‘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.     

Formal and parental sex education differences among Hispanic young women by nativity status

This study sought to investigate the association between nativity status and Hispanic young women’s formal sex education and parental sex education in the USA. We used data from a cross-sectional sample of 310 Hispanic young women aged 18–24 years old from the 2013–2015 US National Survey of Family Growth. We assessed 11 outcomes: four formal sex education topics; receiving any formal sex education; a formal sex education scale; four parental sex education topics; and receiving any parental sex education. The majority of our sample was US-born Hispanic versus foreign born (72.6% and 27.4% respectively). Foreign-born Hispanics were less likely to have received any type of formal sex education than US-born Hispanics (adjusted odds ratio = 0.81; 95% confidence interval: 0.24, 0.68, p < 0.01). Foreign-born Hispanics were less likely to have received parental HIV sex education than U.S.-born Hispanics (aOR = 0.36; 95% CI: 0.14, 0.97, p < 0.05). Nativity status did not have a significant effect on each unit increase on the scale (aB = –0.07, SE = 0.16; aβ = –0.42, p > 0.05). Our results indicate that having appropriate sex education knowledge is better than not being cognisant. Future studies should however examine the quality and content of sex education programmes so policymakers can better understand these young women’s sexual behaviours and decisions.     

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.     

Effects of a life skills-based sexuality education programme on the life-skills,sexuality knowledge,self-management skills for sexual health,and programme satisfaction of adolescents

This study aimed to develop and establish the efficacy of a life skills-based sexuality education programme for junior high school students that focused on prevention. A non-equivalent control-group pretest-posttest design was employed with 105 students in the first-year of junior high school participating. The experimental group received 10 sessions of a life skills-based sexuality education programme, and the control group received 10 sessions of the standard sexuality education, both provided during a home economics class. A comparison of the two groups’ post-test scores showed that the experimental group scored significantly higher than the control group on sexual and reproductive health related knowledge (F = 58.50, p < .001) and life-skills (F = 11.52, p = .007). In addition, the experimental group showed a larger improvement in self-management skills for sexual health than did the control group (F = 9.32, p = .003). A life skills-based sexuality education programme increased life skills levels, knowledge about sexuality and sexual and reproductive health, and helped participants identify appropriate behaviours when facing a sexually risky situation. Results highlight the value of including an evidence-based and practice-oriented life skills-based sexuality education programme in the formal curriculum of junior high schools in Korea.     

“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.     

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.     

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.     

Factors affecting Canadian teachers' willingness to teach sexual health education

Non-specialist teachers in Canada are increasingly required to teach sexual health topics. However, research suggests that they do not always do so willingly. This study examined the associations between the characteristics of non-specialist elementary and middle school teachers (n = 294) in Canadian schools and their willingness to provide sexual health education (SHE) and their perceptions of factors affecting their willingness to provide SHE. On average, the teachers were only somewhat willing to teach SHE and their willingness varied between topics. The teachers who reported greater willingness to teach SHE were more likely to be teaching middle school, have less teaching experience, have received training to teach SHE, feel more knowledgeable about sexual health, and view broad-based SHE as more important. More than 20% of participants identified 10 out of 11 factors as making them less willing to teach sexual health education; conversely, more than 20% of participants identified nine of these 11 factors as making them more willing to teach sexual health education. Teachers who were middle school teachers, had received training to teach sexual health, had more experience teaching SHE, and felt more knowledgeable about sexual health topics were more likely to regard all of these factors as enhancing their willingness to teach SHE. The results are discussed in terms of their implications for training designed to increase teachers' willingness to teach sexual health.     

The Relationships Between Life Satisfaction,Gender, Social Security,and Depressive Symptoms Among Elderly in Turkey

The main aim of this study was to investigate the relationships between life satisfaction, gender, social security, and depressive symptoms of the Turkish elderly. This cross-sectional study included 216 (female = 127, male = 89) participants with ages ranging from 60 to 93 years (mean = 71.60 ± 7.39). Information Gathering Form and Life Satisfaction and Geriatric Depression Scales were used for data collection. It was determined that 42.1% of the elderly who participated in this study had high depressive symptoms scores. Life satisfaction (OR = 0.63, 95% CI = 0.53–0.71), lack of social security benefits (OR = 3.52, 95% CI = 1.25–9.89), and gender (OR = 2.53, 95% CI = 1.17–5.50) predicted the depressive symptoms significantly. The results of the study indicate that while depression risk increases, life satisfaction decreases. In addition, lack of social security benefits and being female also increase the risk of depression in the Turkish elderly.     

