Sex Education Research Articles

Documenting the availability and accessibility of reproductive health services for youth in Albania

Abstract Youth in Albania are initiating sexual activity at an earlier age. However, use of all forms of contraception has declined in the last decade and uptake now stands at 4%. The self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms has risen dramatically, as has reliance on abortion as a predominant method of family planning. In 2020-2022, we conducted a multi-method qualitative study in Albania to document the availability and accessibility of sexual and reproductive health (SRH) services and examine challenges that youth face when seeking SRH care. This study comprised a document review, a curriculum review, a community-based survey with 273 youth, semi-structured interviews with 15 youth, semi-structured interviews with 15 key informants, and a service mapping exercise in Tirana. Lack of adequate infrastructure and bureaucratic hurdles make it difficult for youth to navigate and access SRH services in Albania. A third of survey participants (n = 90, 33%) expressed discomfort inquiring about SRH matters, while nearly two-thirds rarely or never sought SRH services from a doctor or clinic. Furthermore, Albania’s school-based sexuality education curriculum lacks in topics, content, and responsiveness, resulting in inconsistent learning experiences and limited knowledge of SRH. Sexuality education is primarily focused on the anatomy and physiology of reproduction, leading to significant knowledge gaps in other aspects of SRH. Only half of survey participants (n = 150, 55%) had received any education on birth control, contraception, or family planning; and only few had knowledge about gender identity (n = 103, 38%), or consent (n = 77; 28%). Widespread lack of awareness and fear of judgment contribute to the underutilization of SRH services among youth in Albania. Improving knowledge and awareness, alongside investing in infrastructure and capacities, are essential to enhancing accessibility and quality of SRH services for Albanian youth. Key messages • Lack of knowledge and awareness prevent youth from accessing SRH services. • Establishing youth-friendly services and training health providers and educators are crucial to delivering confidential and non-judgmental youth-friendly SRH care.

Sexual health education in Italian schools: preliminary results of EduForIST3 national project

Abstract Background School-based comprehensive sexuality education (CSE) is the best approach to disseminate scientific evidence and promote healthier sexual behaviours among young people. However, in Italy, CSE is not included in schools curricula. This study, funded by the Ministry of Health, seeks to investigate information uptake and attitudes towards sexuality among adolescents included in a pilot CSE intervention in 6 Italian regions, from December 2023 to June 2024. Methods A 10-hours education intervention was implemented in a convenient sample of 26 upper and lower secondary schools (U/LSS), covering topics such as changes in adolescence, relationships and consent, sexual identity, sexually transmitted infections (STIs), contraception and sexual health services. Students’ evaluation comprised pre/post tests assessing knowledge, attitudes towards sexuality and satisfaction. A Solomon 4-group design study was used to compare intervention and control classes. A follow-up test will be conducted 4-6 months post-intervention. Results Preliminary analysis of available data as of 30 April, 510 pre-tests and 266 post-tests, showed incremented correct answers in all items. A significant increase (p<.05) was found in 12/21 items for USS and in 9/19 items for LSS, especially in the domain STIs symptoms and prevention, among those mostly appreciated. Over 90% of students considered schools as suitable setting to receive CSE, preferably by external experts. Ongoing qualitative and long-term analysis will provide further insights of the overall impact of the activity. Conclusions The pilot CSE intervention increased the knowledge and attitudes of the students involved. Additional insights will be available after study completion. Findings from this study will contribute to evaluate the effects of CSE initiatives on sexual health knowledge and attitudes among Italian secondary schools students, as well as the effectiveness of such programs in fostering healthier behaviours. Key messages • Providing evidence-based, relevant information and education on sexual health to young people in secondary schools increases their knowledge and improves attitudes towards sexuality. • CSE should be included in Italian school curricula in order to promote an incremental uptake of information and to improve young people’s sexual health.

