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This study explored school Australian teachers' beliefs towards, and comfort around, socialising with same-sex attracted and trans and gender diverse people, as well as beliefs about inclusive school-based policy and other school strategies to enhance the wellbeing of same sex attracted and trans and gender diverse students. Teachers (n = 109) in Australia demonstrated positive attitudes and beliefs towards, and comfort engaging with same sex attracted and trans and gender diverse people, although participants were significantly more positive in their reactions towards same sex attracted people. While participants were generally supportive of inclusive school strategies and policies, over half reported that policies that were inclusive of sexual and gender minorities were not implemented in their school. Less than one third of participants indicated inclusive education was included in the curriculum at their school. Ongoing professional development was identified as essential by almost all participants. Findings support the need for Australian government policy mandating inclusive education be included in the curriculum and whole school strategies.

Internationally, school-based sexuality education programmes have shown to improve sexual practices and health outcomes for young people. However, perceived parental discord is commonly cited as a barrier to implementation. Within Indonesia, there is limited empirical evidence regarding parents' attitudes towards school-based sexuality education. A sample of 768 Indonesian parents and caregivers completed an online Qualtrics survey to determine their level of support or disapproval towards the provision of sexuality education within primary and secondary schools. The majority of parents supported school-based sexuality education (n = 756, 98.4%) and suggested certain topics should commence as early as kindergarten and elementary school (n = 615, 80.0%). Religious affiliation was not associated with permissiveness. When presented with a range of sexuality topics, most parents agreed their inclusion was important. However, for some topics, there was significant variability in opinion based upon the age, gender, or educational background of the parent; thereby providing opportunity for further work. This preliminary study challenges notions that parents, particularly those with religious affiliations, are barriers to the delivery of sexuality education within Indonesia schools. Further research and advocacy will hopefully encourage educators to expand their current levels of provision, to align with international and evidence-based guidelines.

This study explored the extent to which organisations responsible for initial teacher training, prepare pre-service teachers to deliver comprehensive sexuality education in schools. Five electronic databases were searched to identify publications that reported the provision of CSE training for pre-service teachers. Methodological quality was appraised using The Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Descriptive analyses were conducted to summarise the scope of pre-service teacher preparation. Twenty-two documents, primarily from the UK, Australia and the USA were identified for review. Overall, information regarding training in comprehensive sexuality education for pre-service teachers is limited. The review identified wide variability in training content and positioning in primary and/or secondary programmes as either core or elective requirements. Current provision does not appear to align with international and best-practice guidelines in most instances. Further research and greater transparency regarding the preparation of pre-service teachers to deliver comprehensive sexuality education is recommended to identify and prioritise best-practice holistic teaching concepts to improve teacher and student outcomes.

Introduction: The objective of this demand driven research is to co-design an intervention for upper-secondary students that addresses issues of consent and healthy relationships. In this paper, we (university researchers, student coresearchers, school staff), present the engagement framework that has been critical to the project's development and planned implementation. Methods: An iterative co-design approach grounded in a participatory research approach is currently being adopted. Student co-researchers from three independent secondary schools on Whadjuk Nyungar Country in Boorloo/ Perth, Western Australia, have been engaged as co-researchers in the design of the intervention. Supplementary quantitative and qualitative data from students enrolled at each school site is also being collated to further inform the intervention design. Student co-researchers will provide insights on the overarching design of the intervention including: the scope of key concepts they want to learn, interpretation of supplementary data, and the development of contextually relevant educative content. Results: Retrospective and prospective components of the engagement framework are described and supported with applied examples where applicable. Preliminary results demonstrate the imperative of adopting iterative co-design, and the efficacy of our authentic engagement framework. A draft intervention has been formalized and will soon undergo piloting. The codesign process has already resulted in an intervention that differs from the initial program first conceptualized by university researchers. Conclusion: Imperative to our engagement framework is centering students as experts of their lived experience. It is anticipated that this engagement framework will provide insights around the feasibility, value, and necessity for authentic engagement of upper-secondary school students in the design of their consent and healthy relationship education. [ABSTRACT FROM AUTHOR]

There is a high prevalence of adolescent girls with ovulatory menstrual (OM) dysfunction, which is associated with school absenteeism and mental health challenges. Low menstrual health literacy among this group has evoked calls to review OM health education. This qualitative study sought to explore gaps in current OM health education and to validate a holistic school-based OM health literacy program named My Vital Cycles®. Findings are based on 19 written reflections, six focus group discussions and three interviews conducted with 28 girls aged 14–18 years from 11 schools, and five mothers. Six themes compared current OM health education with My Vital Cycles®: understating health, comprehensiveness, resources, teaching, parents and cycle tracking. Future refinements to the program comprised: inclusion of the complete reproductive lifespan, use of visual media and developing a mobile application. These findings inform future research in a whole school approach, strengths-based teaching and changes in the health curriculum. [ABSTRACT FROM AUTHOR]

