Sexual Health Promotion Programs Research Articles

Sexual risk among Colombian adolescents: knowledge, attitudes, normative beliefs, perceived control, intention, and sexual behavior

BackgroundColombia has one of the highest rates of the human immunodeficiency virus (HIV) and pregnancies - both of which are influenced by lack of condom use -, among adolescent population in Latin America; however, the mechanisms underlying the inconsistent use of condoms in this population are poorly understood. This descriptive and cross-sectional study’s purpose was to examine sexual behavior and its precursors using the theory of planned behavior (TPB) and considering gender-based differences. Another objective was to study the mediating effect of intention in the relationship between behavior precursors and condom use based on the TPB.MethodsWe recruited 1100 adolescents aged between 14 and 19 years old (M = 15.94, SD = 1.30, 54.4% female) from Bogotá and Barranquilla, two of the cities with highest adolescent birth rates among adolescents in Colombia. Sociodemographic variables, knowledge on HIV and other sexually transmitted infections (STIs), HIV/AIDS-related attitudes, including attitudes toward the use of condoms, normative beliefs, perceived behavioral control, behavioral intention, and sexual behavior were assessed using self-reports. All analyses were run using SPSS v25. The indirect effect of intention to explain the relationship between precursors and the use of condoms during sexual intercourse was estimated using the PROCESS v3 macro.ResultsDescriptive analyses suggest a high risk of contracting sexually transmitted infections and unplanned pregnancies associated to inconsistent condom use, medium-low level of knowledge about sexual health, low normative beliefs regarding peers’ condom use, and a certain perceived difficulty for using condoms. Condoms are used 71% of the times they have sex, but only 22% of the participants use them consistently; girls use condoms more consistently than boys. Sexual risk characteristics differed significantly by gender. Mediation analyses indicated that condom use intention mediates the relationship between behavioral precursors and frequency of condom use, according to the TPB.ConclusionsFindings provide a better understanding of sexual risk and highlight important implications for the sexual and reproductive health of adolescents. There is a need of designing and implementing protocolized sexual health promotion programs in schools with the aim of reducing sexual risk behaviors in Colombian adolescents.

Sexual health interventions among early adolescents: an integrative review

Purpose Adolescent pregnancy and sexually transmitted infections including HIV are important public health issues in many countries around the world. The trend is escalating among adolescents of younger ages. Many programmes aim to prevent adolescent sexual risk behaviours associated with these health outcomes. The purpose of this paper is to describe and analyse methodological and substantive features of research on interventions to delay the initiation of sexual intercourse and prevent other sexual risk behaviours among early adolescents. Design/methodology/approach The review includes studies published between 2006 and 2017 that appear in Thai and international databases. Findings A total of 33 studies met specified review criteria. Of the studies reviewed, 14 used randomized control designs, 16 used quasi-experimental designs and three used a pre-test, post-test design. Sample sizes ranged from 64 to 4,776 subjects; nearly two-thirds of the studies (n = 22) included multiple follow-up surveys. The programmes evaluated in these studies can be grouped into three categories: abstinence-based sexuality education programmes (n = 12), comprehensive sexuality education programmes (n = 13) and youth development programmes designed for early adolescents (n = 10). In total, 22 programmes reviewed were effective in changing targeted adolescent psychosocial and/or behavioural outcomes. Research limitations/implications One of the limitations encountered in this study involved the search in library databases published only in Thai and English. Due to the limitation of searching library databases included in the review that reported the effects and differences among the included studies. Moreover, the search included publications consisted of heterogeneous designs and purpose with reports of different types of outcomes made it impossible to compare effect sizes. Practical implications The knowledge gained can be used to design and implement effective sexual health promotion programmes for early adolescents. Moreover, the findings can be applied as a guideline for health provider working in a schools, communities and adolescent health services. Recommendations for future studies are needed to consider methodological and substantive characteristics as well as the people who are involved in youth sexual health outcomes. Social implications It is necessary for government to develop a policy for encouraging parents to be aware and participate in solving the problems. Originality/value The review indicated that the positive effects of parental involvement and technology media as a programme material on the psychosocial and behavioural outcomes.

