Promoting sexual health in schools: a systematic review of the European evidence

Introduction

Sexual ill-health is an urgent public health issue with subsequent social and economic costs. There is, therefore, a need for more effective sexual health promotion interventions in an early stage of life. Previous research has focused on preventive sexual health interventions applying a risk perspective, and the limited and scattered evidence concerning school-based sexual health promotion interventions employing a health-resource perspective has not been compiled and synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in schools in Europe.

Method

A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and included information on study characteristics, intervention content, methods, and outcomes relevant to the current review. A narrative synthesis of the included studies was performed, highlighting the collective results.

Result

Seventeen records were included in the review, reporting on 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All three studies with a qualitative research design described positive effects experienced by the participants. Six of thirteen quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. The outcomes of interest were grouped into five areas, and most studies focused on the area of attitudes toward sexual health.

Conclusion

The findings indicate promising evidence of effect for interventions with a health promotion approach, highlighting the importance of strengthening sexual health resources related to respect, communication skills, attitudes, and other positive psycho-social aspects of sexual health. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas a comprehensive focus on the multi-dimensional sexual health literacy concept is less common and can be recommended to be included in future intervention research.

Four decades of functional community change reveals gradual trends and low interlinkage across trophic groups in a large marine ecosystem

The rate at which biological diversity is altered on both land and in the sea, makes temporal community development a critical and fundamental part of understanding global change. With advancements in trait-based approaches, the focus on the impact of temporal change has shifted towards its potential effects on the functioning of the ecosystems. Our mechanistic understanding of and ability to predict community change is still impeded by the lack of knowledge in long-term functional dynamics that span several trophic levels. To address this, we assessed species richness and multiple dimensions of functional diversity and dynamics of two interacting key organism groups in the marine food web: fish and zoobenthos. We utilized unique time series-data spanning four decades, from three environmentally distinct coastal areas in the Baltic Sea, and assembled trait information on six traits per organism group covering aspects of feeding, living habit, reproduction and life history. We identified gradual long-term trends, rather than abrupt changes in functional diversity (trait richness, evenness, dispersion) trait turnover, and overall multi-trait community composition. The linkage between fish and zoobenthic functional community change, in terms of correlation in long-term trends, was weak, with timing of changes being area and trophic group specific. Developments of fish and zoobenthos traits, particularly size (increase in small size for both groups) and feeding habits (e.g. increase in generalist feeding for fish and scavenging or predation for zoobenthos), suggest changes in trophic pathways. We summarize our findings by highlighting three key aspects for understanding functional change across trophic groups: (a) decoupling of species from trait richness, (b) decoupling of richness from density and (c) determining of turnover and multi-trait dynamics. We therefore argue for quantifying change in multiple functional measures to help assessments of biodiversity change move beyond taxonomy and single trophic groups.