Reducing the risk: impact of a new curriculum on sexual risk-taking.

Reducing the Risk is a new sexuality education curriculum, based on social learning theory, social inoculation theory and cognitive-behavioral theory and employing explicit norms against unprotected sexual intercourse. In a quasi-experimental evaluation, this curriculum was implemented at 13 California high schools; 758 high school students assigned to treatment and control groups were surveyed before their exposure to the curriculum, immediately afterwards, six months later, and 18 months later. Among all participants, the program significantly increased participants' knowledge and parent-child communication about abstinence and contraception. Among students who had not initiated intercourse prior to the pretest, the curriculum significantly reduced the likelihood that they would have had intercourse by 18 months later. Reducing the Risk did not significantly affect frequency of sexual intercourse or use of birth control among sexually experienced students. Among all lower risk youths and among all students who had not initiated intercourse prior to their exposure to the curriculum, the curriculum appears to have significantly reduced unprotected intercourse, either by delaying the onset of intercourse, either by delaying the onset of intercourse or by increasing the use of contraceptives. Among the students not sexually active before participation in the program, effects seem to have extended across a variety of subgroups, including both whites and Latinos and lower risk and higher risk youths, but were particularly strong among lower risk youths and females.     

Keeping middle school students abstinent: outcomes of a primary prevention intervention.

PURPOSE: (a) To test the longer-term (6-12 month) effect of a school-based intervention designed to delay the onset of sexual intercourse on continuation of abstinence, (b) to compare the effect of the intervention when delivered by different providers, and (c) to describe the factors that influence students' transition from abstinence to sexual activity. METHODS: This study was a nonrandomized control trial with one control and three intervention groups. The setting was health education classes in urban, predominantly ethnic minority schools. The participants were middle school students (N = 1352; mean age, 13.1 years) in five schools. Of participants, 50% were African American, 20% white, 16% Hispanic, and 14% other. Youth were assigned to one of four groups. The control group consisted of the regular school health curriculum and teacher. All three intervention groups received the Rochester AIDS Prevention Project curriculum, but implemented by different types of instructors, including ethnically diverse male-female pairs of adult professional educators; male-female pairs of extensively trained high school peer educators; and school district health teachers. A confidential questionnaire administered preintervention and at long-term follow-up (mean, 44 weeks) measured demographics, risk behaviors, and sexual intercourse history. RESULTS: At preintervention, 27% of girls and 62% of boys reported sexual intercourse experience. At follow-up, 19% and 32%, respectively, of the previously abstinent girls and boys had "transitioned" to sexual activity. Increasing age (p <.01, females; p <.001, males), lower socioeconomic status (p <.0001), and higher general risk behaviors (p <.0001) best predicted the transition. Logistic regression indicated that the intervention was effective for peer-taught males (p =.02) and regular teacher-taught males (p =.001) and females (p =.05). CONCLUSIONS: Successful abstinence maintenance was only possible among those subjects who were not already sexually experienced at study enrollment. Baseline scores regarding intercourse and general life risks already evident by seventh grade suggest that urban, school-based primary prevention interventions must occur before adolescence. Early adolescence interventions need to include both abstinence and safer sex messages.     

Daily participation in sports and students' sexual activity

CONTEXT: Previous studies suggest that student athletes may be less likely than nonathletes to engage in sexual behavior. However, few have explored sexual risk behavior among athletes in early adolescence. METHODS: In 2005, a sample of 10,487 students in 26 Los Angeles public middle and high schools completed a self‐administered survey that asked about their demographic characteristics, sports participation, sexual behaviors and expectations, and parental relationships. Chi‐square analyses compared reported levels of daily participation in sports, experience with intercourse, experience with oral sex and condom use at last intercourse by selected characteristics. Predictors of sexual experience and condom use were assessed in multivariate logistic regression analyses. RESULTS: One‐third of students reported daily participation in sports. This group had higher odds of ever having had intercourse and ever having had oral sex than their peers who did not play a sport daily (odds ratios, 1.2 and 1.1, respectively). The increases in risk were greater for middle school sports participants than for their high school counterparts (1.5 and 1.6, respectively). Among sexually experienced students, daily sports participants also had elevated odds of reporting condom use at last intercourse (1.4). CONCLUSIONS: Students as young as middle school age who participate in sports daily may have an elevated risk for STDs and pregnancy. Health professionals should counsel middle school athletes about sexual risk reduction, given that young students may find it particularly difficult to obtain contraceptives, STD testing and prevention counseling.     