Sexual problems, marital intimacy and quality of sex life among married women: A study from an Islamic country

ABSTRACTIntroduction: Female sexual problems as a multifactorial phenomenon is influenced by numerous psychological, interpersonal, physiological and cultural determinants especially among Muslim women, where complaining about sexual issue is not easy. This study aimed to estimate the prevalence of sexual problems and assess its contributing factors.Methods: In 2016, applying a cross-sectional study, cluster, random sampling was employed to recruit 475 married women in the range of 20–35 years of age referred to the urban health centers in Tabriz, Iran. The self-administered Female Sexual Function Index, Sexual Quality of Life-Female and Marital Intimacy were completed by the respondents.Results: Considering the cut-off point of sexual dysfunction index, about 73.7% of the respondents were suffering from sexual problems. In addition, sexual problems, quality of sex life and marital intimacy differed mostly by sex-related behaviors and the characteristics of female sexual dysfunction were related to the quality of sex life and marital intimacy (p < 0.001).Conclusion: High prevalence of sexual problems among Iranian women is an alarming issue that threatens their quality of sex life, marital intimacy and consequently, mental health. Our findings will help family health policy-makers to plan and implement sexual health promotion programs aiming at improving sexual life among couples.

Features of successful sexual health promotion programs for young people: findings from a review of systematic reviews.

Young people have a high burden of sexual and reproductive health (SRH) problems, and it is important to reach this group through health promotion initiatives. We conducted a systematic review of reviews to identify successful elements of health promotion programs for improving SRH of young people. We identified and collated systematic reviews published in 2005-2015 which focused on young people (10-24 years), reported on SRH outcomes (pregnancy, sexually transmissible infections, condoms/contraceptive use, risky sexual behaviour, sexual healthcare access or intimate partner violence), and included primary studies predominantly conducted in high-income countries. This report focuses on features of successful SRH programs identified in the interpretation and discussion of included systematic reviews. We identified 66 systematic reviews, of which 37 reported on program features which were anecdotally or statistically associated with improved program effectiveness and success. Common features of effective interventions were: longer term or repeated implementation; multi-setting and multi-component; parental involvement; culturally/gender/age appropriate; and inclusion of skills-building. SO WHAT?: There is marked consistency of features improving SRH program effectiveness for young people despite the wide variation in interventions reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimising the design of SRH interventions for young people.

Preliminary Findings of a Technology-Delivered Sexual Health Promotion Program for Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study.

BackgroundHuman immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM.ObjectiveThe objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices.MethodsThe study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of care control condition), and completed a 10-minute user-satisfaction survey. Six months later, participants from both conditions returned to complete the follow-up assessment.ResultsA total of 226 participants were enrolled in the study, and 144 completed the 6-month follow-up. Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status (mean difference=−0.608, P=.02), have anal sex without a condom with a positive man who was on HIV medications (mean difference=−0.471, P=.055), have their partner pull out when bottoming with a partner of unknown HIV status (mean difference=−0.651, P=.03), and pull out when topping a partner of unknown status (mean difference=−0.644, P=.03). Real Talk participants were also significantly more likely to disagree with the statement “I will sometimes lie about my HIV status with people I am going to have sex with” (mean difference=−0.411, P=.04). In terms of attitudes toward HIV prevention, men in the control group were significantly more likely to agree that they had less concern about becoming HIV positive because of the availability of antiretroviral medications (mean difference=0.778, P=.03) and pre-exposure prophylaxis (PReP) (mean difference=0.658, P=.05). There were, however, no significant differences between Real Talk and control participants regarding actual condom use or other risk reduction strategies.ConclusionsOur findings suggest that Real Talk supports engagement on HIV prevention issues. The lack of behavior findings may relate to insufficient study power or the fact that a 2-hour, standalone intervention may be insufficient to motivate behavioral change. In conclusion, we argue that Real Talk’s modular format facilitates its utilization within a broader array of prevention activities and may contribute to higher PReP utilization in black MSM communities.

Using Qualitative Methods to Understand Perceptions of Risk and Condom Use in African American College Women: Implications for Sexual Health Promotion.

Young African American women are disproportionately affected with sexually transmitted infections (STIs) and unintentional pregnancies. Despite adequate knowledge, assertiveness, and negotiation skills, consistent condom use remains low. We sought to assess the role of pregnancy and STI risk perception in condom decision making among African American women. We conducted a phenomenological qualitative study. Utilizing a purposive sampling strategy, 100 African American women (18-24 years) were recruited from a historically Black college and university for an open discussion of condom use. Thirteen focus groups were conducted via a semistructured interview guide and analyzed with an inductive thematic approach. Uniformly women perceived pregnancy as a greater threat than STIs which appears to be maintained by (a) their sense of fertility, (b) self-care concept, and (c) experiences with condom failure. Thus, women were skeptical about using condoms as a form of contraception. Women perceived casual sex as having the greatest HIV/STI risk and emphasized the importance of assertiveness and self-respect to negotiate condom use. However, condom use in monogamous relationships is less likely due to (a) testing/knowing partner's status, (b) relationship trust, and (c) the use of hormonal contraception for pregnancy prevention. Perceived threat of infidelity increases condom use. The implications of these findings suggest sexual health promotion programs may focus on improving women's estimate of the effectiveness of condoms to prevent pregnancy and addressing women's reliance on testing for STI prevention.

