Comprehensive Sex Education Programs Research Articles

Attitudes and Beliefs of African Immigrant Mothers Living in the US Towards Providing Comprehensive Sex Education to Daughters Aged 12-17 Years: A Pilot Study.

The literature currently contains no comprehensive sex education (CSE) interventions targeting the African immigrant population. African immigrant mothers have been inhibited by several factors from providing their daughters with CSE. The primary aim of this study was to identify attitudes and beliefs of Sub-Saharan immigrant mothers living in the United States towards providing comprehensive sex education to their daughters aged 12-17years. The study utilized a one-time anonymous nine-question survey. Fifteen women who met the inclusion criteria completed the study survey online or via paper format. African immigrant mothers are willing to allow comprehensive sex to be taught in schools and at home. Accepted education appears to range from religious and moral teaching to some factual information. This research will potentially assist in the designing of more culturally appropriate comprehensive sex education programs for African immigrant mothers and their daughters.

Gaming for Safer Sex: Young German and Turkish People Report No Specific Culture-Related Preferences Toward Educational Games Promoting Safer Sex.

Comprehensive sex education programs specifically designed for adolescents and young adults that take into account gender norms and cultural background have shown promise as a means of countering the high sexually transmitted infection rate in young people. Recently, digital gaming interventions delivered on computers or mobile devices have emerged as another way to promote safer sex behavior in a young population. Tailoring these computer-based interventions to their target population has been recognized to increase positive behavior outcomes. In this qualitative study, we investigated whether young female and male adults from two different cultural backgrounds (all living in Germany) would have different preferences and needs in relation to an educational game promoting safer sex. We conducted four semistructured focus group interviews comprising open-ended questions with male and female participants who had either a German or a Turkish background. In total, 20 individuals, aged between 18 and 22 years, from two socially diverse and ethnically mixed vocational schools in Germany participated. Independent of cultural background and gender, participants preferred a real-world design with a first-person visual perspective over a fantasy-like third-person perspective. Furthermore, they preferred highly customizable avatars. All participants mentioned the importance of including an alcohol-intoxicated avatar and most participants wanted there to be additional information available about various safer sex approaches and about the use of different barrier protection methods. Males and females reported similar preferences for the design of an educational game promoting safer sex, with the only difference being exactly how the topic of having sexual intercourse should be addressed in the game. Males preferred a direct approach, whereas females had a preference for treating this subject more sympathetically. Educational games offer anonymity and can provide young people across different cultural backgrounds with gender-tailored opportunities to experiment with specific safer sex precautions in a nonthreatening virtual environment, free from unwanted parental control and peer monitoring.

Determinants of Age at Sexual Initiation among Nigerian Adolescents: A Study of Secondary Schools Students in a Military Barracks in Nigeria

Context: Adolescent sexual behavior is shaped by series of interlinking individual and family related factors. Information on how these factors influence early sexual debut could help in mounting programmatic strategies to modify adolescent sexual behavior. Objective: To determine the age at first sexual intercourse and its determinants among senior secondary schools students in Ojo military barracks, Lagos. Materials and methods: This was a cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using multistage sampling technique. Datawas collected using pretested, self- administered semi- structured questionnaires and analysed using statistical package for social sciences version 17. Tests of statistical significance were carried out using chi-square and t-tests. A p value of < 0.05 was considered significant. Results: The age group at which respondents had their first sexual intercourse ranged from10 to19 years, the mean ages are 14.1±1.2 and 13.4±1.5 for males and females, while the modal and median ages at first sexual intercourse for both gender are 11 and 12 years respectively with a cumulative frequency percent of 56.5. The girls initiated sex earlier than the boys (p= 0.001). Those brought up by one parent initiated sex at an earlier age (p= 0.000), while age of sex initiation increased with maternal (p= 0.000) and paternal education (p= 0.001). Conclusions: Age at sexual debut was found to be associated with younger age, gender, living with a one parent and parents’ educational status. We recommend formal comprehensive sex education programs targeted at delaying age at first sex.