Correlates of sexual experience among a nationally representative sample of alternative high school students

Little is known about risk and protective factors associated with sexual experience among alternative school students that might prove useful in targeting and guiding early interventions to prevent onset of sexual risk behavior. Researchers analyzed data from the national Alternative High School Youth Risk Behavior Survey. Principal components analysis identified six risk and protective factors: weapon carrying; tobacco use; cocaine, inhalant, and needle use; alcohol and marijuana use; participation in sports; and fighting. Composite variables with significant bivariate relationships to sexual experience, as well as demographic variables, were entered into a logistic regression analysis to determine independent effects of these correlates on students' sexual experience (N = 6.037). Nearly 90% of students reported having sexual intercourse. In multivariate analysis, significant demographic correlates of sexual experience included female gender (58% more likely than males to report ever having sex), African American race (2.83 times more likely than non-Hispanic Whites), and age (28% more likely with each advancing year). Attending school in a rural or suburban region corresponded to a 31% decrease and 46% decrease, respectively, in the odds of ever having sex. Weapon carrying, and cocaine, inhalant, and needle use, were associated with a 35% and 46% increase, respectively, in the odds of ever having sex. Students reporting they had ever used alcohol or marijuana, and those reporting recent fighting behavior, were 2.7 and 1.6 times more likely, respectively, to report sexual experience. Most alternative school students have had sexual intercourse, with those students engaging in substance use, weapon carrying, and fighting behaviors being at greater risk for sexual experience. Prevention programs for high-risk youth attending alternative high schools need to consider how to promote continued abstinence among the small but important minority of alternative school students not yet sexually experienced.     

Effectiveness of abstinence-only intervention in middle school teens

OBJECTIVES: To examine effectiveness of abstinence-until-marriage curriculum on knowledge, beliefs, efficacy, intentions, and behavior. METHODS: Nonrandomized control trial involving 2069 middle school students with a 5-month follow-up. RESULTS: Intervention students reported increases in knowledge and abstinence beliefs, but decreases in intentions to have sex and to use condoms. Intervention did not influence sexual initiation or condom use; however, intervention students who had sex during the evaluation period reported fewer sexual episodes and fewer partners than did controls. CONCLUSIONS: Abstinence-until-marriage interventions can influence knowledge, beliefs, and intentions, and among sexually experienced students, may reduce the prevalence of casual sex. Reduction in condom use intentions merits further study to determine long-term implications.     

Postponing sexual intercourse among urban junior high school students-a randomized controlled evaluation.

PURPOSE: To describe a randomized, controlled evaluation of a school-based intervention to delay sexual intercourse among urban junior high school students. METHODS: Six Washington, D.C., junior high schools were randomly assigned to the intervention or nonintervention control condition for an educational program. During the first school year, seventh graders (n = 582) from the six schools obtained written parental consent to participate. Three health professionals (one per intervention school) implemented the program, which consisted of reproductive health classes, the Postponing Sexual Involvement Curriculum, health risk screening, and "booster" educational activities during the following (eighth grade) school year. Cross-sectional surveys were administered at baseline, the end of the seventh grade, and the beginning and end of the eighth grade. Intervention and control group differences in virginity, attitudes toward delayed sex and childbearing, and sexual knowledge and behavior were assessed at all four time points. RESULTS: At baseline, 44% of the seventh grade males and 81% of the seventh grade females reported being virgins. At the end of the seventh grade (first follow-up), after controlling for baseline study group differences, intervention-group females were more likely to report virginity, self-efficacy to refuse sex with a boyfriend, and the intention to avoid sexual involvement during the following 6 months. At the end of the eighth grade, significantly more intervention- than control-group females reported virginity, birth control use at last intercourse (for nonvirgins), and knowledge of adolescent reproductive health and confidentiality rights. No changes in virginity, self-efficacy to refuse sex, or sexual intent for the next 6 months were observed among male participants at any time during the study. However, on all three follow-up surveys, intervention-group males scored significantly higher than their control-group counterparts in knowledge of birth control method efficacy. No change in attitudes toward abstinence was observed for either gender at any follow-up point. CONCLUSIONS: Gender differences in baseline sexual activity rates and in various study outcomes suggest a possible need for separate, gender-specific intervention activities that can adequately address the social and cognitive needs of both sexes.     

