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

Reproductive Justice as an Alternative to the Pregnancy Planning Paradigm for Teens

In this critical commentary, we describe the many limitations of the pregnancy planning paradigm as applied to pregnant and parenting teens. We describe how this paradigm, in characterizing pregnancies as intended or unintended, has shaped campaigns to prevent teen pregnancy and remains largely embedded in formal sex education and family planning programs in the United States. We argue that a paradigm shift is long overdue and describe how the reproductive justice framework addresses the limitations of the pregnancy planning paradigm. Although reproductive justice is endorsed by a growing number of organizations, recommended policies face formidable obstacles given that comprehensive sex education, contraception, and legal abortion are increasingly at risk in a post-Dobbs world.

"I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States

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.

"I Didn't Realize How Common it Was:" A Mixed-Methods Study Examining Changes in Perceptions of Sexual Assault, Sex and Consent, and Sexual Behavior as a Function of the #Metoo Movement

This mixed-methods study examined awareness and perceived legitimacy of the #MeToo movement and how #MeToo changed perceptions of sexual assault and consent, as well as sexual interactions, in the United States. Adults residing in the U.S. were recruited through CloudResearch to complete an online survey in 2021. Quantitative data from 680 participants (M age = 45.8, 60% women, 77.4% White) indicated moderate awareness and perceived legitimacy of the #MeToo movement; Black, LGBQ+, and more politically liberal respondents had greater #MeToo awareness while younger, more liberal respondents, and those with greater rejection of rape myths rated #MeToo more legitimate. Among 354 participants (M age = 45.0, 65.3% women, 76.4% White) who answered at least one open-ended question with regard to changes resulting from the #MeToo movement, thematic analysis revealed nine primary themes: (1) Describing change; (2) Change in understanding; (3) More cautious; (4) Wrong or requires reporting/punishment; (5) Gendered social norms; (6) Easier to talk about; (7) #MeToo rhetoric; (8) Consequences for survivors, and (9) Empowerment. Several sub-themes were identified among the primary themes and implications for sexual assault prevention and response were discussed. The study findings are contextualized by social constructionism, with a particular focus on gender-based power dynamics, contributing to a growing literature documenting the cultural impact of the #MeToo movement.

Using an intersectional life course perspective to understand familial environment and its impact on sexuality development among Asian American sexual minority college students

There is a dearth of research understanding the sexual health of Asian American adolescents, and even more so for those who identify as sexual minorities (lesbian, gay, bisexual, queer, asexual, and other sexual orientations). This study is a secondary qualitative analysis focused on young adults' recollections of their formal and informal sex education experiences in childhood and adolescence using a sub-sample of in-depth interviews from students who self-identified as both Asian and sexual minorities living in the USA (n = 9). Results were organised into three sections: (1) latent cultural factors (e.g. stigma surrounding sex, self-sufficiency, filial piety); (2) the downstream effects of latent cultural factors (e.g. sex-related discussions, rules disallowing dating, role of lateral family members); and (3) the impact of deficient familial sex-related discussions (e.g. Internet, resentment). Study findings underscore the links between identity concealment and relationship concealment that are unique to Asian sexual minority individuals. We suggest that interventions involving Asian American US youth and their families should be culturally informed and promote cross-generational sex-related discussion. Future research should further explore the role of chosen family and non-parental family members as a point of intervention as they can be helpful sources of informal sex education.

"Ripping Off the Band-Aid": uncovering future health care Professionals' "Fractured Knowledge" about sexual and reproductive health

Background

Research has shown the role of identity on future health professionals' confidence and competence in addressing the sexual and reproductive health (SRH) needs of their patients. While there has been some work in increasing the sexual health literacy of future providers via various curricular approaches and comprehensive clinical-based training, there are research gaps on how social differences around identity impact future healthcare professionals' knowledge and practices around SRH.

Objectives

This article presents research findings on the experiences of US undergraduate students attending a campus that provides training in the health sciences and health professions. Our study aims to understand the perspectives of these students as they pertain to their future career choices in healthcare, with a focus on how their past experiences learning about sex, sexuality, and reproduction impact their current and future professional trajectories.

Methods

We present a qualitative analysis from 40 in-depth interviews with U.S. undergraduates. The interview questions were designed in collaboration with undergraduate researchers interested in sexual health education. These student researchers collected all the interview data and worked with senior researchers to analyze some of these data.

