Predicting intentions to perform protective sexual behaviours among Norwegian adolescents

This paper examines the socio‐cognitive processes underlying intentions to use condoms and contraceptive pills, using the Theory of Planned Behaviour extended with prototypes in a group of young Norwegian adolescents. The data are derived from a questionnaire survey comprising all pupils in Grade Nine at three schools in Oslo (n = 196). Using hierarchical multiple regression analyses, the results showed that prototypes and normative beliefs, especially partner's opinion, were the most important predictors for boys' condom decisions. For girls' condom decisions, normative and attitudinal considerations were most important. Perceived risk of getting sexually transmitted diseases was the most important predictor among behavioural beliefs for condom intention for both girls and boys. Normative beliefs, and especially parental opinions, were most important for girls' decisions to use contraceptive pills. Implications of the findings are discussed.     

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.     

‘I learned to be okay with talking about sex and safety’: assessing the efficacy of a theatre-based HIV prevention approach for adolescents in North Carolina

Adolescents are at increased risk of HIV and sexually transmitted infections (STIs) in the Southern states of the USA, where rates among youth are higher than in the rest of the nation. This paper reports on findings from a pilot study of an HIV prevention intervention that uses interactive theatre to educate young people about sexual health. The intervention was developed in Los Angeles and adapted for testing in the Southern USA, with its legacy of abstinence-based approaches to sexual health education. This study assessed intervention effects among a sample of young people in two public high schools in North Carolina. We used a pre-test, post-test quasi-experimental evaluation design to assess changes in 317 ninth-grade participants' knowledge and attitudes about HIV. At post-test, we found statistically significant increases in participants' HIV knowledge (t = 60.14; p = 0.001), as well as changes in attitudes (χ² = 8.23; p = 0.042) and awareness (χ² = 4.94; p = 0.026). Focus group data corroborated an increase in HIV knowledge and a reduction in HIV stigma as successful outcomes of intervention participation. The findings make an important contribution to the literature on theatre-based interventions for sexual health education. Furthermore, they highlight the importance of considering sociocultural and political context in implementing HIV prevention interventions in schools.     

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.     

Gender differences in associations between exposure to school HIV education and protective sexual behaviors and sexually transmitted disease/HIV diagnosis among high school students

This study aimed to assess associations between school HIV education and protective sexual behaviors and sexually transmitted disease (STD)/HIV diagnosis with a representative sample of male and female high school students. Data from male and female adolescent participants in the 1999, 2001 and 2003 Massachusetts Youth Risk Behavior Survey (n = 12,243) were analyzed. Adjusted regression analyses stratified by gender were conducted to assess relationships between school HIV education exposure and the following outcomes: no sexual initiation, condom use at last sex, no multiple sex partners in the past three months and no history of STD/HIV diagnosis. Participants were mostly White (75%) and were 51% male; the subsample of sexually active students was younger than the total sample but was otherwise similar in demographics. School HIV education was reported by 93% of our sample and was significantly related to sexual initiation among boys (odds ratio = 1.9, 95% confidence interval = 1.4–2.7) but not girls. Among sexually experienced students (n = 4752), boys reporting exposure to school HIV education were significantly more likely to report condom use (odds ratio = 2.2, 95% confidence interval = 1.6–3.1), no multiple sex partners (odds ratio = 3.2, 95% confidence interval = 2.3–4.4) and no STD/HIV diagnosis (odds ratio = 3.2, 95% confidence interval = 2.0–5.0); girls reporting such exposure were significantly more likely to report no multiple sex partners (odds ratio = 2.2, 95% confidence interval = 1.3–3.6). In conclusion, exposure to school HIV education is associated with sexual protective behaviors and reduced likelihood of STD/HIV diagnosis for boys but less so for girls, suggesting the need for more gender‐tailored approaches to school HIV education.     

