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Belcher K, Fishman E, Ramirez-Mercado K, Marshall B, DiPaolo M, Jarpe-Ratner E. Facilitators and Barriers to Implementing a Comprehensive Sexual Health Education Policy in Chicago Public Schools. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 38965747 DOI: 10.1111/josh.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND In 2013, the Chicago Public Schools (CPS) district passed a policy requiring schools to deliver comprehensive sexual health education (SHE) to all K-12th grade students. A performance improvement case study was conducted in the 2019-2020 school year to evaluate the implementation of the policy and identify lessons learned to support implementation in schools. METHODS Key informant interviews were conducted with 11 school principals and 29 teachers to discuss SHE implementation at their school. Interviews were recorded, transcribed, and analyzed to assess school and classroom factors that affect implementation. Themes that cut across these factors were then identified and summarized by 2 evaluators. RESULTS The following themes were identified across key informant interviews: (a) principal prioritization of SHE helps ensure SHE is implemented, (b) the expansion of school and teacher capacity facilitates SHE implementation, and (c) the creation of accountability mechanisms in classrooms and schools fosters adherence to SHE policy. CONCLUSIONS Principals play a crucial role in building capacity to deliver SHE and ensuring SHE accountability mechanisms are implemented in their school. CPS is using these findings to adjust technical assistance and resources provided to principals and SHE instructors.
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Affiliation(s)
- Kristen Belcher
- University of Illinois, Chicago School of Public Health, Chicago, IL
| | | | - Kat Ramirez-Mercado
- Health Promotion, Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL
| | - Booker Marshall
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Marisa DiPaolo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Jayne PE, Szucs LE, Lesesne CA, Grose RG, Johns MM. "I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:158-170. [PMID: 38623631 DOI: 10.1111/psrh.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. METHODS We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences. RESULTS Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender. CONCLUSION There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways.
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Affiliation(s)
- Paula E Jayne
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Atlanta, Georgia, USA
| | - Leigh E Szucs
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Chamblee, Georgia, USA
| | | | - Rose Grace Grose
- Colorado School of Public Health, Community Health Education, University of Northern Colorado, Greeley, Colorado, USA
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Veronese V, Rossetto G. The Role of the School Nurse in the United States, United Kingdom, and Italy During the COVID-19 Pandemic: A Scoping Review. Clin Nurs Res 2024; 33:189-202. [PMID: 38197319 DOI: 10.1177/10547738231219732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
The school nurse has a crucial role in the United States and the United Kingdom and has their own expertise dedicated to school assistance for children, families, school staff, and the community. This study aims to identify the role and skills of the school nurse and understand the effects of COVID-19 on nursing skills in the following countries: The United States, the United Kingdom, and Italy. A Scoping Review was conducted following the JBI methodology for scoping reviews, following the PRISMA-ScR guidelines. Three databases were consulted: PubMed, Cinahl, and Scopus. In all, 58 studies met the eligibility criteria and were included. 93.1% of the studies were carried out in the United States, 5.2% in the United Kingdom, and 1.7% in Italy. 34.5% of the articles were published in 2020, 15.5% in 2021, 31% in 2022, and 19% in 2023. 22.4% of the studies included in the review concerned health promotion and education. Regarding the methodology of the studies, 41.5% of the studies were commentary papers, 15.5% were observational studies, and 12% were cross-sectional studies. Considering the effects of the school nurse in the United States and the United Kingdom, it is possible to reflect on how the systematic presence of a nurse could also have benefits in Italy.
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Silivri M, Wirf T, Hodges EA, Fredholm YS, Björk M. Conversations About Sexual and Reproductive Health and Rights-From a School Nurse Perspective. J Sch Nurs 2023; 39:406-414. [PMID: 34369177 DOI: 10.1177/10598405211029252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Students have the right to receive education about sexual and reproductive health and rights (SRHR). The United Nations Agenda 2030 for sustainable development includes goals regarding SRHR, including the right to universal access to sexual and reproductive health care services and gender equality. The study used a qualitative design with an inductive approach. Data were collected through semistructured interviews. The results are presented in three categories and nine subcategories. The categories were "having an open attitude," "organizational prerequisites," and "challenging tasks." An open attitude was required to create confidence for both school nurses and students in SRHR conversations. Organizational prerequisites, such as planning SRHR education with others, were successful. Multicultural meetings and conversations regarding gender identity and sexual orientation were challenging tasks. Increased knowledge of SRHR and national standardized guidelines are suggested to achieve Agenda 2030 SRHR goals and to ensure equity in school health care.
