Past experiences and preferences for LGBTQ + sex education among LGBTQ + college students

Background: Lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) students experience more negative sexual health outcomes than their cisgender, heterosexual peers and do not have access to relevant sex education. This denial necessitates comprehensive sex education in college for LGBTQ + students. Objective: Given the rise of online learning and that LGBTQ + students are already drawn to online spaces, this research seeks to determine preferences in virtual LGBTQ + sexuality education content and delivery LGBTQ + college students. Methods: We conducted a survey with US college students who identified as LGBTQ+ (N = 91) to identify past experiences with sex education, desires for future sex education, and preferences for online learning. Results: Past sex education, resources used, consequences, preferences for LGBTQ + sexuality and online education are discussed. Conclusions: Overall, we find high comfort with online learning, heteronormative and cisnormative past sex education courses created negative physical and mental health outcomes, and desires for tailored sex education.

Sexual and reproductive health knowledges: a study with Pacific young people enrolled in an Aotearoa New Zealand tertiary institution

Pacific young people living in Aotearoa New Zealand experience disparities in their sexual and reproductive health outcomes, thought to stem from cultural differences and educational inequities. Although these barriers have been characterised in literature, their influence on Pacific youth's understandings of sexual and reproductive health have been relatively unexplored. This study investigated the sexual and reproductive health knowledge of Pacific students enrolled at a university in Aotearoa New Zealand in 2020 and where they gained this knowledge. The study used the theoretical framework of the (revitalised) Fonofale health model and was guided by the Kakala research methodology. Data were collected by means of an online survey comprised of open-ended questions and Likert scales, completed by eighty-one eligible students. Open-ended questions were analysed for general themes and responses to Likert scale items are reported using descriptive statistical analysis. The study found that Pacific youth have strong foundations of health knowledge that is heavily influenced by Polynesian cultural beliefs. Both formal and non-formal learning environments were important in developing participants' health knowledge of these topics and for encouraging independent help-seeking behaviours. This is the first reported study to investigate the sexual and reproductive health knowledges of a pan-Pacific tertiary cohort of young people.

What does it mean to be 'porn literate': perspectives of young people, parents and teachers in Aotearoa New Zealand

Porn literacy education is a pedagogical strategy responding to youth engagement with pornography through digital media. The approach is intended to increase young people's knowledge and awareness regarding the portrayal of sexuality in Internet pornography. However, what being 'porn literate' entails, and what a porn literacy education curricula should therefore include, is not a settled matter. Recognising the importance of end-user perspectives, 24 semi-structured interviews were conducted with parents, teachers and young people in Aotearoa (New Zealand) and analysed via critical, constructionist thematic analysis. Participants drew on a developmentalist discourse and a discourse of harm to construct porn literacy education as a way to inoculate young people against harmful effects, distortions of reality, and unhealthy messages. In addition to this dominant construction of porn literacy education, we identified talk that to some extent resisted these dominant discourses. Building on these instances of resistance, and asset-based constructions of youth based on their agency and capability, we point to an ethical sexual citizenship pedagogy as an alternative approach to porn literacy education.

FIGO position statement on comprehensive sexuality education

Now is a pivotal moment in the fight for reproductive health and justice internationally. Well-established research has recognized the benefits of comprehensive sexuality education for youth and adolescents-including vast reproductive health benefits, decreased interpersonal violence, and improvements on measures of academic success and well-being. Despite these established benefits, challenges to the implementation of culturally sensitive and holistically framed sexuality education are intensifying across the globe. The International Federation of Gynecology and Obstetrics (FIGO) stands firmly in its support of comprehensive sexuality education and re-emphasizes the importance of the implementation of scientifically accurate, age-appropriate, culturally relevant, and inclusive education. Successful implementation relies on active youth leadership, physician involvement, and a renewed focus on high-quality monitoring mechanisms to assess impact and accountability at all levels. Most importantly, future efforts to improve and scale comprehensive sexuality education must emphasize the importance of an inclusive curriculum that addresses previously marginalized youth, such as LGTBQ+ and disabled individuals, through a reproductive justice lens. FIGO commits, and encourages the international healthcare community, to provide continued advocacy for the rights to health, education, and equality, in order to achieve improvement in health outcomes for young people across the globe.

Where do 15- to -17-year-olds in Canada get their sexual health information?

Background

Sexual health education delivered in school, provided by parents, or provided by other formal sources has been associated most closely with increased rates of condom use and improvements in many other sexual risk behaviours. Friends and the internet are other information sources, although quality and accuracy are not always as high. Nationally representative Canadian data about where adolescents obtain their sexual health information are lacking.

Data and methods

Weighted data from the 2019 Canadian Health Survey on Children and Youth were used to examine the sources typically used to obtain sexual health information by 15- to 17-year-olds, as well as the prevalence and characteristics of adolescents reporting not having an adult to talk with about sexual health and puberty.

Results

Most 15- to 17-year-olds in Canada reported having at least one source of sexual health information (96.6%). More than half identified school (55.6%) and parents or guardians (51.2%) as sources of sexual health information. The internet (45.9%), friends (36.2%), and health care professionals (20.9%) were other common sources. Whereas 61.2% of adolescents identified more than one source of sexual health information, 3.4% reported not having any source. Nearly 15% of adolescents reported not having an adult to talk with about sexual health or puberty. Differences in sources consulted and having an adult to talk with depended on many factors, including sexual attraction and/or gender diversity, sex, immigrant status, racialized status, lower-income status, strength of parent-adolescent relationship, region of residence, and mental health.

Interpretation

An improved understanding of the sources of sexual health information used by adolescents and identification of characteristics associated with adolescents reporting not having an adult to talk with could help develop strategies to improve sexual health outcomes via better access to sexual health promotion and educational resources.

A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya: a quasi-experimental study

This study assessed the effectiveness of a school-based stigma-reduction intervention focusing on stigmatising attitudes towards girls associated with abortion and contraceptive use. In February 2017, two gender-mixed secondary schools (n = 1368) in peri-urban areas of Kisumu County, Kenya, were assigned to receive either an 8-hour stigma-reduction intervention over four sessions (intervention school: IS) or standard comprehensive sexuality education (control school: CS). A classroom survey entailing two five-point Likert scales - the 18-item Adolescents Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale, which measures abortion stigma, and the seven-item Contraceptive Use Stigma (CUS) scale - was conducted to collect data at baseline, 1-month and 12-months after the intervention. The intervention was to be considered effective if a mean score reduction of 25% was achieved for both the ASABA (primary outcome) and the CUS (secondary outcome) at the IS between baseline and 12-month follow-up. 1207 (IS = 574; CS = 633) students were included in analyses at 1-month follow-up, and 693 (IS = 323; CS = 370) at 12-months (the final-year students had left school). A decrease in mean score on both scales was observed at 1-month at both schools. At 12-months, the score decrease was 30.1% at the IS and 9.0% at the CS for ASABA, and 27.3% at the IS and 7.9% at the CS for CUS. At the IS, the score decrease for ASABA between baseline and 12-months was 23.3% among girls and 31.2% among boys; for CUS, the decrease was 27.3% and 24.3%, respectively. ASABA and CUS were positively correlated (r = 0.543; p < 0.001), implying a broader perspective on reproductive stigma. A four-session, school-based stigma-reduction intervention could lead to transformed values and attitudes towards gender norms among adolescents regarding abortion and contraceptive use. Stigma associated with abortion and contraception should become a priority for high-quality CSE programmes.

