‘Can you get pregnant when u r in the pool?’: young people's information seeking from a sexual health text line

Young people have questions about sex and development but may have trouble getting answers to them. Text messaging services can serve as a resource. This study analysed 1351 text messages sent to a sexual health text message service designed for young people in North Carolina to determine the types of questions asked of a confidential, accurate source of information. The majority of texts sought information about sexual health topics (89%). A smaller proportion asked for advice (7%) or reassurance (4%) that the sender was developing normally. Questions mainly asked about sexual acts (33.9%), unplanned pregnancy (20.2%), contraception (13.7%), physical or sexual development (12.9%) and sexually transmitted diseases (10.8%). Findings suggest that a confidential and accurate sexual health text message service could be an important resource for young people, especially if they seek advice before engaging in risky sexual behaviour.     

‘Use Condoms for Safe Sex!’ Youth-led video making and sex education

Situated at the intersection between child-led visual methods and sex education, this paper focuses on the potential of youth-led video making to enable young people to develop guiding principles to inform their own sexual behaviour. It draws on findings from a video-making project carried out with a group of South African young people, which engaged them in identifying and tackling critical issues of HIV and AIDS. By analysing one of the youth-generated videos using critical visual analysis, we conclude that youth-led video making can be an effective tool to allow young people to talk about their interests and concerns and to develop guiding principles for their own sexual behaviour. This tool is especially relevant to young people whose needs are not being met by the current sexual health curriculum and can be a fun medium through which to engage participants in ensuring that sex education needs are met.     

‘Everywhere they say that it’s harmful but they don’t say how,so I’m asking here’: young people,pornography and negotiations with notions of risk and harm

Debate about pornography and minors has mainly centred on questions of control, regulation and media policy; the urge to protect children from dangers of sexually explicit content being the primary motivator of these conversations. Instead of discussing the use of pornography by minors in the light of relevant research findings, public discourse on these issues is more usually shaped by views of sexual cultures as inherently dangerous to minors, and young people as vulnerable, easily harmed, and endangered by the media. This paper builds on data consisting of 4212 questions about sexuality that were sent by young people in Finland to experts on sexual health. Only 64 (1.5%) of these contributions explicitly focused on pornography. The small number of porn-related submissions suggests that for young people there are other more important concerns in the field of sexuality than pornography, on which adult guidance is sought. This paper argues that young people’s perceptions of pornography are more diverse than is typically assumed in public debate. Young people challenge risk talk by constantly referring to the vagueness of the alleged harm that characterises the discourse of danger that can be found in much public discussion. According to the findings of this study, blurry notions of harm bother young people more than the actual pornographic content they encounter.     

Young Cypriots on sex education: sources and adequacy of information received on sexuality issues

Introduction: In the absence of standardised sex education and because schools usually limit their teaching to the ‘health’ aspects of sexuality, young people in Cyprus rely on their peers and the media for information on sexuality. This study examines the sources and adequacy of the information received by young people from various sources on matters related to sexuality and sexual health.

Method: Twelve in‐depth interviews were conducted in Cyprus in 2005 with purposively chosen boys and girls aged 15–18 years using a semi‐structured discussion guide. The interviews focused on participants' knowledge of HIV/AIDS and other sexually transmitted infections, safer sex, contraception and abortion. They also explored attitudes and beliefs concerning relationships, homosexuality and mutual consent.

Results: Information about sexual health is primarily received from school in classes that interviewees considered dull or irrelevant. Television, and to a lesser degree magazines, were the main sources of information on sexual relationships, the sexual act, homosexuality and abortion. Sexually transmitted infection knowledge was limited and often erroneous, while attitudes towards contraception use, abortion and homosexuality suggest that negative stereotypes are widespread.

Conclusions: Because the information young people receive on sexuality appears to be inadequate, there is an urgent need to implement comprehensive, evidence‐based sex education in the public schools. It should also address the nature and content of the sexual and reproductive health messages received from peers and the media.     