“Because if we don’t talk about it,how are we going to prevent it?”: Lucidity,a narrative-based digital game about sexual violence

This paper describes the development and evaluation of an interactive, narrative-based, multimedia game to promote learning and communication about sexual violence and health topics. High school-aged participants created the game concept in a three-week workshop, after which assets were assembled and refined by a university-based game design lab. The outcome, Lucidity, was a multimedia game with a nonlinear narrative that led to two different outcomes based on player decisions. The narrative followed the life of one character, an African American woman named Zaria who remembers and grapples with a sexual assault from her past. The player discovers parts of the story by reading comics, watching videos, navigating interactive websites and playing short videogames. The final evaluation consisted of gameplay, a post-game focus group and follow-up interviews. Twenty-four young people participated in three focus group discussions (n = 9, n = 5, n = 10); 23 participated in the follow-up interviews. Salient themes identified in the focus group discussions included: overall approval of the game, the acquisition of new knowledge and minimal past exposure to conversations or education about sexual violence. At follow-up, almost all (n = 22) had initiated a conversation about sexual violence with a parent, peer and/or teacher. Lucidity succeeded in engaging young people and facilitating communication with adults and peers regarding sexual violence and other sexual health topics. Ultimately, a game-based intervention such as this represents a feasible approach for introducing issues of sexual violence, with potential for future implementation in educational settings.     

Young people’s perceptions of advice about sexual risk taking

Sexual and reproductive health indicators for young people in the USA have improved in recent decades, but teenage pregnancies remain high, and large differences between Whites and non-Whites persist in teenage births, abortions, and the acquisition of sexually transmitted infections. Prior research shows that young people are receptive to communication about sex from parents and friends, but peers have been found to be more influential on sexual risk taking. In this study of 617 young people aged 13–20 years in high-risk neighbourhoods for teenage pregnancy in New Jersey, we asked whether sexually inexperienced young people differed from sexually experienced young people in their level of receptivity to the recommendations from their parents, friends, and others about whether to have sex before marriage and whether to use a condom if sexually active. The results showed that the sexually inexperienced were more receptive to messages from figures of authority in their life than those sexually experienced. We also found that stronger message intensity from parents, friends, and others to delay sex until marriage and to use a condom if sexually active was associated with lower sexual intentions in the next six months and the use of a condom if sexually active in the last three months.     

The views,verdict and recommendations for school and home sex and relationships education by young deaf and hearing people

The purpose of this survey study was to explore the views of young deaf and hearing people (16–25 years old) on school and home sex and relationships education (SRE). The study addressed a critical knowledge gap in the research literature on deaf youth's perception of SRE. The small-scale study explored young deaf people's experiences of SRE and the challenges they had faced when learning about sexuality and relationships. Recommendations on how to improve school SRE lessons were also obtained. Data were collected from 81 young people (n = 27 deaf, n = 54 hearing). Overall, deaf participants indicated greater levels of satisfaction with school SRE than hearing respondents. More deaf young people than young hearing people felt that the school had provided them with enough opportunities to learn about sexuality and relationships. The deaf group showed a preference for school SRE lessons to start at a later age than the hearing group. Mothers and friends were the two sources most frequently consulted in both groups. Teachers and school nurses were a third source frequently used by the deaf group. The views of deaf and hearing youth on their own SRE are important for the development, implementation and delivery of the school SRE curriculum. The study's findings can provide educators with valuable insight on the needs of a minority group who are particularly vulnerable to sexual exploitation and sexual misinformation due to their sensory loss and associated factors.     

The broad effectiveness of seventy-four field instances of abstinence-based programming

Evaluations of a large federally funded sexual risk avoidance education (SRAE) efforts in the USA have not been widely reported in the wake of funding cuts. The purpose of this study is to report results from a broad set of programmes to demonstrate the breadth of field effectiveness of these programmes. Twenty-seven separate community-based SRAE programmes were evaluated from 2005 to 2010, comprising 74 separate evaluations and involving over 96,000 young people. Pre- to post-effect sizes on key attitudinal predictors of sexual activity were analysed using meta-analytic techniques, both individually and as an average composite score. The standardised change score effect size on the composite measure were small and statistically significant (d = 0.20, k = 75, p < 0.001), as were effects on individual measures (d = 0.15–0.31). Programmes using a single curriculum showed greater results than those using their own blend of two or more curricula. As a group, this large body of field implementations of SRAE appears to have produced modest but statistically significant effects on key predictors of sexual activity in youth.     