Results

The themes that emerged from the interviews were around experiences with what students perceived as "fractured" sexual and reproductive health (SRH) knowledge they received as children and adolescents. This knowledge shaped essential aspects of their identity as young adults and future healers. Data indicated unique processes implicated in how past as well as present socialization experiences learning about sex, sexuality, and reproduction positions undergraduates in health professions to see young adulthood as a journey of "catching up" on sexual knowledge but also as an ongoing experience of anticipation and planning influencing their career-building journey.

Conclusions

The importance of sexual health literacy among healthcare professionals cannot be overstated, as it is vital in providing patient-centered and non-judgmental sexual and reproductive health (SRH) care and services. To date, there is a shortage of studies looking at the impact of sexual health knowledge on healthcare professionals. More research is needed on educational strategies that could be implemented at the intra-personal level to assist college-aged young adults in healthcare career tracks to "catch up" or "fill in the gaps" in their sexual education journey.

Who Helps Children With Communication Disorders Access Sex Education? Practice Patterns of Speech-Language Pathologists and Psychologists

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.

The influence of pornography on heterosexual black men and women's genital self-image & grooming

Pornography consumption may negatively impact Black men's and women's genital self-image. Poor genital self-image is linked to negative mental health outcomes and sexual dysfunction. Despite this, little work has examined genital self-image among Black men and women, a group whose genital self-image may be informed by racist-gendered stereotypes and perceived expectations for genital grooming. The purpose of this multigenerational qualitative study is to examine how pornography impacts genital self-image and grooming for Black heterosexual men and women. Semi-structured qualitative interviews were conducted with participants (n = 20) across four generational cohorts. An inductive content analysis resulted in three categories and four subcategories. All participants reported pornography consumption at some point in their lifetime. The degree of influence on their genital self-image and grooming was categorized in four ways: no influence, perceived influence, and direct influence, and resisting influence. There were four subcategories within the perceived and direct influence categories: pubic hair grooming & preferences, designer vaginas, penis size, and partnered expectations. Black men and women differed in their reported influence of porn on genital self-image and grooming. Implications of findings for pornography creators, sex educators, and sex partners are discussed.

"What's Something You've Heard About Sex, But Are Unsure If It's True?": Assessing Middle and High School Students' Sex Education Questions

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.

Comprehensive Sexual Health Educational Learning Modules for College Students

Sexual health education in the United States continues to be a controversial topic of discussion with no federal regulations. Due to this, the sex education students receive before college varies greatly. Our team discovered that no mandatory, comprehensive sexual health education is required for students once they enter the California State University system. At Cal Poly specifically, it was found that students were engaging in risky sexual behaviors. For example, the 2021 American College Health Association-National College Health Assessment III Fall 2021 Data Report revealed that less than half (42.1%) of students reported regularly using condoms during vaginal sex, and a mere 5.1% of students reported barrier method use during oral sex. To fill in the noticed gaps in our students' sexual health education, our team developed a set of 10 comprehensive sexual health educational learning modules. The modules cover topics ranging from condom use and STIs to pleasure, porn literacy, and having difficult conversations with a partner. This anonymous online resource provides students with easy-to-read written material and engaging graphics. Future research will focus on user engagement and the effect of the resource on sexual health best practices across our campus.

Self-Reported Sexual Behavior of Transgender Youth

INTRODUCTION

Research indicates transgender/gender diverse (TGD) youth are more likely to engage in sexual behavior, have more sexual partners, and initiate sexual behavior earlier than their cisgender peers. However, no gender-inclusive self-report survey questionnaires (i.e., those that do not assume the gender of sexual partners or body parts used for sex) exist to assess sexual behavior of TGD youth. The current study illustrates a questionnaire with nuanced wording to more accurately portray the sexual behavior of TGD youth presenting for gender-affirming medical care compared to national adolescent norms.

METHODS

Retrospective chart review of 323 youth, ages 13-18, presenting to a pediatric gender clinic between 2015-2021. Youth self-reported their gender identity (i.e., masculine, feminine, gender queer, questioning/unsure), sexual behaviors, and partners via a REDCAP survey.

RESULTS

Rates of dating among TGD youth were significantly lower than national norms (33.7% v 68.3%; X2=172.644, p< 0.0001), as was sexual behavior (14.9% vs. 39.5% X2=80.419, p< 0.0001). Rates of self-reported involuntary sexual activity among TGD youth did not differ significantly from national norms (7.1% vs. 6.9%, ns). Body parts used for sex, the number of sexual partners, and the gender identity of sexual partners are reported.