AbstractAs Australia considers legislative reform regarding the rights of religious schools to discriminate against LGBT students and staff, claims are often made that religious parents or those enrolling children in religious schools do not affirm diversity of sexuality or gender. Using a national dataset of parents (n = 2418), attitudes towards sexual orientation, gender diversity, homophobia and transphobia were examined. Across all religiosities, school sectors and attitudinal statements, significant majorities of parents reported positive attitudes (62.7%–93.5%). Only small minorities expressly reported negative attitudes (1.6%–20.2%). Pairwise religiosity comparisons between parents with children only at a secular school, versus any religious school, revealed few differences. Amongst Catholic parents, those with children at Catholic schools and those with children only at secular schools, held similar attitudes towards LGBT issues and a majority held favourable attitudes, suggesting most Catholic parents who enrol their children in Catholic schools do so despite or in ignorance of Catholic doctrine. Findings suggest a significant majority of parents sending children to religious schools hold supportive attitudes towards diverse sexual orientations, gender diversity, and actions to address homophobia and transphobia. This empirical evidence contradicts religious schools’ calls for the rights to discriminate against LGBT persons based on parental values and attitudes. [ABSTRACT FROM AUTHOR]

This paper describes the formative, process and short term impact evaluation of sexuality and relationships education (SRE) training for teachers in Western Australia (WA) over a three year period. The training represents one component of a broader project, the aims of which are to improve teacher's confidence and skills in delivering SRE, and to support schools to implement effective comprehensive SRE. Formative evaluation conducted prior to the development of the training, found although most respondents were relatively confident and skilled in facilitating SRE, the need for ongoing professional development was highlighted, especially in areas such as gender diversity, pornography, sexting, violence and working with specific groups. Training focusing on the new Australian Health and Physical Education curriculum and mandatory assessment was identified as a need. Workshop evaluation found statistically significant improvements in attitudes towards SRE and increased comfort in teaching SRE, facilitating discussion and facilitating skills and activities, after the workshop. The evaluation identified the need for an integrated and coordinated whole school approach and efforts to engage teachers with lower levels of confidence in teaching SRE. Changes to the Australian Curriculum provide opportunities to enhance the development of SRE in schools. Longer-term impact evaluation is required to identify whole school changes.

Viewing sexually explicit media (SEM) can influence young people’s sexual attitudes and behaviours. Media literacy education can help young people navigate this, yet parental opposition is sometimes cited as a barrier to the implementation of comprehensive school programmes. A scoping review explored parent perspectives towards and comfort with SEM literacy education, parent-focused resources, and the level of parental engagement in resource development. An expansive view of SEM included pornography alongside sexually explicit content in movies, television shows, video games, or other online spaces. Collectively, a focused search of five academic databases, an online search for grey literature and resources from non-governmental and government organisations, and interviews (n = 7) with key stakeholders were undertaken. Screening reduced 4,745 peer-reviewed records to seven. The online search located 35 resources from 28 organisations. While parents support SEM literacy education for their children, other sexuality education topics (e.g. contraception and the prevention of sexually transmitted infections) were more widely endorsed. Parental comfort in providing such education was variable. Online resources vary in type and content, with limited information available about development processes or evaluation. Further research and co-design are needed to ascertain parent needs to support their children’s SEM literacy knowledge and understanding. [ABSTRACT FROM AUTHOR]

Despite significant evidence worldwide that parents support school-based delivery of relationships and sexuality education (RSE), Australian data has generally lacked larger, nationally representative samples. Furthermore, misguided perceptions of parental attitudes are known to impact delivery. In response, online survey data were collected from 2,427 parents (56.5% female) nationwide, to examine their attitudes towards school-based RSE. Most had a child enrolled in a government school (65.3% primary, 55.7% secondary); and reported diverse religious affiliations (38.7% no religion, 21.3% Catholic, 11.1% Anglican) and voting preferences (26.7% Australian Labour Party, 25.1% Liberal/National, 23.6% undecided). Overall, 89.9% of parents supported schools to deliver RSE, with some modest differences being associated with particular demographic variables. Beyond widespread support for RSE, parents emphatically endorsed schools to address a diverse range of RSE-related issues (n = 40 topics). Parents' responses also provided insight regarding when certain topics should first be introduced and the quality of current RSE provision in schools. Findings from this descriptive overview challenge the currently overstated assumption that parents do not support RSE in schools. Such persistent and obstructive discourse is counterproductive to evidence-based strategies that seek to strengthen young people's personal and social development in a comprehensive and contemporary manner. [ABSTRACT FROM AUTHOR]

This study aimed to face validate an adolescent ovulatory menstrual (OM) health literacy questionnaire and to measure reliability by test–retest. Draft questions from an earlier content validation were adjusted following face validity assessment with 28 adolescents. Test–retest reliability was assessed by 89 adolescents aged 14–18 years over a two‐week period across four school sites. The mean levels of agreement recorded from the critical, interactive and functional health literacy domains were 83%, 74% and 68%, respectively. There were 44 out of 74 items with Kappa statistics >0.40. The questionnaire has confirmed face validity and adequate test–retest reliability for assessing adolescent OM health literacy. [ABSTRACT FROM AUTHOR]

Background There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. Methods Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. Results Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%–42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%–5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%–8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. Conclusions Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings. [ABSTRACT FROM AUTHOR]