Predictive machine learning algorithms for metabolic syndrome among Tunisian adults

Abstract Background Metabolic syndrome (MS), a cluster of interconnected risk factors for cardiovascular disease and type 2 diabetes, poses a significant health burden globally. In Tunisia, amidst an ongoing epidemiological transition, the prevalence of MS presents a growing concern. Our study aimed to identify the potential risk factors of MS and propose better machine learning (ML) based models for predicting MS among Tunisian adults. Methods Data was sourced from the Tunisian Health Examination Survey THES-2016, encompassing individuals aged 20 years and older. MS was defined based on the criteria set by the International Diabetes Federation. Logistic regression (LR) was employed to determine risk factors for MS. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Five ML algorithms (Naïve Bayes, Support Vector Machine (SVM), Artificial Neural Network (ANN), AdaBoost, and Random Forest (RF)) were utilized to predict MS. Performance evaluation was conducted using accuracy, precision, recall, and area under the curve (AUC) metrics. Results Among the 8908 participants, the prevalence of MS was 32.8% (95% CI: 31.4% - 34.6%). LR identified age group 60-69 years (aOR: 18.5, 95% CI: 16.9-19.9, p < 0.001), female sex (aOR: 1.7, 95% CI: 1.2-1.9), sedentariness (aOR: 1.6, 95% CI: 1.5-1.8) and low education level (aOR: 1.2, 95% CI: 1.1-1.4) as significant factors associated with MS. Among ML models tested, AdaBoost had the highest accuracy (89.8%), followed by SVM (89.6%). Naïve Bayes had the highest Recall (98.1%) and the most performant AUC (91.4%), while RF had the highest Precision (70.8%). The ANN had an accuracy of 89%, a precision of 70.4%, a recall of 78.7% and an AUC of 85.1%. Conclusions Our study highlighted the effectiveness of ML algorithms like AdaBoost and SVM in predicting MS among Tunisian adults, offering potential as early detection tools. However, further validation with larger datasets is necessary to solidify their utility in healthcare settings. Key messages • Metabolic syndrome, a complex of cardiovascular risk factors, presents a substantial global public health challenge and is particularly pronounced in Tunisia. • Machine learning algorithms, notably AdaBoost and Support Vector Machine, demonstrate promise in forecasting and addressing metabolic syndrome.in Tunisian adults.

Sexual health communication targeting adolescents in public service Media: the case of Finland

Abstract Background Given the substantial time adolescents spend online, sexual health promotion and education through online media constitute a promising public health action. However, monitoring of sexual health-related online media content is warranted, and considering the scope and aims of public service media, this forum can be regarded as being of particular interest. This study aimed to analyze how and to what extent sexuality and sexual health-related content targeting adolescents is communicated and portrayed in public service media in Finland, with a particular interest in health promotion perspectives and participatory practices. Methods Based on predetermined inclusion criteria and guidance from professionals at the Finnish public service company Yle, podcasts were specified as the media format of interest. Three Finnish podcasts (a total of 66 episodes) produced during the years 2021-2023, targeting young people and focusing on sexual health, were included in this study and subject to critical content analysis. Results Most podcast episodes focused equally on the sexual health resource and risk perspectives, while a third emphasized a resource perspective. Concerning participatory practices, adolescents participate in only five episodes in total, and most often, the podcast hosts’ own experiences are at the center of the episodes. Conclusions The findings highlight how sexuality and sexual health content is communicated in public service media podcasts targeting adolescents in Finland, as well as how the communication aligns with health education and promotion guidelines. The study sheds light on participatory practices, emphasizing a lack of stakeholder involvement, i.e., dialogue between podcast hosts and listeners. Results carry implications for developing sexual health promotion through public service media targeting young people in Finland and other European countries alike. Key messages • The findings highlight how sexuality and sexual health content is portrayed in public service media podcasts in Finland and how the communication aligns with health promotion values and principles. • The findings show a lack of participatory practices in Finnish public service media podcasts targeting adolescent sexual health - a health promotion concern also pertinent to other countries.