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Affiliation(s)
| | - Therese Wirf
- Student Health Care, Prastangsskolan, Eksjö, Sweden
| | - Eric A Hodges
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ylva S Fredholm
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Maria Björk
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- CHILD Research Group, Jönköping University, Jonkoping, Sweden
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Marcantonio TL, Nielsen KE, Haikalis M, Leone RM, Woerner J, Neilson EC, Schipani-McLaughlin AM. Hey ChatGPT, Let's Talk About Sexual Consent. JOURNAL OF SEX RESEARCH 2023:1-12. [PMID: 37707442 PMCID: PMC10937333 DOI: 10.1080/00224499.2023.2254772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Access to sexual health education, such as education on sexual consent, is limited in the US. Artificial intelligence (AI), such as ChatGPT, provides a potential opportunity to increase access to sexual consent information and education. However, what ChatGPT knows about sexual consent and if this aligns with the current evidence-based literature on sexual consent is unclear. The goal of this research commentary was to explore what ChatGPT knows about sexual consent with a focus on: 1) the definition of consent, 2) how consent could be communicated, and 3) the impact that substances have on consent. We also examined the reliability of ChatGPT's responses by having three different researchers ask ChatGPT the same set of questions. Across our questions, ChatGPT provided similar and comprehensive responses that discussed key features of consent - that consent is freely given or reversible. ChatGPT provided examples of different verbal and nonverbal cues people can use to communicate and interpret consent and discussed the ways that substances can impact consent communication. Overall, ChatGPT could be a potential resource for educators and young people who seek information about sexual consent; however, we should proceed with caution. ChatGPT is not a replacement for an educator but rather a way to increase access to education.
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Affiliation(s)
- Tiffany L Marcantonio
- Department of Health Science, College of Human Environmental Sciences, University of Alabama
| | - Karen E Nielsen
- Population Health Science, School of Public Health, Georgia State University
| | - Michelle Haikalis
- Department of Behavioral and Social Sciences, School of Public Health, Center for Alcohol and Addiction Studies, Brown University
| | - Ruschelle M Leone
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University
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Dickson E, Brakey HR, Wilson P, Hackett JM, McWethy M. Classroom Voices: Youth Perspectives to Direct School-based Sexual Health Education. SEX EDUCATION 2023; 24:479-496. [PMID: 38947913 PMCID: PMC11213557 DOI: 10.1080/14681811.2023.2218267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 07/02/2024]
Abstract
Sexual health education is a well-known, evidence-based intervention that can improve adolescent health outcomes, increase protective health behaviours, and decrease risky health behaviours. Providing sexual health education in school settings offers opportunities for discussion of critical health topics and can improve the school environment for all students. However, not all sexual health education is taught equitably across classroom environments. As part of a mixed-methods study to describe school-based sexual health education, we conducted focus groups and interviews with recently graduated high school students in New Mexico, a geographically and ethnically diverse state in the US Southwest. Thirty-one young people shared their experiences, explored the sexual health education content they had been taught, and offered recommendations to improve sexual health education. Three key themes were developed: young people wanted and needed sexual health education taught in school settings; the sexual health education currently taught in school is not helpful and sometimes harmful; and the individuals who teach sexual health education are critically important. These findings can inform and support school staff and administrators addressing barriers to school-based sexual health education delivery, particularly in schools within marginalised communities with limited resources. The results support including youth as stakeholders in the planning, delivery and evaluation of school-based sexual health education; and the development of sexual health education training for teachers, with the goal of improving health outcomes for all youth populations.
