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Lohan M, Gillespie K, Aventin Á, Gough A, Warren E, Lewis R, Buckley K, McShane T, Brennan-Wilson A, Lagdon S, Adara L, McDaid L, French R, Young H, McDowell C, Logan D, Toase S, Hunter RM, Gabrio A, Clarke M, O'Hare L, Bonell C, Bailey JV, White J. School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-139. [PMID: 37795864 DOI: 10.3310/ywxq8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design A cluster randomised trial, incorporating health economics and process evaluations. Setting Sixty-six schools across the four nations of the UK. Participants Students aged 13-14 years. Intervention A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). Limitations The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration This trial is registered as ISRCTN10751359. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kathryn Gillespie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Lewis
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kelly Buckley
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Susan Lagdon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Adara
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca French
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Honor Young
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | | | | | - Sorcha Toase
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rachael M Hunter
- Health Economics Analysis and Research Methods Team, University College London, London, UK
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Liam O'Hare
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - James White
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
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Enuameh YAK, Adjei G, Mahama E, Gyan T, Koku E. Effectiveness of population based risk reduction programs for risky sexual behavior among young people in low- and middle-income countries: a systematic review protocol. ACTA ACUST UNITED AC 2018; 15:2242-2248. [PMID: 28902690 DOI: 10.11124/jbisrir-2016-002967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to synthesize the best available evidence on the effectiveness of population based (public health) risk reduction interventions (programs and services) on sexual risk taking among young people (aged 10 to 24 years old) in low- and middle-income countries (LMICs).The specific review questions are.
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Affiliation(s)
- Yeetey Akpe Kwesi Enuameh
- 1The Kintampo Health Research Centre: a Joanna Briggs Institute Centre of Excellence, Kintampo, Ghana 2Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 3School of Medicine, Division of Paediatrics, University of Western Australia, Perth, Australia 4Department of Sociology, Drexel University, Philadelphia, USA
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Lohan M, Aventin Á, Maguire L, Curran R, McDowell C, Agus A, Donaldson C, Clarke M, Linden M, Kelly C, McDaid L, Dunne L, O’Halloran P. Increasing boys’ and girls’ intentions to avoid teenage pregnancy: a cluster randomised controlled feasibility trial of an interactive video drama-based intervention in post-primary schools in Northern Ireland. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAdolescent men have a vital yet neglected role in reducing unintended teenage pregnancy (UTP). There is a need for gender-sensitive educational interventions.ObjectivesTo determine the value and feasibility of conducting an effectiveness trial of theIf I Were JackRelationship and Sexuality Education (RSE) intervention in a convenience quota sample of post-primary schools in Northern Ireland. Secondary objectives were to assess acceptability to schools, pupils (male/female, aged 14–15 years) and parents/guardians; to identify optimal delivery structures and systems; to establish participation rates and reach, including equality of engagement of different socioeconomic and religious types; to assess trial recruitment and retention rates; to assess variation in normal RSE practice; to refine survey instruments; to assess differences in outcomes for male and female pupils; to identify potential effect sizes that might be detected in an effectiveness trial and estimate appropriate sample size for that trial; and to identify costs of delivery and pilot methods for assessing cost-effectiveness.DesignCluster randomised Phase II feasibility trial with an embedded process and economic evaluation.InterventionA teacher-delivered classroom-based RSE resource – an interactive video drama (IVD) with classroom materials, teacher training and an information session for parents – to immerse young people in a hypothetical scenario of Jack, a teenager whose girlfriend is unintentionally pregnant. It addresses gender inequalities in RSE by focusing on young men and is designed to increase intentions to avoid UTP by encouraging young people to delay sexual intercourse and to use contraception consistently in sexual relationships.Main outcome measuresAbstinence from sexual intercourse (delaying initiation of sex or returning to abstinence) or avoidance of unprotected sexual intercourse (consistent correct use of contraception). Secondary outcomes included Knowledge, Attitudes, Skills and Intentions.ResultsThe intervention proved acceptable to schools, pupils and parents, as evidenced through positive process evaluation. One minor refinement to the parental component was required, namely the replacement of the teacher-led face-to-face information session for parents by online videos designed to deliver the intervention to parents/guardians into their home. School recruitment was successful (target 25%, achieved 38%). No school dropped out. Pupil retention was successful (target 85%, achieved 93%). The between-group difference in incidence of unprotected sex of 1.3% (95% confidence interval 0.55% to 2.2%) by 9 months demonstrated an effect size consistent with those reported to have had meaningful impact on UTP rates (resulting in an achievable sample size of 66 schools at Phase III). Survey instruments showed high acceptability and reliability of measures (Cronbach’s alpha: 0.5–0.7). Economic evaluation at Phase III is feasible because it was possible to (1) identify costs of deliveringIf I Were Jack(mean cost per pupil, including training of teachers, was calculated as £13.66); and (2) develop a framework for assessing cost-effectiveness.ConclusionTrial methods were appropriate, and recruitment and retention of schools and pupils was satisfactory, successfully demonstrating all criteria for progression to a main trial. The perceived value of culture- and gender-sensitive public health interventions has been highlighted.Future workProgression to a Phase III effectiveness trial.Trial registrationCurrent Controlled Trials ISRCTN99459996.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Lisa Maguire