Teen Pregnancy Policy: An Analysis of the Healthy Teens Act

The purpose of my research paper is to analyze the proposed bill called the Healthy Teens Act. This bill would provide grant funding for comprehensive sexual education programs in New York State. The Healthy Teens Act would also establish standards for all programs receiving funding including medical accuracy, providing culturally appropriate and unbiased information, family communication, and healthy decision-making skills. The Healthy Teens Act would award grants to programs that exemplify these standards and would set high-need communities as a priority. Currently, there is no legal mandate for schools to teach sexual education in public schools in New York State, with the exception of HIV/AIDS education. The only incentive given to schools is federal funding for abstinence-only sexual education programs. In my paper, I compare the two different types of programs and their approaches to providing sexual education. I ultimately hope to show how a comprehensive sexual education program would ultimately be more effective in reducing teen pregnancy rates.

Why we need to deliver a comprehensive SRE programme

Anna Feuchtwang explains why it is vital that a comprehensive Sex and Relationship Education programme is offered to students and that all schools teach good quality SRE.

Original Article: Socio-demographic Determinants of Sexual Risk Behavior among Senior Secondary Schools Students in a Military Barracks in Nigeria

Context: Social, economic and political factors are rapidly changing the ways that young people must prepare for adult life. These changes have enormous implications also for their sexual health and behaviors. Objective: To determine the socio-demographic factors associated with sexual risk behaviors among senior secondary schools students in Ojo military barracks, Lagos. Materials and methods: This was a cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using multistage sampling technique. Data was collected using pretested, self- administered semi- structured questionnaires and analysed using statistical package for social sciences version 17. Chi-square test was used to identify statistically significant associations between sexual behavior and socio-demographic variables. Logistic regression was used to estimate the probability of ever had sex, adjusted for thirteen design effects. A p value of < 0.05 was considered significant. Results: Respondents from the boys single- sex school 44(55.7%) were most likely to engage in sexual intercourse (p= 0.000). Those from polygamous settings 101(42.8%) were more likely to engage in sexual intercourse (p= 0.034). Low socio- economic background for both parents and doing income earning jobs were associated with sexual intercourse (p= 0.008; p= 0.021; p= 0.000). Living with single parent is a very strong predictor of ever had sex (p=0.000). Conclusions: Sexual risk behavior was found to be associated with increasing age, living with one parent, polygamy, low educational cum socio-economic statuses. We recommend formal comprehensive sex education programs for the students and improved conditions of service for the military personnel.

Evaluation of a Comprehensive Sex Education Program Developed and Implemented by Medical Students [356

INTRODUCTION: The number of sexually transmitted infections (STIs) among young adults continues to rise, demonstrating a need for improved sex education and access to STI screening and treatment. The purpose of this study is to evaluate a comprehensive sex education intervention implemented by medical students in middle and high schools. METHODS: A single-session, comprehensive sex education program was developed by medical students at the University of Miami Miller School of Medicine and delivered to middle and high school students in Miami-Dade County over a 30-month period. A 10-question STI knowledge test was conducted preintervention and postintervention; “passing” grade for the test was set at 60%. Student's t test and χ2 test were performed to assess the curriculum's ability to improve student knowledge. RESULTS: A total of 1,388 students from seventh through 12th grade participated in the intervention. Preintervention and postintervention data were available for 1,173 students (84.5%). There was a significant increase in mean test score after the intervention (pretest=4.5 compared with posttest=8.5, P<.001). The intervention also demonstrated a significant increase in test pass rate (pretest n=437 [31.4%] compared with posttest n=1,098 [93.6%]; χ2, P<.001). CONCLUSION: Middle and high school students continue to be infected with STIs at high rates. This school-based, comprehensive sex education program implemented by medical students demonstrated a significant increase in knowledge about STIs and methods to prevent them. Further research is needed to assess the effect of this intervention on behavior, STI screening, and acquisition.

The role of sexually explicit material in the sexual development of same-sex-attracted Black adolescent males.

Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.

Relationships between attitudes toward sexuality, sexual behaviors, and contraceptive practices among Chinese medical and nursing undergraduates.

