Category:

Barriers to Sexual Health STI Services in Low Resource Countries

8/19/2016

A research review in the July 2016 issue of the Journal of Adolescent Health reports that "youth lacked knowledge about sexually transmitted infections STIs and services. In addition, youth experienced barriers related to service availability and a lack of integration of services. The most reported barriers were related to acceptability of services. Youth reported avoiding services or having confidentiality concerns based on provider demographics and some behaviors. Finally, experiences of shame and stigma were common barriers to seeking care.Improving uptake may require efforts to address clinic systems and provider attitudes, including confidentiality issues. Moreover, addressing barriers to STI services may require addressing cultural norms related to adolescent sexuality. Read more>>
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Renewed Interest in Mandatory Sex Ed, Health Ed: US and England

8/4/2015

(An item from the ISHN Member information service) Several news stories and commentaries were noted this week about the need to review mandatory sex education and health education curricula. In the US, several former surgeon-generals have called for a renewal of sex education, the lack of attention from school districts is noted, a reduced teen pregnancy rate is reported, the US Congress considers making health education part of the core curriculum and Hawaii has dropped its abstinence only approach to sex ed. In the UK, an all party committee has recommended mandatory health education and sex education and a response is expected from the new government by the end of June 2015. Read more>>

Renewed Interest in Sexuality Education: US, Germany & Netherlands

8/4/2015

(An item from the ISHN Member information service) Renewed interest in sexuality education is noted in several items this week. Two articles in Issue #2, 2015 of American Journal of Sexuality Education are part of this trend, with reports on the contents of ten leading programs being used in the USA and the nature of public policies in Germany and the Netherlands. The US analysis "indicate that the majority of programs provide education on sexually transmitted diseases and unplanned pregnancy, abstinence, and contraceptive use. Far fewer address components related to healthy dating relationships, including interpersonal violence and an understanding of gender roles. No programs address nonheterosexual orientations." The european analysis suggests that a more integrative, life span approach is emerging. Read more>>

Parent-Teen Communications about Sex Affect Behaviour in Netherlands

4/7/2015

(From the ISHN Member information service) An article in Issue #3, 2015 of the Journal of Sex research reports on a study in the Netherlands that examined the impact of parent-teen communications on sexual health behaviours. The researchers found that more frequent communications affected some but not all adolescent behaviours. "A nationally representative sample of parent–adolescent dyads (N = 2,965; mean adolescent age = 13.8 years) in the Netherlands was employed to examine the frequency of parent–adolescent sexual communication and its association with adolescent sexual behaviors (defined as sexual initiation, condom use, and contraceptive pill use). Nine communication topics in the areas of anatomy, relationships and rights, and protection and contraception were examined. In all, 75%of parents reported having discussed at least one topic multiple times with their adolescents. Romantic relationships were discussed most frequently. Hierarchical logistic regression analyses indicated that parent–adolescent sexual communication on protection and contraception was positively associated with adolescent sexual initiation and contraceptive pill use but not condom use. This may reflect that adolescents, when they become sexually active, are more likely to discuss sexuality with their parents. Findings are interpreted within the context of Dutch culture, which is generally accepting of adolescent sexuality and characterized by open sexual communication." Read more>>

Parent Programs Have Effect on Communications with Teens

4/7/2015

(From the ISHN Member information service) A systematic review and meta-analyses of parent-based adolescent sexual health interventions reports that they have an effect on communication outcomes. The article appears in Issue #1, 2015 of Perspectives on Sexual and Reproductive Health. "A systematic search of databases for the period 1998–2013 identified 28 published trials of U.S. parent-based interventions to examine theory use, setting, reach, delivery mode, dose and effects on parent–child communication. Established coding schemes were used to assess use of theory and describe methods employed to achieve behavioral change; intervention effects were explored in meta-analyses. Most interventions were conducted with minority parents in group sessions or via self-paced activities; interventions averaged seven hours, and most used theory extensively. Meta-analyses found improvements in sexual health communication: Analysis of 11 controlled trials indicated a medium effect on increasing communication (Cohen's d, 0.5), and analysis of nine trials found a large effect on increasing parental comfort with communication (0.7); effects were positive regardless of delivery mode or intervention dose. Intervention participants were 68% more likely than controls to report increased communication and 75% more likely to report increased comfort. These findings point to gaps in the range of programs examined in published trials—for example, interventions for parents of sexual minority youth, programs for custodial grandparents and faith-based services. Yet they provide support for the effectiveness of parent-based interventions in improving communication. Innovative delivery approaches could extend programs’ reach, and further research on sexual health outcomes would facilitate the meta-analysis of intervention effectiveness in improving adolescent sexual health behaviors." Read more>>

