Sex Education Curriculum Research Articles

Impact of a sex education programme in terms of knowledge, attitudes and sexual behaviour among adolescents in Asturias (Spain).

Sex education in schools is an adolescents' right, and can have health benefits, such as improved knowledge or increased condom use. In Asturias, a secondary school programme called Neither Ogres Nor Princesses educates pupils for four years with trained teaching staff and external workshops. This study examined whether this programme (a) improved adolescents' sexuality knowledge, attitudes and skills, and (b) increased condoms use. A quasi-experimental survey was conducted, with comparison arm, with a pre-test in the first year of secondary school (12- to 13-year-olds), and two post-tests: after the intervention (15- to 16-year-olds) and two years later (17- to 18-year-olds). A questionnaire with socio-demographic, knowledge, attitude, skill and sexual behaviour variables was used. The impact was evaluated with 'difference-indifferences' analyses. There was a greater increase of knowledge in the intervention arm in both post-tests, and an increase in skills in the first post-test. Girls in the intervention arm reported less practices with penetration and greater condom use the first time, this also among boys. However, the impact was limited in time. Interventions that aim to increase sex education in curricula with quality and fidelity are a priority to guarantee children's rights and their health.

Managing Sex Education Controversy Deep in the Heart of Texas: A Case Study of the North East Independent School District (NEISD)

Comprehensive sexuality education (CSE), one of the key evidence-based strategies in our programmatic toolbox to address adolescent pregnancy and birth rates, remains a politically-charged issue countrywide. Though there is some funding available at the federal level, there are no national policies mandating the provision of sex education; as such, most decision-making occurs at the state or even the local level. Consequently, the provision of sex education and the quality and comprehensiveness of curricula used to do so are highly variable across the country, and are heavily influenced by the level of support or resistance in communities. This paper analyzes the experience of institutionalizing an evidence-based sex education in a large suburban school district in San Antonio, Texas, a socially conservative context. Understanding the politics of sex education is key to developing effective policies and strategies to ensure quality sex education programs are provided in public schools. However, there are no published papers documenting specific experiences with resistance to sex education in local communities in the USA. Given this, the strategies employed by opponents and the response by district officials can be informative for other school settings in the USA and around the world. Abbreviations: AFLA: Adolescent Family Life Act; CHAMPSS: Choosing And Maintaining effective Programs for Sex education in Schools Model; CSE: Comprehensive sexuality education; DTL/RTL: Draw the Line/Respect the Line; HSAE: Human Sexuality and Abstinence Education, the middle school sex education curriculum in NEISD prior to 2008; NEISD: North East Independent School District; SAFA: San Antonio Family Association; SHAC: School health advisory council; STI: Sexually transmitted infection; TEC: Texas Education Code; TPIA: Texas Public Information Act; USA: United States of America; UTHSC: University of Texas Health Science Center

Smartphones or computers for online sex education? A contraception information seeking model for Chinese college students

ABSTRACT China has a conservative sex culture and does not include contraception as part of its sex education curriculum. As a result, young people tend to search for sex information online. How college students seek contraception information, by what means, and the factors affecting their information seeking are poorly understood. To better understand these issues, this study compares the Planned Risk Information-Seeking Model (PRISM) with an expanded model that incorporates device preference and differentiates between perceived severity and vulnerability. The expanded model was found to fit and explain the data better than PRISM. Results indicate that perceived vulnerability to unwanted pregnancy is related to information seeking while perceived severity is not. While perceived severity substantially influenced the affective response to unwanted pregnancy, the affective response was not related to information-seeking behaviour. Channel belief on the other hand proved to be a significant predictor of seeking contraception information online. Our findings also suggest that Chinese college students prefer using smartphones to seeking contraceptive information online. We discuss the implications of using this for providing online sex education on demand to young people.

Comprehensive Sexuality Education (CSE) Curriculum in 10 East and Southern African Countries and HIV Prevalence among the Youth

Introduction: Young people easily fall prey to risky and dangerous practices such as drug abuse, unprotected sexual intercourse etc. due to lack of knowledge about the implications of these practices. Comprehensive Sexuality Education (CSE) was developed to solve this problem by educating young minds so that they can avoid risky sexual behaviours and live healthy lives. Methods: The ten countries in East and Southern Africa selected were those whose CSE curriculum had been reviewed by the United Nations Educational, Scientific and Cultural Organization (UNESCO) and United Nations Population Fund (UNFPA). We developed a scoring protocol to be able to specifically group a curriculum into three categories (A, B and C) based on its weakness. The data for HIV was based on the UNAIDS estimation. Data was analyzed with the Microsoft Excel Version 2010. Results: Sixty (60%) percent of the countries involved had CSE curriculum with minor to moderate concerns, while the remaining 40% had moderate to serious gaps. Botswana and Lesotho had high prevalence of HIV among both young males and females. Majority of the countries with CSE curriculum having minor to moderate gaps had high prevalence of HIV among males within age 15-24 years. In the female category, one of the countries using CSE curriculum with moderate to serious gaps had an average HIV prevalence higher than the average of all the 10 countries involved in the study. Conclusion: It is recommended that factors responsible for high HIV prevalence as identified in this study be addressed. This might help reduce the prevalence of HIV.