Efficacy of Human Immunodeficiency Virus/Sexually Transmitted Infection Trial on Condom Use Among Heterosexual Men Patronizing Entertainment Establishments Who Engaged in Casual or Paid Sex in Singapore.

We assessed the efficacy of a multi-component sexual health promotion program on condom use and human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing among heterosexual men (HSM) patronizing entertainment establishments who engaged in casual or paid sex in Singapore. This was a quasi-experimental trial with a comparison group using cross-sectional surveys at baseline and 6 months postintervention. A locality patronized by local HSM was assigned the intervention, a comparable and distant area served as the comparison site. Using time location sampling, cross-sectional samples of these men were assessed on sexual behaviors using an anonymous questionnaire at baseline (n = 604) and 6 months postintervention (n = 360) in both groups. The coprimary outcomes were condom use at last vaginal and oral sex with casual partner respectively. Mixed effects Poisson regression model accounting for clustering by establishment was used to compute the adjusted prevalence ratio (aPR) of the outcomes postintervention. At postintervention, the intervention group was more likely than the comparison group to report condom use at last vaginal (aPR, 1.41; 95% confidence interval [CI], 1.05-1.89) and oral (aPR, 1.70; 95% CI. 1.11-2.61) sex, respectively, with casual partner. Similar findings were found for consistent condom use in the last 6 months for vaginal (aPR, 1.67; 95% CI, 1.13-2.48) and oral (aPR, 1.97; 95% CI, 1.16-3.32) sex, respectively, with casual partner. The HIV/STI testing was not significantly higher in the intervention than the comparison group (aPR, 1.43; 95% CI, 0.98-2.09). This trial was effective in promoting condom use with casual partners but not HIV/STI testing among HSM in Singapore.

Sexuality in the Internet Era: Expressions of Hispanic Adolescent and Young People

ABSTRACTCybersex is an important manifestation of sexuality among adolescents and young people. However, there is not enough information about this sexual expression, in particular, in cultures such as Latino culture, which has a traditional perception of human sexuality. This study evaluates online sexual activity among Hispanic adolescent and young people. For this purpose, 2,227 participants from Mexico and Spain (between 15 and 25 years old) completed the Internet Sex Screening Test. Our findings reveal that the most common use of cybersex is recreational, although men and women show risk for cybersex abuse. This is associated with pornography consumption, anal sex, sexual orientation, and gender for adolescent and young people. The more conservative and gendered tradition seems to modulate some aspects of cybersex in both groups, who have revealed some differences in their behaviors. Therefore, cybersex is also an expression of sexuality among Hispanic adolescent and young people and should be considered in sexual health promotion programs and policies.

C-SAFE: A Computer-Delivered Sexual Health Promotion Program for Latinas.

This article describes the development and evaluation of C-SAFE (Sexual Awareness for Everyone), a computer-delivered sexual health promotion program for Latinas. We first describe the process of adapting an evidence-based, group-level intervention into an individually administered computer-delivered program. We then present the methods and results of a randomized control trial with 321 Latinas in California and Florida to test C-SAFE's preliminary efficacy in reducing sexual health risk. We found no statistically significant differences between the two conditions at a six-month follow-up in terms of sexual behaviors or attitudes toward sexually transmitted infections and condoms, although C-SAFE women reported fewer days in the past month when their mental health was not good (p = .02). C-SAFE condition women also reported more satisfaction than control condition women in their assessment of information presentation (on a scale of 1 = poor and 5 = excellent; C-SAFE = 4.45 vs. control = 4.25, p = .053) and having learned something new (C-SAFE = 95.1% vs. control = 79.3%, χ2 < 0.001), with utility of content for Latinas approaching significance (C-SAFE = 4.50 vs. control = 4.31, p = .058). In conclusion we discuss the importance of teachable moments, matching of delivery modalities to implementation contexts, and possible directions for evidence-based sexual health promotion programs given the current sexual health landscape.

