Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (The JACK trial): a cluster randomised trial

BACKGROUND: The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex. METHODS: This cluster-randomised trial with process and economic evaluations tested a school-based intervention entitled If I Were Jack versus standard RSE (control) for students (aged 14-15 years) in UK schools. Schools were randomly allocated (1:1) and masked to allocation at baseline. The primary outcome was self-reported avoidance of unprotected sex (sexual abstinence or use of reliable contraception at last sex) after 12-14-months. We analysed the data using intention-to-treat mixed effects regression models. FINDINGS: Of 803 schools assessed for eligibility, 263 schools were invited by letter, of which 66 schools agreed to be randomly assigned, of which 62 schools completed follow-up. The trial was done between Feb 1, 2018, and March 6, 2020. 8216 students participated at baseline in 2018; 6561 (79·85%) provided 12-14 months follow-up. There was no significant difference in the primary outcome of avoidance of unprotected sex: 2648 (86·62) of 3057 in the intervention group avoided unprotected sex versus 2768 (86·41%) of 3203 in the control group (adjusted odds ratio [aOR] 0·85 [95% CI 0·58-1·26], p=0·42). Exploratory post-hoc analysis of the two components of the primary outcome showed that significantly more intervention students used reliable contraception at last sex compared with control students and there was no significant difference between the groups for sexual abstinence. No adverse events were reported. INTERPRETATION: The intervention had a null effect on the primary outcome of preventing unprotected sex (increasing sexual abstinence or use of reliable contraception) in the whole student population. However, the results showed significant increases in use of reliable contraceptives for sexually active students. Engaging all young people early through RSE is important so that as they become sexually active, rates of unprotected sex are reduced. FUNDING: National Institute for Health Research

School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT

BACKGROUND: The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. OBJECTIVES: To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. DESIGN: A cluster randomised trial, incorporating health economics and process evaluations. SETTING: Sixty-six schools across the four nations of the UK. PARTICIPANTS: Students aged 13-14 years. INTERVENTION: A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. MAIN OUTCOME MEASURES: Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. RESULTS: The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). LIMITATIONS: The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). CONCLUSIONS: We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. FUTURE WORK: Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. TRIAL REGISTRATION: This trial is registered as ISRCTN10751359. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information

SMARTVOX - A Web-Based Distributed Media Player as Notation Tool For Choral Practices

International audienceThe present paper describes the features and implementation of SmartVox an application designed to help vocal ensembles learn and perform polyphonic music.Technically, SmartVox is a distributed web application that delivers audiovisual scores through the performer’s mobile devices. From a singer’s point of view, this setup allows for the synergy between visual and acoustic stimuli, which facilitates the interpretive and performative processes, particularly in polyphonic passages. It also enables spatial separation of the performers (cori spezzati), and speeds up the learning process of unfamiliar musical materials (e.g. microtonal tuning, texts in a foreign language).The ubiquity of smartphones makes such a distributed system affordable and allows the use of SmartVox in multiple contexts, from professional ensembles to pedagogical and recreational practices

Masculinities and sexual and reproductive health and rights: a global research priority setting exercise

Engaging men and boys in sexual and reproductive health and rights (SRHR), and doing so in a way that challenges harmful masculinities, is neglected but is vital for improving the SRHR of both women and men. To address this gap, the World Health Organization commissioned this global research priority setting exercise on ‘Masculinities and SRHR’. The exercise adapted the Child Health and Nutrition Research Initiative priority setting methodology by combining it with qualitative participatory methods. Informed also by feminist and decolonial perspectives, over 200 diverse stakeholders from 60 countries across all regions participated. The exercise forges a collaborative research agenda emphasising four key areas: gender-transformative approaches to men’s/boys’ engagement in SRHR; applied research to deliver services addressing diversity in SRHR among men and women and to generate gender-equality; research designs to support participation of target audiences and reach to policymakers; and research addressing the priorities of those in lower and middle-income countries.<br/

Promoting social cohesion and peacebuilding through investment in early childhood development programs

Millions of children worldwide will not reach their potential in terms of education and development. However, it is widely known that investment in high-quality early childhood development (ECD) pays rich dividends throughout the lifespan of an individual, impacting their own lives, families, and communities in a positive way. Further evidence points to the importance of ECD in delivering the United Nations’ Sustainable Development Goals (SDGs). The multi-sectoral, integrated provision of ECD services is ideally placed to facilitate holistic positive change and enhance social cohesion in some of the most inequitable and vulnerable contexts. The LINKS project brings together an international network of researchers, who work in strategic partnership with United Nations Children’s Fund (UNICEF) and Early Years the Organisation for Young Children in Northern Ireland to support the development, implementation, and evaluation of ECD programs in low- and middle-income countries impacted by divisions and conflict. The project is designed to contribute to the international evidence base on ECD for social cohesion and sustaining peace to make a real difference in the lives of children, caregivers, and communities

UPDATED PROTOCOL: Universal school‐based programmes for improving social and emotional outcomes in children aged 3–11 years: an evidence and gap map

Abstract This is the protocol for an evidence and gap map. The objective of this EGM is to identify and map all primary studies (including randomised and cluster randomised trials) and systematic reviews on universal, school‐based social and emotional learning programmes for young children (3–11 years) to create a live, searchable, and publicly available evidence and gap map