Effectiveness of Sex Education Interventions in Adolescents: An Overview

Characteristics of emotional and sexuality education programs in the Spanish school population

Sexuality education should be integrated into educational centers as a human right of children and adolescents, and an international recommendation based on scientific evidence. This study sought to identify the sexuality education interventions that were carried out in Spain in year 2021-2022, and to analyze whether they are in line with best practice recommendations. A descriptive study was carried out, considering organization territorial called Autonomous Communities as the unit of study, through key informants identified by purposive sampling. The variables used were based on international recommendations and the information was collected via a telephone questionnaire, by e-mail or by consulting websites referenced by the key informant. Fifteen of 17 Autonomous Communities had sexuality education interventions. Most were programs and only three had optional curricular subjects. Ninety-four percent were aimed at secondary school and were taught by teachers (72 %). Only one program had an impact evaluation and only 28 % complied with best practice recommendations. The voluntary or optional nature of the interventions reduces their scope, which is usually limited to secondary school students. It is necessary to implement mandatory curricular subjects, with a focus on sexual rights and gender.

'You have a lot of mirrors': structural and socioecological factors impacting adolescent pregnancy and reproductive health in the Amazon basin, Peru, a qualitative study

Loreto, in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country. However, underlying causes of adolescent pregnancy are not fully understood as data are limited in Indigenous and remote Amazonian communities. This study investigated adolescent reproductive health within Loreto using an ecological systems framework. Forty-one semi-structured interviews were conducted in June 2022: community leaders (n = 12) and adolescent participants between 15 and 17 years of age (pregnant girls, n = 11; never pregnant girls, n = 9; and boys, n = 9). We also conducted focus group discussions with community health workers and educators in October 2022 (three focus groups, n = 15). Adolescent reproductive health is complex with multi-layered factors that put girls at higher risk of pregnancy. We found a paradoxical relationship between expected social and gender norms and individual desires. This research provides a contextual understanding of the lived experience of adolescents and young people in the Amazon region of Peru. Our findings suggest the need for greater exploration of the contradictory ideas surrounding adolescent pregnancy and female sexuality.

Prevalence of online sexual harassment and online bullying: a nationwide survey among high school students in Denmark

Background

Using data from a nationwide survey among high school students in Denmark, the aim of the current study is to measure the prevalence of online bullying and online sexual harassment and assess gender and age differences in exposure.

Methods

We used data from the Danish National Youth Study 2019, which is a nationwide web survey among high school students, including general, commercial, preparatory and technical high schools. Data were collected from January to April 2019 through a self-administered questionnaire in the classroom. A total of 29,086 students participated (response rate: 66%). The survey included questions about online sexual harassment (victimization and perpetration) and online bullying.

Results

Approximately 11% of students reported receiving sexually offensive inquiries online, and about 10% received a sexual image/video of others without the subjects' consent. Additionally, 4% experienced that other people shared a sexual image/video of them without their consent within the last 12 months. The most common type of online bullying was feeling ignored by others online (25%), followed by someone spreading rumors or writing nasty things about them (13%), and receiving threats/unpleasant messages (12%). Gender results were mixed.

Development and Usability of a Mobile Support Application for Sexual Violence Victims Connecting With Formal Support Organizations

The lack of awareness and accessibility about the support organizations for preventing sexual violence and assisting victims hampers the effectiveness of the social safety net. A mobile application based on a connection to support agencies was developed and evaluated for usability. A group of 15 experts and a group of 30 users evaluated usability. The developed mobile application focused on "Emergency Report," "Support Agencies and Services," and "Counseling for Support." The strength of the application was acknowledged in providing easy-to-find, reliable, useful, and necessary information, highlighting the positive usability and applicability of the mobile support application for sexual violence victims.