Effect evaluation of a comprehensive sexuality education intervention based on socio-emotional learning among adolescents in Jakarta, Indonesia

Introduction

The field of comprehensive sexuality education (CSE) has switched from a focus on adolescents’ health to a more holistic approach, embracing the concept of sexual development with the aim of improving adolescents’ sexual well-being. The growing interest in the link between CSE and socio-emotional learning (SEL) competencies led to the development of the Journey4Life (J4L), a comprehensive sexuality education curriculum based on socio-emotional learning. In the current research, we evaluate the effectiveness of this program on perceived behavioral control, gender equality attitudes, norms, and intentions related to sexual and reproductive health and rights.

Methods

To this end, we conducted a Cluster Randomized Trial among 14 senior secondary schools in Jakarta, Indonesia. A questionnaire was administered before and after implementation of the J4L program among 16–17 year old pupils; n = 906 completed baseline measurement, n = 771 completed endline measurement. With a final matched sample of N = 466 (65.5% girls) we conducted a mixed model repeated measures ANOVA.

Results

Unfortunately, only limited and inconsistent results were found. We found that at endline, girls had stronger positive gender equality attitudes than boys; that overall attitudes towards reporting sexual violence were stronger for girls than for boys. However, contrary to our expectations, respondents had more positive attitudes toward child marriage at baseline than at endline.

Discussion

Inconsistency and non-statistical significance of results limit our ability to draw firm conclusions about the effectiveness of the Journey4Life. We discuss how complex comprehensive sexuality education interventions could best be evaluated, since our study highlights the need for better conceptualization, operationalization and measurement of the interconnection between comprehensive sexuality education and socio-emotional learning.

Intersections between culture, contraception, knowledge and the body in the USA

Women's contraceptive use is a central feature of US culture around reproduction as evinced by high usage rates and nationwide public health efforts to further increase its use. Paradoxically, women know little about contraception within its biomedical framing, and successive public health-related educational campaigns have produced only moderate knowledge gains. Drawing on 86 in-depth interviews with a diverse sample of reproductive-age women, we set out to understand this persistent learning lag. In doing so, we found that women's limited contraceptive knowledge extended beyond simply being uneducated about various methods. Rather, these learning lags can be attributed to many women's lack of knowledge or misunderstandings about their anatomical bodies and reproductive processes. Employing feminist perspectives, we argue that these misunderstandings derive from factors beyond individual women's control. Indeed, they are rooted in cultural norms that stifle and stigmatise women's reproductive learning. Traditional public health efforts may inevitably fail to overcome these cultural barriers, perpetuating women's gaps in knowledge. Recognising the cultural dimensions of contraceptive knowledge and education reveals how critical action is needed around sexuality education in the USA as well as the limitations of on-going educational efforts.

Barriers experienced by emerging adults in discussing their sexuality with parents and health care providers: A mixed-method study

While most parents and health care providers understand the importance of educating young people about their emerging sexuality, many report never discussing sex with the young people in their care. Using data from a survey of 1,193 emerging adults, we applied concept mapping to a corpus of over 2,350 short qualitative responses to two questions: (a) What, if anything, makes it difficult to talk to your parents about sexuality or your sexual health? and (b) What, if anything, makes it difficult to talk to your doctors, therapists, or mental health professionals about sexuality or your sexual health? Qualitative analyses revealed that while embarrassment, shame, and awkwardness were commonly reported barriers to communicating with both parents and providers, participants reported different effects across settings: Parent-related embarrassment was associated with concerns about changing the intimacy of the parental relationship, while provider-related embarrassment was associated with fears of seeming incompetent or eliciting dismissal. These observations were supported by multidimensional scaling and hierarchical cluster analyses, which we used to derive conceptual maps based on quantitative spatial analysis of single-concept statements. These analyses revealed a best-fit solution of eight conceptual groups for barriers to discussing sexuality with health care providers, but only four groups of barriers in discussing with parents. Broadly, our findings reinforce the need to tailor sexual health communication to patient characteristics and settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study

This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.

Experiences of life orientation among teachers teaching sexuality education in secondary schools in Vhembe and Mopani Districts Limpopo Province, South Africa

Teachers' experiences regarding sexuality education are significant indicators of teaching sexuality in secondary schools. However, the importance of including sexuality education in the educational system is rising globally. This suggests that Life Orientation (LO) teachers have a unique and vital role to play, one for which they are not always ready, especially when sexuality education is a cross-curricular subject. This study examined teachers' experiences regarding teaching sexuality education in Limpopo Province. This study aimed to explore and describe the experiences of the Life Orientation (LO) teachers teaching sexuality education in secondary schools in Vhembe and Mopani districts Limpopo Province, South Africa. A qualitative, exploratory-descriptive phenomenological design was employed. In-depth face-to-face interviews were conducted with 14 LO teachers from four (4) sets of public secondary schools in Vhembe and Mopani districts. Interviews were audio recorded. Field notes were used to capture nonverbal communication from participants. Data saturation was reached on the seventh (7th) face to face interviews. A Qualitative thematic analysis was employed to analyses data. The results revealed four themes: Participant experiences of sexuality education; Communication concerns; Role shifting in imparting sexuality education and challenges experienced by LO teachers in the classes room. Ethical considerations and trustworthiness was ensured. The study concluded that participants experiences of sexuality education; communication concerns; role shifting in imparting sexuality education operate as barriers to comprehensive sexuality education. Recommendations: teachers need to be equipped with knowledge and skills and to teach various sexuality topics, including providing human and material resources.

In-school adolescents' perception of sexuality education in region 1 of the Gambia

Unmet sexual education needs of adolescents due to socio-cultural challenges have been ignored in different societies. This study investigated students' perception on the sexual education they received at school level, and what they really preferred and needed. In this qualitative study, five focus group discussions with 50 adolescents and 10 individual in-depth interviews were conducted among respondents aged 15-19 in both public and private schools in region 1, The Gambia. Data were analyzed using qualitative content analysis. The study results revealed that the adolescents were dissatisfied with the sexuality education in their schools. The emerged themes included: lack of priority for sexuality education, lack of appropriate educational materials and trained teachers and inconsistency of the sexuality education content with the adolescents' needs. The adolescents in this study showed great abilities to appraise sexuality education and health services delivered for them, and so any program for sexual health promotion in adolescents ought to address adolescents' needs, demands, and aspirations.

