Peer-led Sex Education Research Articles

Unmet Needs in Sex Education—What Adolescents Aim to Understand About Sexuality of the Other Sex

PurposeSex education programs need to modify their focus in light of changing societal norms and increasing exposure to pornography. This study investigates what adolescents want to know about the sexuality of the opposite sex. This will allow practitioners to adjust sex education curricula to the needs of adolescents, thereby supporting the establishment of healthy, respectful, and sexually fulfilling relationships. MethodsTwo thousand three hundred forty-three adolescents from the age of 11–19 years (123 classes) were asked to formulate questions addressed to the opposite sex as part of peer-led sex education classes, where girls and boys were divided into separate groups. Groups of 10–12 individuals each formulated about 11 questions, resulting in a total of 2,625 questions. The questions were categorized using content analysis. ResultsThe largest portion of questions addressed sexual interaction (35.8%), with many questions further addressing sexual preference (e.g., oral sex, sex positions) and the logistics and qualitative aspects of first-time sexual intercourse. Adolescents were also interested in questions about the body (e.g., anatomy, body hair, 15.2%), relationships (e.g., love, dating, 13.9%), ideal characteristics of men/women (10.5%), masturbation (10.1%), and pornography (7.3%). ConclusionAdolescents show a high degree of interest in understanding the feelings and perceptions of the opposite sex. Acquiring this knowledge could be beneficial in building emotionally and physically fulfilling relationships. To increase adolescents' sexual and relationship competence, sexual education curricula should encompass pleasure and desire aspects of sexuality, initiating and managing relationships, societal ideals, and addressing pornography, in addition to sexual and reproductive health knowledge.

“Kids Know What They Are Doing”: Peer-Led Sex Education in New York City

The reasons for peer education's ascendance as a core pedagogy in sex education are as much historical as they are reasonable or ethical. This article traces the history of peer-led sex education from the 1970s to the 1990s against the backdrop of New York City's financial ruin, social unrest, and a public health crisis. Starting with an analysis of the Student Coalition for Relevant Sex Education's Peer Information Project, founded in 1974, it investigates the application of new pedagogical techniques, the interplay between pedagogy and bureaucracy, and the transformation of school culture. Peer education thrived when educators and activists agreed that young people were more likely to accept advice from other young people, a reasonable contention that was nonetheless underassessed. Yet peer education's least intriguing attribute proved to be its most important characteristic: it could be quickly and inexpensively enacted. When HIV/AIDS began to decimate New York City's adolescent population, and the Board of Education proved slow and contradictory in its actions, the city turned to peer education, henceforth coupling the concepts of sex education and peer education.

China's Sex Education Still Miles to Go - Sex Education Needs in College Students: A Cross-Sectional Study

Background: In China, rapid development in all walks of society has been accompanied by dramatic transition of traditional culture and by negative effects on sexual health of young people. We investigated knowledge, attitudes, values and behaviors of college students in relation to sex and sex education in Tianjin, China, with an aim of informing sex education policy under the context of the great rejuvenation of the Chinese nation. Methods: We selected seven main universities in Tianjin. Methods were: questionnaire survey of 2105 college students; sex education topic campus lectures about sexually transmitted infections/acquired immunodeficiency syndrome (STIs/AIDS) and sex health of students. Qualitative and quantitative data were assessed separately with thematic and statistical analysis respectively and then combined. Findings: We have found five main findings about Tianjin college student's sexual wonders, knowledge, values, attitudes and behaviors: Tianjin college students have some knowledge of basic sex physiology, while the largely arranged sex education curriculum fails to reach the needs for adults; background factors (ie, gender, native places and urban/rural) are crucial in the sex education and the outcome of sex education, which might provide theoretical basis for policymakers and researchers; sexual education lags behind sexual behaviors (ie, sex drive, masturbation and sex); medical universities should realize the importance of sex education and the implement of sex education; homosexuality and sperm bank are new territories for sex education. Interpretation: Results of this exploratory study suggest five ways that could be developed to improve sex education: qualified specialists or teachers are the best educators to address learning needs of college students; background factors are of great significance in sex education and sex education learning, group differences and individual differences should be considered in sex education; for urban students, sex education from parents/teachers might be better than peer-led sex education; homosexuality and sperm bank are new territories in sex education, sex education must keep abreast with times. Funding Statement: No specific grant from funding agencies in the public, commercial, or not for- profit sectors. Declaration of Interests: We declare that we have no conflict of interest. Ethics Approval Statement: Ethics approval was obtained from Tianjin Medical University General Hospital ethics committee. Written informed consent was obtained from each participant before data collection.

Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries

Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges’ g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges’ g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.

‘The real deal’: A feasibility study of peer-led sex education for early school leavers

Objectives To explore female early school leaver's experience of sexual activity and sex education, and to assess the feasibility and potential impact of a peer-led sex education intervention.Methods Forty five young female early school leavers and ten peer educators participated in the study. The ten peer educators, early school leavers who were teenage mothers, were trained to deliver the peer-led education intervention. Both quantitative (self-completed questionnaire) and qualitative (focus groups) research methods were used to evaluate the intervention.Results The average age of participants was 17.5 years. The average age at leaving school was 15 years. Many participants were smokers and took alcohol on a regular basis. Over three quarters of the young women were sexually active. Although most used contraception in the past, over 30% had not the last time they had sex. While participants' knowledge around sexual issues showed some improvement following the pilot intervention, there was little change in attitudes to sexual behaviour.Conclusions This feasibility study was very well received by both peer educators and participants. To assess the effectiveness of the intervention we recommend that a larger randomised control trial be conducted.

Perspectives on Peer-led Sex Education Programs at Schools in Japan

Perspectives on Peer-led Sex Education Programs at Schools in Japan

The Long-Term Effects of a Peer-Led Sex Education Programme (RIPPLE): A Cluster Randomised Trial in Schools in England

BackgroundPeer-led sex education is widely believed to be an effective approach to reducing unsafe sex among young people, but reliable evidence from long-term studies is lacking. To assess the effectiveness of one form of school-based peer-led sex education in reducing unintended teenage pregnancy, we did a cluster (school) randomised trial with 7 y of follow-up.Methods and FindingsTwenty-seven representative schools in England, with over 9,000 pupils aged 13–14 y at baseline, took part in the trial. Schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). Peer educators, aged 16–17 y, were trained to deliver three 1-h classroom sessions of sex education to 13- to 14-y-old pupils from the same schools. The sessions used participatory learning methods designed to improve the younger pupils' skills in sexual communication and condom use and their knowledge about pregnancy, sexually transmitted infections (STIs), contraception, and local sexual health services. Main outcome measures were abortion and live births by age 20 y, determined by anonymised linkage of girls to routine (statutory) data. Assessment of these outcomes was blind to sex education allocation. The proportion of girls who had one or more abortions before age 20 y was the same in each arm (intervention, 5.0% [95% confidence interval (CI) 4.0%–6.3%]; control, 5.0% [95% CI 4.0%–6.4%]). The odds ratio (OR) adjusted for randomisation strata was 1.07 (95% CI 0.80–1.42, p = 0.64, intervention versus control). The proportion of girls with one or more live births by 20.5 y was 7.5% (95% CI 5.9%–9.6%) in the intervention arm and 10.6% (95% CI 6.8%–16.1%) in the control arm, adjusted OR 0.77 (0.51–1.15). Fewer girls in the peer-led arm self-reported a pregnancy by age 18 y (7.2% intervention versus 11.2% control, adjusted OR 0.62 [95% CI 0.42–0.91], weighted for non-response; response rate 61% intervention, 45% control). There were no significant differences for girls or boys in self-reported unprotected first sex, regretted or pressured sex, quality of current sexual relationship, diagnosed sexually transmitted diseases, or ability to identify local sexual health services.ConclusionCompared with conventional school sex education at age 13–14 y, this form of peer-led sex education was not associated with change in teenage abortions, but may have led to fewer teenage births and was popular with pupils. It merits consideration within broader teenage pregnancy prevention strategies.Trial registration:ISRCTN (ISRCTN94255362).

Approaches to sex education: peer-led or teacher-led?

David Ross discusses a new study of school-based peer-led sex education in London and whether it reduced unintended teenage pregnancy.