Barriers and facilitators to uptake of condoms among Filipinx transgender women and cisgender men who have sex with men: A situated socio-ecological perspective

ABSTRACTTransgender women (TW) and cisgender men who have sex with men (cis-MSM) are disproportionately impacted by the national HIV crisis in the Philippines, where the HIV incidence has, in large part, been attributed to condomless sex. This study sought to qualitatively examine the socio-ecological factors that contribute to low condom uptake among Filipinx TW and cis-MSM communities in Manila. Between July and August 2017, we conducted semi-structured qualitative interviews with 30 TW and cis-MSM participants (n = 23 and 7, respectively). We identified structural factors described by TW and cis-MSM, and noted that they varied per situation and context of: (a) friends (e.g. as condom promoters and educators), (b) schools (e.g. lack of sex education and HIV curriculum), (c) health care facilities (e.g. availability, educational programmes, and HIV testing requirement), (d) stores (e.g. placement of condoms, distance to store, and cost), and (e) church (e.g. prohibition of condom distribution programmes, and unsupportiveness). Condom-related stigma as a social factor was pervasively present across all situation or context. Our findings support the need for multilevel condom promotion interventions that are tailored per situation or context. Future research is needed to identify factors that can be leveraged for condom promotion strategies within diverse situations.

Abstinence versus harm reduction approaches to sexual health education: views of key stakeholders in Saudi Arabia

ABSTRACT This study elicited views of key stakeholders on the need for adolescent sex education and the appropriate model to adopt in Saudi Arabia. Semi-structured interviews were conducted in Riyadh, Saudi Arabia, with 28 stakeholders: policy-makers; social and healthcare providers; teachers and school staff; and religious scholars. Interviews were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes. Stakeholders saw the need to provide sex education. Opinions fell across a spectrum of model preference: abstinence-only or harm reduction. The conceptualisation of harm incorporated social risks. Silences and avoidance marked the boundaries between what was permitted and what was prohibited. In determining the form of any sex education curriculum in Saudi Arabia, caution is needed in assuming the ready transferability of Western-based models of sex education since in Saudi Arabia harm is conceptualised as damaging personal reputation, social structure and physical health. Religious doctrine and scientific evidence are perceived as non-conflicting sources for formulating a culturally sensitive programme. Local idiom characterised by indirectness and ambiguity offers challenges and possibilities for conveying sensitive messages. Findings from this study can be useful for communities with similar religious beliefs or social traditions intending to formulate an acceptable sex education programme.

Starting at the Roots: Using Human-Centered Design to Develop a Sex and Pregnancy Education Curriculum for Adolescents in Kenya

The rate of adolescent pregnancy worldwide remains unacceptably high. Sixteen million adolescent girls between the ages of 15 and 19, and 2 million under the age of 15 become pregnant each year. Ninety-five percent of these births occur in low-income countries, with four times the rate of adolescent pregnancy in the poorest regions of the world compared to high-income countries. There has been a shift globally to focus on the sexual and reproductive health needs of adolescents, including adolescent pregnancy. With increased awareness of this need has come a renewed call for evidence-based provision of adolescentfocused sexual and reproductive health (ASRH) services, as well as programs to prevent pregnancy in this age group.
 “Human-centered design” methodology is emerging as an innovative, feasible, and effective participatory approach to program design and implementation in health care. The standard Human Centered Design format includes 5 steps: (1) Understand people’s experiences, challenges, and priorities; (2) Use existing knowledge and new research to define and clarify the problem; (3) Prompt creative thinking to design many different solutions; (4) Build and workshop prototypes of ideas to quickly learn how they can be improved; and (5) Deliver solutions that meet the needs of the target population.
 Through this process, design team members identified a need to “help adolescents by removing the uncertainty that surrounds information on pregnancy and treatment choices”. To meet this need, we utilized participatory program development to build an adolescent-specific sex and pregnancy education program at Moi Teaching and Referral Hospital in Eldoret, Kenya.

Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content

BackgroundTransgender and non-binary (TNB) youth face disparities in sexual health risks compared with cisgender peers. Comprehensive sex education programs have the potential to result in delayed sexual debut, increased condom and contraceptive use, and reduced sexual risk-taking; however, little research has explored the specific sex education needs of TNB youth. AimTo use insights from TNB youth, parents of TNB youth, and healthcare affiliates to understand deficits in sex education experienced by TNB youth, and to elicit recommended content for a comprehensive and trans-inclusive sex education curriculum. MethodsWe conducted 21 in-depth interviews with non-minor TNB youth (n = 11) and with parents (n = 5) and healthcare affiliates (n = 5) of TNB youth recruited from Seattle Children’s Gender Clinic and local TNB community listerv readerships. Data was analyzed using theoretical thematic analysis. OutcomesParticipants described prior sex education experiences and content needs of TNB youth. ResultsParticipants described 5 key sources where TNB youth received sexual health information: school curricula, medical practitioners, peers, romantic partners, and online media. Inapplicability of school curricula and variable interactions with medical practitioners led youth to favor the latter sources. 8 content areas were recommended as important in sex education for TNB youth: puberty-related gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, consent and relationships, sex and desire, sexually transmitted infection prevention, fertility and contraception, and healthcare access. Clinical ImplicationsDependence on potentially inaccurate sex education sources leaves TNB youth vulnerable to negative outcomes, including sexually transmitted infections, pregnancy, unsanitary/unsafe sex toy use, and shame about their body or sexual desires. Strengths & LimitationsStrengths included capturing perspectives of an underserved population using open-ended interview questions, which allowed topics of greatest importance to participants to arise organically. Limitations included a sample size of 21 participants, and racial and geographic homogeneity of youth and parent participants. Only 1 author identifies as TNB. One-on-one interview methods may have omitted participants who would otherwise have been willing to share their perspective in a more impersonal format. ConclusionThis study demonstrates that TNB youth have unique sex education needs that are not well covered in most sexual health curricula. Recommended content for this population includes standard sex education topics that require trans-inclusive framing (eg, contraception), topics specific to TNB youth (eg, gender-affirming medical interventions), and topics absent from standard curricula that warrant universal teaching (eg, information on consent as it relates to sex acts aside from penile-vaginal sex).Haley SG, Tordoff DM, Kantor AZ, et al. Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content. J Sex Med 2019;16:1834–1848.

Intersectional Interventions into Queer and Trans Liberation: Youth Resistance Against Right-Wing Populism Through Fashion Hacking

Ontario, Canada’s most populous province, recently elected a socially conservative Premier who repealed the progressive sexual education curriculum that teaches about queer and trans relationships and bodies. This election occurs within the broader context of neoliberal capitalism and settler homonationalism that oppresses the most vulnerable queer and trans citizens. The paper examines how queer and trans youth in Ontario leverage fashion hacking to intervene into the current context that reinforces heteronormativity, white supremacy, patriarchy and ableism. We draw upon a series of participatory workshops with queer and trans youth, most of whom identify as Black, Indigenous, people of color, disabled and/or working class, in two cities in Ontario. During these workshops, the youth deconstructed and reconstructed existing fashion media, clothing and fashion shows to express their experiences, identities and desired futures. We use an intersectional queer world-making framework to analyze the artifacts that the participants created as well as the interviews with them following the workshops. Our findings demonstrate that fashion hacking enables the most vulnerable queer and trans youth to resist and temporarily exist outside of right-wing ideologies, neoliberal capitalism and settler homonationalism. We argue that engaging queer and trans youth in fashion hacking fosters community and skills that can be mobilized beyond these settings to affirm their intersectional identities and resist oppressive movements, policies, discourses and systems.

Design and Implementation of the Sex and Gender Specific Health Multimedia Case-Based Learning Modules

This case presents the design and implementation process of multimedia case-based learning modules for a Sex and Gender Specific Health (SGSH) education curriculum. The learning modules were designed to advance understanding of sex and gender differences, increase awareness of gender-specific health issues, and improve clinical knowledge of sex and gender evidence-based medicine. This paper describes the three phases of the project. In the first phase of planning, five diseases actively examined in the medical field were chosen to address sex and gender differences, and the instructional development team specifically adapted a case-based learning framework to provide more authentic and interprofessional learning opportunities for health science trainees. In the second phase, learning modules were structured with multiple revisions incorporating multimedia case-based learning strategies, such as case movie trailers, expert guides, and case solutions. In the third phase, a number of decisions regarding module interface, case videos, and server management were made. Throughout the phases, the instructional designers resolved a number of issues, such as communication with subject matter experts (SMEs), consistency of learning materials, copyright, case movie production tool, closed captioning, server configuration, and dissemination. The design process and challenges described in this paper would be useful for others developing similar instructional materials in a healthcare environment.