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Rhonda Curran
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | | | - Ashley Agus
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Carmel Kelly
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office (MRC/CSO) Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Laura Dunne
- School of Education, Queen’s University Belfast, Belfast, UK
| | - Peter O’Halloran
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
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Aventin Á, Lohan M, O'Halloran P, Henderson M. Design and development of a film-based intervention about teenage men and unintended pregnancy: applying the Medical Research Council framework in practice. EVALUATION AND PROGRAM PLANNING 2015; 49:19-30. [PMID: 25483572 DOI: 10.1016/j.evalprogplan.2014.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/27/2014] [Accepted: 11/10/2014] [Indexed: 06/04/2023]
Abstract
Following the UK Medical Research Council's (MRC) guidelines for the development and evaluation of complex interventions, this study aimed to design, develop and optimise an educational intervention about young men and unintended teenage pregnancy based around an interactive film. The process involved identification of the relevant evidence base, development of a theoretical understanding of the phenomenon of unintended teenage pregnancy in relation to young men, and exploratory mixed methods research. The result was an evidence-based, theory-informed, user-endorsed intervention designed to meet the much neglected pregnancy education needs of teenage men and intended to increase both boys' and girls' intentions to avoid an unplanned pregnancy during adolescence. In prioritising the development phase, this paper addresses a gap in the literature on the processes of research-informed intervention design. It illustrates the application of the MRC guidelines in practice while offering a critique and additional guidance to programme developers on the MRC prescribed processes of developing interventions. Key lessons learned were: (1) know and engage the target population and engage gatekeepers in addressing contextual complexities; (2) know the targeted behaviours and model a process of change; and (3) look beyond development to evaluation and implementation.
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Affiliation(s)
- Áine Aventin
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Maria Lohan
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Peter O'Halloran
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland UK.
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Lohan M, Aventin Á, Maguire L, Clarke M, Linden M, McDaid L. Feasibility trial of a film-based educational intervention for increasing boys' and girls' intentions to avoid teenage pregnancy: Study protocol. INTERNATIONAL JOURNAL OF EDUCATIONAL RESEARCH 2014; 68:35-45. [PMID: 25284956 PMCID: PMC4183752 DOI: 10.1016/j.ijer.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/13/2014] [Accepted: 08/16/2014] [Indexed: 06/03/2023]
Abstract
The World Health Organisation, amongst others, recognises that adolescent men have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. This study seeks to fill this gap by determining the feasibility of conducting an effectiveness trial of the If I Were Jack intervention in post-primary schools. This 4-week intervention aims to increase teenagers' intentions to avoid unintended pregnancy and addresses gender inequalities in sex education by explicitly focusing on young men. A cluster randomised feasibility trial with embedded process evaluation will determine: recruitment, participation and retention rates; quality of implementation; acceptability and feasibility of the intervention and trial procedures; and costs.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland/Scotland, United Kingdom
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland/Scotland, United Kingdom
| | - Lisa Maguire
- Centre for Public Health, Queen's University Belfast, United Kingdom
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, United Kingdom
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland/Scotland, United Kingdom
| | - Lisa McDaid
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
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Raghupathy S, Klein C, Card J. Online Activities for Enhancing Sex Education Curricula: Preliminary Evidence on the Effectiveness of the Abstinence and Contraception Education Storehouse. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2013; 12:160-171. [PMID: 24078799 PMCID: PMC3782065 DOI: 10.1080/15381501.2013.790749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this research was to conduct a preliminary evaluation of the Abstinence and Contraception Education Storehouse (ACES), a digital, classroom-based resource designed to supplement existing sex education curricula with highly interactive materials such as video clips, multimedia polls and quizzes, and audiovisual demonstrations. 335 students ages 14-19 were randomly assigned to an ACES-based (treatment) or a standard (control) sex education curriculum. Data were collected at the onset of the intervention and 3-months after the completion of the intervention. Preliminary results were highly encouraging, with ACES participants who were sexually initiated at baseline reporting at the 3-month follow-up significant reductions in the number of times they had sex in the past four weeks. Both sexually initiated and non-sexually initiated youth who experienced the ACES curriculum also demonstrated greater intent to abstain from the sex during the follow-up period than those in the control group.