The Role of External Professionals in Education about Sexual Orientation−towards good practice

Throughout England, young people in schools are entitled to a comprehensive programme of sex education as part of Personal, Social and Health Education (PSHE). Current debate about the content of such a programme is informed by new government guidance on sex and relationship education as well as pre-existing concerns about homophobic bullying, sexual health and mental health. In an English local authority, an externally funded Young Gay and Bisexual Men's Development Worker provided educational activities to address sexual orientation and identity issues to four schools. An evaluation sought to identify whether successes had been achieved and why. A further aim was to identify useful learning about the role of external professionals in carrying out effective education about sexual orientation with young people in schools. The evaluation was developed within the context of a number of 'real-world' limitations. Nevertheless, a significant number of project successes (and areas for development) were documented. Successes included raising awareness of key issues among pupils and supporting teachers engaged in PSHE. Key factors contributing to success included: adequate preparation of teachers and pupils in schools; an appropriately skilled and experienced project worker; and a considered approach to building partnerships with schools and working with young people.     

Collaboration between a child telephone helpline and sexual and reproductive health and rights organisations in Senegal: lessons learned

This study identifies lessons learned from a collaboration between a child telephone helpline and sexual and reproductive health and rights (SRHR) organisations in Senegal established in the context of an SRHR programme for young people. We assessed how helpline operators are equipped to address sexual health and rights issues with young people, what the relevant skills of operators are, and to what extent referral to sexual and reproductive health (SRH) service providers took place. A documentary review, a vignette study and interviews with six key informants and all seven operators took place. The collaboration led to promising initiatives, such as the provision of SRH training, the exchange of staff, referral to SRH service providers. However, the counselling advice provided by operators was not always in line with the rights-based approach and responses were influenced by underlying norms concerning young people’s sexuality. Additionally, concerns about confidentiality were noted. The collaboration was an innovative attempt to respond to young people’s limited access to SRHR information and services but there is a need for more in-depth training of helpline operator’s skills and the development of a standardised rights-based counselling manual.     

Sexuality education in South Africa: Three essential questions

Sex education is the cornerstone on which most HIV/AIDS prevention programmes rest and since the adoption of Outcomes-Based Education (OBE), has become a compulsory part of the South African school curriculum through the Life Orientation learning area. However, while much focus has been on providing young people with accurate and frank information about safe sex, this paper questions whether school-based programmes sufficiently support the needs of young people. This paper is based on a desk-review of the literature on sex and sexuality education and examines it in relation to the South African educational context and policies. It poses three questions: (a) what do youth need from sexuality education? (b) Is school an appropriate environment for sex education? (c) If so, what can be said about the content of sex education as well as pedagogy surrounding it? Through reviewing the literature this paper critically engages with education on sex and sexuality in South Africa and will argue that in order to effectively meet the needs of youth, the content of sexual health programmes needs to span the whole spectrum of discourses, from disease to desire. Within this spectrum, youth should be constructed as “knowers” as opposed to innocent in relation to sex. How youth are taught as well as how their own knowledge and experience is positioned in the classroom is as important as content in ensuring that youth avoid negative sexual health outcomes.     

Sex education,first sex and sexual health outcomes in adulthood: findings from a nationally representative sexual health survey

This study investigated the relationship between school sex education and sexual health behaviours at first sex and later in adulthood, using nationally representative data. Respondents were adults from the 2010 Irish Contraception and Crisis Pregnancy Survey, a cross-sectional survey designed to assess knowledge, attitudes and behaviours relating to sex, contraception and pregnancy in Ireland. Results indicate that respondents who received sex education were more likely to have first sex at an older age and use contraception on this occasion. Sex education also significantly increased the likelihood of using contraception at first sex, when first sex occurred before 17 years of age. The effect of sex education and sexual health behaviours into adulthood was also investigated. Sex education increased the likelihood of having a history of sexually transmitted infection testing and decreased the likelihood of having experienced a crisis pregnancy. No association was found between sex education and contraception use over the past year. Findings suggest that sex education is an important factor in the context of first sex and later sexual health, and programmes should continue to equip young people as they make immediate sexual behaviour decisions and further sexual health-related decisions throughout their lifespan.     