Framing the Debate: The Status of US Sex Education Policy and the Dual Narratives of Abstinence-Only Versus Comprehensive Sex Education Policy

Like abortion, contraception, and guns, the debate over sex education policy in the United States is divisive and seems intractable. While ample policy research and analysis have focused on the former issues, less attention has been paid to the latter. This study begins to fill this gap through a thematic analysis of sixteen interviews conducted with a range of health policy and sex education experts. The study’s goal is to explore conceptions of US sex education policy—contested issues, evidence use, and the narratives that influence policy formulation—in order to advance the discussion and ultimately improve sex education curricula. The author identified four common themes across these interviews: ultimate objectives, teaching approaches, views on teen sex, and limitations of evidence. These lend important insight into how experts and advocates frame the sex education debate, revealing stark areas of contestation as well as potential common ground. Such insights can inform deliberative inquiry to improve community decision making and guide collaboration among scientists, health professionals, advocates, and policymakers toward collective policy formulation.

Audit tool for assessing child sexual abuse prevention content in school policy and curriculum

Although audit and feedback has not been well-used in social research, it is a useful method by which to answer research questions concerned with the notion of “best practice”, for example, whether a policy or program meets a required standard or benchmark. This paper draws on educational research conducted for a 5-year nation-wide public inquiry: the Australian Royal Commission into Institutional Child Sexual Abuse. The research comprised an audit of the strength and comprehensiveness of child sexual abuse prevention education policy and curriculum in 32 Australian school systems. The paper describes the development of the audit tool including its conceptual background, step-by-step process for identifying and synthesising evidence to generate the audit criteria and descriptors, and an explanation of how the tool was used. It also presents a succinct protocol for the research method, and critical commentary on the strengths and weaknesses of audit and feedback for social research.

Good sex matters: Pleasure as a driver of online sex education for young people

Background There are few documented examples of online sex education platforms that make an impact on young people’s sexual health and wellbeing, yet research shows that new media has enormous potential to be harnessed in this way. The same is true for a pleasure-positive approach to sex education curricula and programmes. This research provides empirical evidence from the Love Matters' websites in Mexico, Kenya, Nigeria, Egypt, and India to highlight the prevalence and importance of talking about pleasure-related topics with young people. Methodology Love Matters is an online sex education platform targeting seven countries and attracting 30 million website visits in 2018. We analysed data through Google Analytics to explore the difference between sex education-focused content and pleasure-focused content and how young people engage with different types of sexual health information on the Love Matters platforms. Results Pleasure-focused content is 1.5 times more popular than sex education-focused content across all platforms. However, education-focused content attracts more organic traffic, suggesting young people purposefully search for sexual health information online. Users generally spend longer on the site engaging with sex education-focused content than pleasure-focused content. Conclusion This research provides empirical evidence from five countries in the Global South to support the notion that young people are actively looking for sexual health information that covers the full scope of sexual experience and pleasure, including – but not limited to – the reduction of health risks. This paper furthers the efforts to adopt a pleasure-positive approach to both online and offline sex education interventions.

Feasibility and preliminary efficacy of a parent-mediated sexual education curriculum for youth with autism spectrum disorders.

Youth with autism spectrum disorder can face social-communication challenges related to sexuality, dating, and friendships. The purpose of this study was to assess the feasibility, acceptability, and preliminary efficacy of the Supporting Teens with Autism on Relationships program. In total, 84 youth with autism spectrum disorder aged 9 to 18 and their parents participated in this study; two groups received the Supporting Teens with Autism on Relationships program (interventionist-led parent group vs parent self-guided), while an attentional control group received a substance abuse prevention program that included instruction in problem-solving and social skills. Feasibility and acceptability of the Supporting Teens with Autism on Relationships program was high overall. The Supporting Teens with Autism on Relationships program was effective in increasing parent and youth knowledge of sexuality, while the attentional control was not. There was preliminary support for improvement in parenting efficacy related to discussing sexuality with their children. Gains were seen among completers regardless of whether the parent received support from a facilitator. Implications and future directions are discussed.