Evaluation of a Collegiate Women's Sexual Health Promotion and Education Program

Evaluation of a Collegiate Women's Sexual Health Promotion and Education Program

Evaluating the Sharing Stories youth theatre program: an interactive theatre and drama-based strategy for sexual health promotion among multicultural youth.

Issue addressed Rates of sexually transmissible infections among young people are high, and there is a need for innovative, youth-focused sexual health promotion programs. This study evaluated the effectiveness of the Sharing Stories youth theatre program, which uses interactive theatre and drama-based strategies to engage and educate multicultural youth on sexual health issues. The effectiveness of using drama-based evaluation methods is also discussed. Methods The youth theatre program participants were 18 multicultural youth from South East Asian, African and Middle Eastern backgrounds aged between 14 and 21 years. Four sexual health drama scenarios and a sexual health questionnaire were used to measure changes in knowledge and attitudes. Results Participants reported being confident talking to and supporting their friends with regards to safe sex messages, improved their sexual health knowledge and demonstrated a positive shift in their attitudes towards sexual health. Drama-based evaluation methods were effective in engaging multicultural youth and worked well across the cultures and age groups. Conclusions Theatre and drama-based sexual health promotion strategies are an effective method for up-skilling young people from multicultural backgrounds to be peer educators and good communicators of sexual health information. Drama-based evaluation methods are engaging for young people and an effective way of collecting data from culturally diverse youth. So what? This study recommends incorporating interactive and arts-based strategies into sexual health promotion programs for multicultural youth. It also provides guidance for health promotion practitioners evaluating an arts-based health promotion program using arts-based data collection methods.

Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents.

The aim is to evaluate the effects of the Competencias para adolescentes con una sexualidad saludable (COMPAS) program and compare them with an evidence-based program ( ¡Cuídate!) and a control group (CG). Eighteen public high schools were randomly assigned to one of the three experimental conditions. Initially, 1,563 Spanish adolescents between 14 and 16 years of age participated, and 24 months after their implementation, 635 of them completed a survey. Self-report measures collected data on sexual behavior, knowledge, attitudes, intention, sexual risk perception, and perceived norm. Compared to the CG, COMPAS increased the level of knowledge about sexually transmitted infections and improved the attitudes toward people living with human immunodeficiency virus at the 2-year follow-up. Neither intervention had a long-term impact on behavioral variables. Results suggest that COMPAS has a comparable impact to the other intervention on the variables predicting consistent condom use. Reinforcing the messages and skills that have the greatest impact on condom use and adding booster sessions following program completion as strategies to maintain long-term effects are necessary.

Risk and Protective Factors Affecting Sexual Risk Behavior Among School-Aged Adolescents in Fiji, Kiribati, Samoa, and Vanuatu.

There are limited studies on the prevalence and correlates of sexual risk behavior among adolescents in Pacific Island countries. In order to inform public sexual and reproductive health interventions, the aim of this study was to assess the prevalence and correlates of various sexual risk behaviors among in-school adolescents in 4 Pacific Island countries using data from the Global School-Based Health Survey. In a cross-sectional study, 6792 school-going adolescents (49.7% boys and 50.3% girls; 13-16 years old) from Fiji, Kiribati, Samoa, and Vanuatu were surveyed with a self-administered questionnaire. Overall, 18.9% of students reported to ever had sex (ranging from 12.9% in Vanuatu to 57.5% in Samoa), and of those sexually active, 38.0% had an early sexual debut (<14 years), 38.1% had 2 or more sexual partners during their lifetime, 39.5% had not used a condom at last sex, 50.9% had not used birth control at last sex, and 77.8% engaged in sexually risky behavior using a composite measure. Multivariate logistic regression found that male sex, older age, tobacco use, alcohol use, mental distress, having no close friends, and truancy were associated with several of 5 or all 5 sexual risk behaviors. Sexual and reproductive health promotion programs are indicated to address the high risk of sexually transmitted infection, HIV, and pregnancy in this adolescent population.