Young people’s perceptions of relationships and sexual practices in the abstinence-only context of Uganda

The Ugandan government has been criticised on several grounds for its abstinence-only policies on sexuality education directed towards young people. These grounds include the failure to recognise the multiple realities faced by young people, some of whom may already be sexually active. In the study reported on this paper, students’ perceptions of relationships and sexual practices were analysed to obtain an understanding of how young people construct and negotiate their sexual agency in the context of abstinence-only messages provided in Ugandan secondary schools and at the wider community level. Ten in-depth interviews and six focus group discussions were conducted with students aged 15–19 years (N = 55) at an urban co-educational secondary school. Data were transcribed verbatim and analysed using grounded theory. Findings show that students engage in sexual activity despite their belief that contraception is ineffective and their fears for the consequences. Students’ age, gender, financial capital and perceived sexual desire further increase risk and vulnerability. To improve their effectiveness, school-based sexuality education programmes should support students to challenge and negotiate structural factors such as gender roles and sociocultural norms that influence sexual practices and increase vulnerability and risk.     

The role of cues,self-efficacy,level of worry,and high-risk behaviors in college student condom use

A sample of 879 undergraduate students were recruited from a public university in western New York state during the 1993-94 academic year in order to study condom use among sexually active young people 18-24 years old. A 104-item questionnaire was administered consisting of 5 instruments and single-item measures of sexual behavior and demographics. The instruments were: the Condom Use Self-Efficacy Scale (CUSES), the Perceived Barriers to Condom Use, the Perceived Susceptibility to HIV/AIDS and other STDs, the Cues to Condom Action Scale, and the Perceived Norms scale. 92% of students reported having had sexual intercourse in the past, while 86.75 reported having sexual intercourse in the previous year. About 61% reported having 1 sex partner in the previous 12 months, whereas 35.2% reported having 3 or more partners. 22.4% reported 2 or more 1-night stands. 54.5% reported worrying about HIV/AIDS occasionally, while 23.1% reported doing so frequently. 17.2% (99) of the students were classified as non-users of condoms, 50.2% (289) as sporadic users, and 32.6% (188) as consistent users. 78 (12%) could not be classified. A multiple discriminant function analysis was also conducted to distinguish among the 3 condom user groups totalling 576 cases. The variables were age, gender, frequency of drunkenness during sexual intercourse, number of sex partners, and number of 1-night stands in the past 12 months, perceived barriers, worrying about HIV/AIDS, perceived susceptibility, condom use self-efficacy, and cues to condom action. Two significant functions emerged. Function 1 clearly separated the sporadic users from the consistent users (p 0.001), while Function 2 clearly separated the sporadic users from the non-users (p 0.001). The discriminating variables correctly classified 64.58% of the respondents into the 3 condom user groups. The variables were most effective at correctly classifying non-users (68.7%), consistent users (67.8%), and sporadic users (61.2%). Sporadic users were more diverse with respect to condom use than the other 2 groups.     

An implementation and outcome evaluation of a multicomponent sexuality education programme for high school students

Numerous classroom-based interventions have aimed to improve sexual health outcomes for young people, yet few have shown strong, lasting effects. Ecological approaches that address multiple levels of a young person’s environment offer largely untapped potential to positively change sexual behaviour. This paper presents results of a cluster-randomised trial of a multicomponent sexuality education intervention that integrated a classroom curriculum, parent education workshops and materials, peer advocate programme, and sexual health services at 10 urban high schools. An implementation evaluation, employing quantitative and qualitative instruments, was conducted to examine whether the individual components of the intervention were delivered as planned and how they were received by the target populations. Multilevel modelling was used to evaluate the effect of the multicomponent intervention on outcomes at one-year follow-up. Results showed that the intervention components were successfully implemented with and well received by target populations. Students receiving the multicomponent intervention reported greater increases in the use of sexual health services (odds ratio [OR] = 1.73, 95% CI = 1.09–2.75) and the likelihood of carrying a condom (OR = 2.71, 95% CI = 1.44–5.09) relative to those receiving a control condition. No effects were found for other behaviours, possibly due to low prevalence of sexual activity in the sample and the small number of schools randomised.     