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Affiliation(s)
- Elizabeth Dickson
- College of Nursing, Albuquerque, University of New Mexico, New Mexico, USA
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Persephone Wilson
- Planned Parenthood of the Rocky Mountains, Albuquerque, New Mexico, USA
| | - Janna M. Hackett
- College of Nursing, Albuquerque, University of New Mexico, New Mexico, USA
| | - Magdalena McWethy
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
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Johnson KE, Thurman W, Hoskote A, Preston A, Rew L, Maughan ED. School Nurse Staffing in Texas Alternative High Schools: A Mixed Methods Exploration. J Sch Nurs 2022:10598405221126178. [PMID: 36237131 PMCID: PMC10097838 DOI: 10.1177/10598405221126178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School nurses represent cost-effective investments in students' health and educational success. Alternative high schools (AHSs) serve an understudied population of youth who are at risk for school dropout and face numerous social inequities, heightening their risk for poor health outcomes. In this two-phase explanatory sequential mixed methods study, we examined school nurse staffing in Texas AHSs. Findings suggest Texas AHSs face understaffing for familiar reasons common across districts (e.g., lack of funding), but also reveal potential deeper inequities. Quantitative findings indicate 71% of Texas AHSs have some form of nursing support, most often an on-call or part-time nurse. Qualitative findings support and enrich this finding with insights into the negative consequences of not having a full-time nurse, indiscriminate approaches to staffing AHSs, and how AHSs can be the only school in the district without a full-time nurse. Altogether, our findings reveal opportunities to better support AHSs with adequate nursing support.
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Affiliation(s)
- Karen E. Johnson
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Whitney Thurman
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Ashwini Hoskote
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Angela Preston
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Lynn Rew
- The University of Texas at Austin School of Nursing, Austin, TX, USA
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Santarato N, Barbosa NG, da Silva ALC, Monteiro JCDS, Gomes-Sponholz FA. Characterization of adolescent sexual practices. Rev Lat Am Enfermagem 2022. [PMID: 36197394 PMCID: PMC9647882 DOI: 10.1590/1518-8345.6289.3711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE to characterize adolescents' sexual practices and their association with sociodemographic variables, sources of information and behavioral habits. METHOD a descriptive, observational, cross-sectional study conducted with 85 adolescents from public elementary and high schools in a city in the state of São Paulo. Data were collected through a structured, self-administered and anonymous questionnaire. Statistical analysis was performed using the χ2 test and Fisher's test. RESULTS 21.2% had started their sexual life through oral sex, with a predominance of females (94.4%), self-reported brown color (55.0%). The practice of vaginal sex was reported in 31.8%, with a mean age of initiation at 14.5 years. The female sex was predominant (77.0%), with a self-reported brown color (40.0%). The practice of anal sex was detected in 7.1%, with a mean age of 14.4 years, prevalent in females (83.3%), with a self-reported black color (50.0%). There was an association of alcohol, drugs and tobacco use with sexual practices (p<0.05). CONCLUSION a diversity of sexual practices associated with substance use was detected, emphasizing the importance of the nurse's role in planning and carrying out health education interventions with adolescents and families. UNLABELLED (1) Analysis of the sequence and time of initiation of sexual practices, demonstrating the diversity of sexual activities performed by adolescents. (2) Family context and low openness to dialogue and its correlation with the initiation of adolescent sexual practices. (3) Behavioral habits: association of alcohol, tobacco and drug consumption by adolescents with sexual activities.