“Smart boys” and “sweet girls”—sex education needs in Thai teenagers: a mixed-method study

In Thailand, rapid increases in economic prosperity have been accompanied by erosion of traditional cultural and religious values and by negative effects on sexual health of young people. We investigated knowledge, attitudes, norms, and values of teenagers, parents, teachers, and policymakers in relation to sex and sex education in Chiang Mai, Thailand, with a view to informing sex education policy. We selected six secondary schools for maximum variation in socioeconomic background, religious background, and location. Methods were: narrative interviews with key stakeholders, and analysis of key policy documents; questionnaire survey of 2301 teenagers; 20 focus groups of teenagers; questionnaire survey of 351 parents; and two focus groups of parents. Qualitative and quantitative data were assessed separately with thematic and statistical analysis, respectively, then combined. We noted five important influences on Thai teenagers' sexual attitudes and behaviour: ambiguous social roles leading to confused identity; heightened sexual awareness and curiosity; key gaps in knowledge and life skills; limited parental input; and impulsivity and risk-taking. Male teenagers aspire to be "smart boys", whose status depends on stories of sexual performance and conquests. Female teenagers, traditionally constrained and protected as "sweet girls", are managing a new concept of dating without their parents' support, and with few life skills to enable them to manage their desires or negotiate in potentially coercive situations. School-based sex education is biologically focused and inconsistently delivered. Results of this large exploratory study suggest five approaches that could be developed to improve sex education: targeted training and support for teachers; peer-led sex education by teenagers; story-based scenarios to promote applied learning; local development of educational materials; and use of trained sexual health professionals to address learning needs of pupils, teachers, and parents.

Integrating Process with Outcome Data in a Randomized Controlled Trial of Sex Education

Integration of process with outcome evaluations has been recommended as a way of addressing some of the criticisms of Randomized Controlled Trials (RCTs) for evaluating social interventions. This is the second of two articles (the first was published in issue 10(4) of this journal) discussing the design, implementation and analysis of a process evaluation as an integral part of the RIPPLE (Randomized Intervention of Pupil Peer-Led sex Education) Study. The methods for integrating process and outcome data are outlined and findings are presented to illustrate how integration of process and outcome data enabled exploration of: 1) variation between schools in the extent and quality of the intervention implemented, and any impact of this on outcomes; 2) the processes by which the intervention might affect outcomes; and 3) the extent to which different subgroups of students or schools may have responded differently to the intervention. The article concludes with a discussion of the methodological issues arising from this attempt at integrating process and outcome evaluations within the design of an RCT.

Peer-led approach to sex education in school has limited impact compared with teacher-led education

QuestionDo peer-led sex and relationship education programmes reduce unsafe sex and unwanted pregnancies compared with traditional teacher-led sex education in schools?Study designRandomised controlled trial.Main resultsThere were no significant differences between intervention and control schools in the proportion of pupils reporting unprotected first heterosexual intercourse by 16 years of age (difference in cumulative proportion: −0.8%, 95% CI −3.5 to 1.8; p=0.53). At 18 months follow up, peer-led education improved pupils’ satisfaction with their sex education compared with teacher-led education (p=0.001). Peer-led education non-significantly reduced unwanted pregnancies (p=0.07). Following intervention, girls were less likely to report having had sexual intercourse by 16 years (p=0.0008), although the difference was not significant for boys (p=0.35) (see results table).Authors’ conclusionsPeer-led sex education in schools only modestly improved sexual behaviour. Young people report that they learn most about sex outside school. Wider strategies of education such as media and service delivery need to be assessed.

Evaluating Processes

This article explores the rationales offered in the evaluation literature for studying the processes involved in programme implementation, and their relationship with current arguments about the use of experimental designs to evaluate social interventions. It describes, as a case study, a process evaluation carried out as an integral part of a randomized controlled trial of peer-led sex education. The process evaluation was designed to answer important questions about the implementation of the intervention, the social context of the trial, and the experiences of trial participants. The article describes the methods used to collect process data, and some of the challenges involved. It concludes by arguing that process evaluation is necessarily complex, but essential to the task of understanding why and how interventions and outcomes may be related.

Teaching sex education improves medical students' confidence in dealing with sexual health issues

Medical students at the University of Edinburgh in Scotland can volunteer to participate in an undergraduate options project that gives them the opportunity to provide sex education for secondary school (high school) pupils. Using a questionnaire presenting a set of fictional case histories, we assessed medical students' theoretical confidence at dealing with sexual health consultations. Students who had participated in delivering peer-led sex education felt significantly more confident at discussing sexual health issues with patients of all age groups (p = 0.001) than students who had not participated in the project. All students felt more comfortable seeing patients of the same gender as themselves but more than half felt that their training left them generally ill-equipped to handle sexual health consultations.

