Early Predictors of Sexual Behavior: Implications for Young Adolescents and Their Parents

The study provides empirical evidence of the independent contribution of nonsexual romantic relationships in the seventh grade to the onset of sexual intercourse by the ninth grade for both males and females. In addition, it shows that among females, seventh graders in serious relationships with older teenagers—uniquely defined as those two or more years older—have an increased likelihood of sex in the ninth grade. Finally, the study demonstrates that seventh graders of both genders who have had serious romantic relationships were already significantly different in the sixth grade from those who have not: They had peers who were more accepting of sexual activity, they had experienced more unwanted sexual advances and situations that could lead to sex (i.e., where parental monitoring is limited) and, for females, they had undergone earlier menarche. The findings suggest important aspects of the pathways to early sexual intercourse that have not typically been addressed in either school or parentbased sex education programs

Practice Notes: Strategies in Health Education

Objective: The purpose of the Be Red Cross Ready Community Outreach Project (BRCR) was to train health education students to provide high-quality, theory-driven community preparedness education in a community on the U.S.-Mexico border. This aim was achieved through an innovative partnership between a community organization, a federal research center, and a university. The ultimate goal of the project was to increase disaster and emergency preparation to protect, promote, and preserve the health of the public

Relationships and Context as a Means for Improving Disease Prevention and Sexual Health Messages

In many ways, the HIV epidemic changed the discourse about sex in the United States and worldwide (Ehrhardt, 1992; Everett, 1986) and continues to drive approaches to sex education. After a period of rapid growth in the late 1980s (approximately 150,000 new infections per year), by the late 1990s, HIV rates in the United States slowed to some 40,000 new infections annually (Centers for Disease Control and Prevention [CDC], 2001), and new HIV infections continue to hover around that number. The first successful examples of behavior change that resulted in decreased HIV transmission emerged from communities of men who have sex with men (MSM; Coates, Richter, & Caceres, 2008). However, although the past decade has been marked by longer survival rates, and significant reductions in new infections in some population groups, MSM remain the largest HIV transmission category in the United States and the only one associated with an increasing number of HIV/AIDS diagnoses (CDC, 2008). In 2010, some 61% of newly diagnosed HIV infections were attributed to male-to-male sexual contact (CDC, 2012). Over this same period, school-based sex education programs have varied widely in focus and content (Kirby, 2007; Santelli et al., 2006). The political landscape from the 1990s through 2008 yielded the largest investment of federal funds in abstinence-only-until-marriage programs. In 2009, however, funds awarded in the Teen Pregnancy Prevention initiative were primarily for comprehensive sex education programs, with some funds for abstinence education programs appropriated in the 2010 health reform legislation (Boonstra, 2010), despite their limited effectiveness. Currently, state standards for school curricula vary widely, with 18 states requiring instruction on the importance of engaging in sexual activity only within marriage, whereas 19 others require instruction on condoms and contraception (Guttmacher Institute, 2011). Within this highly politicized context, questions remain as to how to stem the tide of disease and teen pregnancy, while addressing the needs of both youth and adults, heterosexual and non-heterosexual, as they seek healthy sexual relationships and protection from harm over their life course. It may be that our very efforts to point lasers at disease, with abstinence (Guttmacher Institute, 2011) or condoms (Warner, Gallo, & Macaluso, 2012) as a central focus, rather than at the context in which sexual behavior occurs, has limited our vision to find messages that more effectively lead to the kinds of outcomes we seek. This issue of Health Education & Behavior carries six articles focused on sexuality within the context of various types of relationships, providing important implications for sex educators and others addressing risks related to sexual activity. The articles highlight several specific population groups and the unique aspects of their sexual relationships and risk-taking. Together they suggest the limitations of prevention messages that focus solely on sexually transmitted infections and HIV, that promote either abstinence or condom use as their nearly universal emphasis, and that do not take relationships and other social contexts into account

Program “Miracle Grow”: Program Staff and Evaluators Joining Forces to Power-Up Program Potential

Like all living things, health education programs grow, change, and mature. If left unattended, however, they can fade, fail, or fall apart. Evaluation can strengthen a program, particularly when it is rooted in a strong relationship among experienced, knowledgeable, and motivated teams of planners, implementers, clients, and evaluators. Evaluation can be the key to helping your program realize its full potential and, even, if threatened, flourish. When program and evaluation staff work together on pilot/demonstration projects, new program roll-outs, or established interventions, the results are like “Miracle Grow” to your programs