School-based Health Clinics Promote Sexual Health

3/30/2015

(From the ISHN Member information service) An article in the March 2015 issue of Journal of Adolescent Health reports that school-based health centresd can effectively promote sexual health among their clients. The researchers report that "Reproductive health indicators among students at four urban high schools in a single building with an SHC in 2009 were compared with students in a school without an SHC, using a quasi-experimental research design (N = 2,076 students, 1,365 from SHC and 711 from comparison school). The SHC provided comprehensive reproductive health education and services, including on-site provision of hormonal contraception. Students in the SHC were more likely to report receipt of health care provider counseling and classroom education about reproductive health and a willingness to use an SHC for reproductive health services. Use of hormonal contraception measured at various time points (first sex, last sex, and ever used) was greater among students in the SHC. Most 10th–12th graders using contraception in the SHC reported receiving contraception through the SHC. Comparing students in the nonintervention school to SHC nonusers to SHC users, we found stepwise increases in receipt of education and provider counseling, willingness to use the SHC, and contraceptive use. Read More>>

Constraints on Schools in Health Promotion: Sex Education Especially

3/4/2015

(From the ISHN Member information service) One of the themes being discussed in the ISHN International Discussion Group on Integration of Health/Social Programs Within School Systems focuses on the political, normative and practical constraints on schools in doing this work. A special issue of Health Education (#1, 2015) illustrates these constraints as several articles discuss the nature and delivery of sexual education in several countries. The editorial introducing this special issue makes note of these powerful differences imposed by the national, state or local contexts. "The papers highlight contrasts, tensions, potentials and barriers embedded in the ways sexuality education is delivered to children and young people internationally. Examples are drawn from Russia, Wales, China and the USA; they identify historical and structural issues related to the implementation of comprehensive progressive approaches. Topics discussed include the importance of appropriate content, theoretical/conceptual frameworks, modes of delivery, timing, attitudes from key stakeholders and the need for comprehensive evaluation of innovative approaches to the delivery of sexual education." . These constraints are especially true for sex education but other, less sensitive issues can also be contentious. These include compulsory vaccinations, the use of alcohol, gender equity, child abuse and neglect, and more. Even actions taken to promote huealthier school lunches can be politicized (eg the recent debates in the US) or cause controversy when letters are sent to parents asking them to prepare healthier lunches or that their child is overweight.

Rights-based Approaches to Sex Education: Context & Language Matter

2/14/2015

(From the ISHN Member information service) An analysis of three school-based initiatives in AIDS/HIV education based on a rights-based approach suggests that we are left with some unfinished business. The article prompting this discussion appears in Issue #1, 2015 of Sex Education: Sexuality, Society and Learning. The authors suggest that "Over the past 25 years, there has been growing investment in concepts of rights in the areas of HIV prevention, care and treatment, including HIV- and AIDS-related education delivered in schools. Despite this increasing commitment to the notion of rights, few efforts appear to have been made to understand the varying conceptions of rights that underpin different kinds of initiatives. Engaging with a multi-disciplinary body of literature on the issue of rights, and through a focus on three rights-informed HIV- and AIDS-related initiatives, this paper seeks to address this gap in the current literature. In so doing, it also examines a central tension within human rights discourse, namely between the construal of rights as shared and universally applicable to all human beings, while being created in and limited by the location in which they were elaborated, as well as by the language used to formulate them. More explicit engagement with the diversity of approaches made possible through a commitment to human rights may facilitate forms of HIV- and AIDS-related education that are more meaningful to young people." Or, in our view, a rights-based approach may create political and social barriers to the expansion and improvement of sex education in schools where the understandings about human rights differ from those articulated by experts and UN agencies. Read more>>

Sexuality Education: Emerging Trends in Evidence and Practice

1/30/2015

(From the ISHN Member information service) Several articles in Supplement Issue #1, 2014 of Journal of Adolescent Health report on an international conference on sexual and reproductive healthhealth, One article reviews emerging trends in evidence & practice in sexuality education. "Drawing from these documents, reviews and meta-analyses of program evaluations, and situation analyses, this article summarizes the elements, effectiveness, quality, and country-level coverage of CSE. Throughout, it highlights the matter of a gender and rights perspective in CSE. It presents the policy and evidence-based rationales for emphasizing gender, power, and rights within programs—including citing an analysis finding that such an approach has a greater likelihood of reducing rates of sexually transmitted infections and unintended pregnancy—and notes a recent shift toward this approach. It discusses the logic of an “empowerment approach to CSE” that seeks to empower young people—especially girls and other marginalized young people—to see themselves and others as equal members in their relationships, able to protect their own health, and as individuals capable of engaging as active participants in society." Read more>>