Empowering Futures: Intersecting Comprehensive Sexual Education for Children and Adolescents With Sustainable Development Goals

This scoping review synthesizes the intersection of comprehensive sexual education (CSE) for children and adolescents with sustainable development goals (SDGs) to assess the potential for empowering future generations. Considering the global challenges in addressing sexual health, this review explores the potential role of CSE in contributing to the achievement of the SDGs, particularly in the context of empowering youth and ensuring their well-being. The review begins by providing a comprehensive overview of CSE, emphasizing its role in promoting informed decision-making, gender equality, and preventing sexual and reproductive health issues among young individuals. It then delves into the overarching framework of the SDGs, mainly focusing on goals related to health, education, gender equality, and sustainable development. The synthesis examines the alignment and potential synergies between CSE and various SDGs, highlighting how CSE can contribute to outcomes such as improved health and well-being, quality education, gender equality, and reduced inequalities. Furthermore, the review brings attention to potential challenges and barriers in implementing CSE programs in different cultural and socio-economic contexts. Ultimately, this scoping review provides a critical analysis of the intersection between CSE and the SDGs, offering insights into how the comprehensive education of children and adolescents in sexual and reproductive health can play a significant role in advancing sustainable development and empowering future generations worldwide.

The downstream effects of COVID-19 on adolescent girls in the Peruvian Amazon: qualitative findings on how the pandemic affected education and reproductive health

Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout, exploitation, gender-based violence, pregnancy and early unions. In Peru, the government closed schools from March 2020 to March 2022, declaring a national emergency that affected an estimated 8 million children. These closures may have unintended consequences, including increased adolescent pregnancy, particularly in Peru's rural, largely indigenous regions. Loreto, located in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country and poor maternal and child health outcomes. The underlying causes may not be fully understood as data are limited, especially as we transition out of the pandemic. This qualitative study investigated the downstream effects of COVID-19 on adolescent education and reproductive health in Loreto's districts of Nauta and Parinari. In-depth interviews (n=41) were conducted with adolescents and community leaders. These were held in June 2022, 3 months after the reinstitution of in-person classes throughout Peru. Focus group discussions (FGDs) were also completed with community health workers and educators from the same study area in October 2022 to supplement our findings (3 FGDs, n=15). We observed that the economic, educational and health effects of the COVID-19 pandemic contributed to reduced contraceptive use, and increased school abandonment, early unions and adolescent pregnancy. The interplay between adolescent pregnancy and both early unions and school abandonment was bidirectional, with each acting as both a cause and consequence of the other.

Social marketing and mass media interventions to increase sexually transmissible infections (STIs) testing among young people: social marketing and visual design component analysis

INTRODUCTION

Globally, sexually transmissible infections (STIs) continue to disproportionately affect young people. Regular STI testing is an important public health strategy but remains low among this age group. Raising awareness of testing is an essential step and requires effective interventions designed for young people. To inform the development of effective interventions that promote STI testing among young people, we conducted a systematic literature review to describe the social marketing and visual design components commonly found in STI testing interventions and explore associations of these components with intervention effectiveness.

METHODS

We used a systemic review methodology to identify peer-reviewed articles that met pre-defined inclusion criteria. Social marketing and visual component analyses were conducted using structured data extraction tools and coding schemes, based on the eight key social marketing principles and 28 descriptive dimensions for visual analysis.

RESULTS

18 studies focusing on 13 separate interventions met the inclusion criteria. Most interventions used photograph-based images, using conventionally attractive actors, positioned centrally and making direct eye contact to engage the viewer. The majority of interventions featured text sparingly and drew on a range of tones (e.g. serious, humorous, positive, reassuring, empowering and informative) and three interventions used sexualised content. Four articles explicitly stated that the interventions was informed by social marketing principles, with two explicitly referencing all eight principles. Around half of the articles reported using a formal theoretical framework, but most were considered to have theoretical constructs implicit in interventions materials. Four articles provided detailed information regarding developmental consumer research or pre-testing. All articles suggested segmentation and development of materials specifically for young people. Explicit consideration of motivation and competition was lacking across all articles. This study found that there were some design elements common to interventions which were considered more effective. High social marketing complexity (where interventions met at least seven of the 11 criteria for complexity) seemed to be associated with more effective interventions.

CONCLUSIONS

Our findings suggest that the incorporation of social marketing principles, could be more important for intervention effectiveness than specific elements of visual design. Effective and systematic use of social marketing principles may help to inform future evidence-informed and theoretically based interventions and should be employed within sexual health improvement efforts.