In this study, we investigated attitudes toward sexuality, the prevalence of sexual behaviors and contraceptive use among Chinese medical and nursing undergraduates, and relationships between attitudes toward sexuality and sexual and contraceptive practices among these participants. This was a descriptive, cross-sectional study carried out by using a Personal Attitude toward Sexuality Scale and Sexual and Contraceptive Questionnaire. The participants were recruited in the researcher's lectures. A total of 158 participants joined this study. Overall, Chinese medical and nursing undergraduates in this study held relatively conservative attitudes toward sexuality. The prevalence of sexually-active students was relatively low, and the percentage of contraceptive use among those sexually-active students was also low. Participants' attitudes toward sexuality had statistically-significant effects on their sexual and contraceptive practices. Nearly half of the sexually-active participants reported never using any contraceptive method during sexual intercourse. This finding has important public health implications, as young people represent the group with the largest rate of new infections of HIV/AIDS in China. A more comprehensive sexual education program that extends to college undergraduates and promotes the social acceptability of using contraception, specifically condoms, is needed.

Role of gynecologists in reproductive education of adolescent girls in Hungary.

The aim of this study was to assess whether the socioeconomic characteristics of adolescent girls, their knowledge about cervical cancer screening, and their sexual activity are associated with whether or not they have already visited a gynecologist. A self-administered questionnaire-based study was performed among secondary school girls (n = 589) who participated in professional education provided by a pediatric and adolescent gynecologist. The questionnaire comprised sociodemographic characteristics, sexual activity, knowledge on contraceptive methods, cervical screening and sources of their knowledge. Simple descriptive statistics, χ(2) and one-way-anova tests, multivariate logistic regression analysis and Pearson correlation were applied. All statistical analyses were carried out using spss 17.0 for Windows. A total of 50.3% of adolescent girls had already had a sexual contact. Half of the sexually active participants had already visited a gynecologist, and most of them did so due to some kind of complaint. The overall knowledge about cervical screening was quite low; higher knowledge was found among those having visited a gynecologist. Adolescent girls' knowledge on cervical screening was improved by previous visits to a gynecologist. The participation of an expert--a gynecologist--in a comprehensive sexual education program of teenage girls is of high importance in Hungary.

Protective Effects of Middle School Comprehensive Sex Education With Family Involvement

School-based comprehensive sex education programs can reduce early adolescents' risky sexual behavior. The purpose of this study was to assess the effectiveness of a 3-year comprehensive sex education program in delaying vaginal sex for middle school students and whether the family component of the intervention contributes to its effectiveness. This longitudinal evaluation followed a cohort of 6th graders (N = 2453) through the end of 8th grade. The design used random assignment of 24 schools into treatment and comparison conditions. The analysis included multiple-group logistic regression to assess differences in delay of sex between intervention and comparison groups. In schools where the program was taught, 16% fewer boys and 15% fewer girls had had sex by the end of 8th grade compared to boys and girls at comparison schools. Completing family activities during the first year of the program predicted delayed sexual debut for boys. Theory-based, developmentally appropriate, comprehensive sex education programs that include parent involvement can be effective in delaying vaginal sex for middle school students. Parent involvement is particularly important for boys, as family activities may encourage parents to talk with their sons earlier and more frequently.

Beyond Teacher Training: The Critical Role of Professional Development in Maintaining Curriculum Fidelity

PurposeTo examine how teacher characteristics affected program fidelity in an impact evaluation study of the Positive Prevention PLUS program, and to propose a comprehensive teacher training and professional development structure to increase program fidelity. MethodsCurriculum fidelity logs, lesson observations, and teacher surveys were used to measure teacher characteristics and implementation fidelity including adherence, adaptation, and lesson quality. ResultsCompared with non–health credentialed teachers, credential health education teachers had greater comfort and self-efficacy regarding sex-related instruction. Teacher self-efficacy and comfort were significant predictors of adherence. ConclusionsImplementation fidelity may be linked to teacher characteristics that can be enhanced during curriculum training. A 2-day teacher training may not adequately address teacher facilitation skills or the maintenance of institutional supports for implementing a program with fidelity and quality. A new model of comprehensive teacher training and support is offered. This new training infrastructure is intended to contribute to the school district's institutionalization of higher-quality comprehensive sexual health education and increase program fidelity.

Implementation of The World Starts With Me, a comprehensive rights-based sex education programme in Uganda

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation according to the manual), as well as to identify the main barriers and facilitators of implementation. Teachers' confidence in teaching WSWM was negatively associated with dose delivered. Confidence in educating and discussing sexuality issues in class was positively associated with fidelity of implementation, whereas the importance teachers attached to open sex education showed a negative association with fidelity. Main barriers for implementing WSWM were lack of time, unavailability of computers, lack of student manuals and lack of financial support and rewards. Other barriers for successful implementation were related to high turnover of staff and insufficient training and guidance of teachers. Teachers' beliefs/attitudes towards sexuality of adolescents, condom use and sex education were found to be important socio-cognitive factors intervening with full fidelity of implementation. These findings can be used to improve the intervention implementation and to better plan for large-scale dissemination of school-based sex education programmes in sub-Saharan Africa.