"Hooking Up" Definitions and Related Norms

12/26/2013

(An item from the ISHN Member information service) An article in Issue #8, 2013 of the Journal of Sex Research reports on a small study of the perceptions of college students of hooking up. "A random sample (N = 1,468) of undergraduates (56.4% female) completed a Web-based survey composed of measures of drinking and sexual behavior. Open-ended definitions of hooking up were content-coded and analyzed using a mixture model to explore discrete definitions of hooking up among college students. Findings indicated three clusters of student definitions of hooking up: Cluster 1 had the broadest definition, referring to sex in general, not specific sexual acts, and to making out. Cluster 2 placed an emphasis on interpersonal and social aspects. Cluster 3 defined hooking up as sex with notable references to specific sexual acts. Results further indicated that hooking up behavior and normative perceptions differentiated these three groups of definitions. Clinical implications regarding the inconsistency of student definitions of hooking up and how they may impact negative consequences associated with hooking up are discussed. Read more>>

Systematic Review of Interventions Low Income Countries to Reduce Teen Childbearing

12/25/2013

(An item from the ISHN Member information service) A systematic review of over 700 studies of programs to reduce adolescent child bearing in low and middle income countries, published in issue #4, 2013 of Studies in Family Planning, reports that "A total of 737 studies published between 2000 and 2011 were reviewed; 19 were identified as meeting eligibility criteria. Studies were included that: evaluated program effects on adolescents and young people, either as the primary target population or as a subset of a broader target group; evaluated an intervention intended to reduce adolescent fertility or generate improvements on a related outcome; and reported childbearing-related outcomes. Evidence indicates that a variety of interventions may be successful at reducing fertility, including school-based programs, health counseling, and cash transfers. An overview of evaluation efforts to date is provided, and potential best practices are highlighted." Read more>>

Reframing Sexual Health

7/18/2013

(An item from the ISHN Member information service) Several articles in a Supplementary Issue of Public Health Reports provide a comprehensive reframing of sexual health promotion, moving away from disease-focused, preventive strategies towards a holistic and health promoting approach. One article in the issue presents an excellent ecological analysis and then presents the principles that could underlie ecology-based actions. These principles include contextualizing the issues, using systemic thinking, focusing on relationships, acknowledging sexuality and emphasizing wellness. Another article reports on how the state or Oregon is shifting from a teen pregnancy strategy to a sexual health promotion approach. Two articles present indicators for monitoring progress in the US and Canada. Two articles discuss the impact of socio-economic status on teen pregnancy and early initiation of sexual activity. Read more>>

Youth Sexual Knowledge, Attitudes, Beliefs in Africa

4/10/2013

(An item from ISHN Member information service) Several articles in Issue #4 Supplement 2, 2012 of African Journal for Physical, Health Education, recreation & Dance describe the knowledge, attitudes, beliefs and perceptions of young people in different parts of Africa. One article notes the paucity of information about STD's among students in the Eastern Cape Province of South Africa. Perceptions about condoms in Limpopo Province of SA was the fovus of the second article. A third article on students in that same province examined student awareness of the consequences of pregnancy. Read more>

Using New Digital Media to Improve Adolescent Sexual Health: Review

12/21/2012

(An item from ISHN Member information service) A systematic review reported in the December 2012 Issue of the Journal of Adolescent Health reports that ten studies out of 142 studies of new digital media interventions were of sufficient quality to be included (which says something already). The authors report that "Eight described Web-based interventions, one used mobile phones, and one was conducted on an SNS. Two studies significantly delayed initiation of sex, and one was successful in encouraging users of an SNS to remove sex references from their public profile. Seven interventions significantly influenced psychosocial outcomes such as condom self-efficacy and abstinence attitudes, but at times the results were in directions unexpected by the study authors. Six studies increased knowledge of HIV, sexually transmitted infections, or pregnancy. This area of research is emerging and rapidly changing. More data from controlled studies with longer (>1 year) follow-up and measurement of behavioral outcomes will provide a more robust evidence base." Read more.