DISCUSSION

Results suggest that rates of dating and sexual behavior among TGD youth are significantly lower than national norms, supporting a need for screening of sexual health among TGD youth utilizing gender-inclusive measures. A standardized gender-inclusive questionnaire of sexual behavior is needed to improve data accuracy and help develop inclusive programs to address the sexual health needs of TGD youth.

Unlearning and relearning sexuality: a qualitative exploration of The Sex Wrap, a sex education podcast

BACKGROUND

Traditional school-based sexuality education has a myriad of problems with its successful delivery, including access to comprehensive sexuality curricula, access to trained facilitators, and community and parental fears. As an alternative form of sexuality education, The Sex Wrap podcast is released in weekly episodes of about 20-45min, providing listeners with diverse, evidence-based sexual health information.

METHODS

Participants in a larger mixed-methods study evaluating The Sex Wrap were invited to participate in qualitative in-depth interviews to explore their experiences with sexuality education, including The Sex Wrap , and how they relate to information received through the podcast. Seventeen interviews were conducted with listeners of The Sex Wrap , aged 20-25years old.

RESULTS

One core category and three axial codes were identified in the interview data. The core category is: sexuality education is an ongoing process that includes learning and unlearning. The three temporally related axial codes are: (1) experiences with formal and informal sexuality education (mostly negative) drove participants to seek more information about sex, (2) participants use The Sex Wrap as a way of exploring and personalising information about sexuality, and (3) participants equipped with comprehensive sexuality education are empowered to educate their peers.

CONCLUSIONS

This study suggests that podcast-based interventions, such as The Sex Wrap , can play a key role in young people's process of sexuality education and should be considered for incorporation into other forms of sex education.

"I feel like it gives me what I need to know": A qualitative study on adolescent perceptions of two contraceptive decision aids

OBJECTIVES

We sought to understand how adolescents perceive two commonly used contraceptive decision aids and which elements adolescents identified as most important to them.

STUDY DESIGN

We conducted a cross-sectional qualitative study of adolescents' perceptions of two decision aids, Your Birth Control Choices designed by the Reproductive Health Access Project and Birth Control: What's Important to You? designed by Power to Decide for Bedsider.org. We conducted semistructured interviews with 20 adolescents (aged 15-19 years) who were assigned female sex at birth and attended a single clinic in North Carolina. Interview questions addressed the decision aids' aesthetic design, informational content, inclusivity, and comprehensibility. We transcribed and analyzed interviews using Dedoose software. We developed a codebook using a combination of a priori and inductive codes followed by content analysis to identify themes.

RESULTS

All participants agreed that both decision aids could be helpful with contraceptive decision-making and with patient-provider discussions. However, some phrasing and descriptions of contraceptive methods were confusing. Participants preferred realistic imagery, clear explanations of side effects, and details on method use. Participants expressed a preference for the information contained in the detailed Reproductive Health Access Project decision aid, while most favored the aesthetic design and layout of the Bedsider decision aid.

CONCLUSIONS

Although adolescents expressed sentiments of increased knowledge and empowerment after reviewing the decision aids, this study suggests neither decision aid completely meets adolescent needs and preferences. Additional adaptations are necessary to create adolescent-centered contraceptive decision aids.

IMPLICATIONS

Adolescents in this study found two contraceptive decision aids as useful adjuncts to conversations with providers. The decision aids improved contraceptive knowledge and may facilitate decision-making. However, neither of the studied decision aids fully met the perceived needs of adolescents. Future adaptations or designs should include additional adolescent-centered content.

Sex education through the lifespan: a pilot intervention for older adults in changing attitudes and comfort with sexuality

Researchers conducted a four-week pilot sexual health education intervention to investigate changes among older adults' attitudes about and comfort with sexuality. Six adults between the ages of 74-83 participated in a pilot intervention on sexual health and were administered a pretest and posttest on comfort with and attitudes about sexuality. The intervention included information on personal history of sexuality, sex education, masturbation, sexuality and bodily change in older adulthood, safe sex, healthy relationships, and talking to health care providers. Descriptive statistics for average responses in the pretest and posttest before and after the intervention were used to highlight differences among the participants. Implications for gerontologists, geriatric providers, and education and research regarding older adults are shared.