Acceptability and feasibility of CyberSenga: an Internet-based HIV-prevention program for adolescents in Mbarara, Uganda

Capitalizing on emerging data suggesting that HIV-preventive behaviors can be positively affected by Internet-based programs, we developed and tested CyberSenga, an Internet-based, comprehensive sexuality education program for adolescents in Mbarara, Uganda. Three hundred and sixty-six secondary school students were randomly assigned to either the five-lesson program (+ booster) or a treatment-as-usual control. At three-month follow-up, intervention participants provided feedback on the program acceptability. Six focus groups with intervention participants were additionally conducted after the final follow-up at 6 months. Data support a hypothesis of feasibility: despite schedule interruptions, 95% of intervention participants completed all the five modules; only 17% deviated from the once-a-week intended delivery schedule. Internet service was uninterrupted during the field period and, in general, the technology performed to specifications. The intervention also appears to be acceptable: 94% of intervention youth somewhat or strongly agreed that they learned a lot and 93% said they were somewhat or very likely to recommend the program. Although more than two in three youth somewhat or strongly agreed that the program talked too much about sex (70%) and condoms (75%), 89% somewhat or strongly disagreed that “I do not think kids like me should do the CyberSenga program.” Feedback from focus group participants further suggested that the content was generally acceptable and did not contradict local norms in most cases. In fact, despite concerns from some local stakeholders to the contrary, information about condoms did not appear to be confusing or contradictory for youth who were abstinent. Nonetheless, some of the sexual topics seemed to be unfamiliar or uncomfortable for some participants – particularly brief references to oral and anal sex. Together, both qualitative and quantitative data suggest that the program is a feasible and acceptable way of delivering HIV preventive information to both sexually experienced and inexperienced adolescents in Mbarara, Uganda.

A Randomized Effectiveness Trial of a Sex Education Program for Minority Youth in Miami, Florida

Through this study the authors assessed the outcomes of a randomized effectiveness trial of Project U-Turn, a comprehensive sex education program for at-risk youth in Miami, Florida. Data collection occurred at pretest, three month, and six month follow-ups with a sample of teenagers randomly selected and assigned to treatment (n = 549) and control (n = 424) groups. Results from logistical and generalized multilevel modeling indicated the program did not contribute to teen responses at three or six month follow-ups. Other variables, however, had some influence on predicting teen responses to questions about their current and future sexual activity. Gender, use of alcohol, and participation in religious services predicted responses from teens at pretest and at three and six month follow-ups. Discussion of the findings, as well as implications for evidence-based social work with teens conclude the article.

The Effect of Comprehensive Sexual Education Program on Sexual Health Knowledge and Sexual Attitude Among College Students in Southwest China

The purpose of this study was to evaluate whether a comprehensive sexual education program for college students in Southwest China (a) improved sexual health knowledge in reproduction, contraception, condom use, sexually transmitted diseases, and HIV; (b) increased accepting attitudes toward lesbian, gay, bisexual, and transsexual individuals; and (c) altered participants' attitudes toward premarital sex and monogamy. The program used diverse teaching methods, providing 6 sessions over a period of 9 weeks about sexual health knowledge and sexual attitudes to college students (age 18-26 years) in Southwest China. Sexual health knowledge and sexual attitudes of 80 comprehensive sexual education class students (education group) and 92 general mental health education class students (control group) were measured at baseline, the end of course (posttest), and 3 weeks after the end of course (follow-up). There were significant effects of the program on (a) sexual health knowledge, including reproductive health, contraception, condom use, and HIV/AIDS and (b) positive attitudes toward sexual minorities, although these changes may require further reinforcement. In contrast, the program did not alter students' attitudes about premarital sex or monogamy. The results are discussed in terms of recommendations of sex education in China and future directions for research.