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Affiliation(s)
- Shobana Raghupathy
- Address correspondence to Dr. Shobana Raghupathy, Phd, Sociometrics, 170 State St., Los Altos, CA 94022, USA.
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Ritchie D, Amos A, Martin C. Public places after smoke-free—A qualitative exploration of the changes in smoking behaviour. Health Place 2010; 16:461-9. [DOI: 10.1016/j.healthplace.2009.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 11/06/2009] [Accepted: 12/06/2009] [Indexed: 11/25/2022]
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Braun V. “She'll be right”? National identity explanations for poor sexual health statistics in Aotearoa/New Zealand. Soc Sci Med 2008; 67:1817-25. [DOI: 10.1016/j.socscimed.2008.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Indexed: 11/30/2022]
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Power R, Langhaug L, Cowan F. "But there are no snakes in the wood": risk mapping as an outcome measure in evaluating complex interventions. Sex Transm Infect 2007; 83:232-6. [PMID: 17344248 PMCID: PMC2659103 DOI: 10.1136/sti.2006.022434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To complement biological and social behavioural markers in evaluating the complex intervention of sexual and reproductive health among adolescents in rural Zimbabwe, community-derived markers of effectiveness were sought. Through a participatory workshop with adolescent boys and girls, an innovative "risk map research workshop" was developed to be conducted throughout the study sites. METHODS 78 gender-specific standardised workshops were conducted among secondary school students. Participants drew risk maps of their community. Focus group discussions explored each risk area identified on the map. Grounded Theory was used to create "categories" and "subcategories." Workshops continued to be held until "saturation", whereby no new categories emerged. "Axial coding" identified the inter-relationship between categories and subcategories according to their relevance to sexual and reproductive health risk. RESULTS Six "risk area" Grounded Theory categories emerged from the data: bush/rural terrain, commercial centres, homes, school environs, religious and spiritual venues, and roadsides. 17 subcategories emerged, grouped under each of the risk area categories, such as riverbeds, growth points, homesteads, classrooms, all-night prayer meetings and truck stops. Risks and the consequences of risks included sexually transmitted infections (including HIV), violence, sexual abuse, expulsion from school and illegal abortion. CONCLUSIONS Risk maps provide unique data that can be used to measure more subtle changes that occur as a result of social behavioural interventions aimed at addressing reproductive and sexual health. Another round of risk map research workshops will be held towards the end of the study to explore changes in milieu, behaviour and experiences, and will complement and triangulate the biological and other social behavioural outcome measures.
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Affiliation(s)
- Robert Power
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria 3001, Australia.
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Henderson M, Wight D, Raab GM, Abraham C, Parkes A, Scott S, Hart G. Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial. BMJ 2007; 334:133. [PMID: 17118950 PMCID: PMC1779834 DOI: 10.1136/bmj.39014.503692.55] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS. DESIGN Follow-up of cluster randomised trial 4.5 years after intervention. SETTING NHS records of women who had attended 25 secondary schools in east Scotland. PARTICIPANTS 4196 women (99.5% of those eligible). INTERVENTION SHARE programme (intervention group) v existing sex education (control group). MAIN OUTCOME MEASURE NHS recorded conceptions and terminations for the achieved sample linked at age 20. RESULTS In an "intention to treat" analysis there were no significant differences between the groups in registered conceptions per 1000 pupils (300 SHARE v 274 control; difference 26, 95% confidence interval -33 to 86) and terminations per 1000 pupils (127 v 112; difference 15, -13 to 42) between ages 16 and 20. CONCLUSIONS This specially designed sex education programme did not reduce conceptions or terminations by age 20 compared with conventional provision. The lack of effect was not due to quality of delivery. Enhancing teacher led school sex education beyond conventional provision in eastern Scotland is unlikely to reduce terminations in teenagers. TRIAL REGISTRATION ISRCTN48719575 [controlled-trials.com].