北京市三所卫校女生性相关知识、态度和行为调查研究

目的 了解卫生类中专女生性相关知识、态度和行为的现状,为该类学校加强学生保健工作提供依据.方法 采取无记名自填问卷方法,对三所卫生类中专在校一、二年级女生进行问卷调查.结果 卫生类中专女生异性性行为的报告率为8.8％,同性性行为的报告率为4.7％.Logistic回归分析发现,随年级增加、男女同校、有男朋友、有同性性行为、吸烟、看过色情制品、有离家出走意念是被调查女生发生异性性行为的危险因素,而通过学校青春期相关课程了解性相关知识是保护因素;有同性恋人、有异性性行为是被调查女生发生同性性行为的危险因素.结论 对卫生类中专,特别是男女同校学生应加强相应课程或性健康教育活动,引导学生建立正确的性观念和采取安全性行为.     

Reducing sexual risk taking behaviors among adolescents who engage in transactional sex in post-conflict Liberia

Transactional sex (TS) has been correlated with HIV/STD infection, pregnancy, early marriage, and sexual violence in sub-Saharan Africa (SSA). Few Western-based HIV prevention programs adapted for SSA have examined intervention impacts for this group. This article examines whether an HIV prevention intervention, delivered to sixth-grade students in Liberia (age range 14–17) and found to increase condom use and other mediators for the larger sample, significantly impacted sexual behaviors and mediators for those who engaged in TS. Using an attention-matched, group-randomized controlled design, four matched pairs of elementary schools in Monrovia, Liberia, were randomly assigned to an adapted eight-module HIV prevention or a general health curriculum. Nine-month impacts of the intervention on sexual risk behaviors and mediators for those who engaged in TS, when compared with other study participants, are presented. Twelve percent of our sample of sixth graders (n?=?714) ever engaged in TS. The majority of females reported being promised something in exchange for sex (52%), whereas the majority of males (52%) reported being both the giver and recipient of gifts in exchange for sex. Compared with other students, those who engaged in TS reported greater increases in the number of sex partners, reported greater frequency of sexual intercourse, were more likely to try to get pregnant or someone else pregnant, and reported greater reductions in protective sexual attitudes and HIV risk perception at the nine month follow-up, in both the intervention and the control groups. Our intervention, although successful for the general in-school adolescent sample, did not impact risk behaviors or mediators for adolescents who engaged in TS. Future research should explore the complex sexual economy in which TS is embedded and consider adapting HIV prevention interventions to the needs of this high-risk group.     

Attitudes, experience, and anticipation of sex among 5th graders in an urban setting: does gender matter?

To identify gender differences in correlates of anticipation and initiation of sexual activity in the baseline survey of 562 African-American 5th grade students prior to initiation of a school-based pregnancy prevention intervention curriculum. Students from 16 elementary schools were administered the baseline questionnaire during classroom periods. Using these data, binary and ordered logistic regression models were used to analyze the factors affecting virginity and anticipation of sexual activity separately by gender, and tests of interaction between each factor and gender were conducted on the combined sample. More boys than girls had already had sex (18% vs. 5%) and anticipated having sexual intercourse in the next 12?months (56% vs. 22%). Boys and girls also differed in the factors that affected these outcomes. The perception that their neighborhood was safe reduced the odds that boys anticipated sexual activity but was not associated with this outcome among girls. Pubertal knowledge increased the odds of anticipation, but only among boys. Attitudes favoring abstinence decreased anticipation of sex among both genders, but slightly more among girls than boys. Having more frequent parent-child communication about sex was associated with increased anticipation among girls but decreased anticipation among boys. Curriculum based approaches to adolescent pregnancy prevention are appropriate for 5th grade elementary students who may already be anticipating sexual activity in communities with disproportionate rates of teen pregnancy. The design of the interventions should consider the differences in motivating factors by gender.     