I wish I had known sooner: stratified reproduction as a consequence of disparities in infertility awareness, diagnosis, and management

ABSTRACTInfertility affects one in eight couples in the US, yet many couples report feeling blindsided by the diagnosis. Lack of awareness about infertility can lead to missed opportunities for prevention, delays in diagnosis, and greater emotional distress when a diagnosis is made. This paper reports on the results of interviews with 54 American women experiencing infertility, conducted via phone between 2013 and 2015 with participants from across the country. The interviews explored whether differences in infertility awareness were related to patient trajectories for time to diagnosis and initiation of treatment. Interview data indicated a significant lack of informational resources for these women concerned about fertility. Older participants expressed regret that they were not educated about age-related fertility decline, while patients with infertility secondary to medical conditions often reported delays in diagnosis and lack of counseling about fertility implications. Participants’ data also revealed that infertility was consistently absent from sex education curricula and that minorities may be more likely to experience delayed diagnosis of infertility and lack of appropriate fertility counseling. These findings suggest that the inequitable distribution of health information and education about reproduction is one mechanism by which experiences of infertility can become racially stratified.

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.

The global school-based student health survey as a tool to guide adolescent health interventions in rural Guatemala

BackgroundAdolescents from rural areas in low-middle income countries face increasing physical and mental health challenges that are not well characterized or addressed due to resource limitations. We used the Global School-based Student Health Survey (GSHS) to describe adolescent health behaviors, and to inform prioritization of health promotion efforts in a resource-limited, rural, agricultural region in Guatemala.MethodsIn July 2015, a group of volunteers administered the GSHS to students from seven schools in four communities in the southwest Trifinio region of Guatemala. Prevalence and predictors of nutritional, mental, and sexual health behaviors were calculated from survey responses, and summarized in region- and school-level reports. Facilitated discussion of survey results with local leadership in January 2016 led to the identification of priorities for school-based health interventions.ResultsFive hundred fifty-four out of 620 (87%) students aged 12–18 years completed the survey. Prevalence of unhealthy dietary behaviors and body size was high: 61% reported high current soft drink intake, 18% were overweight, and 31% were moderate-severely stunted. In multivariable regression models, being food insecure was marginally associated with being underweight/stunted (OR = 1.95, 95%CI = 0.95–4.0). Boys were more likely than girls to report being sexually active (25% versus 6.4%, p < 0.001). Local school leadership identified food insecurity and sexual education as priority areas for intervention, and made plans for providing breakfast in schools, sexual education curriculum development and teacher training, and continued adolescent health reporting and evaluation.ConclusionsThe GSHS is a rapid, cost-efficient, useful tool for surveillance of adolescent health behaviors in vulnerable, resource-limited populations. Results of a locally-administered GSHS informed school-based interventions to decrease food insecurity, early sexual initiation, and teen pregnancy in a rural Guatemalan region.

What does the teaching and learning of sexuality education in South African schools reveal about counter-normative sexualities?

ABSTRACTUsing the interlocking concepts of power, knowledge and discourse, this article focuses on how counter normative sexualities are discursively constructed in the sexuality education classroom and with what effects. Drawing on in-depth interviews with teachers and classroom observation, the evidence highlights the presence of specific discourses about the teaching and learning of sexuality diversity. First, while many teachers argued for the inclusion of counter-normative sexualities, in their teaching and responses they privileged heterosexuality as legitimate and natural and same-sex sexualities as deviant and Other. Second, teachers’ discourses construct queer youth not only as innocent and childlike but also as hypersexual and rebellious – requiring discipline and intervention. These constructions link closely to discourses of pity and tolerance, or blame when counter-normative sexualities were expressed. Finally, despite heterosexuality being privileged in the classroom, teachers’ and pupils’ questions about gender and sexuality diversity suggest the need for a more defined and inclusive curriculum sexuality education curriculum. Findings justify concern about how counter-normative sexualities are addressed in the sexuality education classroom and advocate for improvement in teaching and learning about counter-normative sexualities in South African secondary education.

Learners’ perspectives on Life Orientation sexuality education in South Africa

ABSTRACTThis article examines the views of male and female learners regarding how Life Orientation (LO) sexuality education is taught at their schools. Learners in the study were selected from five former ‘Black’ schools in the Eastern and Western Cape Provinces of South Africa. Focus groups were used to identify what learners could recall about their LO sexuality education classes. The strong trend in the data speaks to how LO sexuality education implies a gendered, heteronormative and moralistic approach to youth sexuality which silences and negates same sex relationships and girls’ accounts of sexuality. Although LO sexuality curricula are, as crafted on paper, often sophisticated learning programmes, participants point to a disjuncture between the official LO sexuality education curriculum and how LO sexuality education is taught in the studied schools. The paper concludes with some specific recommendations for teachers to promote a non-judgemental approach to sexuality education that challenges heteronormativity and other gendered injustices as part of the teaching of LO sexuality education.

Designing a Framework for Sexual Education Curriculum on the Basis of Islamic Training Foundations

Designing a Framework for Sexual Education Curriculum on the Basis of Islamic Training Foundations