‘It was as useful as a chocolate kettle’: sex education in the lives of same‐sex‐attracted young people in Australia

Sex education is a contested site in the school curriculum as communities grapple with who should teach young people about sex and how it should be taught. In this paper we ask whether same‐sex‐attracted young people are being exposed to appropriate and relevant sex education at school, and if they are not whether it is necessary that sex education be inclusive of sexual difference. In the second Australian survey of 1749 same‐sex‐attracted youth of 14–21 years old, we ask young people about sex education classes at school, how useful they were for them, their sources of information regarding gay and lesbian relationships and safe sex, sexual behaviours and incidence of sexually transmissible infections and pregnancy. We find from the data that most of these young people found sex education to be useless because it was not inclusive. In comparison with normative studies, these young people were, on average, sexually active earlier, had higher rates of diagnosed sexually transmissible infections and at least as high an incidence of pregnancy. We conclude from the data that there is a need for sex education in schools to be inclusive of the sexuality of all students, not just those who are attracted to the opposite sex.     

Design,implementation and evaluation of school-based sexual health education in sub-Saharan Africa: a qualitative study of researchers’ perspectives

This study investigated facilitators and challenges to designing, implementing and evaluating school-based sexual health education in sub-Saharan Africa, using interviews with intervention designers and researchers. At the pre-planning and planning stages, participants reported that facilitating factors included addressing the reproductive health needs of participants, contextual (culture, religion, economic and social) considerations and the adoption of holistic approach to sexuality education. Lack of open communication about sexual health matters between young people and adults; concerns that sexual health education could encourage sexual activity; and inadequate funding, were key barriers. Implementation was facilitated by the involvement of relevant stakeholders, the training of facilitators and adopting strategies to overcome resistance to sexual health education. The provision of structured, detailed lessons plans and monitoring with supportive supervision optimised fidelity of delivery. Barriers to implementation included facilitators’ resistance to teaching safe sex promotion and logistical challenges in school environments. Participants also reported that the validity of self-reported adolescent sexual behaviour (as part of evaluation) may be improved by complementing well-designed self-report surveys with computerised audio devices for data collection, qualitative interviews and participant observation. Study findings generate recommendations to improve future forms of school-based sexual health education in sub-Saharan Africa.     

Sexual behaviour profiles of HIV-positive youth in the Netherlands

Young people living with HIV are challenged when it comes to exploring their sexuality. Their sex education is hampered by the fact that their preferences and attitudes towards sexual behaviour are little known about. In this study from the Netherlands, Q-methodology was used to identify sizeable and meaningful sub-groups sharing common attitudes and viewpoints. Thirty of 48 eligible HIV-positive young people aged 12–21 years treated in one of the four Dutch HIV centres rank-ordered 45 statements on the topic. Thereafter, they explained their ranking. By-person factor analysis identified five distinct sexual behaviour profiles (SBPs): (a) safer sex & disclosure to steady partner; (b) motivated by faith and culture; (c) disclosure to good friends, values peer support; (d) conscientious, worries about disclosure and future; (e) self-confident, faith and family are important. Profiles differ in terms of the roles of culture and religion, the influence of family and friends, personal views about disclosure of HIV status, knowing the transmission mode, and viral load. Study results indicate that different approaches to sexual health education are required based on these different orientations. Q-sorts and SBPs may be helpful in discussing sexual behaviour with HIV-positive young people and in developing tailored strategies to meet their interests and needs.     

Knowledge and attitudes of secondary school teachers regarding sexual health education in England

Objective To assess the sexual health knowledge of teachers who contribute to secondary school sexual health education in order to determine whether teachers are adequately prepared to implement present government education and public health policies.

Design Results were obtained from a questionnaire as part of a two‐phase intervention study.

Setting Nineteen mixed‐sex, state secondary schools in central England.

Participants One hundred and fifty‐five teachers (94 female, 61 male) participated.

Main outcome measures The questionnaires were distributed to teachers to assess their knowledge of sexual health, contraception and sexually transmitted infections. In addition, teachers' attitudes on the subject of sex and relationships education were evaluated.