Advancing Access to Care through Digital Health: Perspectives from Youth on a Novel Platform to Increase Access to Sexual and Reproductive Health Care and Education for Adolescents and Young Adults

STUDY OBJECTIVE

Youth account for half of new sexually transmitted infections (STIs) in the United States annually. Barriers to STI prevention include a lack of accurate sexual and reproductive health (SRH) education and low STI testing. We sought to obtain youth feedback on a digital health platform prototype designed to address these barriers.

METHODS

The platform prototype included SRH content, free STI testing and treatment, and anonymous question submission. Five focus group discussions, each lasting 45-60 minutes with 5-6 youth living in a high-prevalence STI region (Baltimore, Maryland), were conducted. Thematic analysis was conducted.

RESULTS

There were 28 participants with a mean age of 15.9 years (range 14-19), among whom 89% self-identified as female, 57% Black/African American, 29% Asian American, 14% White, and 7% Hispanic/Latino. Youth felt that the prototype platform was comprehensive and understandable. They suggested adding peer reviews to increase trustworthiness.

CONCLUSION

Youth reported that the platform (violetproject.org) was an acceptable tool for SRH education and STI testing. Participants expressed enthusiasm and willingness to use the platform as a reliable SRH educational tool to combat medical misinformation on the Internet and a non-clinic-based source of STI testing. This platform could fill gaps in access to SRH care and education for youth.

Adolescent Awareness of the Changing Legal Landscape of Abortion in the United States and Its Implications

PURPOSE

Restrictions on abortion in the United States will have disproportionate and negative impacts on adolescents. Prior to the Supreme Court ruling to overturn federal protection of abortion, we sought to examine adolescents' awareness and knowledge about the legal landscape of abortion and how changes might affect them.

METHODS

We fielded a 5-question open-ended survey via text message to a nationwide sample of adolescents aged 14-24 years on May 20, 2022. We coded the responses using inductive consensus coding. Summary statistics were calculated for code frequencies and demographic data, and analyzed qualitatively using visual inspection of results overall and by subgroups (e.g., age, race and ethnicity, gender, and restrictiveness of state of residence).

RESULTS

A total of 654 responded (79% response rate), of which 11% were under 18 years. Most adolescents were aware of potential changes to abortion access. Most adolescents reported using the internet and social media for information about abortions. Overall, negative emotions about the changing legal landscape predominated, including anger, fear, and sadness. When considering factors for abortion decisions, adolescents most often discussed finances and life circumstances including their future, age, education, maturity, and emotional stability. Themes were relatively, uniformly distributed across subgroups.

DISCUSSION

Our study suggests that many adolescents are aware of and concerned about potential impacts of abortion restrictions, across a diversity of ages, gender, racial/ethnic, and geographic perspectives. Understanding and amplifying the voices of adolescents during this critical time is necessary to inform novel access solutions and policy initiatives that center the needs of youth.

Classroom Voices: Youth Perspectives to Direct School-based Sexual Health Education

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.

AIDS or HIV Education and Sexual Behaviors Among Adolescent Sexual Minority Males: National HIV Behavioral Surveillance, 3 U.S. Cities, 2015

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.

Reproductive coercion in college health clinic patients: Risk factors, care seeking and perpetration

AIMS

Reproductive coercion is associated with poor health outcomes in women. This study examined exposure to and use of reproductive coercion and care seeking among college students.

DESIGN

A cross-sectional survey was administered to 2291 college students of all genders seeking care in college health and counselling centres as baseline data for a cluster-randomized controlled trial.

METHODS

Online surveys were collected (9/2015-3/2017). Descriptive statistics, chi-square, Fisher's exact and t-tests were analysed.

RESULTS

Among female participants, 3.1% experienced reproductive coercion in the prior 4 months. Experience was associated with older age (p = .041), younger age at first intercourse (p = .004), Black/African American race (p < .001), behaviourally bisexual (p = .005), more lifetime sexual partners (p < .001) and ever pregnant (p = .010). Sexually transmitted infection (p < .001), recent drug use or smoking (p = .018; p = .001), requiring special health equipment (p = .049), poor school performance (p < .001) and all categories of violence (p = <.001-.015) were associated with women's reproductive coercion experience. Participants who experienced reproductive coercion were more likely to seek care for both counselling and healthcare, (p = .022) and sexually transmitted infection (p = .004). Among males, 2.3% reported recent use of reproductive coercion; these participants reported sexual violence perpetration (p = .005), less condom use (p = .003) and more sexual partners than non-perpetrators (p < .001).

CONCLUSION

Although reproductive coercion was reported infrequently among college students, those students experiencing it appear to be at risk for poor health and academic outcomes. Health and counselling centres are promising settings to address RC and related health behaviours.