Attitudes,Experience, and Anticipation of Sex Among 5th Graders in an Urban Setting: Does Gender Matter?

To identify gender differences in correlates of anticipation and initiation of sexual activity in the baseline survey of 562 African-American 5th grade students prior to initiation of a school-based pregnancy prevention intervention curriculum. Students from 16 elementary schools were administered the baseline questionnaire during classroom periods. Using these data, binary and ordered logistic regression models were used to analyze the factors affecting virginity and anticipation of sexual activity separately by gender, and tests of interaction between each factor and gender were conducted on the combined sample. More boys than girls had already had sex (18% vs. 5%) and anticipated having sexual intercourse in the next 12 months (56% vs. 22%). Boys and girls also differed in the factors that affected these outcomes. The perception that their neighborhood was safe reduced the odds that boys anticipated sexual activity but was not associated with this outcome among girls. Pubertal knowledge increased the odds of anticipation, but only among boys. Attitudes favoring abstinence decreased anticipation of sex among both genders, but slightly more among girls than boys. Having more frequent parent–child communication about sex was associated with increased anticipation among girls but decreased anticipation among boys. Curriculum based approaches to adolescent pregnancy prevention are appropriate for 5th grade elementary students who may already be anticipating sexual activity in communities with disproportionate rates of teen pregnancy. The design of the interventions should consider the differences in motivating factors by gender.     

Comparison of Health Risk Behaviors Between Students in a Regular High School and Students in an Alternative High School

ABSTRACT: Prevalence of selected health risk behaviors of students attending an alternative high school (AHS) designed as a dropout prevention/dropout recovery high school was determined using the Youth Risk Behavior Survey. The survey also was administered to a sample of students attending a regular high school (RHS) in the same school district. A larger percentage of AHS students reported being involved in a physical fight the past year, having smoked at least one cigarette the past month, having drunk at least one drink on five or more occasions the past month, having drunk five or more drinks at least once the past month, having smoked marijuana at least once the past month, having used cocaine at least once the past month, and having ever had sexual intercourse. Results indicate a need for comprehensive health education/intervention programs to address the needs of youth in alternative school settings. (J Sch Health. 1993;63(10):421–425)     

University Students’ Definitions of Sexual Abstinence and Having Sex

We asked 298 heterosexual Canadian university students about their definitions of the terms abstinence and having sex. For both terms, students were provided with a list of 17 sexual behaviors and indicated whether they would include each in their definition. The majority of both male and female students included activities that did not involve genital stimulation in their definition of sexual abstinence and did not include these activities in their definition of having sex. Conversely, most students did not include bidirectional sexual stimulation (penile–vaginal intercourse or penile–anal intercourse) in their definitions of sexual abstinence but did include them in their definitions of having sex. Students were quite mixed in whether activities involving unidirectional genital stimulation (e.g., oral sex, genital fondling) constituted abstinence, having sex, or neither abstinence nor having sex. However, they were more likely to see these behaviors as abstinent than as having sex. Students were more likely to rate a behavior as abstinence if orgasm did not occur. A canonical correlation analysis was used to examine the patterns of association between a number of predictors and inclusions of behaviors involving no genital stimulation, unidirectional stimulation, and bidirectional genital stimulation in abstinence definitions. The results indicated that male participants who were more involved with their religion and sexually conservative, less sexually experienced, and who had not received sexual health education at home were more likely to define bidirectional genital stimulation and less likely to define no genital stimulation and unidirectional sexual stimulation as sexual abstinence. The research and health promotion implications of these results are discussed.     

Draw the line/respect the line: a randomized trial of a middle school intervention to reduce sexual risk behaviors

OBJECTIVES: This study evaluated the long-term effectiveness of Draw the Line/Respect the Line, a theoretically based curriculum designed to reduce sexual risk behaviors among middle school adolescents. METHODS: The randomized controlled trial involved 19 schools in northern California. A cohort of 2829 sixth graders was tracked for 36 months. RESULTS: The intervention delayed sexual initiation among boys, but not girls. Boys in the intervention condition also exhibited significantly greater knowledge than control students, perceived fewer peer norms supporting sexual intercourse, had more positive attitudes toward not having sex, had stronger sexual limits, and were less likely to be in situations that could lead to sexual behaviors. Psychosocial effects for girls were limited. CONCLUSIONS: The program was effective for boys, but not for girls.     