Student support for reproductive health education in middle schools: findings from Lebanon

Reproductive health education (RHE) programmes in schools are a well-recognised means of helping young people make informed decisions relating to their sexual health and well-being. Very little research however has investigated attitudes towards such programmes among students in the Arab world. A national HIV education curriculum was developed in Lebanon in 2005. However, in the context of competing priorities and mixed levels of social resistance, curriculum implementation to date is far from universal. This study aimed to determine the prevalence of support for school-based RHE and the main factors associated with such support among young people aged 11–16 years in Lebanon. A secondary analysis of data from the 2011 Global school-based Student Health Survey (GSHS) was conducted. Students who supported RHE (58.1%) were more likely to be of higher grade level (adjusted OR [Odds Ratio]?=?1.78, p-value = 0.005), to have ever drunk alcohol (adjusted OR = 1.52, p-value = 0.012), to prefer mixed classes for RHE (adjusted OR = 3.19, p-value < 0.0001), to say RHE should start before or at puberty (adjusted OR = 3.57, p-value < 0.0001), and to be exposed to more health education topics in school (adjusted OR = 1.2, p-value < 0.0001). Identifying such sub-groups in the student body should inform the equitable implementation of RHE in culturally diverse settings like Lebanon.     

Assessing physicians' intentions to talk about sex when they vaccinate nine-year-old to 15-year-old girls against HPV

The human papillomavirus (HPV) vaccine provides physicians with an opportunity to have conversations with girls about sex and sex-related topics. Current research suggests that these conversations are not happening. This study was designed to assess whether physicians would use the HPV vaccination as an opening to communicate with nine-year-old to 15-year-old female patients about sex using the Theory of Planned Behavior as a framework. The study also assessed what sexual health topics physicians were willing to discuss when they vaccinated patients and at what ages they would be willing to discuss each topic. Differences in communication were also examined between older and younger physicians and female and male physicians. A random sample (n = 207) of all family practice and pediatric physicians in a rural, Midwest state in the USA were mailed a survey about the HPV vaccine and their intentions to talk about sex-related topics. Specifically, the survey questions assessed the theoretical constructs: attitudes, subjective norms, and perceived behaviour control. The results point to physicians' intentions to talk about sex when they vaccinate. Most physicians intended to talk about sexually transmitted infections when they vaccinate against HPV (90.3%). A multivariate linear regression reveals that physicians' intentions to talk about sex are influenced by attitudes (β = 0.18, p < 0.05), subjective norms (β = 0.53, p < 0.001), and perceived behavioural control (β = 0.15, p < 0.05). Physicians intended to talk about a variety of sex-related topics when they vaccinate nine-year-old to 15-year-old girls against HPV. The research indicated that physicians' intentions were high, but do not indicate how well physicians are prepared for this communication with nine-year-old to 15-year-old girls about sex.     

The International Platform of Sexuality & Relationship Education

This study was an investigation of the additional risk conferred by the experience of psychogenic amnesia for memories of childhood sexual abuse (CSA) on the likelihood of becoming a victim of sexual assault in later life. A total of 210 community respondents completed a retrospective web-based trauma survey. The majority of respondents were female (74.3%) and their ages ranged from 16 to 65 years, with a mean age of 33 years. Chi-squared analysis revealed that survivors of CSA demonstrated significantly greater risk (58%, χ^2 = 44.461, p = 0.0005) of experiencing sexual assault in adolescence in comparison with their non-abused counterparts (13%). Furthermore, survivors who reported having been amnesic for their abuse-related memories demonstrated a higher rate of adolescent revictimisation (86%) than survivors who had retained continuous memories of their victimisation (48%, χ^2 = 8.626, p = 0.003). Overall, once-amnesic survivors of CSA demonstrated 6.6 times the risk of sexual assault and an eight-fold risk for rape during adolescence in comparison with their non-abused counterparts. It is proposed that the elevated risk conferred by amnesia for CSA might be mediated by two distinct pathways, both of which are associated with the use of dissociation as a defence mechanism.     