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Affiliation(s)
- M Henderson
- Medical Research Council Social and Public Health Sciences Unit, Glasgow G12 8RZ.
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Myklestad I, Rise J. Predicting Willingness to Engage in Unsafe Sex and Intention to Perform Sexual Protective Behaviors Among Adolescents. HEALTH EDUCATION & BEHAVIOR 2006; 34:686-99. [PMID: 16885507 DOI: 10.1177/1090198106289571] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article examines the sociocognitive processes contributing to intention to use contraception and willingness to engage in unsafe sex, using extended versions of the theory of planned behavior (TPB) and the Prototype/Willingness model (Gibbons & Gerrard, 1995, 1997). Data were obtained from a questionnaire delivered to all the pupils in ninth grade ( N = 196) at three schools in Oslo. Hierarchical multiple regression analysis was used to predict intention and willingness. The results showed that subjective norm was the most important predictor of intentions for girls, whereas moral norm was most important for boys' intentions and willingness. Prototypes were the most important predictor for girls' willingness. Implications of the findings are discussed.
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Tucker JS, Fitzmaurice AE, Imamura M, Penfold S, Penney GC, Teijlingen EV, Shucksmith J, Philip KL. The effect of the national demonstration project Healthy Respect on teenage sexual health behaviour. Eur J Public Health 2006; 17:33-41. [PMID: 16601108 DOI: 10.1093/eurpub/ckl044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As part of the independent evaluation of Healthy Respect (a national demonstration project to improve teenage sexual health in Scotland) this study examined the effect of the school-based sexual health education intervention comprising multiprofessional classroom delivery and alongside drop-in clinics on teenage sexual behaviour outcomes. METHODS Before-and-after cross-sectional surveys of secondary school pupils (average age 14 years and 6 months) were used in 10 Healthy Respect intervention schools in Lothian region and 5 comparison schools without intervention in Grampian region (2001 and 2003). RESULTS By 2003, the proportion of pupils in Lothian feeling confident about getting condoms and using condoms properly significantly increased, more Lothian pupils (particularly boys) showed improved knowledge about condoms being protective against sexually transmitted infections. No further evidence of improved knowledge, attitudes, or intentions was evident after the intervention. Pupils in Lothian remained more likely to think using a condom would be embarrassing (especially girls), would reduce sexual enjoyment (especially boys), and intentions about condom use (as closer predictors of actual behaviour change) showed no significant improvement. More Lothian ( approximately 24%) than Grampian ( approximately 19%) pupils report having had sexual intercourse at age <16 years, both before and after the intervention, with no evidence of a significant reduction in Lothian by 2003. Overall differences in attitudes to condom use by gender were noted. Findings remain consistent in both unadjusted and adjusted comparisons. CONCLUSION These findings demonstrate limited impact on sexual health behaviour outcomes, and raise questions about the likely and achievable sexual health gains for teenagers from school-based interventions.
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Affiliation(s)
- Janet S Tucker
- Dugald Baird Centre for Research on Women's Health, Department of Obstetrics and Gynaecology, University of Aberdeen, UK.
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Whitehead D. In pursuit of pleasure: health education as a means of facilitating the “health journey” of young people. HEALTH EDUCATION 2005. [DOI: 10.1108/09654280510595272] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Valle AK, Torgersen L, Røysamb E, Klepp KI, Thelle DS. Social class, gender and psychosocial predictors for early sexual debut among 16 year olds in Oslo. Eur J Public Health 2005; 15:185-94. [PMID: 15728133 DOI: 10.1093/eurpub/cki121] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Variations in early sexual debut among 16 year olds were investigated by social level variables, parental occupation, gender, ethnicity, family structure, family functioning, and individual level variables, future aspirations, academic and social self-perception, and depressed moods. METHODS The variations in sexual debut were investigated by examining proportions of 16 year olds reporting their first intercourse before age 16. The data were collected by self-reporting questionnaires administered to in-school-youth, in Oslo. Multivariate logistic regression analyses were used to test for associations. Gender interactions with all variables were tested. RESULTS Overall, 25% reported early debut. Independent effect of social class on differences in proportions in early sexual debut were found. Gender interaction with social class, ethnicity and academic self-perception as they associate to proportions having had early sexual debut, were found. For girls the pattern of social class differences was linear and the highest proportions were found among working classes. For boys the pattern was U-shaped and upper managerial and manual working class youth had similar, higher proportions of early debutants. High scores of parental monitoring, future aspirations and academic self-concept and low scores of depressed moods, are protective factors. While high social self-perception is positively associated with early debut for both genders. CONCLUSION Early sexual debut varies according to social class, following gender-specific patterns, among 16 year olds in Oslo. The negative association between early debut and academic self-perception are for boys less influenced by other social and individual level factors, than for girls.