A Replication Study of Reducing the Risk, a Theory-Based Sexuality Curriculum for Adolescents

ABSTRACT: Reducing the Risk is a theory-based, sexuality education curriculum shown to influence the knowledge and behaviors of secondary students. This study determined whether the behavioral effects of the curriculum could be duplicated in a southern, rural state. In a quasiexperimental design, pretest and posttest inventories were administered to students in treatment and comparison groups to determine the influence of Reducing the Risk on sexual behaviors. Results of the 18-month study indicated students receiving the curriculum significantly delayed initiating sexual intercourse. Sexually active students in the treatment group were significantly more likely to protect themselves from STD/HIV and pregnancy than sexually active students in the comparison group. In addition, students receiving Reducing the Risk showed a significant increase in parent-child communication about sexual issues. These results reinforce previous research that found positive behavioral effects for students receiving the Reducing the Risk curriculum     

高中女生生殖健康知识及健康教育干预的影响

目的:了解高中女生生殖健康知识状况以及健康教育干预的影响。方法:抽取武汉地区中等规模的高中8所,其中4所作为干预组,另4所作为对照组,干预组学生采用1∶1的比例配对对照,对干预组实施健康教育干预持续3个月后,对干预组、对照组同时进行调查。结果:杂志、报纸、课外书籍是女生目前获取生殖健康知识的主要途径;女生了解性行为、性疾病、妊娠等方面知识的比例随着年级的增高而增长;女生对生殖健康知识相关问题的正确选择率多接近或超过60%,但对于性病概念的正确认识、手淫、性交与妊娠的关系等正确选择率较低;43.12%的女生感觉获取生殖健康知识不容易,84.02%的女生有清洗外阴习惯,有手淫、性交史的女生分别为5.65%、0.28%,女生了解性知识和找校医咨询的意愿均较低;干预后,干预组生殖健康问题的正确选择率较对照组明显提高。结论:高中女生生殖健康知识水平尚待进一步提高,健康教育对于提高高中女生的生殖健康知识水平有较为明显的作用。     

江苏省高中生性行为及艾滋病知识态度现状

目的 了解江苏省高中生性行为及艾滋病知识态度的现状,为制定相应的教育策略和预防措施提供科学依据.方法 采用多阶段分层整群随机抽样方法,对江苏省南京、苏州、扬州、徐州、盐城5个城市的17 911名高中生,使用“中国青少年健康危险行为调查问卷”进行健康危险行为调查.结果 江苏省高中生性行为的报告率为3.8％,男生(6.4％)显著高于女生(1.5％);职业高中学生性行为的报告率(6.2％)高于普通高中学生(2.9％)和重点高中学生(2.2％);重组家庭学生边缘性行为报告率较高(7.1％);女生被迫发生过性行为的报告率(31.4％)高于男生(25.8％),差异有统计学意义(χ2=55.3,P＜0.01).学生对艾滋病病原体的知晓率为66.4％,男生(68.0％)高于女生(64.9％),重点高中学生(84.3％)高于普通高中(74.7％)和职业高中学生(42.3％).结论 对高中生进行科学的、适宜的性行为和艾滋病预防教育非常必要,要针对不同的人群特别是职业高中学生和重组家庭学生,采取相应的干预措施.     