The effects of a data use intervention on educators’ satisfaction and data literacy

Schools in many different countries are increasingly expected to use data for school improvement. However, schools struggle with the implementation of data use, because building human capacity around data use in education has not received enough attention. Educators urgently need to develop data literacy skills for being able to use data. For supporting schools with the endeavor of developing data literacy skills, we developed and implemented a data use intervention in secondary schools based in the Netherlands. This study therefore focuses on the effects of this intervention on educator satisfaction with the intervention and their data literacy skills and attitude toward data use. This study uses a quasi-experimental research design and employs a mixed-methods approach with a data use questionnaire filled in by data team schools (N = 9) and comparison schools (N = 42), a satisfaction questionnaire filled in by data team participants (N = 55), pre- and posttest knowledge tests filled in by data team participants (N = 36), and interview data (N = 11) from three case study schools. The results show that the participants were, for example, very satisfied with the support received during the intervention. Also, respondents developed new data literacy skills and showed a more positive attitude toward data use. The results show how teachers can be supported systematically in data use in their educational practice. In the conclusions, we discuss some important implications for practice regarding the intensity and duration of support and implications for further research.     

Challenges of engagement with health services in Sweden’s schools: listening to the views of school nurses and students with recurrent pain

This article reports on the views of school nurses (n = 25) and students with recurrent pain (n = 24) in Sweden with regard to school-based pedagogic practices. A number of common categories with implications for pedagogic practice were identified by analysing qualitative interviews with these groups, using the coding techniques of grounded theory. The results indicate that a failure to develop trust made it difficult for some students to initiate contact with a school nurse and that some students perceive the issue of recurrent pain being of relevance to all young people, deserving coverage in the curriculum. We thus conclude that it is important to integrate personal, social and health education in the ordinary spaces of teaching and learning in order to complement and bolster the conventionally organised school health services in Sweden. However, this might be difficult to achieve because many of the school nurses emphasised that health and education were commonly treated on parallel tracks in their schools, under the management of different authorities.     

Sexualities of initial teacher education applicants in the Republic of Ireland: addressing the hidden dimension of diversity in teaching

While research and policy recommendations internationally have pointed to the need to diversify teaching populations with regard to ethnicity, social class background and, to a lesser extent, dis/ability, there is a paucity of research addressing sexualities as a diversity dimension in teaching. This article explores initial teacher education (ITE) applicants’ and entrants’ (N = 746) sexualities and the intersections of sexualities with other socio-demographic background variables and career motivations. The analysis suggests that the topic of sexual orientation caused high levels of discomfort among respondents and that sexual minority student teachers are underrepresented in ITE cohorts in Ireland. The socio-demographic and motivational profiles of our non-heterosexual respondents generally mirrored those of their heterosexual counterparts. Non-heterosexual respondents reported a stronger motivation to affect social change and lower levels of participation in religious services. Findings are discussed within the context of persisting cultural and institutional barriers for sexual minority (student) teachers in Irish schools and in ITE.     

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.     

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.     

Sexual health discussions between African-American mothers and mothers of Latino descent and their children

We examined approaches used by African-American mothers and mothers of Latino descent for informal sex-related discussions with their children to inform sexually transmitted infection (STI)/HIV intervention development efforts. We recruited mothers (of children aged 12–15) from youth service agencies and a university in southern California. Fourteen focus groups were conducted: eight with African-American mothers (n = 31) and six with mothers of Latino descent (n = 24). Data were transcribed, coded for most common themes by four of the authors and reviewed for differences by gender of child. Four key themes emerged when focusing on parent–child discussions about sex: (1) sexual activity discussions took place for both sons and daughters; (2) protection from STI/HIV and pregnancy was a key topic; (3) the use of a direct, honest approach was preferred by mothers; and (4) seizing the moment was important for discussion opportunities. These data help broaden our understanding about the strategies used by African-American mothers and mothers of Latino descent for sexual health discussions with their sons and daughters. Evaluations of these for their potential impact on youth sexual health outcomes are warranted. The data can also contribute to the development of new culturally tailored parent–child communication strategies and HIV prevention interventions for young people of colour.     