Knowledge, attitudes, and practices of parents toward sexuality education for primary school children in China

This cross-sectional study provides insight into the perceptions of Chinese parents of primary school children with respect to sexuality education. A sample of 19,745 parents was surveyed using an online questionnaire in Beijing, Tianjin, and Hebei, China. SPSS version 23.0 was used for data analysis. In this study, nearly 90% of parents had positive attitudes toward the sexuality education of children in primary schools. However, Chinese parents had limited knowledge of sexuality education. More than 60% of parents were unaware of the sexuality questions that children may encounter at different ages and did not have any accurate information on child sexual abuse prevention education. Although ~ 70% of parents (both fathers and mothers) reported that they had used television and Internet resources to talk with their children about sexuality and 63% reported that they had read books with their children about sexuality, < 30% reported using appropriate terminology with their children on sexuality education and only 40% reported talking to their children about sexuality comfortably. The multivariate linear regression equation showed some factors associated with the practices of parents in sexuality education, including parental knowledge, attitudes, their experience in receiving sex education in childhood, and their educational level. The findings from this study suggest that it is important to develop culturally relevant training programs for parents of primary schools in Chinese society. The implications and limitations of these findings are discussed.

A Qualitative assessment of adolescent-parent sex talk in Ghana

Young people's views on sexuality in sub-Saharan Africa are poorly understood. We know little about what they think of their sexual upbringing and how it influences their sexual and reproductive health decisions and behaviors. Guided by feminism and an intersectionality framework, the current study uses narratives from purposefully sampled adolescents and parents from rural households within Adaklu District, one of the eighteen districts in the Volta Region of Ghana, to examine parents' and young people's perceptions of young adolescents' acquisition of sexuality knowledge, their sexual encounters and experiences, and the overall dynamics in educating young adolescents aged 16-19 years about sex. Specifically, we explored the types of sexuality issues parents discussed with their wards at home, and where appropriate, analyzed the inherent gender disparities in these discussions. Generally, parents agree that young people should know about sex. However, they emphasized that sexuality education should be age-specific and should be guided by cultural values and religious faith. Adolescents' exposure to multiple sources, including parental upbringing, the media, and information from peers, determines the extent they either engage or not engage in sexual activities. Parent-adolescent conversations were structured along gender lines, emphasizing adolescent girls' needs due to their perceived vulnerability compared to boys. While some of the findings support earlier views in terms of a very conservative, morally scripted way of training young people, it also suggests that young people's sexual upbringing is not as repressive as previous studies would make it appear. Young people keep pushing the boundaries as they develop agencies to learn about sex from multiple sources. Therefore, policies seeking to promote young people's sexual and reproductive rights in Ghana should pay close attention to what young people know about sex and how they know what they know, recognizing that their knowledge-seeking is part of human development and not inherently "bad".

Level and comfort of caregiver–young adolescent communication on sexual and reproductive health: a cross-sectional survey in south-western Uganda

Background

Communication on sexual and reproductive health (SRH) between caregivers and their young adolescent children plays a significant role in shaping attitudes and behaviours that are critical to laying the foundations for positive and safe SRH behaviours in later adolescence. Nevertheless, this communication is often limited, particularly in countries where adolescent sexuality is taboo. This study assessed the topics discussed (‘level’) and the comfort of caregivers with communicating with young adolescents on SRH, and their correlates. 

Methods

A cross-sectional survey was conducted among 218 caregivers of young adolescents (10–14 years) in Mbarara district of south-western Uganda in January and February 2020. Participants were selected through consecutive sampling. A structured, pre-tested questionnaire administered by interviewers was used for data collection. The surveys were computer-assisted using Kobo Collect software. Data was exported to STATA 14 for analysis. Level of SRH communication was measured based on 10 SRH communication topics, while comfort was based on 9 SRH discussion topics. Bivariate and multivariate linear regression analyses were conducted to determine correlates of level of, and comfort with, SRH communication P-value < 0.05 was considered for statistical significance.

Results

The mean number of topics that caregivers discussed was 3.9 (SD = 2.7) out of the 10 SRH topics explored. None of the respondents discussed all the topics; 2% reported ever discussing nine topics with their young adolescent, while 3.5% reported never discussing any of the topics. General health and bodily hygiene (89.9%) and HIV/AIDS and other sexually transmitted infections (STIs) (77.5%) were the most commonly discussed, while night emissions in boys (4.3%) and condoms (8.3%) were least discussed. The majority of caregivers (62%) reported a high level of comfort with discussing SRH. The mean comfort score was 21.9 (SD = 3.8). In general, the level of SRH communication increased with an increase in comfort with SRH communication β = 0.22 (0.04); 95% CI = (0.15, 0.30). The level of comfort with SRH communication decreased with an increase in the number of YAs in a household β = -0.92 (0.38); 95%CI = (-1.66,-0.18).

Conclusion

Overall, the level of SRH communication is low and varies according to the number of SRH topics. Caregivers’ comfort with SRH communication with YAs was a significant correlate of SRH communication. This justifies the need for interventions that aim to improve caregivers’ comfort with communicating with young adolescents about SRH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14561-3.

Communication between parents and children about sexual and reproductive health (SRH) during the early adolescence stage (10–14 years) plays a significant role in creating positive reproductive health outcomes in later adolescence and adulthood. We conducted surveys in rural areas of Mbarara district among 218 pairs of caregivers and their children aged 10–14 years between January and February 2020. The purpose of the study was to understand whether there is communication between the two, and how comfortable they felt having discussions about SRH. We also asked caregivers and their children about their knowledge of SRH, and how they generally felt about SRH for young people. This study, however, reports only results from caregivers.

We found that, on average, caregivers discussed 4 of the 10 SRH topics explored in this survey with their child, and that the majority of the caregivers reported being very comfortable discussing SRH—especially general health and bodily hygiene—with their children. On the whole, we found that caregivers’ SRH communication was largely influenced by their comfort with discussing SRH with their adolescent child. The level of comfort was influenced by the number of young adolescents living in a household. However, there is no clear justification for this finding from existing literature.

In conclusion, there is a need for interventions that facilitate improvement of communication on SRH between parents/caregivers and young adolescents. These should focus on improving comfort levels by promoting communication skills for caregivers and emphasizing value clarification.

Secondary Education and Class Stratification: Understanding the Hierarchy of Sexuality Education in a Chinese Vocational High School

The discussion of sexuality education has a long history in China since the onset of modernisation in the early 20th century. Sexuality education has also existed in China’s educational system for a long time but in various forms. However, the discussions regarding students’ experiences and the influence of social stratification in China’s particular social context are still limited. From March to September 2019, the author visited an academic high school (pugao) and a vocational high school (zhigao) in Tianjin, China, to gain first-hand data to understand young people’s sexuality education experiences. In this paper, the author specifically paid attention to China’s social class, a rarely discussed topic in China’s society. She also tried to listen to the voices of young people and schoolteachers and help them to be heard. By presenting the insights from schoolteachers, students, as well as the materials from a nationally approved textbook, the author conducted a thematic analysis about how social class influences young people’s sexuality education experiences in secondary education in China.