Capacity mapping of comprehensive sexuality education in Gabon: A qualitative analysis

Abstract Background Access to comprehensive sexuality education (CSE) is crucial for adolescent health and well-being. Following UNESCO’s recommendations, Gabon revised its sex education policy in 2017 to better address adolescents’ sexual health needs. This study aims to map the capacities of the public health and education sector to implement Gabon’s CSE policy. Methods Semi-structured interviews were held with 15 professionals from ministries, NGOs, and development partners. Thematic analysis guided by Aluttis et al’s public health capacity model allowed to assess the existing capacities and gaps in leadership, organizational structures, partnerships, resources, and knowledge development for CSE. Results The implementation of CSE in Gabon is hindered by sociocultural and political factors, including the taboo on adolescent sexuality influencing perceptions of CSE content, natalist policies, and socio-economic disparities. Governmental involvement in CSE is limited to key ministries. Organizational structures for CSE lack cohesion due to changes in governance regimes and a lack of support for civil society organizations. Human resources are unevenly distributed, and financial constraints impede government initiatives, causing a strong reliance on external funding. An important role in supporting CSE is played by development partners and partnerships between stakeholders. While knowledge development for CSE is underway, monitoring and evaluation procedures are insufficient, and evidence mobilization by key professionals is insufficient. Conclusions Enhancing stakeholder collaboration, addressing structural constraints, and mobilizing human and financial resources are critical for effective CSE implementation in Gabon. Addressing these barriers requires coordinated efforts among stakeholders and addressing systemic challenges. This study provides insights for policymakers and practitioners to strengthen CSE programs and promote adolescent sexual health in Gabon. Key messages • CSE implementation is hindered by taboos on adolescent sexuality, natalist policies, and socio-economic gaps. • Evaluation and evidence mobilization deficits limit effectiveness.

The use of digital technologies to promote sexual health in young adults: a narrative review

Abstract Background New technologies have the potential to play an important role in promoting sexual health, especially among young people, who are the biggest users and those at greatest risk of contracting Sexually Transmitted Infections (STI). The risk behavior assumed by young people today highlights this vulnerability in several contexts, such as individual, social, economic, and family. In this sense, it becomes relevant to approach sex education in schools using digital technologies. Objectives To identify the evidence in the literature on the use of digital technologies to promote the sexual health of young adults. Methods Narrative literature review. Three independent reviewers extracted, analyzed and synthesized the articles and results. Results Through the selection process, four studies were included. The articles show that the use of digital technologies (mobile phones/applications) leads to increased knowledge, improved attitudes and sexual behavior among young adults. The interventions studied in the studies were based on Short Message Service, electronic mail interventions and the MyPEEPS mobile application, with the following main focuses: Increased knowledge, attitudes, and behaviors of young adults. Considering the results of the studies, all interventions proved to be effective as facilitators of sexual health promotion. Conclusions The use of digital technologies allowed an increase in the promotion of the sexual health of the participants, since there was an increase in the level of knowledge with the use of digital technologies such as SMS, emails and mobile applications when comparing the experimental and control groups. The use of these digital technologies also allowed for a change in attitudes and behaviors, such as a significant increase in serological testing for STIs and an increase in health care seeking. Key messages • The use of digital technology promotes the sexual health of young adults, so these strategies should be implemented by health professionals. • The dissemination of these digital strategies will have an impact on Public Health, specifically regarding the sexual health of young adults.

Comprehensive sexuality education: indicators to evaluate interventions in Italian schools