Men engaging boys in healthy masculinity through school-based sexual health education

Young people’s sexual health is a significant concern to parents, educators, health professionals and policy makers in Canada. However, challenges exist with respect to the nature of school-based sexual health education content and mode of delivery. These include the lack of attention paid to the impact of gender ideologies on the development and expression of youth sexuality, and the tendency to exclude boys and young men by focusing primarily on the sexual and reproductive needs of girls and young women. This article discusses findings from a participant observation and focus group study conducted with the facilitators of WiseGuyz, a school-based sexual health and healthy relationship programme, which involves boys aged 13–15 years in Calgary, Alberta. Findings suggest that the process of facilitation is as important as curriculum content in securing positive outcomes for young men. Implications for school-based sexual health education and further research in this area 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.     

Predictors of adult quality of life for foster care alumni with physical and/or psychiatric disabilities

INTRODUCTION: This study used quality of life and resilience as theoretical frameworks for evaluating predictors of outcomes for adults who received foster care services alumni of foster care and were diagnosed with a physical or psychiatric disability while in foster care. METHOD: First, outcomes for foster care alumni with and without physical and psychiatric disabilities (N=1,087) were compared according to quality of life variables. Second, using only participants with disabilities (N=578), stepwise regression analyses were performed to determine whether risk and protective factors were associated with specific outcomes. RESULTS: Alumni with disabilities had significantly lower economic (p=.020) and health (p=.001) outcomes; and reported lower educational attainment (p=.002), more difficulty paying monthly bills (p=.026), more psychiatric diagnoses (p=.006), lower self-esteem (p=.013), and worse physical health (p=.001) than those without disabilities. For alumni with disabilities, receiving special education services and experiencing sexual abuse while in foster care were significant risk factors for poor self-esteem; conversely, receiving services and resources that prepared foster care alumni for leaving foster care (e.g., protective factors) predicted better outcomes. CONCLUSIONS: By expanding the quality of life outcomes analyses to investigate the impact of risk and protective factors on outcomes of foster care alumni with disabilities, this study fills a gap in the literature by assessing outcome differences within the foster-care population. The study found protective factors were associated with more educational attainment and higher self-esteem in adulthood. Conversely, those who received special education services and experienced sexual abuse while in foster care may be at the greatest risk of poor self-esteem and therefore, could benefit from services that enhance self-esteem.     

‘Sex education should be taught,fine…but we make sure they control themselves’: teachers' beliefs and attitudes towards young people's sexual and reproductive health in a Ugandan secondary school

Although schools have been identified as important settings in which young people's sexual and reproductive health (SRH) can be promoted, there has been limited research into the role of teachers in delivering sex education programmes. This paper describes findings from a qualitative study of teachers' beliefs and attitudes towards young people's SRH in a Ugandan secondary school, and discusses the ways in which conservative attitudes to young people's sexual activity and an adherence to gender stereotypes can limit students' access to SRH information and services. Teachers' attitudes, beliefs and often superstitions relating to young people's sexual activity inevitably affect the content and nature of school-based sex education. Findings from this preliminary study suggest that, rather than assuming teachers act as neutral delivery mechanisms in schools, these attitudes and beliefs must be taken into consideration and addressed in the development of school-based sex education programmes.     

Slut-shaming and victim-blaming: a qualitative investigation of undergraduate students’ perceptions of sexual violence

Sexual violence is a significant public health issue on US college campuses. This qualitative study aimed to better understand college student perceptions of sexual violence and bystander intervention. Gendered group and individual interviews were conducted with male (n = 3) and female (n = 12) undergraduates. Eight major themes emerged which included slut shaming; victim blaming; the preventive power of social networks; the importance of family influence and early education; ambiguous definitions of sexual behaviour and assault; perpetrator typology; and gendered actions. Sexual behaviour is simultaneously a topic of confusion and importance to college students. Future prevention efforts may be more relevant and efficacious by addressing the university experience and campus climate as perceived by the students.