Examining the Prospective Effects of Making a Virginity Pledge Among Males Across Their 4 Years of College

Objectives: The authors examined prospective associations of making a virginity pledge on sexual behaviors among male college students. Participants: A sample of 795 males was followed for 4 years (2008, 2009, 2010, 2011), with response rates ranging from 72% to 82% across the follow-up years. Methods: Males were surveyed at the end of each of their 4 years in college about sexual behavior activities and other risky behaviors. Results: Multivariate regression analyses indicated that males who made private virginity pledges were significantly more likely to remain abstinent across all 4 years of college and have fewer sexual partners at the end of their third and fourth years of college, even after controlling for age, race, high-risk drinking, impulsivity, and religiosity. Making a pledge was not related to condom use. Conclusion: Findings suggest that abstinence-based messages alone are not sufficient yet should be included as part of comprehensive sex education programs.

Evaluation of Two Comprehensive Sexuality Education Programs: Safer Choices and Reducing the Risk

It has been over ten years since the Safer Choices and Reducing the Risk comprehensive sexuality programs have been evaluated with high school students. A pretest- posttest design was used to examine the effectiveness of these two programs with a 2009 sample. Three hundred and seventy-four middle school students participated in the Safer Choices program and 469 high school students participated in the Reducing the Risk program. Findings show that knowledge of pregnancy and sexually transmitted infections as well as behavioral intentions to engage in safer sex behavior significantly increased from pretest to posttest. Overall, the programs were found to be effective for males and females and the race/ethnic groups examined.

Prevalence and correlates of sexual behaviors among university students: a study in Hefei, China

BackgroundIn China, sexual health and behaviors of young people have become a growing public concern but few studies have been conducted to investigate the prevalence and psychosocial correlates of the phenomenon.MethodsA self-reported questionnaire survey on youth sexual behaviors was conducted among 1,500 university students in 2011 at Hefei, a middle-size city in eastern China. A total of 1,403 students (age = 20.30 ± 1.27 years) completed the questionnaire with a high response rate of 93.5%.ResultsAmong the respondents, 12.6% (15.4% of male versus 8.6% of female) students reported having pre-marital heterosexual intercourse; 10.8% (10.5% of males versus 11.2% females) had oral sex; 2.7% (3.4% of males versus 1.7% females) reported same-sex activities; 46% (70.3% of males versus 10.8% of females) reported masturbation behaviors; 57.4% (86.2% of males versus 15.6% females) students viewed pornography. In terms of sexual communication about sexual knowledge acquisition, 13.7% (10.7% of males versus 18% of females) talked to their parents about sex; 7.1% (6.1% of males versus 8.4% of females) students reported having conversation with parents on contraception. About forcing sexual behavior, 2.7% (4% of males versus 0.9% of females) reported forcing their sexual partners to have sex, and 1.9% (2.4% of males versus 1.2% of females) reported being forced to have sex. Gender was found to be significant predictor of sexual behaviors in university students: males reported more sexual behaviors including sexual fantasy, heterosexual intercourse, masturbation, viewing pornography and talking about sex with friends. Several correlates of sexual behaviors were identified for students of different gender separately. For males, having romantic relationships, past sex education experiences, low educational aspirations, time spent on the Internet, and urban native settings were significantly associated with more sexual behaviors. For female students, having romantic relationships and urban native settings predicted sexual behaviors.ConclusionSexual behavior among University students in China is not uncommon, although there are limited ways for students to acquire sex-related knowledge: male students showed significantly more sexual behaviors than female students. Having romantic relationships and more time spent online were important predictors of sexual behaviors among university students. To guide healthy sexual behaviors in young people, comprehensive sex education programs that provide necessary sexual health knowledge about safe sex should be developed and implemented in universities in China, particularly for students who have romantic relationships and those who spend long periods of time on the Internet.

Measurement and Design Issues in the Study of Adolescent Sexual Behavior and the Evaluation of Adolescent Sexual Health Behavior Interventions

To improve the quality of research and commentary concerning adolescent sexuality and evaluation of both comprehensive sexuality education and abstinence education programs, this article aims to help readers (1) select appropriate measures to study adolescent sexual behavior, (2) develop appropriate study designs to evaluate adolescent sexual health behavior intervention outcomes, and (3) interpret study results. Examples of measures that have been used in studies are identified. Suggestions are made as to measures that may be better choices. Additionally, different types of designs are highlighted and discussed. Instances in which reports and published articles have incorrectly interpreted the results of research studies are presented.