Abstract Background Comprehensive sexuality education (CSE) is globally acknowledged as the most effective approach to promoting sexual health and preventing Sexually Transmitted Infections (STIs). However, in Italy, CSE is not consistently part of the school curriculum. The EduForIST project, funded by the Ministry of Health, introduced and tested a unique CSE model in a sample of secondary schools across six Italian regions, aiming to develop an evaluation model for potential nationwide implementation. Methods The EduForIST partnership, comprising experts from various institutions, devised a framework for monitoring and evaluating CSE interventions. Through monthly focus group discussions from April 2023 to February 2024, they established indicators for short-, medium-, and long-term evaluation of clinical and behavioral outcomes, as well as process indicators to assess intervention implementation. Results A total of 35 indicators were developed, including clinical and behavioral ones for medium and long-term outcomes, short-term behavioral outcomes, and process indicators. Data for clinical and behavioral indicators can be obtained from administrative sources like the Ministry of Health and Regional Health Authorities. The National Institute of Health provides data from relevant surveillance programs. However, many process indicators require specific data collection and calculations. Challenges such as under-reporting and underestimation persist, especially in regions with limited CSE implementation. Conclusions Creating an effective monitoring system for CSE interventions necessitates integrating diverse data sources, including health records, administrative data, and behavioral assessments. The proposed model’s effectiveness will be fully assessed by comparing pre- and post-intervention after widespread implementation in secondary schools. Meanwhile, the selected indicators serve as a foundation for evaluating baseline status of STIs and behaviors in Italy. Key messages • The EduForIST project establishes a robust framework for evaluating Comprehensive Sexuality Education (CSE) interventions in secondary schools, addressing gaps in nationwide implementation. • By devising indicators encompassing several measures, the project lays the groundwork for a comprehensive monitoring system, vital for assessing the effectiveness of CSE interventions in Italy.

ESPRIT study, analysis of the results of the pre-intervention survey in upper secondary schools

Abstract Background Sexually transmitted infections are a major public health problem, and their number is increasing in Italy. However, affective sexuality education is not yet part of the curricula. Therefore, a project entitled ESPRIT was launched, involving 3 regions (Friuli-Venezia Giulia, Lazio and Sicily), the IRCSS ‘Burlo Garofolo’ and the Istituto Superiore di Sanità, and implemented with the technical and financial support of the Ministry of Health - CCM. Methods A multicenter prospective intervention study was designed involving public upper secondary school students (grade 10-11). All target groups completed a KAP (knowledge, attitude, practice) questionnaire before and after participation in the educational intervention to measure its effectiveness. The questionnaires from the first phase were collected between January and April 2024, and the results were analyzed using R statistical software. Results The analysis of the overall results (463 students in total; female 58%, male 39%, other 2%; FVG 49%, Lazio 25%, Sicily 26%) showed that the group of upper secondary school students, targeted by peer education answered the knowledge part correctly by 56.6±13.8% on average. Applying the Kruskal-Wallis test showed that the percentage was significantly higher for females than males (p-value=0.005) and for licei students compared to technical and vocational schools (p-value=0.000). In terms of to attitudes, only 17% of students talked at length about sexually transmitted infections, and in 86.6% of cases, the interlocutors were friends or peers. Conclusions The results of the first phase show differences between the sexes and between the different types of educational institutions. The current level of knowledge still leaves much room for intervention and improvement. Analyzing the results of the follow-up phase will allow us to understand the effectiveness of the peer education intervention. Key messages • Adolescents’ knowledge of sexually transmitted infections needs to be improved. • Gender and the type of school attended affect the level of knowledge.

Sex related cardiovascular risk is non-dichotomous: artificial intelligence enhanced electrocardiography reveals continuum of risk in females