Results The results suggest that teachers have insufficient sexual health knowledge to effectively teach sexually transmitted infections or emergency contraception, although their general sexual health knowledge was good. Therefore, at present teachers do not have adequate specialist knowledge in sexual health to contribute to current recommendations for sex and relationships education in secondary schools. There were no statistically significant differences in the results regarding location of school, area of residence, gender or age of the participant.

Conclusions Many teachers are being expected to contribute to secondary school sexual health education programmes at a time when they do not have sufficient knowledge to provide young people with adequate sexual health education and when they do not feel prepared to teach, and in many cases would prefer not to teach, these programmes.     

Parental attitudes about teenage pregnancy: impact on sexual risk behaviour of African-American youth

African-American youth suffer disproportionately from sexual risk consequences including unintended pregnancy and sexually transmitted infections. Parents educating young people about sex may be one approach to reduce sexual risk behaviour among this population. The purpose of this study was to determine young people's perceptions of parents' attitudes about sex and assess whether these perceptions affect sexual risk. Data were collected from 560 African-Americans, aged 9–19 years. Most (73.4%) thought their parents would be unhappy if they got someone pregnant/got pregnant, with more girls feeling this way than boys (p = 0.013). Sexually active boys who thought their parents would be unhappy if they got someone pregnant reported fewer sexual partners within the past year (p < 0.01) and fewer sexual encounters in the past 3 months (p = 0.01) compared to those whose parents would think otherwise. Our research illustrates that parents' explicit and unstated attitudes are apparent to their offspring, and young people's perceptions can impact their risk behaviour. As such, early and often sex education communication between parents and young people should be encouraged. Sexual health interventions encouraging parents to educate about sex and its consequences could enhance the health of young African-Americans.     

Positive and negative aspects of relationship quality and unprotected sex among young women

The aim of this study was to examine both positive and negative aspects of relationship quality in relation to condom use. Sexually active young women aged 14–18 years (n = 111; 34% non-white) were recruited from community clinics and schools in the Midwest USA and provided data via an online survey. The number of unprotected sex acts in the past month with the most recent male partner was regressed on relationship quality with that partner, adjusting for demographics and other characteristics. Negative relationship quality was associated with a greater number of unprotected sex acts among women reporting a low level of positive relationship quality and among women taking hormonal/IUD contraception. Positive relationship quality was associated with unprotected sex among women who reported multiple partners in the past month. Both positive and negative aspects of relationship quality may confer risk for unprotected sex. This risk appears to be modified by patterns of contraceptive use and other sexual behaviours. Health professionals and sexual health educators may be more effective in promoting condom use if they ask questions about both positive and negative aspects of young people’s relationship quality and tailor their conversations based on the responses received.     

Improving sexual health for young people: making sexuality education a priority

How well do young people understand their developing sexuality and what this means? This paper reports on findings from the Our Lives: Culture, Context and Risk project, which investigated sexual behaviour and decision-making in the context of the everyday life experience and aspirations of Indigenous and non-Indigenous young people (16–25 years) in the Northern Territory, Western Australia and in South Australia. Using qualitative data, this paper focuses on what participating young people thought was necessary to improve the quality of sexuality education. Participants suggest that current forms of sexuality education are too clinical, didactic and unengaging, and are missing in relevant content. Young people requested more information on relationships, first sexual experiences and negotiating condom use. These requests indicate that young people realise that they need more knowledge in order to have healthy relationships, which conflicts with the popular belief that providing young people with open, honest information around sex will encourage them to have sex or increase sexual risk taking. Making sexuality education more of a priority and listening to the needs of young people could be a positive step towards improving sexual health and well-being.     