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

BACKGROUND

Sexual education programs in the United States are rooted in inequitable structures and are often inadequate at educating marginalized student groups such as students of color, Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), women, and disabled students.

CONTRIBUTIONS TO THEORY

Current sexual education is irregularly implemented and often excludes or misrepresents the experiences of students with marginalized identities. This theoretical paper specifically discusses ways that sexual education has been harmful or exclusionary for marginalized student groups and how a shift toward making sexual education inclusive and equitable will improve outcomes for students of all identities.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

This paper discusses several recommendations on improving access to equitable sexual health education for all students including reviewing and improving sexual education curriculum and delivery, as well as the need for additional research focused on this topic.

CONCLUSIONS

This article provides an overview on the current sexual education system, its inadequacies, and how comprehensive sexuality education programs can be leveraged as a tool for equity for students of all backgrounds, but particularly those who are underrepresented in sexual education curricula.

Sex 101: A Rapid Review of Research in the United States on the Impacts of College Sexual Health Curricula

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.

Sexual health indicators for the United States: Measuring progress and documenting public health needs

Introduction

Today, we are facing increased and continued adverse sexual health outcomes in the United States, including high post-COVID-19 pandemic rates of sexually transmitted infections (STIs). For the past 20 years, there have been calls for a national health strategy and a more comprehensive sexual health approach to address the myriad of persistent sexual health problems in this country. Employing a sexual health approach requires shifting from a longstanding, stigmatizing focus on morbidity toward a holistic and integrated focus on health rather than disease. While strategies are being implemented by multisectoral stakeholders, it is also important to establish a core set of indicators that broadly describe the state of sexual health in the U.S. and allow for measurement across time. The development of a comprehensive scorecard with key sexual health indicators has been proposed by other entities (e.g., Public Health England, World Health Organization), but such an attempt has not been made in the U.S.

Methods

A review of national U.S. surveys and surveillance systems with items related to sexual health was conducted for years 2010-2022 to develop an inventory of existing data that yield national estimates for potential indicators of sexual health.

Results

We selected 23 sexual health indicators in four broad domains including: (1) knowledge; communication and attitudes (five indicators); (2) behaviors and relationships (four indicators); (3) service access and utilization (seven indicators); and (4) adverse health outcomes (seven indicators). Recent data for each indicator are provided.

Discussion

A growing body of evidence shows the positive effects of moving away from a morbidity focus toward an integrated, health-promoting approach to sexual health. Yet, not much has been done in terms of how we implement this national shift. We argue that measurement and monitoring are key to future change. We envision these core sexual health indicators would be published in the form of an index that is publicly available and updated frequently. These sexual health indicators could be used for ongoing monitoring, and to guide related research, programming, and policy development to help promote sexual health in coming years.

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

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.

Parents' attitudes towards the content of sex education in the USA: Associations with religiosity and political orientation

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.

Increased Parent Support for Comprehensive Sexuality Education Over 15 Years

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.

National trends and disparate access to formal and informal sex education among youth involved with the child welfare system in the USA

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.

The Pediatrician in the Post-Roe Landscape

This Viewpoint discusses adolescent and young adult reproductive health care in a post-Roe environment.

Dobbs v. Jackson Decision: It's Time to Get Uncomfortable

The recently announced decision of the Supreme Court in the Dobbs v. Jackson case has left health care providers, researchers, and administrators struggling to defend reproductive health care against legal restrictions. Although some hospital-based providers may not consider reproductive health care as part of their "wheelhouse," anyone who cares for adolescents and young adults must see this as a call to action. Reproductive health screening is often missed in the primary care setting1 which has led to recommendations to provide this care wherever adolescents and young adults present for care.2 As adolescents are under the legal age of majority and typically have less experience, education, and resources to help them access reproductive health care when needed, these new abortion laws will create disproportionate burdens on the adolescent population. For low-income youth and adolescent and young adults of color, this will likely worsen the disparities that already exist with regard to access to reproductive health care.3 Adolescents have the highest rates of unintended pregnancy4 and these pregnancies are more likely to end in abortion than adult pregnancies.5,6 Adolescents younger than age 20 make up 12% of individuals who have abortions in the US; minors who are 17 years or younger account for about 4% of all abortions in the US.7.

Trends in Teaching Sexual and Reproductive Health Skills in US Secondary Schools in 35 States, 2008 to 2018

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.