Abstract Background Females are typically underserved in cardiovascular medicine and often considered lower risk of cardiovascular disease. The use of sex as a dichotomous variable for risk stratification fails to capture the heterogeneity of risk within each sex. Purpose We aimed to develop an artificial intelligence-enhanced ECG (AI-ECG)-derived continuous sex score that can capture the continuum of risk and sex phenotypes within each sex, with the particular goal of addressing the female disadvantage. Methods We trained a convolution neural network to identify sex using the 12-lead ECG. The derivation cohort was 1,163,401 ECGs from 189,538 subjects from a USA secondary care hospital cohort and validated inthe UK Biobank (UKB). The model outputs a continuous value from 0 to 1 for sex prediction. The AI-ECG sex discordance score is the difference between predicted sex and biological sex. Results AI-ECG accurately identified sex in both the USA cohort (AUROC 0.943 (0.942-0.943)) and UKB datasets (n = 42,386, AUROC 0.971 (0.969-0.972)). In explainability analyses we found QRS duration, T wave morphology, QT interval, heart rate and QRS voltage as the most important factors in contributing to AI-ECG sex identification. In females only but not in males, sex discordance score was associated with a covariate-adjusted increased risk of cardiovascular death in outpatients with normal ECGs from the USA cohort, (Females hazard ratio (HR) 1.64 (1.18-2.29) p = 0.003, Males HR 1.04 (0.66-1.63), p = 0.86). This pattern persisted in the UKB: Females HR 1.39 (1.08-1.78) p = 0.01, Males HR 0.97 (0.77-1.22), p = 0.80, Fig 1). In phenome-wide association studies, we found females with a higher sex score discordance were more likely to have heart failure or myocardial infarction. Covariate-adjusted cox models confirmed the association of sex score discordance with increased future heart failure (HR 1.21 (1.07-1.37) p = 0.002 and future myocardial infarction (HR 1.32 (1.11-1.56) p = 0.001). In age- and body size-adjusted analyses, females with higher sex discordance score had increased left ventricular mass, and chamber volumes as well as increased muscle mass, reduced body fat percentage (Fig 2). In a genome-wide association study of sex discordance score we identified variants adjacent to IGF1R and NDRG4 in females, which have been previously associated with LV mass and sex hormone levels (Fig 2). Conclusion We describe sex discordance score as a novel AI-ECG biomarker capable of identifying females with disproportionately elevated cardiovascular risk. Sex discordance score may help uncover potential underlying mechanisms of cardiovascular disease among females, and future clinical studies are needed to determine its potential utility in identification of females at higher risk of cardiovascular events. Rather than exacerbating biases, AI-ECG has the potential to reduce female cardiovascular health inequalities.

Experiences of Dating Violence and Protective Factors Among Adolescents in Vulnerable Contexts

ABSTRACT Adolescents in vulnerable living contexts (e.g., foster care, juvenile justice facilities, and experiencing homelessness) may be at increased risk of adolescent dating violence victimization (ADV) due to unstable environments and trauma exposure. They may also experience different protective factors. Yet, research is limited on ADV in these contexts. This study assessed differences in ADV experiences among adolescents (10–21 years) in vulnerable contexts compared to adolescents at home utilizing data from a sexual health education program serving communities facing health inequities in California. Descriptive analyses compared adolescents in vulnerable contexts (n = 1,951) with those living at home (n = 10,682). Multivariable logistic regression was used to estimate the odds of experiencing past year physical and/or sexual ADV by context, controlling for sociodemographic variables. We also examined two potential protective factors: meaningful communication with a parent/guardian and pro-social friendships. Significantly more adolescents in vulnerable contexts than at home identified as male (65.6% vs. 51.6%), 18 years or older (16.5% vs. 8.7%), non-Hispanic Black or African American (14.4% vs. 5%), and LGBTQ+ (15.3% vs. 10.8%). Among adolescents who dated in the past year, 21% in vulnerable contexts reported experiencing physical and/or sexual ADV, compared to 15% of those at home, and reported lower levels of protective factors. Adolescents experiencing homelessness/unstable housing and those in juvenile justice facilities had greater adjusted odds of ADV compared to adolescents at home (56% and 54% higher odds, respectively). It is critical to address systemic factors, which disproportionately impact the most marginalized and disadvantaged adolescents, in approaches for ADV prevention.

Attitude of Students in Rural Secondary Schools Towards Sex Education in District Shimla of Himachal Pradesh based on Gender

This research seeks to examine the perspectives of high school students in the countryside of Shimla. Stratified random sampling method was employed to select a cohort of one hundred students from two rural educational institutions in the Shimla District: Government Senior Secondary School, Shoghi and Government Senior Secondary School Ghanahatti. Dr. Usha Mishra’s standardized scale for assessing attitudes towards sex education was utilized for data collection. The t-test has applied to evaluate the significance of the differences among the various groups. The results indicated no notable difference in the attitudes of male and female pupils attending a rural secondary school in the Shimla District. Int. J. Soc. Sc. Manage. Vol. 11, Issue-4: 115-118.

