over the life course. Future research should continue to include populations with disabilities and other minority groups to ensure that their experiences are represented in sexual health policies and programs.

Teenage pregnancy and experience of physical violence among women aged 15-19 years in five African countries: Analysis of complex survey data

BACKGROUND

Pregnant teenage women are prime targets of violence against women perpetrated by intimate partners, family members, and miscreants in their neighborhoods. This study estimated the prevalence of Teenage pregnancy (TP) and Physical Violence (PV) and further assessed the relationship between TP and PV in five Low-and-Middle-Income Countries (LMICs).

METHODS

The study was conducted among five LIMCs (Burkina Faso, Kenya, Malawi, Nigeria, and Tanzania) using data from the most recent Demographic and Health Surveys conducted in these countries. Modified Poisson with the robust standard error was used to quantify the association between TP and PV. All analyses adjusted for the complex survey design structure (clustering, weighting, and stratification).

RESULTS

The analysis involved a total of 26055 adolescent women aged 15-19 years across the five countries. The overall prevalence of TP was 25.4% (95%CI = 24.4-26.4) with the highest prevalence occurring among Malawians [29.0% (95%CI = 27.4-30.7)]. Meanwhile, the prevalence of TP among older adolescents (18-19 years) was approximately two-thirds significantly higher compared with young adolescents [aPR(95%CI) = 1.60[1.49-1.71)]. The prevalence of PV among teenagers across the five countries was 24.2% (95%CI = 22.3-26.2). The highest prevalence of PV was recorded among Nigerian adolescent women [31.8% (95%CI = 28.5-35.3)]. The prevalence of PV among adolescent women who were pregnant was approximately 5-folds significant compared to those who were not pregnant (adjusted prevalence ratio; aPR = 4.70; 95% CI: 3.86-5.73; p<0.0001).

CONCLUSION

There was a high prevalence of pregnancy among older teenagers aged 18-19 years. Close to a quarter of teenage women ever experienced physical violence. Pregnant teenage women ever experience of physical violence was very high compared to non-pregnant peers. Intervention should target PV and TP by adopting a gender-sensitive approach to eliminate physical violence, particularly among teenagers to prevent TP.

Exploring the Protective Effects of Judaism on Risky Behaviors in College Students: A Pilot Study

BACKGROUND

Common risky behaviors among college-aged young adults include risky sexual behaviors and substance use.

PURPOSE

This study examines the protective effects of Judaism on students' engagement in risky behaviors, building on a body of research on the protective effects of religious beliefs on risky health behaviors.

METHODS

Validated and reliable measures were used to assess religiosity and risky behaviors through anonymous surveys. Data was collected in Fall 2018 from a small cohort (N = 15) of Jewish day school students.

RESULTS

Females had overall higher rates of risky behaviors such as drinking or using drugs before sex (27% compared to 13% for males), not using condoms (62% to 0% for males), and higher rates of binge drinking (62% to 20% for males).

CONCLUSION

Higher religiosity was more associated with delayed sexual activity than substance use behaviors. Judaism and religiosity were more strongly associated with the male participants than the female.

PRACTICE IMPLICATIONS

Since the participants still had low rates of condom use and other high risk behaviors despite speaking with their healthcare providers, the health care community must better educate adolescents and young adults on the health and social consequences of such risky activities, both in formal education programs during middle and high school, and in office visits.

Parent-Teen Communication about Sexual and Reproductive Health: Cohort Differences by Race/Ethnicity and Nativity

Parent-teen discussions about sexual and reproductive health (SRH) are associated with delayed sex and higher contraceptive use among teens. Using the National Survey of Family Growth, we conducted bivariate and multivariate analyses of different types of parent-teen SRH discussions among two cohorts of teens. We describe differences in patterns for males and females by race/ethnicity and nativity, and test for racial/ethnic interactions within each cohort. Analyses found that the prevalence of parent-teen discussions about SRH increased across cohorts. For males and females, there were increases in parent-teen discussions about condoms, and for males only, there were increases in any SRH discussions and discussions about contraception and STIs. Based on interactions, parent-teen discussions and STI discussions increased most for Hispanic females, and among Hispanics, increased most for the foreign-born. These data indicate increases in different types of parent-teen SRH discussions, particularly for males and foreign-born teens overall, and for Hispanic teen females regarding condom use. Future research should examine what factors are driving these changes, including changes in the structure of U.S. Hispanic communities and expansion of evidence-based teen pregnancy prevention programs.

Is developmental change in gender-typed behavior associated with adult sexual orientation?

The goal of this article was to examine gender-typed behavior longitudinally and to consider its relationship with sexual orientation in adulthood. Data were from 10,624 respondents who completed Wave 1 (adolescence), Wave 3 (emerging adulthood), and Wave 4 (early adulthood) of the National Longitudinal Study of Adolescent to Adult Health. First, we described the distributions of gender-typed behavior by adult sexual orientation at each of the three developmental stages. Next, we performed multilevel mixed regression models to assess longitudinal variation in gender-typed behavior from adolescence to adulthood within sexual orientation groups. Results showed that gender-typed behavior varied both within and between sexual orientation groups, as well as over time. For males, the differences in gender-typed behavior among the sexual orientation groups were relatively consistent at each stage, whereas differences in gender-typed behavior among sexual orientation groups varied more at each stage among females. Longitudinal models exhibited curvilinear patterns, such that gender-typed behavior strengthened from adolescence to early adulthood but peaked in emerging adulthood. To our knowledge, this is the first study to use population representative data to study gender-typed behavior both prospectively and at multiple time points from adolescence to adulthood, and to consider how such behavior is related to adult sexual orientation. This research contributes to a growing body of prospective literature on the link between gendered behavior and sexual orientation and provides further justification for more age- and cohort-specific measures of gender-typed behavior in future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development and Feasibility Testing of a Videogame Intervention to Reduce High-Risk Sexual Behavior in Black and Hispanic Adolescents

