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6. SEXUAL HEALTH
6.1 Sexual Health: Literature Reviews
The UK currently has the highest rates of teenage pregnancy in Europe, and the sexual health of young people in terms of sexually transmitted infections is rapidly declining (Select Committee on Health, 2003). An analysis of the National Child Development Study (NCDS) in the UK found that parents under the age of 22 were less likely to have performed well in school and to have completed their education with qualifications (Kiernan, 1995). However, research has shown that properly implemented, sexual education programmes can be effective in reducing risky behaviours and increasing positive behaviours (e.g., Mellanby, Phelps, Crichton & Tripp, 1995).
Kirby (2002) reviewed sex education programs and found a number of benefits of some of the more comprehensive programs. Effects of sexual and STD/HIV education programs on contraceptive use consistently find increase in contraceptive use. STD/HIV education that promotes abstinence, but also covers condoms or contraception do not increase sexual activity, can lead to some delay the initiation of sex, reduce its frequency and reduce the number of partners. Abstinence-only programmes have not shown reliable significant effects on delaying the onset of sexual intercourse, although methodological problems make it difficult to draw conclusions (Fullerton, 2004; Kirby, 2002). Two sexual education programmes, SHARE and APAUSE, are reviewed in Section 6.2.
Cowie, Boardman, Dawkins, & Jennifer (2004) report that good communication skills, self-esteem and an ability to understand and control feelings are all important in healthy sexual behaviours. Consequently, programmes which teach these elements are more likely to be successful. Sexual education literature (Cowie, et al., 2004; DfES, 2001; Fullerton, 2004; Kirby, 2002) has outlined the following characteristics of programmes which are associated with positive results:
Deliver and consistently reinforce clear prevention messages about abstinence, condom use and other forms of contraception
Include behavioural goals, teaching methods and materials that are appropriate to the age, sexual experience and culture of the students
Use theoretical models and methods shown to be effective in reducing other risky behaviours
Provide basic, accurate information about the risks of sexual activity and about ways to avoid intercourse or methods of protection against HIV/STI and pregnancy
Include activities that address social pressures related to sexual behaviours
Provide modelling and practice of communication. Include examples of, and rehearse (e.g., role play), communication, negotiation and refusal skills
Use teaching methods that involve students and have them personalize the information
Last a sufficient amount of time to cover a range of activities
If applicable, select teachers or peer leaders who support the programme
Involve pupils own assessment of their needs
6.2 Sexual Health: Selected Specific Programmes
The effectiveness of a Scottish sex education programme, SHARE, aimed at 13-15 year olds was reviewed by Abraham, Henderson & Der (2004). The programme aimed to decrease the incidence of unsafe sex by encouraging students to delay sexual intercourse until they were sure they were ready and to always use a condom. The programme also aimed to improve the quality of sexual and romantic relationships. The 10-lesson programme used videos, discussions and covered topics such as conception, contraception and condom use.
Students in the programme had significantly higher scores on the belief that there are alternatives to sexual intercourse in romantic/sexual relationships, intentions to resist unwanted sexual activities and intentions to discuss condoms with sexual partners. SHARE recipients were also less likely to agree that condom use would reduce sexual enjoyment. However, effect sizes were not significantly different from those of conventional sexual education programmes. A preliminary study on the effects of SHARE also showed that pupils in the intervention arm were more knowledgeable than those in the control arm (Wight, Henderson, Raab, Abraham, Buston, Scott & Hart, 2000; Wight, Raab, Henderson, Abraham, Buston, Hart & Scott, 2002).
APAUSE is a programme run in the UK aimed at improving sexual health in teenagers (Kay, Tripp, Mellanby, Hinde & Hull, 2002; Mellanby, Phelps, Crichton & Tripp, 1995). The programme emphasizes knowledge as well as elements of self-development. Subjects covered included puberty, reproduction, contraception and negotiation in relationships, including training in assertiveness skills. The emphasis on avoidance of risks was taught by involving students in role play and group work. While it used a programme team including a doctor teaching some lessons, training and support was also provided for the schools' own teachers (and for a few sessions, peer leaders) to deliver parts of the intervention.
Compared to control students not participating in the programme, students participating in APAUSE were:
more likely to have correct knowledge of sex, contraception and sexually transmitted diseases
less likely to report that intercourse should be part of relationships for those under age 16
more tolerant of the behaviour of others
less likely to be sexually active
those that were sexually active were less likely to have unprotected sex
more likely to approve of their "sex education"
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