Determination of sexual developmental characteristics of adolescents with intellectual disabilities

This cross-sectional study was carried out in order to determine the opinions of mothers on sexual development in children with intellectual disabilities. The sampling of this study included mothers of children aged 10-19 years with moderate and severe intellectual disabilities. Of the mothers, 45.7% stated that they felt incapable of providing sexual education to their adolescent children with disabilities and 97.6% stated that they had received no information on this subject themselves. Based on the mothers' opinions, the mean score for the sexual development of adolescent children was 11.33 ± 16.18. In the sub-dimensions of sexual arousal (20.97 ± 5.71), sexual harassment (12.22 ± 3.13), sexual satisfaction (15.79 ± 3.85) and sharing sexual issues (12.74 ± 2.67) the mean score of the scale was found to be high. The knowledge levels of the mothers concerning the sexual development of their children with intellectual disabilities were found to be low, and they required education on this issue.

Experiences of grade 8 learners on sexuality education from home and school at Mopani and Vhembe districts

Globally, adolescents' risk of sexual behaviour has become a concern owing to the world's poor home and school sexuality education, not excluding both the Mopani and Vhembe Districts of Limpopo Province. This study examined the experiences of grade 8 learners on sexuality education from home and school. The study was mainly qualitative, involving eight focus group discussions [FGDs] with grade 8 learners aged 13-15 years. The findings revealed that participants experience confusion regarding physiological body changes. Inadequate knowledge about contraception noted. Findings further revealed Communication concerns related to Cultural barriers, fear of embarrassment, Reactive sharing of information instead of being proactive and gender stereotype. The study concluded that these concerns operate as barriers to comprehensive sexuality education. The study recommended that learners, parents, and teachers receive training about communication on sexuality to acquire knowledge and improve their communication skills with children.

Once upon a crush story: transforming relationships and sexuality education with a post-qualitative art-ful praxis

This paper shares a rhizomatic unfolding of how a creative, post-qualitative praxis for becoming adventurous in the field of Relationships and Sexuality Education (RSE) can unfold in a conducive policy and practice context (Wales, UK). Specifically, we focus on the making and mattering of what we call 'Crush-Cards'. These are a suite of illustrated data calling-cards designed to re-animate research findings and stay close to the ways in which children and young people are entangled in, and navigate their way through, complex human and more-than-human gender and sexuality assemblages. Each section progressively provides a glimpse at how our art-ful rhizomatic praxis has evolved and how the resource and emergent CRUSHing pedagogy is becoming resourceful in unexpected ways.

Giving condoms to school children: educators' views on making condoms available in South African schools

One of the policy goals of the South African Department of Basic Education's National Policy on HIV, STIs and TB of 2017 is to reduce the incidence of HIV and pregnancy among learners. This is expected to be achieved by improving access to prevention services, including the provision of condoms in schools. This study uses street- level bureaucracy theory to explain how educators can play a more productive role in ensuring that policy goals are achieved. Educators provide their views on their role as condom promotion agents, their perception of demand and utilisation among learners, as well as their insights on suitable distribution mechanisms in the school setting. Trepidation exists among educators about their roles in the promotion and education of condoms. Educator statements suggest that they see the value in their policy-ascribed role to deliver sexual health messages and are also open to performing a role in the distribution of condoms at schools. However, our findings reveal that their role as policy communicators or "street-level bureaucrats" is complicated by inadequate policy guidance. We therefore conclude that to achieve optimal outcomes in terms of safer sexual practices among learners, condom messaging and distribution mechanisms in school settings require evidence-informed implementation strategies.

The CDC's Division of Adolescent and School Health Approach to Sexual Health Education in Schools: 3 Decades in Review

BACKGROUND

School health education, including sexual health education, plays a crucial role in shaping adolescents' protective health behaviors, experiences, and outcomes. Adolescents need functional knowledge and skills to practice, adopt, and maintain healthy behaviors for preventing sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), and unintended pregnancy.

METHODS

The US Centers for Disease Control and Prevention's Division of Adolescent and School Health (CDC/DASH) has advanced school-based approaches to STI/HIV and pregnancy prevention through surveillance, research and evaluation, and program partnership and collaboration for over 3 decades.

RESULTS

CDC/DASH uses systematic and innovative strategies to identify the breadth of adolescent sexual health evidence; characterize key elements of effective educational curricula; and provide practical guidance to support school-based delivery. CDC/DASH's approach to effective health and sexual health education in schools has changed dramatically over the past 30 years and must continue to progress.

CONCLUSION

This paper describes how and why that approach has evolved and outlines directions for the future.

What One Gets Is Not Always What One Wants-Young Adults' Perception of Sexuality Education in Poland

There is a discrepancy between the educational needs and the opportunities to obtain reliable knowledge about sexuality in adolescence. This study aimed to assess the conjunctive influence of family and school in shaping this knowledge.

METHODS

Data were collected retrospectively within a cross-sectional survey conducted in Poland in 2017 (18-26 yrs; N = 595). The respondents' experiences in terms of the presence and quality of sexuality education (SE) at school and in conversations with parents about related issues were considered.

RESULTS

Of all the respondents, 31.1% had no sexuality education classes in school or rated them as useless, 41.5% never discussed sexuality-related topics with parents and both were true for 17.6%. Puberty and contraception were most frequently discussed with parents, while sexual pleasure and masturbation were discussed least frequently. The diversity of topics taken up with parents and the possibility of discussions with mothers turned out to be the most important factors for shaping adolescents' knowledge. A relationship with the quality of sexuality education at school was additionally revealed for girls, while a relationship with talking to fathers was revealed for boys.

CONCLUSIONS

Schools and families should work together to strengthen proper sexual development by meeting adolescents' needs in the field of their knowledge on human sexuality.

The World Association for Sexual Health's Declaration on Sexual Pleasure: A Technical Guide

This article provides technical guidance on the content, meaning, and application of the World Association of Sexual Health (WAS) Declaration on Sexual Pleasure to various stakeholders and practitioners working in the area of sexuality, sexual health, and sexual rights. A growing body of work shows that sexual pleasure is integral to broader health, mental health, sexual health, well-being and rights and indeed can lead to improvements in health. Yet, more research is needed to identify the best ways to incorporate sexual pleasure to achieve sexual health for different outcomes and populations. In the first part of this article, we deconstruct each statement from the WAS Declaration on Sexual Pleasure and provide key evidence from the literature supporting these statements. In the latter part of the article, we provide guidance on how to include sexual pleasure as a fundamental part of sexual health and sexual rights work. We include a series of case studies and highlight key actions and principles for advocacy, implementation, and quality assurance in terms of law and policy, comprehensive sexuality education, health care services and dissemination of knowledge. This technical document seeks to inspire our partners and collaborators to embark on a journey toward a pleasure-based approach to sexual health and sexual rights. Our hope is that the literature, guidance and case studies provided here can ignite ongoing advocacy and collaboration to embrace sexual pleasure in all settings.