Switching on After Nine: Black gay-identified men's perceptions of sexual identities and partnerships in South African towns

ABSTRACTThere is considerable diversity, fluidity and complexity in the expressions of sexuality and gender among men who have sex with men (MSM). Some non-gay identified MSM are known colloquially by gay-identified men in Mpumalanga, Province, South Africa, as ‘After-Nines’ because they do not identify as gay and present as straight during the day but also have sex with other men at night. Based on, key informant interviews and focus group discussions in two districts in Mpumalanga, we explored Black gay-identified men's perceptions of and relationships with After-Nine men, focusing on sexual and gender identities and their social consequences. Gay-identified men expressed ambivalence about their After-Nine partners, desiring them for their masculinity, yet often feeling dissatisfied and exploited in their relationships with them. The exchange of sex for commodities, especially alcohol, was common. Gay men's characterisation of After-Nines as men who ignore them during the day but have sex with them at night highlights the diversity of how same-sex practicing men perceive themselves and their sexual partners. Sexual health promotion programmes targeting ‘MSM’ must understand this diversity to effectively support the community in developing strategies for reaching and engaging different groups of gay and non-gay identified men.

Inuit women's stories of strength: informing Inuit community-based HIV and STI prevention and sexual health promotion programming

BackgroundThere is a dearth of literature to guide the development of community-based HIV and sexually transmitted infection (STI) prevention and sexual health promotion programs within Inuit communities.ObjectiveThe aim of this study was to create a dialogue with Inuit women to address the lack of information available to inform programming to improve the sexual health of Inuit women, their families, and their communities in the Canadian Arctic.DesignThis study used Indigenous methodologies and methods by drawing from Inuit Qaujimajatuqangit and postcolonial research theory in a framework of Two-Eyed Seeing, and using storytelling sessions to gather data. Community-based participatory research principles informed the design of the study, ensuring participants were involved in all stages of the project. Nine storytelling sessions took place with 21 Inuit women aged 18–61 years. Storytelling sessions were audio recorded and transcribed verbatim, and Atlas.ti aided in the organization of the data for collaborative thematic analysis within three participatory analysis sessions with 13 of the participating women.ResultsFrom the storytelling and analysis sessions, five major themes emerged: (a) the way it used to be, (b) change, (c) family, (d) intimate relationships and (e) holistic strategies. Participating women emphasized that HIV and STI prevention and sexual health promotion programming needs to take a holistic, community-wide, family-focused and youth-centred approach within their communities.ConclusionParticipants identified several important determinants of sexual health and shared ideas for innovative approaches they believe will work as prevention efforts within their communities. This article specifically focuses on key characteristics of programming aimed at STI and HIV prevention and sexual health promotion that were identified throughout participants’ stories. This study has provided a narrative to complement the epidemiological data that highlight the urgent need for prevention programming.

Community Influences on Married Women’s Safer Sex Negotiation Attitudes in Bangladesh: A Multilevel Analysis

The influence of disadvantaged or deprived community on individuals' health risk-behaviors is increasingly being documented in a growing body of literature. However, little is known about the effects of community characteristics on women's sexual attitudes and behaviors. To examine community effects on married women's safer sex negotiation attitudes, we analyzed cross-sectional data from the 2011 Bangladesh Demographic and Health Surveys on a sample of 15,134 married women in 600 communities. We estimated two multilevel logistic regression models. Model 1, which included only individual-level variables, showed that women's autonomy/empowerment, age, and HIV knowledge had significant associations with their safer sex negotiation attitudes. We did not find any socioeconomic status gradient in safer sex negotiation attitudes at the individual level. Adding community-level variables in Model 2 significantly improved the fit of the model. Strikingly, we found that higher community-level poverty was associated with greater positive safer sex negotiation attitudes. Prevailing gender norms and overall women's empowerment in the community also had significant effects. While research on community influences calls for focusing on disadvantaged communities, our research highlights the importance of not underestimating the challenges that married women in economically privileged communities may face in negotiating safer sex. To have sufficient and equitable impact on married women's sexual and reproductive health, sexual and reproductive health promotion policies and programs need to be directed to women in wealthier communities as well.

Early Sexual Debut and Associated Factors among In-school Adolescents in Six Caribbean Countries.

This report examines early sexual debut (< age 15 years) among 15-year old in-school adolescents in six Caribbean countries. The total sample included 9948 school children aged primarily 13-16 years from nationally representative samples from six Caribbean countries. Univariate and multivariate analyses were conducted to assess the relationship between early sexual debut and substance use, unintentional injuries and violence, mental distress, physical activity, protective factors and socio-economic status variables. Approximately one-fourth of the sample (26.9%) had experienced sexual debut before age 15 years, 37.2% among boys and 16.9% among girls. In multivariate logistic regression analysis, it was found that male gender, substance use (smoking and alcohol use), having been in a physical fight in the past 12 months, sedentary behaviour, truancy and lack of parental or guardian attachment were associated with early sexual debut. This study found a high prevalence of early sexual debut. The risk factors identified were consistent with the Problem Behaviour Theory, which can be incorporated into broader sexual health promotion programmes.