SEXUALITY EDUCATION AND ITS IMPACT ON ADOLESCENT REPRODUCTIVE HEALTH KNOWLEDGE IN MANCAR VILLAGE

Adolescence is a critical period of transition marked by biological, psychological, and social changes. This community service program aimed to educate adolescents on reproductive health through sexuality education at the Youth Posyandu in Mancar Village, Jombang. Conducted on June 26, 2024, the program involved 15 adolescent participants. It addressed the lack of knowledge about reproductive health and sought to improve adolescents' understanding and attitudes toward their reproductive well-being. A series of activities, including seminars, discussions, and demonstrations, were held to provide comprehensive information on reproductive health. The results showed a significant increase in the participants' knowledge, with 100% of the adolescents demonstrating a good understanding of reproductive health by the end of the program. This initiative highlighted the importance of open access to reproductive health education for adolescents and encouraged parental involvement in discussing reproductive health topics. The program concluded successfully, with participants actively engaging in the learning process and demonstrating increased awareness of reproductive health issues.

Understanding the influence of children’s mental health, cognitive development, and environmental factors on learning outcomes in Chile

Mental health, cognitive development, and social background are related to educational success. While growing evidence is available in cultural settings other than Western countries, more knowledge is needed, especially regarding interactions among these dimensions. Rather than studying isolated factors, we propose an integrated approach to consider the diverse interrelated dimensions influencing children’s learning. Life course theory supports this approach underlying the role of early events in subsequent life paths and the multidisciplinary nature of these events. The sample consisted of 610 children (49.1% male) attending first grade. The children completed reading, mathematics, and visuospatial working memory (VWM) assessments. Parents completed the Strengths and Difficulties Questionnaire (SDQ-P) and reported their demographic information. A multilevel path model was estimated, including direct relationships between (i) children’s socioemotional behavior (SEB) and learning, (ii) VWM and learning, and (iii) SEB and VWM. The effects of sex and maternal education were also controlled. School and student level variances were modeled. At the school level, VWM, reading, and mathematics have variance, whereas SEB does not. At the student level, VWM, SEB, and maternal education have significant and differential effects on learning. Hyperactivity and peer problems were negatively related to reading and mathematics, while emotional problems were not, and conduct problems exhibited mixed results. These results reinforce developmental life course approaches, that is, from the beginning of schooling, promoting positive mental health can improve children’s learning outcomes.

Factors associated with risky sexual behaviors among undergraduate students in Thailand