The Continuum of Support for Building Intimacy Knowledge in College for Students With Intellectual Disability

Postsecondary education (PSE) programs allow for college students with intellectual disability to experience a higher level of autonomy in choice making, which they may not have experienced in their family home or high school. This includes choice making related to romantic and sexual relationships. The Continuum of Support for Intimacy Knowledge in College Survey (CoSIK-C) was used to examine how PSE programs support college students in building their intimacy knowledge. Types of resources and services used to build intimacy knowledge and the frequency and context in which support was provided were identified and varied across programs. Implications for practice and future research are provided.

Facebook Doesn't Like Sexual Health or Sexual Pleasure: Big Tech's Ambiguous Content Moderation Policies and Their Impact on the Sexual and Reproductive Health of the Youth

This paper explores the modern challenges hindering access to sexual health resources in the age of Big Tech and their impact on public health. Research data from sexual health organizations, Internet experts, and corporate financial documents shows instances of conflict between Big Tech's business model and the sexual health organizations' efforts to provide accurate information about sexually transmitted diseases and unplanned pregnancy prevention to the youth. Results show that as younger generations turn to the internet for sexual health resources, they are met with misinformation and roadblocks, enabled by the dominant corporations in the market. Sexual pleasure, for instance, remains an overlooked dimension of these resources despite the fact that it is important to people. In conclusion, given the rise in popularity of tech platforms, and the youth's reliance on them as basic information resources, Big Tech must be held accountable for its role and impact on public health, and collaborative closely and actively with sexual health experts to establish appropriate content moderation policies for sexual health content online.

Effects of an Internet-Based and Teacher-Facilitated Sexuality Education Package: A Cluster-Randomized Trial

BACKGROUND

This study aimed to evaluate the effects of an internet-based and teacher-facilitated sexuality education package on the sexual knowledge and attitudes of Chinese adolescents.

METHODS

Six middle schools where no sexuality education had been performed with a total of 501 adolescent students (245 males and 256 females) were included in the trial. In total, 14 classes were randomly assigned to the intervention (internet-based sexuality education package) or the control group (classes were conducted as per normal). Students' sexual knowledge and attitudes were assessed at the baseline, at the end of the intervention, and 12 months after the intervention. Generalized linear models were employed to assess the effects of the intervention.

RESULTS

Positive effects of the intervention were observed on sexual knowledge (β = 4.65, 95% CI: 4.12-5.17) and attitudes (β = 1.25, 95% CI: 1.00-1.50) at the end of the intervention. After 12 months, the effects sustained but the magnitude declined for sexual knowledge (β = 2.39, 95% CI: 1.85-2.93) and attitudes (β = 0.49, 95% CI: 0.23-0.75). There were no significant differences between male and female students.

CONCLUSIONS

Although further modifications are required, the sexuality education package can increase the accessibility of comprehensive sexuality education to adolescents in rural areas in China.

A mixed methods evaluation of Girls' Talk+: A sexuality education programme for girls with mild intellectual disabilities

BACKGROUND

Girls with a mild intellectual disability generally receive less sexuality education than their non-disabled peers, while their needs for sexual knowledge are possibly greater. This study aimed to evaluate the effect and process of a new sexuality education programme (Girls' Talk+), focused on sexual health among girls with a mild intellectual disability in the Netherlands.

METHODS

A mixed methods approach was applied, using participant questionnaires (n = 249), logs written by trainers (n = 17) and interviews with trainers (n = 10). Descriptive statistics and linear regression models were used to analyse the quantitative data. Several coding phases were used to analyse the interviews.

RESULTS AND CONCLUSIONS

This study provides some indication that Girls' Talk+ has positive results on improving knowledge, attitude, and self-efficacy in relation to sexual health as well as trainer and participant satisfaction with the programme.

Sexual Health Promotion among Swedish Adolescents - Professionals' Experiences

In this grounded theory study the aim was to explore professionals' experiences of promotion of adolescents' sexual health, and views on inter-professional collaboration in relation to this subject. Data collection was by five focus group interviews and two pair interviews with professionals working with sexual health promotion in health care and schools. The results showed that professionals were reaching out to young people through competence and trusting relationships along with working on a broader front. In conclusion, professionals need to be knowledgeable about the world of young people, accessible and able to offer adequate support, and improve their inter-professional collaborations.

The Flint women's study: community perspectives on contraception and family planning, sexuality education and barriers to reproductive health

Teenage pregnancy can have adverse social and health outcomes, and rates are high in Flint, Michigan as compared to the rest of the state and the USA. It is important to understand contributing factors to adolescent pregnancy to be able to better address this issue. This study examined qualitative data from interviews with 100 community members who participated in the Flint Women's Study, a study designed to better understand the hopes, dreams and needs of women in Flint, and their suggestions for how to address identified needs. Using a Community Based Participatory Approach, data were collected and analysed by a team of community members and academic researchers. The paper focuses on the theme of family planning among young women which included attitudes about contraception, sexuality education and bio-medical and structural barriers to accessing reproductive health. Community members emphasised the need for increased access to comprehensive contraception options, improved sexuality education in schools and from health care providers, and ultimately valuing young women.

Youth Response to Rape: Rape Myths and Social Support

Adolescents and young adults face the highest incidence of sexual assault, yet only limited research focuses on the experience of adolescent survivors, adolescent rape myth acceptance, or the ways youth respond to rape. Survivors tend to disclose to at least one person, typically peers, and the response, whether positive or negative, can impact well-being and help-seeking behaviors. Focus groups across Oregon, a leader in state-level comprehensive sexuality education policy, solicited high school-student reactions to an alcohol-involved rape scenario. These rich-case participants had taken comprehensive sexuality education classes and were affiliated with health and sexuality organizations. These youth were anticipated to showcase best possible outcomes resulting from current sexuality education practices. After hearing a hypothetical scenario involving a friend's experience with alcohol-involved sexual assault, participants were asked how they would respond. Participants spontaneously discussed whether the actions described constituted rape, often relying on victim-blaming rape myths as evidence. Alcohol use was a critical factor in interpretations. Female use increased her perceived culpability and male use decreased his. After assessing blame and whether the incident constituted rape, youth described three types of support (informational, instrumental or practical, and emotional support) they would offer as well as barriers when responding to the victim and intentions to hold victims accountable. These responses paint a concerning portrait of the ways youth make sense of sexual violence and consider responding to a friend's disclosure. Sexuality education policy mandates and intervention programs must target the problematic links between alcohol, rape, and rape myths while reinforcing non-victim-blaming support.