Successes in sexual health communications development, programmatic implementation and evaluation in the Torres Strait region 2006 to 2012

Objective:To evaluate the Indigenous sexual health promotion program in the Torres Strait 2006–2012 that culminated in an education‐entertainment radio drama, Kasa Por Yarn (KPY). Methods:A mixed methods approach applied to unpublished program documents and program‐derived peer‐reviewed publications was utilised. Results:Early initiatives established a strong partnership with Torres Strait Islander stakeholders. Significant community engagement throughout ensured a positive process. Telephone survey data (n=100, TSI, 15–24 years) found: 95% had heard of KPY and 80% listened to 2 or more episodes (reach); 86% recalled storylines/characters (recall); and 54% talked about KPY to family/friends (resonance). There was improvement in sexual health knowledge scores (p<0.00) in the 15–19‐year‐old Torres Strait Islander population between 2007 and 2012. The 2012 15–24‐year‐old population exposed to KPY had higher sexual health knowledge scores compared with those unexposed (p=0.02). Conclusions:This is an uncommon comprehensive evaluation of population‐based sexual health communications strategies delivered over years in a remote Australian setting. The findings are encouraging but demonstrate that positive shifts take time and are incremental. Implications:In addition to clinical strategies, strategic and sustained investment in sexual health promotion expertise that leads community partnership and program development is required to reduce youth risk and prevent HIV/AIDS in remote populations.

A 1-year follow-up evaluation of a sexual-health education program for Spanish adolescents compared with a well-established program.

Competencies for adolescents with a healthy sexuality (COMPAS) is the only school-based sexual health promotion program in Spain that has been found to be as effective as an evidence-based intervention (¡Cuídate!) in the short term. This study's aim was to compare data from a 12-month follow-up evaluation on the effects of COMPAS on adolescents' sexual risks (knowledge, attitudes, perceived norms, sexual risk perception and intentions) and sexual behaviours (age of the first sex, consistent condom use and multiple partners) with an evidence-based intervention (¡Cuídate!) and a control group. Eighteen schools from five provinces of Spain were randomly assigned to one of three conditions: COMPAS, ¡Cuídate! and a control group. The adolescents (N = 1563; 34% attrition) were evaluated 1 week before and after the program, and 1 year post-program implementation. We found that the COMPAS program was as effective as ¡Cuídate!, the evidence-based program, in increasing the adolescents' knowledge about sexually transmitted infections and in fostering favourable attitudes about condom use and people living with HIV/AIDS. COMPAS was more effective than ¡Cuídate! in increasing the adolescents' perceptions of their peer's consistent condom use and the age delay of their first vaginal intercourse. However, it was less effective in maintaining the adolescents' intentions to use condoms and in delaying the age of their first oral sex experience. COMPAS was as effective as ¡Cuídate! in reducing sexual risk among adolescents.

Exploring the role of gender norms in nutrition and sexual health promotion in a piloted school-based intervention: The Philadelphia Ujima™ experience

Perceptions of masculinity and femininity influence behaviors and can be identified in young children and adolescents (Brannon, 2004). Thus, adolescents’ engagement in health risk or promoting behaviors is influenced by perceptions of masculinity and femininity and the differences in expectations, norms and responsibilities for girls and boys (WHO, 2007). Girls and boys have different needs, and gender-based interventions that consider similarities as well as differences are needed. A gender-based nutrition and sexual health promotion program was developed and piloted by the Philadelphia Ujima Coalition in a high school setting. To explore the gender differences in adolescents’ perceptions of the influence of gender norms on weight, nutrition, physical activity, and sexual health and the implication of these differences in future gender-integrated health promotion programming for youth, a content analysis of student and facilitator debriefing forms were implemented for the participating schools. The content analysis was used to identify central themes, concepts gained, and overall impact of the intervention sessions. Overall, gender norms influence healthy eating practices and activity through influencing perceptions of body type in adolescents. Gender norms also influence sexual activity and decision making through influencing perceptions of beauty, masculinity, femininity, pressures and popular concepts related to sexual activity. Thus, interventions that address gender may more effectively promote health and wellness in adolescents.