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Affiliation(s)
- Nathalia Santarato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Nayara Gonçalves Barbosa
- Universidade Federal de Juiz de Fora, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Minas Gerais, Brasil
| | - Anderson Lima Cordeiro da Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Juliana Cristina dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
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Santarato N, Barbosa NG, da Silva ALC, Monteiro JCDS, Gomes-Sponholz FA. Characterization of adolescent sexual practices. Rev Lat Am Enfermagem 2022; 30:e3712. [PMID: 36197394 PMCID: PMC9647882 DOI: 10.1590/1518-8345.6289.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE to characterize adolescents' sexual practices and their association with sociodemographic variables, sources of information and behavioral habits. METHOD a descriptive, observational, cross-sectional study conducted with 85 adolescents from public elementary and high schools in a city in the state of São Paulo. Data were collected through a structured, self-administered and anonymous questionnaire. Statistical analysis was performed using the χ2 test and Fisher's test. RESULTS 21.2% had started their sexual life through oral sex, with a predominance of females (94.4%), self-reported brown color (55.0%). The practice of vaginal sex was reported in 31.8%, with a mean age of initiation at 14.5 years. The female sex was predominant (77.0%), with a self-reported brown color (40.0%). The practice of anal sex was detected in 7.1%, with a mean age of 14.4 years, prevalent in females (83.3%), with a self-reported black color (50.0%). There was an association of alcohol, drugs and tobacco use with sexual practices (p<0.05). CONCLUSION a diversity of sexual practices associated with substance use was detected, emphasizing the importance of the nurse's role in planning and carrying out health education interventions with adolescents and families. UNLABELLED (1) Analysis of the sequence and time of initiation of sexual practices, demonstrating the diversity of sexual activities performed by adolescents. (2) Family context and low openness to dialogue and its correlation with the initiation of adolescent sexual practices. (3) Behavioral habits: association of alcohol, tobacco and drug consumption by adolescents with sexual activities.
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Affiliation(s)
- Nathalia Santarato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Nayara Gonçalves Barbosa
- Universidade Federal de Juiz de Fora, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Minas Gerais, Brasil
| | - Anderson Lima Cordeiro da Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Juliana Cristina dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brasil
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Caruso I, Valdez ES, Lovell CC, Chan J, Beatriz E, Gubrium A. The Need for Community-Responsive and Flexible Sex Ed for Historically Marginalized Youth. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:94-102. [PMID: 35494623 PMCID: PMC9038439 DOI: 10.1007/s13178-022-00717-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION When it is offered, sexuality education in the USA is far from standardized. While studies have explored differences in delivery and type of sexuality education across the USA, sexual and reproductive health inequities persist among historically marginalized groups (Latino/a/x, Black, African American, LGBTQ +). There is a critical need to better understand the systemic barriers to receiving effective sexuality education in these communities. METHODS Participatory research methods were used in working with a community advisory board (CAB)-consisting of emerging adults and service providers from community-based organizations (CBOs) serving youth-to examine how structural barriers contribute to adolescent sexual and reproductive health (ASRH) inequities in Massachusetts. CAB meetings and semi-structured interviews were conducted in the cities of Springfield (n = 14) and Lynn (n = 9) between December 2020 and May 2021. RESULTS Inflexible funding guidelines, a related evidence-based curricular mandate, and a lack of community-responsive sexuality education fail to meet the sexual and reproductive health (SRH) needs of these youth. CONCLUSIONS Current evidence-based mandates must be revisited to improve young people's access to quality sexuality information in public schools. To guarantee sexuality education curricula is centered in the context of the community and population in which it is implemented, collaboration between youth-serving CBOs and school districts could improve students' overall experience and social-emotional growth by providing comprehensive, positive, and community-responsive curricula. POLICY IMPLICATIONS Funders and programming should prioritize community responsiveness by financially supporting and developing and/or adapting evidence-based curricula to better match the community's needs, which can be completed through culture-centered training and community-based partnership.
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Affiliation(s)
- Isabella Caruso
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Elizabeth Salerno Valdez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Camille Collins Lovell
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Jazmine Chan
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Elizabeth Beatriz
- Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108 USA
| | - Aline Gubrium
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
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Schmidt EK, Hand BN, Havercamp S, Sommerich C, Weaver L, Darragh A. Sex Education Practices for People With Intellectual and Developmental Disabilities: A Qualitative Study. Am J Occup Ther 2021; 75:12507. [PMID: 34781351 DOI: 10.5014/ajot.2020.044859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE People with intellectual and developmental disabilities (IDD) express a clear interest in intimate relationships but face many barriers to receiving sex education (SE) that would support their engagement in these relationships. OBJECTIVE To understand barriers to, the context of, and recommendations for SE for people with IDD. DESIGN Qualitative study design with interviews and focus groups with four key stakeholder groups. Data were analyzed using a constant comparative approach. PARTICIPANTS Participants were 8 youths with IDD, 9 parents, 12 health care providers, and 8 educators. RESULTS Four barriers to SE were identified: (1) values and cultural issues, (2) parental attitudes toward their child's sexuality, (3) a lack of organizational policies and standards, and (4) limited professional education or societal biases. These barriers contribute to a SE context primarily initiated by people with IDD or provided reactively. The participants recommended proactive, formal SE provided by multiple stakeholders throughout adulthood. CONCLUSIONS AND RELEVANCE Stakeholders should advocate for policies, standards, and additional training for parents, educators, and health care providers to support SE for people with IDD throughout adulthood. What This Article Adds: Barriers to SE contribute to the current context in which SE is shared with people with IDD. Stakeholders can advocate for policies, standards, and training to overcome these barriers and support recommendations for proactive, formal SE provided by multiple stakeholders through adulthood.