School-based Sexuality Education Experiences across Three Generations of Sexual Minority People

Sexual minority people face greater risk for compromised sexual health than their heterosexual peers, yet school-based sexuality education often excludes them. Little is known about whether or how sexual minority people's sexuality education experiences have varied across sociohistorical contexts of rapid social change in both sexuality education and sexual minority visibility. Semi-structured qualitative interviews were conducted among 191 sexual minority people from three distinct sociohistorical generations (ages 18-25, 34-41, and 52-59, respectively) and four geographic regions of the United States. Data were analyzed using thematic content analysis following a consensual qualitative protocol. Fifty-one participants (i.e., 27%) discussed school-based sexuality education experiences despite the lack of an explicit question in the interview protocol prompting them to do so. Four distinct yet overlapping themes emerged in participants' experiences of sexuality education: 1) Silence; 2) The profound influence of HIV/AIDS; 3) Stigma manifest through fear, shame, and prejudice; and, 4) Comparing school-based experiences to sexuality education outside of school. The presence of themes varied across groups defined by sociohistorical generation. The implications of sexuality education experiences for the wellbeing of sexual minority people are discussed.

Local realities or international imposition? Intersecting sexuality education needs of Ghanaian adolescents with international norms

The content of comprehensive sexuality education (CSE) programmes is contested in many parts of the world, yet we know less about what primary beneficiaries (learners) consider as (in) appropriate school curriculum. I examined this phenomenon in Ghana. Data generated from focus group discussions suggests that, overall, participants used positive phrases to describe the need for sexuality education. The prevalent and recurrent needs of adolescents centred around personal reproductive health hygiene, pregnancy prevention, healthy relationships, reproductive infections and control, reproductive physiology and maturation, gender differences and sexual orientations, and sexual pleasure and pain. However, these needs varied in some ways between males and females and between early adolescents and older adolescents. The study shows that what adolescents seek to learn fall within international norms/standards on CSE. However, some of these concepts were not covered in the guidelines proposed for Ghana. The prevalent view among many opponents that CSE is not driven by local need may not be consistent with adolescents' own aspirations and realities. The voices of children and adolescents should constitute part of the discussions on the form and content of sexuality education.

Evidences of an Implemented Training Program in Consensual and Responsible Sexual Relations for People with Intellectual Disabilities

(1) Background: While there is a growing awareness of the rights of individuals with intellectual disabilities, very limited progress has been made in supporting these people to create and maintain intimate and personal relationships. (2) Methods: This paper reports the results from a program aimed at promoting responsible and consensual sexual relations of adults with intellectual disabilities. Of the 44 participants, 31.8% were women and 68.2% were men aged 22 to 67 years. Pre and post measurements regarding the attitudes toward sexual relations were taken, and difficulty and discrimination indexes were calculated. (3) Results: Statistically significant improvements were identified in the overall measurements, as were they for the domains of privacy, safety, and respect. The difficulty index changed from 0.67 to 0.79 in a pre-post assessment, denoting more positive attitudes. This and other results support the relevance and usefulness of the intervention program and encourage further intervention efforts.

Intimate Partner Cyberstalking, Sexism, Pornography, and Sexting in Adolescents: New Challenges for Sex Education

Background: Within the context of the widespread use of technologies by adolescents, the objectives of this study were to identify the perpetrators of intimate partner cyberstalking (IPCS) in adolescents; to analyze the relationship between IPCS and gender, age, sexting behaviors, pornography consumption, and ambivalent sexism; and to investigate the influence of the study variables as predictors of IPCS and determine their moderating role. Methods: Participants were 993 Spanish students of Secondary Education, 535 girls and 458 boys with mean age 15.75 (SD = 1.47). Of the total sample, 70.3% (n = 696) had or had had a partner. Results: Boys perform more sexting, consume more pornographic content, and have more hostile and benevolent sexist attitudes than girls. However, girls perpetrate more IPCS than boys. The results of the hierarchical multiple regression indicate that hostile sexism is a predictor of IPCS, as well as the combined effect of Gender × Pornography and Benevolent Sexism × Sexting. Conclusions: it is essential to implement sexual affective education programs in schools in which Information and Communication Technologies (ICT) are incorporated so that boys and girls can experience their relationships, both offline and online, in an egalitarian and violence-free way.

A Cross-Sectional Community Readiness Assessment for Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan

Evidence indicates that school-based sexuality education empowers children and adolescents with the skills, values, and attitudes that will enable them to appreciate their health and well-being, nourish respectful social and sexual relationships, understand their rights, and to make informed choices. Owing to organized community resistance and prevalent misconceptions, promoting sexual and reproductive health has been challenging, especially in conservative settings like Pakistan. This study aimed at systematically exploring communities' perceptions regarding implementing school-based comprehensive sexuality education by conducting a cross-sectional community readiness assessment in Islamabad, Pakistan. A total of 35 semi-structured interviews were conducted with community key informants. Following the guidelines of the community readiness handbook, the interviews were transcribed and scored by two independent raters. The results indicate that, overall, the Islamabad community is at stage two of community readiness, the denial/resistance stage. Individual dimension scores indicate that knowledge of efforts, resources for efforts, knowledge about the issue, and leadership dimensions are at the denial/resistance stage. Only community climate was rated at stage three of community readiness, the vague awareness stage. This indicates that, for promoting sexuality education in the Pakistani context, it is essential to tackle resistance by sensitizing the community and the stakeholders through awareness campaigns.

Teachers' Experiences With LGBTQ+ Issues in Secondary Schools: A Mixed Methods Study

OBJECTIVE

This study investigated teachers' experiences with LGBTQ+ instruction as well as other school environment changes related to LGBTQ+ issues. It looked at teachers' attitudes towards LGBTQ+ individuals, comfort levels with the topics and administrative support, self-perceived knowledge and teacher preparation, and supports and barriers to instruction. Lastly, the study investigated teachers' in-service and pre-service training experiences.

DESIGN

Using a sequential mixed methods approach, research began with qualitative inquiry, followed by quantitative assessment via self-administered paper surveys.

METHODS

There were 11 in-depth participant interviews, and 94 surveys assessing teachers' attitudes, comfort levels, self-perceived knowledge and preparation, and supports and barriers to LGBTQ+ topics.

RESULTS

Data analysis revealed teachers' school location and pre-service and in-service training experiences impacted comfort levels and self-perceived knowledge and preparation levels to teach these issues. Data also indicated that new teachers were the least comfortable with LGBTQ+ topics in the classroom and school environment.

CONCLUSION

Data demonstrated lack of LGBTQ+ teacher training, indicated need to support new Health Education professionals, and inadequate pre-service teacher training.