Age at first intercourse in an Australian national sample of technical college students

OBJECTIVE: This study aims to broaden the current body of knowledge regarding the sexual behaviour of young Australians by examining the age and correlates of age of first intercourse in a national sample of Technical and Further Education apprentices. METHOD: In 1995, students at randomly selected technical colleges in Australia were surveyed on HIV-related issues. Questionnaires were administered to a stratified cluster sample of automotive, hairdressing and commercial cookery apprentices. Respondents were asked the age at which they first had heterosexual vaginal or anal intercourse. RESULTS: Of 4,055 respondents aged 15-24 years, 3,848 answered the question; 3,195 (83%) had had intercourse. Males and females did not differ significantly. Median age at first intercourse was 16 (range 12-23). In multivariate analysis, older age at first intercourse was associated with: greater age at interview; higher school education; church attendance; and State of residence. The model, however, accounted for only 14% of the variance in age at first intercourse. CONCLUSIONS AND IMPLICATIONS: In this sample, those apprentices who completed secondary school became sexually active later on average than those who left before the end of Year 10. For sex education to occur before sexual initiation, it needs to be offered in primary schools and the first year of high school (aged 11-13 years). Further, as technical college students are likely to initiate sex earlier than their age mates still at school, colleges may be in a position to take responsibility for the continuing sexual education of this group, especially for those students entering college at 15 or 16 years of age.     

Factors associated with safe sex among public school students in Minas Gerais, Brazil

A cross-sectional study was conducted to evaluate factors associated with safe sex among sexually active public school students in Minas Gerais State, Brazil. The study focused on correlations between the variables gender, age, schooling, current grade, ethnicity, religion, importance attributed to religion, mothers' education, prior exposure to any sex education, promotion of juvenile protagonism, and participation by health professionals in school activities and consistent condom use with casual or stable partners and with use of other modern contraceptive methods. Bivariate and multivariate logistic regression analyses were used. Male gender and participation by health professionals in school activities were positively associated with all indicators of safe sex, and maternal schooling of more than eight years was positively associated with consistent condom use with casual and stable partners. Secondary (versus elementary) schooling and age (older) were inversely associated with consistent condom use with casual and stable partners, respectively. Ascribing greater importance to religion and Evangelical religion were negatively associated with use of modern contraceptives in the last sexual intercourse.     

The impact of an appearance-based educational intervention on adolescent intention to use sunscreen

During adolescence, there is a steady decline in the use of sun protection and increased use of indoor tanning lights. Previous health education efforts have changed knowledge but not these behaviors. Middle school students (n=113) received a single educational class that included personal viewing of skin changes visible under ultraviolet (UV) filtered light. Pre-/post-surveys assessed past, current and future intent to use sunscreen, as well as sun benefit and sun risk attitudes. Prior to the session, 42% were sunscreen non-users and 21% were consistent users. At post-test, one-third of students who had not previously intended to use sunscreen in the next month now intended to use it. Among students who had seen skin damage, 59% reported intention to use sunscreen in the next month versus 35% who did not see skin changes (P = 0.04). Viewing sun damage was an independent predictor of intent to use sunscreen in the next month (OR 2.9, P = 0.04), as was older age (OR 2.6, P = 0.04) and previous consistent sunscreen use (OR 6.1, P = 0.004). A brief educational intervention that emphasizes risk-to-appearance and personalizes the risks of UV exposure has the potential to influence early adolescent sun protection. Long-term studies of this approach are needed.     

Evaluation of a sexual education intervention among Swedish high school students

AIMS: To evaluate an intervention aimed at improving knowledge of, attitudes to, and practices regarding condoms and emergency contraception (ECP) among Swedish high school students. METHODS: An intervention study with quasi-experimental design. A strategic sample of classes from two vocational high school programs was divided into an intervention group and a comparison group. All students completed questionnaires before and after the intervention, which included sexual education lessons by a nurse-midwife and medical students, free condoms on request and access to telephone counseling. RESULTS: Of the 461 eligible students, mean age 17 years, 390 (85%) completed the pre-test and 326 (71%) the post-test. Three out of four (77%) had experienced sexual intercourse. The majority (76%) had used contraception, mostly condoms at first intercourse. The students already had good knowledge of condoms with no change after the intervention, but attitudes improved and condom use increased. Knowledge of, and attitudes towards ECP improved but use remained stable (29%). The most important source of information about ECP changed from "friends" to "school" after the intervention. More than one out of four (28%) had opted for free condoms but only 3% had requested telephone counseling. CONCLUSIONS: Condom use increased after the intervention whereas the use of ECP remained stable. Knowledge of ECP improved and the attitudes towards both condoms and ECP became more positive. Participation of nurse-midwives and medical students, skill rehearsal, and improved access to condoms may be useful elements in sexual education.