Sexuality Information Needs of Latino and African American Ninth Graders: A Content Analysis of Anonymous Questions

This study used qualitative content analysis to examine anonymous questions about sex and sexuality submitted by Latino and African American adolescents in Los Angeles, California, classrooms. The majority of questions asked about sexuality and sexual behavior, or anatomy and physiology, with fewer questions about pregnancy and pregnancy prevention, sexually transmitted infections, and condoms. Overall, a notable mix was found of questions implying exposure to or awareness of a wide range of sexual activities, together with questions demonstrating fundamental misunderstandings or confusion about some of the most basic aspects of sex and sexuality. Gender differences emerged across topics, subtopics, and question types. The results of this study suggest that differences exist between what Latino and African-American teens yearn to know about sex and sexuality, and what information they are getting on these topics from other sources. This reinforces the importance of considering the concerns and needs of the intended audience in designing and evaluating health education programs.     

Evaluating the need for sex education in developing countries: sexual behaviour,knowledge of preventing sexually transmitted infections/HIV and unplanned pregnancy

Young people's need for sex education is evidenced by their typically early initiation of sexual activity, the often involuntary context within which they have sexual intercourse, high‐risk sexual behaviours and the inadequate levels of knowledge of means of protecting their sexual health. The earliness of initiation of sexual intercourse has implications for the age by which sexuality education should be provided. The extent and context of sexual behaviour is a firm indicator of the need for sex education as well as for counselling, information and services related to sexual and reproductive health. Apart from behaviours, information on the extent of knowledge and accuracy of knowledge about risks to sexual health and about means of preventing unhealthy or undesired outcomes are important indicators of young people's need for information to help them make choices and to engage in safe and healthy behaviours. Such measures of behaviour and knowledge can also be relevant and valid indicators of the effectiveness of sex education interventions. The context with which young people live and key characteristics such as school attendance and literacy are important considerations in providing information and in evaluating interventions.     

Who am I? 52 Tuesdays,intimacy and the search for an authentic life

Recent research shows that young people list media entertainment as one of the sources where they find information about what they really want to know about sex and what is not taught through the school curriculum – namely, relationships and eroticism. This paper addresses the potential role that may be played by small independent alternative feature films such as 52 Tuesdays in the sexual education of young people. While 52 Tuesdays’ purpose was never explicitly pedagogic, the subject matter – family relationships, sexual experimentation, sexual identity and agency, and transgender experience – situates it firmly within the concerns of contemporary young people.     

‘You shouldn’t be making people feel bad about having sex’: exploring young adults’ perceptions of a sex-positive sexual health text message intervention

Young adults are disproportionately affected by negative sexual health outcomes, such as sexually transmitted infections. One strategy for reducing such negative outcomes involves the use of comprehensive sexual health education. As comprehensive sexual health education programmes are adopted, there is a need to evaluate the messaging approaches that might best connect with young people. Sex-positive approaches, which describe sex as a healthy practice and personal choice, are becoming popular, but whether this strategy works has not been tested from a message design perspective. This study examines the reactions of young adults to sex-positive or sex-negative messages, framed as a gain or loss, designed for a text message-based intervention. Participants quantitatively evaluated 24 messages on their mobile phones. Gain frames were preferred over loss frames, and sex-positive messages were rated as more believable and persuasive. An interaction between the two concepts was also found. Results highlight how sex-positive messages that focus on the benefits of certain behaviours tend to resonate better with young adults. Implications for health educators and practitioners are discussed.     

Parent and family influences on young women's romantic and sexual decisions

Parents can play an important role in reducing their children's risk for teenage pregnancy and sexually transmitted infections, and in promoting sexual health during adolescence. The purpose of this study was to explore communication between parents, family members and young people and how it influences their romantic and sexual behaviours. Semi-structured interviews were conducted with 28 African American, American Indian, Euro-American and Latina women aged 19–29 years. Findings clustered into five themes. First, mothers were often the primary source of reproductive education. Second, fathers provided valuable guidance, although they were not the first source of information. Third, parental expectations influenced young people's sexual behaviours both positively and negatively. Fourth, aunts, uncles and grandparents were trusted sources of advice for personal discussions. Fifth, over one-third of participants perceived that there was no adult available to them during their teenage years for discussions about romance. Sex educators can encourage and guide parents to discuss romantic and sexual issues with young people as a way to support their young people's healthy sexual and romantic behaviours. Health and sex educators should also identify young people lacking support and encourage stronger relationships with family including fathers and extended family members.