'Sex Is Not Just about Ovaries.' Youth Participatory Research on Sexuality Education in The Netherlands

Young people are not satisfied with the sexuality education they receive in Dutch high schools. They rate their sexuality education as mediocre (5.8 on a scale of one to ten). In cooperation with 17 young peer researchers, we explored what good sexuality education looks like from the point of view of young people. The peer researchers collected data in their own high school, using mixed methods, starting with individual interviews, followed by focus group discussions and Photovoice sessions to get more in-depth views on topics, class atmosphere, and teacher skills. In total, 300 pupils aged 12–18 participated in the research. Our findings demonstrate that young people want more sexuality education, during their whole school career. They want sexuality education to move beyond biological functions, sexually transmitted diseases, and reproduction into issues like dating, online behavior, sexual pleasure, relationships, and sexual coercion. Moreover, pupils want sexual diversity integrated and normalized in all content. One of the main issues is that sexuality education should be given in a safe class atmosphere, which demands sensitivity from the teacher. In addition to the findings of the study, this article reflects on the steps to be taken to realize the changes desired by young people.

How Sexuality Education Programs Have Been Evaluated in Low-and Lower-Middle-Income Countries? A Systematic Review

Background: Complex sexual and reproductive health interventions, such as sexuality education (SE), contain multiple components and activities, which often requires a comprehensive evaluation design and adaptation to a specific context. In this review, we synthetize available scientific literature on types of evaluation designs used for SE programs in low- and lower-middle-income countries. Methods: Two databases yielded 455 publications, from which 20 articles met the inclusion criteria. Narrative synthesis was used to summarize the findings. Evaluation approaches were compared to recommended evaluation frameworks. The quality of articles was assessed by using MMAT 2018. Results: A total of 15 interventions employed in 10 countries were evaluated in the 20 selected articles, with the quality of publications being moderate to high. Randomized controlled trial was the predominant study design, followed by quasi-experimental design. There were seven process evaluation studies, using mixed methods. Main outcomes reported were of public health or behavioral nature—condom use, sexual debut or delay, and number of sexual partners. By comparing evaluation designs to recommended frameworks, few studies fulfilled at least half of the criteria. Conclusions: Evaluations of SE are largely dominated by quantitative (quasi-)experimental designs and use of public health outcomes. To improve understanding of SE program effectiveness, it is important to assess the quality of the program development, its implementation, and its impact, using existing evaluation frameworks and recommendations.

Zimbabwean secondary school Guidance and Counseling teachers teaching sexuality education in the HIV and AIDS education curriculum

In spite of the importance of sexuality education and HIV and AIDS education in preventing HIV infections, Zimbabwean secondary school Guidance and Counseling teachers are not engaging optimally with the current Guidance and Counseling, HIV and AIDS & Life Skills education curriculum, and hence, they are not serving the needs of the learners in the context of the HIV and AIDS pandemic. The aim of the study, therefore, was to explore how Guidance and Counseling teachers could be enabled to teach the necessary critical content in sexuality education in the HIV and AIDS education curriculum. A qualitative research design, informed by a critical paradigm, using participatory visual methodology and methods such as drawing and focus group discussion, was used with eight purposively selected Guidance and Counseling teachers from Gweru district, Zimbabwe. The study was theoretically framed by Cultural Historical Activity Theory. Guidance and Counseling teachers found themselves in a community with diverse cultural practices and beliefs of which some seemed to contradict what was supposed to be taught in the curriculum. The participatory visual methodology, however, enabled a process in which the Guidance and Counseling teachers could reflect on themselves, the context in which they taught, their sexuality education work and learn how to navigate the contradictions and tensions, and to use such contradictions as sources of learning and sources for change. The results have several implications for policy in terms of the Guidance and Counseling curriculum and engaging with cultural issues; and for practice in terms of teacher professional development, teacher training, and for stakeholder contribution.

Sexual Practices among Senior Students in Private Secondary Schools in Uyo, Southern Nigeria

Sexual practices of adolescents have enormous consequences on their health and career outcome. The objective of this study was to assess the sexual practices among senior secondary students in private schools in Uyo, Nigeria. This was a descriptive crosssectional study. Data were collected using structured, self administered questionnaire and analyzed with SPSS version 23 software. Level of significance was set at 0.05. A total of 353 respondents participated in the study. The mean age was 14.84±1.10 years with a male to female ratio of 1:1.17. The prevalence of sexual intercourse was 14.2%. The mean age of sexual debut was 11.7±2.60 years, being significantly lower in males, (10.83 ±2.64 years) than females, (12.67±2.42 years) (p=0.00). Risky sexual behaviour included low contraceptive use 15 (30.0%) and having multiple sexual partners 9(18%). A total of 25.8% males and 9.0% females engaged in pornography (p=0.00). Also, 8.6% of males and 2.6% females both masturbated and had sexually active friends respectively (p=0.01). In view of the early sexual debut and risky sexual practices reported among senior secondary students in private schools in Uyo, there is need for early integration of sexuality education into the curriculum of such schools to improve sexual behaviour among the students.

Revisiting the 'Thai gay paradise': Negative attitudes toward same-sex relations despite sexuality education among Thai LGBT students

School settings are volatile and often violent for LGBT teens who are first coming to terms with their sexuality. We explored the attitudes of LGBT students in Thai secondary schools towards homosexuality. Students aged 12-19 years were surveyed in 393 public institutions providing secondary-school education in six regions of Thailand, selected by a multistage cluster sampling. Among 1088 LGBT-identified students, 378 (35%) reported negative attitudes toward homosexuality. Factors associated with homonegative attitudes in a multivariable logistic regression analysis were identifying as a transgender (Adjusted Odds Ratio [aOR] 2.5, 95% CI 1.5-4.1), having low academic performance (GPA scores of 2-3 [aOR 2.6, 95% CI 1.7-4.1] or less than 2 [aOR 2.1, 95% CI 1.5-2.]), and attending sexuality education classes covering topics such as bullying LGBT students (aOR 1.9, 95% CI 1.2-3.1) and safe homosexual practices (aOR 2.1, 95% CI 1.7-4.1). Sexuality education in its current form in Thai public schools may not be effective in reducing homonegative attitudes of LGBT-identified students. A more comprehensive sexuality education emphasising gender and rights along with strategies addressing social disparities due to sexual orientation is needed to enable Thai LGBT teens to accept their sexuality without shame and self-disrespect.

Caring Adults: A Brief Report Assessing Adults' Needs in Feeling More Comfortable Having Sexual Health Conversations with Youth in South Texas

Objectives

As part of a larger Substance Abuse and Mental Health Services Administration-funded project in South Texas, this study sought to understand adults' needs with regard to engaging in sexual health conversations with youth and young adults.

Methods

A total of 223 participants were surveyed to assess comfort engaging in sexual health conversations. Data were analyzed using thematic coding. Stigma surrounding sexual health conversations underlined all themes.

Results

Differences by gender and sexual orientation in the data were noted. Stigma around sexual health topics reduced participants' comfort.

Conclusions

To this end, interventions must go beyond psychosocial and educational programs and address societal factors that contribute to the stigma.