Teen Sexual Attitudes and Behaviours in China

12/7/2012

(An item from ISHN Member information service) An article in Issue #6, 2012 of Health & Social Care in the Community reports on changing sexual attitudes and behaviours among teens in China. The authors report that "A literature review was conducted between 2000 and 2010, using both English (Medline, CINAHL, PsycINFO, ASSIA) and Chinese language databases (China National Knowledge Infrastructure, Wanfang database). Thirty-six studies were included and reviewed. It was found that young people reported poor sexual knowledge, especially in relation to reproductive matters and sexually transmitted infections. The media, such as television, magazines and the Internet, were seen as their main sources of information on sex. Despite the frequently reported liberal attitudes to sexual behaviour, only a small number of young people had already lost their virginity or been involved in pregnancies. Young men were more likely than young women to report having had sex, while respondents at vocational high schools were less likely to remain virgins than those at common/key high schools. Although the prevalence of sexual intercourse among Chinese teenagers was still lower than that reported in studies conducted in most western countries, the findings do reflect some changes in sexual values and behaviour of young people within the country. They also suggest the need to develop more comprehensive sex education programmes". Read more.

The Little Red Schoolbook: Sexual Revolution & My Teaching

11/27/2012

(An item from ISHN Member information service) An article in Issue #5, 2012 of Sex Education recalls the important role played by a little handbook called The Little red Schoolbook, which was published in the 1960's and formed part of the sexual revolution underway at that time. The authors note that "After the book's publication in the UK, opponents were successful in pressing for its publisher's prosecution. The ensuing trial led to its withdrawal and its bowdlerisation. It is argued that the work played some part in changing social and sexual mores and sex education practice in the UK, being, in effect, the Urtext of the ‘harm reduction approach’ in sexual health education. The article caught my eye because in the early 1970's, I used the little book with my class of troubled students in a middle class high school in Montreal. The book included practical advice on sex for teens (my students used to enjoy watching me get embarrassed by its frankness) but also included invaluable survival advice for students who were barely tolerated in mainstream education at that time and who got little support at home. We used the book for class discussions and it was a great resource. Read more.

Including fertility messages in school sex education

11/27/2012

(An item from ISHN Member information service) An article in Issue #5, 2012 of Sex Education states that "sex education in England (and almost all other countries) has mostly focused on ‘damage limitation’, emphasising only the dangerous inevitability of pregnancy and childbirth after unprotected sex and the hazards of sexually transmitted diseases. This approach is largely based on restrictive notions of teenage sexuality, characterising teenagers as hypersexual beings for whom sexual drives continuously threaten to produce unwanted babies unless preventive action is taken. Thde authors go on to suggest that " Yet, recent demographic evidence shows that educated women in Europe continue to delay first childbirth for a number of reasons. At the same time they are also subject to seductive and deceptive media messages about the possibilities of conception at late reproductive age through reporting on ‘older’ celebrity mothers, and the role that reproductive technologies play in conquering infertility. In the light of these demographic trends, and the misleading hidden curriculum, this paper contends that discourses of damage limitation are no longer appropriate in sex education. Instead, if educated women are to gain full reproductive autonomy then new, more balanced conceptualisations of sex education that also incorporate appropriate messages about the finite nature of the reproductive lifespan are needed". Read more.

Sex Ed Programs Decline in US

6/28/2012

(An item taken from the daily/weekly/monthly ISHN Member information service) An analysis of the School Health profiles in 45 US states reveals that the commitment to effective school sexual health education may be waning. CDC analyzed 2008 and 2010 School Health Profiles data for public secondary schools in 45 states. This report summarizes the results of those analyses, which indicated that in 2010, compared with 2008, the percentage of secondary schools teaching 11 topics on HIV, other STD, and pregnancy prevention in a required course in grades 6, 7, or 8 was significantly lower in 11 states and significantly higher in none; the percentage of secondary schools teaching eight topics in a required course in grades 9, 10, 11, or 12 was significantly lower in one state and significantly higher in two states; and the percentage of secondary schools teaching three condom-related topics in a required course in grades 9, 10, 11, or 12 was significantly lower in eight states and significantly higher in three states. Read more...

Two CDC Sex Ed Reviews focus on key risk behaviours/outcomes

6/7/2012

The effectiveness of sexual health education is often debated in regard to whether such can delay the initiation or experimentation of sexual activity. As well, often the media reports the results of studies that report on first sexual intercourse as if this experimentation was ongoing and part of the ongoing behaviour of teens. Two reviews of sexual health education done for the CDC Community Guide review system help to correct those impressions by reporting on the impact of programs on several specific, key behaviours or outcomes. These include current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies. Read more..