BackgroundRisky sexual behaviors refer to actions or practices that increase the likelihood engaging in sexual intercourse. Such behavior can lead to HIV infection/AIDS, sexually transmitted diseases, and unintended pregnancy. The impact of risky sexual behaviors is a growing public health concern. These issues pose significant challenges to public health, particularly among university students and younger age groups who may be more vulnerable to various factors. Thus, this research aimed to examine the factors and sexual health literacy associated with risky sexual behaviors among undergraduate students in the four major regions of Thailand.MethodA cross-sectional study was conducted among 916 undergraduate students in their final semester of the 2023 academic year, from March to May 2024, at public, autonomous, and private universities across four regions: northern, central, southern, and northeastern of Thailand. The study employed multistage random sampling method. A self-administered structured questionnaire was used to assess risky sexual behaviors and the data were analyzed using multiple logistic regression.ResultsA total of 916 students participated in the study. The prevalence of risky sexual behavior was 46.84% (95% CI:43.56% to 50.12%) students engaged in risky sexual behaviors. Risky sexual behavior was significantly associated with grade point averages (GPA) between 2.00–3.00 could protective risky sexual behaviors was 42% as compared to GPA > 3.00 (AOR = 0.58, 95%CI:0.42 to 0.79), ex-substance use (AOR = 3.48, 95%CI:1.46 to 8.26), Current smoker (AOR = 2.90, 95%CI:1.90 to 4.43), negative attitudes toward risky sexual behaviors (AOR = 2.32, 95%CI:1.32 to 4.06), access to places of ill repute and access to sexual arousal stimuli (sometime) (AOR = 2.23, 95%CI:1.41 to 3.52), social influences (high level) (AOR = 0.29, 95%CI:0.15 to 0.55), and sufficient to excellent level of the application of information about sexual health (AOR = 0.48, 95%CI:0.26 to 0.87) of statistical significance at P < 0.05, which was significantly associated with risky sexual behavior.ConclusionThe findings of this study offer important insights for preventing risky sexual behaviors among undergraduate students across four regions. By promoting healthy sexual practices and encouraging behavior modification, negative consequences can be reduced. Public health care providers, policymakers, and stakeholders should implement tailored strategies, such as comprehensive sexual education and accessible health services, to address the specific needs of these students. These targeted interventions can significantly reduce the prevalence of risky sexual behaviors.

Refining out-of-school youth sexualities empowerment programmes using a sexual and reproductive citizenship lens: the Masizixhobise toolkit

ABSTRACT Out-of-school comprehensive sexuality education (CSE) programmes are viewed by UNFPA as important in empowering youth. These programmes may, however, be critiqued for, firstly, inadvertently equating empowerment with individual agency to the exclusion of social justice; and, secondly, using the word empowerment as a self-evident signifier. We propose that empowerment be conceptualised within a critical sexual and reproductive citizenship (CSRC) framework that draws on feminist and queer re-workings of the principles of citizenship. To operationalise this conceptualisation, we developed the Masizixhobise toolkit from the five key issues outlined in the CSRC framework. The aim of the toolkit is to aid in the design and refinement of theoretically embedded empowerment CSE programmes. In this paper, we demonstrate the use of the toolkit. To do so, we analyse the Partners in Sexual Health’s (PSH) Sexual and Reproductive Health and Rights facilitator’s manual. A template analysis was conducted on this manual using a priori of themes from the toolkit. We sift through the PSH manual’s alignments or misalignments with the CSRC framework and make recommendations for enhancing the empowerment components of the manual. This example may assist others in designing and refining theoretically embedded and socially just youth empowerment CSE programmes.

Theorising Relationships and Sex Education (rse) as a Children’s Rights Issue Using A Foucauldian Lens

Abstract This article seeks to analyse the problems with provision of Relationships and Sex Education (rse) in English schools using a Foucauldian perspective. Through this analysis, I demonstrate that the rse curriculum is used as a tool for “governing” or controlling children’s exercise of their sexuality to ensure conformity with norms, behaviours and attitudes that adults perceive children should ascribe to. However, adults tend to deny children’s developing agency and their autonomy to make decisions in relation to their sexual lives. This ignores the realities of children’s lives, in which they are exposed to sexual knowledge and information through their interactions with others, or via the internet. Using Foucault’s conceptualisation of bio-power, I argue for shifting some of the power around rse discourses from adults to children themselves, through a children’s rights-based approach. This approach to rse will ensure that the curriculum is adequate, appropriate and effective for children.

Picturing sexuality education in Thailand: a visual methods approach

ABSTRACT Visual research methods are increasingly utilised in educational research and scholars have used them to develop accounts of sexuality in schooling contexts. This article advances this work with an analysis of secondary students’ drawings of their experiences with sexuality education. We performed a thematic analysis on 150 drawings created during participatory focus group discussions (FGDs) among students in 30 Thai general secondary and vocational schools. We present summaries of six key themes identified in the visual data (‘emphasis on puberty, anatomy, and reproduction’; ‘emphasis on preventing pregnancy and infection’; ‘emphasis on the negative consequences of sex’; ‘hidden curriculum of heteronormativity’; ‘absence of complexities in the images’; and ‘a traditional classroom environment’). Conducted as a part of a multi-method study that also included teacher and student surveys, the analysis of students’ drawings highlighted the nature of Thai sexuality education from a complementary vantage point. While our previously reported survey findings indicated relatively comprehensive topic coverage, our interpretation of the student drawings suggests that pregnancy prevention may be emphasised over other topic areas. Our analysis of the drawings also supported earlier survey findings pointing at a lecture-heavy approach to teaching and learning rather than more learner-centred pedagogy.