Objective: Develop and test feasibility of a mobile videogame intervention to decrease high-risk sexual behavior in black and Hispanic adolescents. Materials and Methods: Iterative design to develop intervention in partnership with target audience. Feasibility and preliminary impact data collected at baseline, following 2-3 hours of gameplay and at 8-week follow-up. Results: Twenty-six 15-17-year-olds completed pilot testing: 16 (62%) were male, 20 (77%) black or Hispanic. Pilot testing demonstrated feasibility, including producing a usable videogame prototype, incorporating videogame testing within a high school, and participants' acceptability of the videogame. Participants' gameplay experience reflected that most would play the videogame again (77%), stated that they felt responsible for the choices they made in the videogame (73%), and would tell their friends to play the videogame (58%). Most suggested adding more videogame content to further engage participants. From baseline to follow-up, participants demonstrated improvements in condom and contraception self-efficacy (P = 0.003), risk perceptions (P = 0.009), and high-risk sexual behavior knowledge (P < 0.0001). Among black or Hispanic adolescents, we found improvements in summary measures of intentions (P = 0.04), self-efficacy (P = 0.003), risk perceptions (P = 0.002), and sexual knowledge (P = 0.0002). Adolescents with previous sexual experience showed similar improvements. Conclusion: Pilot testing of an innovative videogame, developed in partnership with the target audience, demonstrated feasibility and preliminary impact with this cohort of black or Hispanic adolescents. We developed a usable videogame prototype and gained important data about how to enhance the next videogame iteration. Future plans include targeting an older age group to maximize our ability to measure potential impact among sexually experienced adolescents.

Associations Between Patterns of Sexual Initiation, Sexual Partnering, and Sexual Health Outcomes from Adolescence to Early Adulthood

The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6587 respondents from the National Longitudinal Study of Adolescent to Adult Health. Bivariate analyses and adjusted logistic and ordinary least squares regression models were used to determine associations between membership in three sexual initiation classes, lifetime sexual partner counts, and multiple health outcomes, including lifetime sexually transmitted infection or disease (STI/STD) diagnosis, lifetime unintended pregnancy, and romantic relationship quality. Broadly, having fewer lifetime sexual partners was associated with lower odds of STI/STD diagnosis and unintended pregnancy, and better relationship quality; however, findings also indicated both within and between sexual initiation class differences in the relationship between lifetime sexual partners and all three health outcomes. In particular, results showed little variation in health outcomes by sexual partnering among those who postponed sexual activity, but members of the class characterized by early and atypical sexual initiation patterns who had fewer lifetime partners exhibited better health outcomes than most other initiation groups. These results show that while both sexual initiation and partnering patterns add important information for understanding sexual health from adolescence to early adulthood, partnering may be more relevant to these sexual health outcomes. Findings indicate a need for more comprehensive sexuality education focused on sexual risk reduction and promotion of relationship skills among adolescents and adults.

The Role of Policy on Sexual Health Education in Schools: Review

Teen pregnancy and sexually transmitted infections are leading public health problems in the United States. While abstaining from sexual intercourse is the best way to avoid these conditions, abstinence only education (AOE) programs in schools have been shown ineffective in delaying sexual initiation or decreasing the teen pregnancy rate. Conversely, comprehensive sex education (CSE) programs have demonstrated the ability to decrease teen pregnancy and delay initiation into sex. However, federal funding continues to primarily support AOE programs, and a majority of states favor AOE in schools, rather than CSE. The purpose of this review was to examine the role of policy on sexual health education, which can have an impact on the health and well-being of adolescents. The review provides school nurses with information to help them educate parents and administrators to the negative repercussions of AOE, so they can advocate for policy change.

Adolescent Sexual Health and Education: Where Does the Pediatrician's Responsibility Fall?

Adolescence is a stressful time with a considerable amount of change, not only physically, with all the changes expected throughout puberty, but also emotionally, spiritually, and psychosocially. Teens are learning how to build and sustain relationships, learning boundaries in all areas of their lives, experimenting, as well as setting values that will sustain them throughout their lives. Home, school, various social settings, and places of worship all contribute to where adolescents learn what their values are, what they want their values to be, and how they start to make choices about their personal beliefs, which may not always align with their family values. Adolescents spend most of their time in school, so the classroom is a logical place where certain discussions, such as puberty and sexuality, should happen regarding changes that are occurring with their bodies. The home environment, as well as the willingness of parents to have open, honest dialogue about sexual education, is also a vital component of ensuring that adolescents feel safe to openly discuss this topic. Pediatric clinicians also play an important role in helping to inform adolescents and their families about sexual health and development. [Pediatr Ann. 2018;47(4):e136-e139.].

Sexual and Reproductive Health Care Services in the Pediatric Setting

Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.