Adolescents' Perceptions of Sexuality: A Qualitative Study

Adolescents have a greater risk of acquiring sexually transmitted infections (STIs), which is a serious public health problem. Education is an effective strategy to improve adolescent sexual health outcomes. However, Spanish adolescents have a lack of sex education. The aim of this study was to explore the perceptions and opinions of a sample of adolescents regarding sexually transmitted infections (STIs). Photovoice is a research method that uses the search for images of everyday events with the intention of bringing about social change. An exploratory, descriptive design was used with a qualitative approach based on the Photovoice methodology. The sample consisted of 26 high school and baccalaureate students of Almería (Spain) selected through a convenience sample. The age of the participants ranged from 14 to 17 years, with a mean age of 15.31 years. Two main categories were extracted from the data analysis: 'Towards a culture of preventing STIs and promoting healthy sexual practices' and 'Adolescents' needs from their perspective'. In conclusion, numerous changes take place at the biopsychosocial level during adolescence that imply a need to explore their sexuality in depth. A lack of knowledge and a carefree attitude during sexual initiation can increase the risk of developing STIs. The study's adolescents stated that they do not have adequate sex education to acquire sufficient knowledge about sexuality and sexual health, and therefore, request that the traditional format be modified in order to achieve better results.

Sexual and Dating Violence Prevention Programs for Male Youth: A Systematic Review of Program Characteristics, Intended Psychosexual Outcomes, and Effectiveness

Sexual and dating violence (SDV) by male youth (≤ 25 years)-including sexual harassment, emotional partner violence, and rape-is a worldwide problem. The goal of this preregistered (PROSPERO, ID: CRD42022281220) systematic review was to map existing SDV prevention programs aimed at male youth, including their characteristics (e.g., content, intensity), intended psychosexual outcomes, and empirically demonstrated effectiveness, guided by the principles of the theory of planned behavior (TPB). We conducted searches in six online databases for published, peer-reviewed quantitative effectiveness studies on multi-session, group focused, and interaction based SDV prevention programs for male youth ending March 2022. After screening of 21,156 hits using PRISMA guidelines, 15 studies on 13 different programs, from four continents were included. Narrative analysis showed, first, broad ranges in program intensity (2-48 h total), and few program curricula included explicit discussion of relevant aspects of the TPB. Second, programs' main intended psychosexual outcomes were to change SDV experiences, or related attitudes, or norms. Third, significant effects were found mostly on longer term behaviors and short-term attitudes. Other theoretical proxies of SDV experiences, such as social norms and perceived behavioral control, were sparsely investigated; thus, program effectiveness on these outcomes remains largely unknown. Assessed with the Cochrane Risk of Bias Tool, moderate to serious risk of bias arose in all studies. We present concrete suggestions for program content, such as explicit attention to victimization and masculinity and discuss best practices for evaluation research, including assessments of program integrity, and examining relevant theoretical proxies of SDV.

Determinants of the utilization of youth-friendly sexual and reproductive health services in public secondary schools of Kogi State, Nigeria: an explorative study

BACKGROUND

This study explored the factors associated with the utilization of Youth-Friendly Sexual Reproductive Health (YFSRH) services among school-going Nigerian adolescents.

METHODS

This cross-sectional study employed a mixed method involving school-going students attending five public secondary schools in Kogi State, Nigeria. Descriptive statistics were used to determine the patterns of utilisation of YFSRH services, whereas inferential statistics were performed to determine factors associated with utilization of YFSRH services. Qualitative data were analysed by thematic analyses of records using an inductive analysis.

RESULTS

One in two secondary school-going students had used the YFSRH services. Most of the participants had poor awareness of YFSRH services and limited access to YFSRH services. While gender positively predicted the utilisation of YFSRH services among secondary school-going students (aOR = 5.7; 95% CI: 2.4-8.95, p = 0.001), we found that age (aOR = 0.94; 95% CI: 0.67-0.99, p = < 0.001), and religious beliefs (aOR = 0.84; 95% CI: 0.77-0.93, p = 0.001) showed a negative relationship with the utilization of YFSRH services.

CONCLUSIONS

Our findings highlight the influence of gender, age, and religion on utilizing YFSRH services. This study recommends the inclusion of sexuality education into secondary school-going student's curricula, in order to create awareness about the benefit of utilization of sexual and reproductive health services, and this is to encourage young people to utilize the YFSRH services.