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Affiliation(s)
- Ann-K Valle
- Department of Preventive Medicine and Epidemiology, University of Oslo, Norway.
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Whitehead D, Russell G. How effective are health education programmes—resistance, reactance, rationality and risk? Recommendations for effective practice. Int J Nurs Stud 2004; 41:163-72. [PMID: 14725780 DOI: 10.1016/s0020-7489(03)00117-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Behavioural-change-related health education programmes represent a mainstay of health care activity. Where adopted, however, the theoretical and practical constructs and constraints are not always considered. The failure of many health education programmes to achieve their intended life-style-related behavioural-change outcomes is often directly related to the complexity of the task itself. Changing a client's health behaviour is notoriously difficult and requires concerted and systematic activities to ensure any measure of success. This article draws upon existing literature to develop a critical theoretical and practical perspective for health education practice in nursing. It aims to explore the underpinning theoretical considerations for undertaking behavioural-change health education programmes. This article also proposes specific recommendations for nurse's current and future health education practice, as a means for facilitating a more structured approach to health education programme planning and evaluation.
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Affiliation(s)
- Dean Whitehead
- Institute of Health Studies (Exeter), Faculty of Health, University of Plymouth, Veysey Building, Earl Richards Road North, Exeter, Devon EX2 6AS, UK.
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Wight D, Raab GM, Henderson M, Abraham C, Buston K, Hart G, Scott S. Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial. BMJ 2002; 324:1430. [PMID: 12065268 PMCID: PMC115856 DOI: 10.1136/bmj.324.7351.1430] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether a theoretically based sex education programme for adolescents (SHARE) delivered by teachers reduced unsafe sexual intercourse compared with current practice. DESIGN Cluster randomised trial with follow up two years after baseline (six months after intervention). A process evaluation investigated the delivery of sex education and broader features of each school. SETTING Twenty five secondary schools in east Scotland. PARTICIPANTS 8430 pupils aged 13-15 years; 7616 completed the baseline questionnaire and 5854 completed the two year follow up questionnaire. INTERVENTION SHARE programme (intervention group) versus existing sex education (control programme). MAIN OUTCOME MEASURES Self reported exposure to sexually transmitted disease, use of condoms and contraceptives at first and most recent sexual intercourse, and unwanted pregnancies. RESULTS When the intervention group was compared with the conventional sex education group in an intention to treat analysis there were no differences in sexual activity or sexual risk taking by the age of 16 years. However, those in the intervention group reported less regret of first sexual intercourse with most recent partner (young men 9.9% difference, 95% confidence interval -18.7 to -1.0; young women 7.7% difference, -16.6 to 1.2). Pupils evaluated the intervention programme more positively, and their knowledge of sexual health improved. Lack of behavioural effect could not be linked to differential quality of delivery of intervention. CONCLUSIONS Compared with conventional sex education this specially designed intervention did not reduce sexual risk taking in adolescents.
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Affiliation(s)
- Daniel Wight
- Medical Research Council Social and Public Health Sciences Unit, Glasgow G12 8RZ.
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Abstract
This paper reviews the nature and explores the context of, and reactions to, reproductive health education in China by both the target population of adolescents at school and the wider public. The debate about reproductive health education and its content is taking place within the context of rapid behavioural and sociological changes in China which, in turn is, generating conflicting demands concerning the need for education by the population and the control of the population by the government. Foucault's theories on sexuality and discipline are found to be useful in exploring the subject of reproductive health education in China.
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Affiliation(s)
- C Hoy
- Department of Geography, University of Dundee, Dundee DD1 4HN, UK.
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Kvalem IL, Træen B. Self-Efficacy, Scripts of Love and Intention to Use Condoms Among Norwegian Adolescents. J Youth Adolesc 2000. [DOI: 10.1023/a:1005199725666] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Evans D, Rees J, Okagbue O, Tripp J. Negotiating sexual intimacy: A PAUSE develops an approach using a peer‐led, theatre‐for‐development model in the classroom. HEALTH EDUCATION 1998. [DOI: 10.1108/09654289810238159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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