Three Decades of Research: The Case for Comprehensive Sex Education

Purpose School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education. Methods Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving 39. In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence reflecting the full range of topic areas. Eighty articles constituted the final review. Results Outcomes include an appreciation of sexual diversity, dating and intimate partner violence prevention, development of healthy relationships, prevention of child sex abuse, improved social/emotional learning, and increased media literacy. Substantial evidence supports sex education beginning in elementary school, which is scaffolded and of longer duration, as well as LGBTQ–inclusive education across the school curriculum and a social justice approach to healthy sexuality. Conclusions A review of the literature of the past three decades provides strong support for comprehensive sex education across a range of topics and grade levels. Results provide evidence for the effectiveness of approaches that address a broad definition of sexual health and take positive, affirming, inclusive approaches to human sexuality. Findings strengthen justification for the widespread adoption of the National Sex Education Standards

Impact of the Choosing the Best Program in Communities Committed to Abstinence Education

States vary in standards for sex education, some requiring an emphasis on abstinence. Schools seek to identify curricula that reflect local community values and meet state standards. Choosing the Best (CTB), a classroom-based abstinence education curriculum, has been implemented in 75 Georgia school districts since 1995. CTB Inc., sought to determine if this popular program had an impact on abstinence attitudes, intentions, and behavior. Six Georgia public schools (1,143 ninth graders) participated in the study in 2009-2010. Four randomly assigned schools received the CTB curriculum, taught by trained CTB staff. Two control schools received their usual textbook-based abstinence lessons. Surveys were conducted at the beginning and end of 9th grade, and the beginning of 10th grade. Data demonstrated significant impact of CTB at the end of 9th grade on commitment to abstinence, proabstinence beliefs and attitudes, intentions to maintain abstinence, and lower onset of sexual intercourse, and at the beginning of 10th grade on proabstinence attitudes. In two communities that sought an abstinence education approach, CTB had a short-term impact on abstinence attitudes, commitment, and behaviors, and a longer term impact on abstinence attitudes only

Three Decades of Research: The Case for Comprehensive Sex Education

Purpose School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education. Methods Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving 39. In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence reflecting the full range of topic areas. Eighty articles constituted the final review. Results Outcomes include the appreciation of sexual diversity, dating and intimate partner violence prevention, development of healthy relationships, prevention of child sex abuse, improved social/emotional learning, and increased media literacy. Substantial evidence supports sex education beginning in elementary school, which is scaffolded and of longer duration, as well as LGBTQ–inclusive education across the school curriculum and a social justice approach to healthy sexuality. Conclusions A review of the literature of the past three decades provides strong support for comprehensive sex education across a range of topics and grade levels. Results provide evidence for the effectiveness of approaches that address a broad definition of sexual health and take positive, affirming, inclusive approaches to human sexuality. Findings strengthen justification for the widespread adoption of the National Sex Education Standards

Practice Notes: Strategies in Health Education Program, “Full Service”: Talking About Fighting Prostate Cancer—in the Barber Shop!

The purpose of this project is to promote prostate cancer screening, education about disease risk and the importance of early detection, and survivorship among African American males who frequent African American–owned barber shops

Family Preservation and Healthy Outcomes for Pregnant and Parenting Teens in Foster Care: The Inwood House Theory of Change

Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data from a demonstration project which took place in the residential program of a New York City foster care agency, with an approach that addressed the developmental needs of adolescents and the practical needs of parenting. Inwood House’s experience provided insights into the role of a theory of change focused on the development of young people, not only their protection, to improve the health and well-being of young mothers and their babies, and reduce intergenerational placement in care. Insights and data derived from this project, which reflect the challenges of research in foster care, are discussed

A retrospective analysis of sex education messages received by LGB youth

Using focus groups, this qualitative study asked thirty-five gay, lesbian, and bisexual (LGB) young adults to reflect on messages they received about sex and sexuality around the time they first had sex. Focus groups were conducted, recorded, transcribed, and analyzed. Through thematic analysis, the authors identified two messaging sources identified by participants: (1) formal education sources (i.e., school and parents), and (2) informal education sources (e.g., internet, peers). Formal sources often included messages perpetuating heteronormative assumptions, emphasizing abstinence, pregnancy and HIV/STI prevention, or silence as a form of messaging. Informal sources consisted of LGB-specific information. These findings suggest informal sources may provide more useful and relevant information to LGB youth, further suggesting a need for more inclusive and comprehensive sexuality education