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Affiliation(s)
- Elizabeth K Schmidt
- Elizabeth K. Schmidt, PhD, OTR/L, is Postdoctoral Fellow, Families and Autism Research Laboratory, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA;
| | - Brittany N Hand
- Brittany N. Hand, PhD, OTR/L, is Assistant Professor, Department of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Susan Havercamp
- Susan Havercamp, PhD, is Associate Professor, Nisonger Center, College of Medicine, The Ohio State University, Columbus
| | - Carolyn Sommerich
- Carolyn Sommerich, PhD, is Associate Professor, Department of Integrated Systems Engineering, The Ohio State University, Columbus
| | - Lindy Weaver
- Lindy Weaver, PhD, OTR/L, is Assistant Professor, Injury Prevention and Rehabilitation Research Laboratory, Department of Occupational Therapy, The Ohio State University, Columbus
| | - Amy Darragh
- Amy Darragh, PhD, OTR/L, FAOTA, is Division Director and Associate Professor, Injury Prevention and Rehabilitation Research Laboratory, Department of Occupational Therapy, The Ohio State University, Columbus
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Jarpe-Ratner E, Marshall B. Viewing Sexual Health Education through the Lens of Critical Pedagogy: A Case Study in Chicago Public Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1443. [PMID: 33557062 PMCID: PMC7913844 DOI: 10.3390/ijerph18041443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
Comprehensive sexual health education (SHE) programs are being implemented in many state and local jurisdictions. Much research has focused on the strength and effectiveness of such programs. However, the experiences of teachers and students in their implementation is underexplored. A case study of the implementation of the SHE policy and curriculum in Chicago Public Schools sought to explore teachers' and students' experiences. Sixteen teachers were interviewed and five student focus groups, including 46 students, were conducted. Both teachers and students identified opportunities to improve upon the current program, including to (1) incorporate more student-centered learning opportunities and allow for tailoring to each specific group of students; (2) use discussion and dialogue to encourage students' exploration of their own opinions and identities and development of a sense of agency over their own learning; (3) shift focus from risk reduction to a more holistic focus on healthy sexual wellbeing; and (4) directly discuss current health inequities, contributing factors, and intersectionality. These findings align with a critical pedagogical approach and underscore the need to understand SHE implementation within its sociopolitical context. Implications of the use of critical pedagogy as a framework for SHE in Chicago and beyond are discussed.
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Affiliation(s)
| | - Booker Marshall
- Office of Student Health and Wellness, Chicago Public Schools, 42 W. Madison St. Chicago, IL 60602, USA;
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Pavelová Ľ, Archalousová A, Slezáková Z, Zrubcová D, Solgajová A, Spáčilová Z, Krištofová E, Slamková A. The Need for Nurse Interventions in Sex Education in Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020492. [PMID: 33435342 PMCID: PMC7827239 DOI: 10.3390/ijerph18020492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/23/2020] [Accepted: 01/02/2021] [Indexed: 11/24/2022]
Abstract
Background: Developmentally appropriate evidence-based sexual health education should be included as part of a comprehensive school health education program and be accessible to all students. The registered school nurse is a valuable resource to parents and educators in this area and supports the implementation of evidence-based sexual health education programs that promote healthy sexual development for adolescents. Methods: The research group consisted of 438 adolescents aged 12 to 15 years in a selected region in Slovakia, 186 boys and 252 girls. Average age of the girls was 13.2 and the boys 13.3 years. A nurse—a specialist in community nursing—collected the data using a self-designed questionnaire. The questions evaluated by the five-point Likert scale focused on finding out the knowledge and attitudes of adolescents to the role of school nurses regarding sexuality and reproductive health. Results were analyzed using parametric comparison tests with significance value 0.05: Student t-test for independent samples. Results: The girls and the boys most often drew information on sexuality and reproductive health from their parents and friends. The evaluation of the adolescents’ views on who should be a competent professional in the field of sexual education at schools found statistically significant differences between the boys and girls. For the boys and girls, a sexologist received the most significant assessment of competence. The interest in a school nurse in a school environment would be statistically significantly more appreciated by the girls compared to the boys, not just for solving problems related to healthy lifestyle, but also regarding sexuality, parenting and marriage. The adolescents consider the education for marriage and parenthood as the least discussed issue at present. In evaluating topics the adolescents would discuss, there were statistically significant differences between the boys and girls. Conclusions: A community or school nurse would also be able to successfully perform sexual education at schools. In Slovakia, this applied nursing discipline is lacking.