Influence of preventive sex education programmes in compulsory secondary education students: a descriptive observational study

BACKGROUND

Sex education programmes conducted by health professionals and educators are essential for young people to adopt healthy habits and attitudes towards their sexuality. The Forma Joven Program, promoted by the Andalusian Regional Government's Ministry of Health and Families and Education, is a good example of this. The aim of the study is to determine if different "degrees of intervention" in the informative consultancies of the Forma Joven Program imply differences in knowledge and attitudes towards sexuality.

METHODS

This descriptive observational study analysed 27 Compulsory Secondary Education high schools in Huelva. These were included in the Program and belonged to a Primary Care Health District. Out of the 17 institutes initially selected because they met the inclusion criteria (4.256 students), finally 14 (3.596 students) participated. During the 2018/2019 school year, students from 3rd, 4th year of Secondary Compulsory Education (ESO), 1st, and 2nd Baccalaureate of the selected centres were asked to fill in a questionnaire of knowledge and attitudes towards sexuality. It collected variables such as age, sex, school year, institute, educational level and employment status of the father or mother and profile of the professional who delivers the counselling.

RESULTS

A total of 1.237 students completed the questionnaire, which represents a participation rate of 34.4%. The average age was 15.59 years (SD 1.26) and 39.9% were girls. In some evaluated questions, we found statistically significant differences between the groups with different levels of exposure to counselling and the acquisition of knowledge and attitudes towards students' sexuality, although in most of them no such differences were found. The results of this study suggest the importance of the quality of counselling over quantity. Some classic myths persist in relation to sexuality and in some situations, they can be decisive when adopting preventive measures to avoid risks related to pregnancy and contagion of STIs.

CONCLUSIONS

A greater number of counselling sessions does not imply acquiring a higher level of knowledge or better attitudes towards sexuality. Perhaps the quality of the education is more important than the quantity of counselling sessions.

The effectiveness of a tailored programme to promote reproductive-health-promoting behaviour in young women based on the Precaution Adoption Process Model: A randomized controlled trial

AIM

The study aimed to evaluate a tailored reproductive health promotion programme based on the Precaution Adoption Process Model (PAPM) for young adults.

DESIGN

This was a two-group, non-blinded randomized controlled trial.

METHODS

This study was performed with women aged 18-25 who were not performing reproductive health-related behaviour from September 2018 to November 2018 in Seoul, South Korea. The participants were stratified by stage of PAPM (1, 2 or 3) and were randomly allocated to the intervention group (n = 30) and the control group (n = 30). Women in the intervention group were given the programme, which was customized according to the stage of PAPM over 8 weeks, such as lectures, giving information, discussions, practical training, Q&A, case experience and counselling. The control group received educational material. The primary outcomes were reproductive-health-promoting behaviour and rate of contraception use.

RESULTS

Reproductive-health-promoting behaviour was significantly higher in the intervention group than the control group post-intervention, as were reproductive health beliefs, motivation and self-efficacy.

Exposure to Sex Education and Its Effects on Adolescent Sexual Behavior in Nigeria

Sexual behavior during adolescence fundamentally steers the future life of both girls and boys, and it should be guided with appropriate education, especially as it also represents a key factor to be considered in attainment of sustainable developmental goals. The study assessed the effect of exposure to sex education on adolescents' sexual behavior. The primary and cross-sectional survey data used for this study were analyzed using basic descriptive statistics and binary logistic regression analytical technique. The results, among others, highlighted that the most common sources of first sex education among the respondents are school (54.6%), family (21.6%), social media (9.5%), and others like television (7.6%) and books or magazines (4.9%). Frequency of discussion on sexual matters is positively associated with the use of protection such as condom (β = 0.261; p ≤ 0.01). The study gave support to the increasing pursuit of sexuality education. However, since adolescents' needs could vary by demographics, streamlining sex education need by age and sex characteristics could enhance its effectiveness.

Chinese adolescents' sexual and reproductive health education: A quasi-experimental study

OBJECTIVE

This study investigated the effectiveness of an interactive sexual and reproductive health education program in aspects of knowledge, attitudes, and self-efficacy among adolescents.