Sexualised violence against children: a review of laws and policies in Kenya

Child sexual abuse (CSA) is a major global health challenge. Extant literature shows that CSA is prevalent in Kenya. As a signatory of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, the Kenyan government is mandated to ensure that children are protected from sexual abuse through sound laws and policies. This paper reviews existing laws and policies on CSA and highlights their strengths and weaknesses. Our findings indicate that laws on child protection exist and are protective to a large extent, as harsh penalties are outlined for sexual offences. Survivors of CSA are entitled to free legal and medical services. However, there are no reparations offered to survivors in criminal proceedings. Moreover, there is no legislation on age-appropriate comprehensive sexuality education which plays an important role in cultivating positive gender norms and describing what constitutes CSA and reporting procedures. The national standard operating procedures for the management of sexual violence against children lack CSA screening procedures. There is urgent need for review of these laws and policies and development of multisectoral protocols at the national and county level, that outline roles and responsibilities for various service providers, supervisory and accountability measures and referral networks.

Sexuality as taboo: using interpretative phenomenological analysis and a Foucauldian lens to explore fathers' practices in talking to their children about puberty, relationships and reproduction

Background

Fathers can play an important role in their children's learning about relationships and sexuality but we know very little about the father's lived experience in this regard.

Aim

To explore eight fathers' perceptions and experiences of discussing puberty, relationships and reproduction with their 10-year-old children.

Methods

The paper commences with a genealogical analysis of the history of sex education in England from the Public Health Act of 1848 to the present day. Interpretative phenomenological analysis (IPA) was used as both a methodology and a method. Face-to-face interviews were conducted with each father and results were analysed ideographically, followed by analysis across the group. Interpretations were developed using a Foucauldian lens of governmentality and biopower.

Findings

The paper explores how synthesis of IPA with a Foucauldian lens revealed significant tensions between the fathers' cognitions, accounts and behaviours, which were underpinned by an enduring perception of sexuality as taboo.

Conclusion

By providing a contextualised understanding of the fathers' practices, this study demonstrates that a more informed approach to health promotion strategy can be achieved and the implications for nursing are explored.

Teachers' conflicting cultural schemas of teaching comprehensive school-based sexuality education in Kampala, Uganda

Teachers can feel uncomfortable teaching sexuality education when the content conflicts with their cultural values and beliefs. However, more research is required to understand how to resolve conflicts between teachers' values and beliefs and those implicit in comprehensive approaches to sexuality education. This study uses cultural schema theory to identify teachers' cultural schemas of teaching sexuality education and the internal conflicts arising between them. In-depth interviews were conducted with 40 secondary school teachers in Kampala, the capital city of Uganda. Embedded in a context of morality, conflicting cultural schemas of sexuality education and young people's sexual citizenship in traditional and present-day Ugandan society were found: young people are both innocent and sexually active; sexuality education both encourages and prevents sexual activity; and teachers need to teach sexuality education, but it is considered immoral for them to do so. In countries such as Uganda, supportive school regulations and a mandate from society could help teachers feel more comfortable adopting comprehensive approaches to sexuality education.

[Historical Transition of Sexuality Education in Japan and Outline of Reproductive Health/Rights]

In this paper, we describe the historical transition of sexuality education in Japan and the direction of sexuality education taken by the Ministry of Education, Culture, Sports, Science and Technology (MEXT). Reproductive health/rights, a key concept in sex education, is also discussed. In Japanese society, discussion on sexuality has long been considered taboo. After the Second World War, sexuality education in Japan began as "purity education." From 1960 until the early 1970s, physical aspects such as genital organs, function, secondary sexual characteristics, and gender differences were emphasized. Comprehensive education as a human being, including physiological, psychological, and social aspects, began to be adopted in the late 1970s. In 2002, it was criticized that teaching genital terms at primary schools and teaching about sexual intercourse and contraceptive methods at junior high schools were "overdue guidance" and "extreme contents." Sexuality education in schools has become a problem and has stagnated for about 10 years. Currently, schools teach sexuality education that does not deviate from the MEXT course guidelines. The direction of MEXT regarding sexuality education should be examined from the basic position that sexual activity by children is inappropriate. Reproductive health/rights apply the concept of human rights to sexuality and reproduction. Reproductive health/rights are key concepts that support sex education and women's health.

[Trends in Research on Adolescent Sexuality Education, Fertility Awareness, and the Possibility of Life Planning Based on Reproductive Health Education]

In this paper, we describe the trends in research on adolescent sexuality education in Japan and other countries and on fertility awareness, as well as the possibility of life planning based on sex and reproductive health education. Mason-Jones AJ et al. reviewed the results of school-based intervention studies on the prevention of human immunodeficiency virus infection, sexually transmitted diseases, and pregnancy. There is little evidence supporting the idea that educational curriculum-based programs alone are effective in improving sex and reproductive health outcomes in adolescents. In another study, the effectiveness of school-based sexuality education for adolescents in Japan was evaluated. The Japan Medical Abstract Society was searched for articles published in the last 10 years. In many studies, the effects were compared before and after a single sexuality education lecture by professionals, such as doctors, midwives, and public health nurses. In Japan, effort has been directed toward sexuality education, but no systematic program based on behavior theory has been adopted. Therefore, sex education is insufficient. A third study clarified research on fertility awareness in adults and issues regarding improvements in related education and research. The Japan Medical Abstract Society and PubMed were searched for articles published in the last 10 years. The review suggested that awareness of female fertility is insufficient. Delaying childbearing based on inaccurate knowledge of the decline in female fertility could lead to unintended infertility. For males and females, sexual health education in schools and communities should include information on the age-related decline in female fertility. Although the determinants of the timing of childbearing are multifactorial, education on fertility issues is necessary to help adults make informed reproductive decisions based on accurate information. Finally, in this paper, we introduce examples of the pioneering efforts in sexual health education through collaboration between the governments of Oita and Okayama Prefectures and Oita and Okayama Universities.

The Need for Sexuality Education in Pakistan

Sexuality education is an extremely controversial topic in countries like Pakistan where any dialogue regarding sexual practices is considered taboo. Yet, it is a country with a high prevalence of abortions and sexually transmitted illnesses (STIs). Current knowledge about such issues in the general public is also very poor. Hence, it is extremely important to discuss the advantages of having sexual education programs in Pakistan and analyze the current impact of an absence of such programs and public awareness campaigns.

Indigenous (Māori) sexual health psychologies in New Zealand: Delivering culturally congruent sexuality education

Indigenous (Māori) psychologies of sexual health occur at the cultural nexus of Indigenous and Western knowledge, colonising influence and intervention. Formal school-based sexuality education holds potential to intervene in this psychological space by decolonising notions of Māori sexuality, relationships and reproduction. This research utilises an Indigenous feminist (Mana Wāhine) methodology and interviews with 43 Māori participants (26 women and 17 men). We explore how Māori knowledges (mātauranga Māori), responsive to the surrounding colonising context, were interwoven through four themes: relationships, reproductive responsibility, open conversations about sexuality and contraceptive education. Indigenous knowledges can contribute to good sexual health psychologies for all.