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Affiliation(s)
- Ľuboslava Pavelová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia; (A.A.); (D.Z.); (A.S.); (Z.S.); (E.K.); (A.S.)
- Correspondence:
| | - Alexandra Archalousová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia; (A.A.); (D.Z.); (A.S.); (Z.S.); (E.K.); (A.S.)
| | - Zuzana Slezáková
- Faculty of Nursing and Professional Health Studies, Slovak Medical University, 833 03 Bratislava, Slovakia;
| | - Dana Zrubcová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia; (A.A.); (D.Z.); (A.S.); (Z.S.); (E.K.); (A.S.)
| | - Andrea Solgajová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia; (A.A.); (D.Z.); (A.S.); (Z.S.); (E.K.); (A.S.)
| | - Zuzana Spáčilová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia; (A.A.); (D.Z.); (A.S.); (Z.S.); (E.K.); (A.S.)
| | - Erika Krištofová
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia; (A.A.); (D.Z.); (A.S.); (Z.S.); (E.K.); (A.S.)
| | - Alica Slamková
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia; (A.A.); (D.Z.); (A.S.); (Z.S.); (E.K.); (A.S.)
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Leung E, Wanner KJ, Senter L, Brown A, Middleton D. What will it take? Using an implementation research framework to identify facilitators and barriers in implementing a school-based referral system for sexual health services. BMC Health Serv Res 2020; 20:292. [PMID: 32264884 PMCID: PMC7140539 DOI: 10.1186/s12913-020-05147-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Across the United States, sexually transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools, due to their proximity and access to youth, can increase student access to sexual health services (SHS) by creating referral systems (RS) to link students to school- and community-based SHS. From 2013 to 2018, the Centers for Disease Control and Prevention's Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools and stakeholders to develop and implement RS to increase student access to SHS. Cicatelli Associates Inc. (CAI) was funded to provide capacity-building to LEA. In 2016-2017, CAI conducted case studies at two LEA, both large and urban sites, but representing different geographical and political contexts, to elucidate factors that influence RS implementation. METHODS Nineteen LEA and community-based healthcare (CBH) staff were interviewed in the Southeastern (n = 9) and Western U.S. (n = 10). Key constructs (e.g., leadership engagement, resources, state and district policies) across the five domains of the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Qualitative data was analyzed using the Framework Method and contextual factors and themes that led to RS implementation were identified. RESULTS Interviewees strongly believed that school-based RS can decrease STI, HIV and unintended pregnancy and increase students' educational attainment. We identified the following contextual key factors that facilitate successful implementation and integration of an RS: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies can have significant impact and influence to impede or promote those policies. CONCLUSIONS Through the use of the CFIR framework, the interviews identified important contextual factors and themes associated with LEAs' implementation barriers and facilitators. The study's results present key recommendations that other LEA can consider to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.
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Affiliation(s)
- Emily Leung
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
| | - Kathryn J. Wanner
- Franklin and Marshall College, College Square 931 Harrisburg Ave. 1st Floor, Lancaster, PA 17603 USA
| | - Lindsay Senter
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
| | - Amanda Brown
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
| | - Dawn Middleton
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
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