DESIGN

Quasi-experimental study underpinned by social cognitive theory.

SAMPLE

A stratified cluster sample of 469 students from the two-branch middle school in a city in eastern China who were assigned to the experimental (n = 233) and control (n = 236) groups.

MEASUREMENTS

Students' sexual knowledge, attitudes, and refusal self-efficacy were assessed before (T0), immediately after (T1), and 1 month after the intervention (T2), respectively.

INTERVENTION

Students in the experimental group received two 40-min sessions of the educational program while the control group received the usual mode of sexual and reproductive health education.

RESULTS

Compared with the control group, students in the experimental group acquired more sexual knowledge (p < .01), and developed more positive sexual attitudes (p < .05) and stronger sexual self-efficacy (p < .05) across the study period.

CONCLUSIONS

The proposed sexual and reproductive health education program incorporating various interactive activities was effective and could be used for school-based implementation led by nurses and other health care workers.

Sex Education in the Spotlight: What Is Working? Systematic Review

Adolescence, a period of physical, social, cognitive and emotional development, represents a target population for sexual health promotion and education when it comes to achieving the 2030 Agenda goals for sustainable and equitable societies. The aim of this study is to provide an overview of what is known about the dissemination and effectiveness of sex education programs and thereby to inform better public policy making in this area. Methodology: We carried out a systematic review based on international scientific literature, in which only peer-reviewed papers were included. To identify reviews, we carried out an electronic search of the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. This paper provides a narrative review of reviews of the literature from 2015 to 2020. Results: 20 reviews met the inclusion criteria (10 in school settings, 9 using digital platforms and 1 blended learning program): they focused mainly on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), whilst obviating themes such as desire and pleasure, which were not included in outcome evaluations. The reviews with the lowest risk of bias are those carried out in school settings and are the ones that most question the effectiveness of sex education programs. Whilst the reviews of digital platforms and blended learning show greater effectiveness in terms of promoting sexual and reproductive health in adolescents (ASRH), they nevertheless also include greater risks of bias. Conclusion: A more rigorous assessment of the effectiveness of sexual education programs is necessary, especially regarding the opportunities offered by new technologies, which may lead to more cost-effective interventions than with in-person programs. Moreover, blended learning programs offer a promising way forward, as they combine the best of face-to-face and digital interventions, and may provide an excellent tool in the new context of the COVID-19 pandemic.

Women's knowledge and attitudes towards cervical cancer prevention: A qualitative study in the Spanish context

AIMS AND OBJECTIVES

To explore the knowledge, attitudes and practices related to cervical cancer and its prevention in Spain.

BACKGROUND

Worldwide, women's knowledge about cervical cancer is low, and their attitudes towards its prevention are good, but they do not correlate with the screening uptake. Although the rates of Spanish women performing cervical cancer screening are mostly acceptable, their knowledge and attitudes about it have not been explored.

DESIGN

Qualitative descriptive study.

METHODS

Three focus groups were conducted, with 21 women aged 25 to 65 years. Participants were recruited through convenience sampling. For intragroup homogeneity, women participated in age groups. The COREQ reporting guidelines were used.

RESULTS

Women expressed their knowledge about cervical cancer was low. None of the participants identified the human papillomavirus as a cause of cervical cancer, nor did they mention the vaccine as a preventive measure. They all knew about the screening existence, but not about its frequency nor target population. About the attitudes and practice, 18 women had an appropriate screening, and they were favourable to this health check, claiming an increase in its frequency. Nineteen women claimed they had not received enough information from the healthcare system and a lack of social awareness in comparison with breast cancer. They demanded from the professionals more health education, a reminder of their appointments and a report of the Pap test results.

CONCLUSIONS

There was a self-perceived low level of knowledge about cervical cancer risk factors and its prevention in the participants. However, they expressed favourable attitudes towards screening, and they demanded more information about cervical cancer and its prevention measures, and they regretted its low social awareness.

RELEVANCE TO CLINICAL PRACTICE

Midwives, general nurses and other nurse specialists may have a leading position in health education for cervical cancer prevention in different population levels.