Sexual consent in K–12 sex education: an analysis of current health education standards in the United States

In the USA, universities have recently developed policies and programmes on sexual consent education. But waiting until students enroll in higher education may be too late to begin this work. To examine the extent that K–12 health education standards promote sexual consent education, we conducted a pilot study and found that only two of eighteen states explicitly mentioned sexual consent in their health education standards. Using a small sample (n = 4 states), we then identified four themes as making implicit reference to sexual consent: communication skills, decision making, personal space and interpersonal relationships. Finally, in a robust sample (n = 18 states), we conducted a content analysis of published standards regarding these themes related to sexual consent. Our analysis suggests that sexual consent is likely not discussed in sex education at K–12 schools. We recommend the more explicit inclusion of sexual consent in health education curricula via the identified themes that already exist in most or all standards, emphasising the importance of teaching young people about the nuances of sexual consent and its communication before they become sexually active.     

Differences between residential and non-residential fathers on sexual socialisation of African American youth

This study investigated differences between residential and non-residential fathers on topics discussed during father–child sex communication and factors associated with child sexual socialisation. Young people (N = 159, 53% female) provided self-reports using computer surveys on the role of their fathers on father–child sex communication, general communication, parental monitoring, father social support and topics discussed during father–child sex communication. The analysis revealed differences in topics discussed between young people with residential vs. non-residential fathers. Independent group t-tests revealed significant differences between young people with residential vs. non-residential fathers on social support and parental monitoring for sons and parental monitoring for daughters. Sons and daughters with residential fathers had higher scores on these variables. Discriminant function analyses, chi-square tests and hierarchical linear regression analyses were carried out to determine whether there were meaningful distinctions between young people with residential vs. non-residential fathers. The analysis revealed social support and parental monitoring provided the most meaningful distinction between young people with residential vs. non-residential fathers. These results highlight the importance of non-residential fathers in the sexual socialisation of their young people through parent–child sex communication. Discussion focuses on the need for development of interventions to promote the inclusion of non-residential fathers in the sexual socialisation of African American youth.     

Young people’s expressed needs for Comprehensive Sexuality Education in Ecuadorian schools

This study analyses the expressed sexuality education needs of young people from Azuay, a region of Ecuador characterised by a large proportion of young people whose parents have migrated abroad, a group often considered at risk to developing of sexual health problems. Multi-stage stratified cluster sampling was used to recruit young people aged 11 and 19 years to the study. The expressed needs of participants were analysed in relation to gender, parents’ migratory status, age and geographical location. Survey findings revealed that young people expressed high needs with respect to the different components of Comprehensive Sexuality Education: gender roles, sexual and reproductive health, sexual citizenship, pleasure, violence, diversity and relationships. Ordinal regression analyses revealed few significant differences in relation to socio-demographic variables, which was surprising, in particular, with respect to the group of young people with migrating parents. Given the high levels of expressed needs, the findings carry important implications for the design and implementation of future sexuality education programmes.     

Evaluation of the Somos Fuertes HIV prevention programme in college women

The goal of this study was to examine the impact of a culturally appropriate HIV prevention and sexual empowerment curriculum workshop on female college students at a Hispanic-serving institution in the USA. Female participants in the Somos Fuertes: Strong Women Making Healthy Choices curriculum (n = 175) from a variety of ethnicities completed pre- and post-surveys during the academic years 2007–2008, 2008–2009, and 2009–2010. Paired t-tests were conducted to examine pre- and post-results on five scales: perceived sexually transmitted infection (STI) risk, perceived HIV risk, intended use of barriers during sex, effective communication skills, and behavioural self-efficacy. The analyses showed significant differences with at least medium effect sizes for all variables except perceived STI risk. The evaluation results demonstrate that the workshop offers a viable curriculum to implement on college campuses interested in affecting change related to HIV prevention strategies in a multicultural female population.