Pupil-led sex education in England (RIPPLE study): cluster-randomised intervention trial

Improvement of sex education in schools is a key part of the UK government's strategy to reduce teenage pregnancy in England. We examined the effectiveness of one form of peer-led sex education in a school-based randomised trial of over 8000 pupils. 29 schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). In intervention schools, peer educators aged 16-17 years delivered three sessions of sex education to 13-14 year-old pupils from the same schools. Primary outcome was unprotected (without condom) first heterosexual intercourse by age 16 years. Analysis was by intention to treat. By age 16 years, significantly fewer girls reported intercourse in the peer-led arm than in the control arm, but proportions were similar for boys. The proportions of pupils reporting unprotected first sex did not differ for girls (8.4% intervention vs 8.3% control) or for boys (6.2% vs 4.7%). Stratified estimates of the difference between arms were -0.4% (95% CI -3.7% to 2.8%, p=0.79) for girls and -1.4% (-4.4% to 1.6%, p=0.36) for boys. At follow-up (mean age 16.0 years [SD 0.32]), girls in the intervention arm reported fewer unintended pregnancies, although the difference was borderline (2.3% vs 3.3%, p=0.07). Girls and boys were more satisfied with peer-led than teacher-led sex education, but 57% of girls and 32% of boys wanted sex education in single-sex groups. Peer-led sex education was effective in some ways, but broader strategies are needed to improve young people's sexual health. The role of single-sex sessions should be investigated further.

A school-based randomized controlled trial of peer-led sex education in England

This article discusses the design of an ongoing cluster-randomized trial comparing two forms of school-based sex education in terms of educational process and sexual health outcomes. Twenty-nine schools in southern England have been randomized to either peer-led sex education or to continue with their traditional teacher-led sex education. The primary objective is to determine which form of sex education is more effective in promoting young people's sexual health. The trial includes an unusually detailed evaluation of the process of sex education as well as the outcomes. The sex education programs were delivered in school to pupils ages 13–14 years who are being followed until ages 19–20. Major trial outcomes are unprotected sexual intercourse and regretted intercourse by age 16 and cumulative incidence of abortion by ages 19–20. We discuss the rationale behind various aspects of the design, including ethical issues and practical challenges of conducting a randomized trial in schools, data linkage for key outcomes to reduce bias, and integrating process and outcome measures to improve the interpretation of findings.

Using Random Allocation to Evaluate Social Interventions: Three Recent U.K. Examples

Although widely accepted in medicine and health services research, randomized controlled trials (RCTs) are often viewed with hostility by social scientists, who cite a variety of reasons as to why this approach to evaluation cannot be used to research social interventions. This article discusses the three central themes in these debates, which are those of science, ethics, and feasibility. The article uses three recent U.K. trials of social interventions (day care for preschool children, social support for disadvantaged families, and peer-led sex education for young people) to consider issues relating to the use of random allocation for social intervention evaluation and to suggest some practical strategies for the successful implementation of “social” RCTs. The article argues that the criteria of science, ethics, and feasibility can and should apply to social intervention trials in just the same way as they do to clinical trials.

Using research questionnaires with young people in schools: the influence of the social context

Whilst there is an extensive literature on the use of self-completion questionnaires as a research tool, very little attention has been paid to the influence of the social context in determining the ways in which questionnaires are used in practice. This paper describes our experiences of working with 27 English, mixed sex, state schools to carry out a questionnaire survey with 4754 students aged 13–14 years. The survey was part of a randomized controlled trial of peer led sex education. Using data from the questionnaires and from researcher fieldnotes, we highlight ways in which aspects of the social context affected the administration of the questionnaire, students' participation in the survey and the quality of the data collected.

A Comparison of Students' Evaluations of a Peer-delivered Sex Education Programme and Teacher-led Provision

This article reports data from the process evaluation of a randomised controlled trial of peer-led sex education in English secondary schools. Data from 52 focus group discussions in 19 schools and selected items from a questionnaire survey completed by 7770 students in 1998/99 are used to compare student views on teacher- and peer-led sex education. Questionnaire data show that a significantly greater proportion of students taught by peer educators than teachers felt that sex education was enjoyable, engaging and useful to them. Data also show that a slightly greater proportion of students taught by teachers felt the classroom was well controlled. Data from an analysis of the focus group discussions are used to explore and illustrate factors which students associated with the acceptability and satisfaction of the peer-led intervention. The importance of peer educator empathy and similarity with students is highlighted and data show how these characteristics are associated with peer educators' choice of teaching methods, the content of lessons and the sexual values and attitudes they espouse. The influence of contextual factors like student prior expectations and experiences of relationships with teachers, school environment and norms are considered along with the potential influence of the research process on responses.