Exploring European Parents’ Attitudes Towards the Age Appropriateness of Digital Sexuality Education for Adolescents

We conducted a multinational cross-sectional survey in Europe to explore parental attitudes toward the appropriate age for adolescents to receive sexuality education through an app interface. This was delivered via an online survey across Belgium (n = 479), the United Kingdom (n = 445), and Italy (n = 454). Parents from Belgium consistently accepted their children accessing digital material at the youngest ages, whereas Italian participants selected the oldest age groups. Most parents, however,endorsed a spiral curriculum, whereby topics are introduced sequentially throughout adolescents’ school careers. Thus, whilst on average participants were comfortable with adolescents having access to content on body anatomy younger ages (from 9–12 years to 12–15 years), they approved virtual content on relationships and sex at older school ages (from 12–15 years to 15–18 years). European ethnicity, liberal sociosexual attitudes, lower religiosity, and higher educational attainment were associated with parents approving adolescent exposure to digital sex education at younger ages. To our knowledge, this exploratory study is the first to quantitatively examine parental attitudes toward digital sex education curricula, as well as explore the parental characteristics that relate to these attitudes. This work should inform educators internationally on their future efforts to deploy virtual sexuality learning.

The effect of very preterm birth on the Five-Factor Model of personality traits: A meta-analysis of individual participant data

There is mixed evidence on personality differences among those born very preterm or with very low birth weight (VP/VLBW). This meta-analysis of individual participant data aimed to examine differences in personality traits between VP/VLBW ( n = 568) and term-born ( n = 1,060) adults, and the role of neonatal characteristics and neurosensory impairments in childhood, which have not been previously investigated. Six studies were identified from two research consortia and a systematic search of the literature (PubMed and Scopus); studies were eligible if they included VP/VLBW and term-born adults followed from birth and assessed personality using the Five-Factor Model. Risk of bias (Newcastle-Ottawa Scale) was generally not a concern apart from the use of self-reported measures and the rate of follow-up. Using a one-stage approach, VP/VLBW scored lower on extraversion and openness and higher on neuroticism and agreeableness than term-born participants after adjusting for sex and parental education. Within the VP/VLBW group, those with bronchopulmonary dysplasia scored lower on extraversion and higher on neuroticism, with similar findings after removing participants with neurosensory impairments. Altogether, these findings suggest that a proportion of the effect of VP/VLBW birth on personality may be attributed to neonatal morbidities and altered brain development, although other confounding factors require further research.

Adapting a human sexuality curriculum for students with disabilities

Background: The US Individuals with Disabilities Education Act requires that children with disabilities receive a free appropriate public education. However, it does not specifically include the subject of health education. Currently, 30 US states require public schools to teach sexuality education as a part of the health education curriculum, but 36 do not include youth with disabilities in their sexuality education requirements. Objective: The current situation is particularly concerning due to the higher rates of unplanned pregnancy, sexual abuse, and sexually transmitted infections experienced by teenagers with disabilities. Students from across several disability groups report societal barriers, physical barriers, and poor educational outcomes with respect to sexuality education. Results: This review article sought to investigate the current state of sexuality education for students with disabilities, as well as best practices to support the learning of sexuality education content. Conclusion: Focusing sexuality education classes on practical ways so as to develop relationships, promote self-advocacy and self-determination, and incorporate privacy messages, can support students with disabilities to make healthy choices.