Universities are undergoing rapid and unprecedented changes due to the COVID-19 pandemic, and the needs of learners during this transition are not necessarily well understood or addressed. This study aimed to examine the impact of the "remote internal" unit delivery in a large Western Australian university, as experienced by students and teaching staff within a department of health promotion and sexology (DHPS). In the remote internal mode, previously "internal" (face-to-face) students received prerecorded lectures and attended workshops and seminars in real time through use of the learning platforms. The mixed methods study was conducted across three phases in 2020. A quantitative online student survey was followed by student and teaching staff focus groups and document analysis. Six themes were uncovered regarding the student experience of the remote internal mode: (1) face-to-face contact provides a sense of community, (2) online learning is better when it is interactive, (3) online learning is convenient, (4) delivery mode affects student willingness to contribute to discussions, (5) students enjoy a mixture of teaching patterns, and (6) technological issues create barriers to effective learning. Five themes were revealed regarding teaching staff experience of the remote internal mode: (1) connections matter, (2) face-to-face delivery enhances engagement, (3) learning outcomes are a priority for teaching staff, (4) online delivery needs effective supports, and (5) students have online privacy concerns. Considerations for course modalities, methods to enhance interactivity, and supportive technology and infrastructure are recommended to ensure that the technological, demographic, and socio-environmental needs of students are adequately met. [ABSTRACT FROM AUTHOR]

Background Research focused on adolescents' attitudes towards abortion is limited, and validated scales are not routinely used. A greater understanding of adolescents' attitudes towards abortion could better inform the sexuality education strategies targeted at this age group.Methods: A cross-sectional survey was completed by 1470 adolescents (437 males, 1033 females) aged 12-19 years and living in Perth, Australia. Participants were recruited from secondary schools, antenatal clinics and termination clinics to capture varying experiences of sexual activity and pregnancy. Survey items investigated abortion attitudes, sexual behaviour and pregnancy history alongside other demographic and psychosocial factors. Analyses included comparative means and adjusted linear regressions.Results: Sexually active participants (n = 554) and females reporting a previous abortion (n = 196) held more supportive attitudes towards abortion (P < 0.001 for both). Among sexually active females, more supportive attitudes were held by those reporting a previous abortion (β = 2.60, 95% confidence interval 0.93-4.27, P = 0.002), later age (≥16 years) at first vaginal intercourse (P < 0.001), use of oral contraception at last sex (P = 0.029), previous condom use (P < 0.001) and/or three or more oral sex partners in the previous 12 months (P = 0.005). For sexually active males, more supportive attitudes were reported by those whose female partners had used oral contraception at last sex (P = 0.013) or ever (P = 0.017). Multivariable analyses indicated that other correlates, including risky sexual behaviour, had minimal or no effect on attitudes.Conclusions: Adolescents' attitudes towards abortion appear to be influenced by their ability to personalise and contextualise the effect of a pregnancy. Associations between less-effective contraceptive use and reduced support for abortion may be explained by a diminished perceived risk of parenthood. Educational strategies should acknowledge and respond to differences in abortion attitudes as adolescents commence and navigate sexual relationships. [ABSTRACT FROM AUTHOR]

Introduction A review of international and Australian school-based resources suggests that teaching of the ovulatory-menstrual (OM) cycle is predominantly couched in biology. A whole-person framework that integrates spiritual, intellectual, social and emotional dimensions with the physical changes of the OM cycle is needed to facilitate adolescent OM health literacy. This paper describes the protocol for a study that aims to develop and trial an intervention for adolescent girls aged 13-16 years that enhances positive attitudes towards OM health coupled with developing skills to monitor and self-report OM health. These skills aim to foster acceptance of the OM cycle as a 'vital sign' and facilitate confident communication of common OM disturbances (namely, dysmenorrhoea, abnormal uterine bleeding and premenstrual syndrome), which are known to impact school and social activities. Methods and analysis Phase I will comprise a Delphi panel of women's health specialists, public health professionals and curriculum consultants and focus groups with adolescent girls, teachers and school healthcare professionals. This will inform the development of an intervention to facilitate OM health literacy. The Delphi panel will also inform the development of a valid and reliable questionnaire to evaluate OM health literacy. Phase II will trial the intervention with a convenience sample of at least 175 adolescent girls from one single-sex school. The mixed-method evaluation of the intervention will include a pre-intervention and post-intervention questionnaire. One-on-one interviews with teachers and school healthcare professionals will expand the understanding of the barriers, enablers and suitability of implementation of the intervention in a school-based setting. Finally, focus groups with purposively selected trial participants will further refine the intervention. Ethics and dissemination The study findings will be disseminated through local community seminars, conferences, peer-review articles and media channels where appropriate. The Curtin University of Human Research Ethics Committee has approved this study (approval HRE2018-0101). This project is registered with the 'Australian and New Zealand Clinical Trials Registry'. Trial registration number ACTRN12619000031167; Pre-results. [ABSTRACT FROM AUTHOR]

Introduction There is recognition of the importance of comprehensive relationships and sexuality education (RSE) throughout the school years worldwide. Interventions have found some positive outcomes; however, the need for a greater focus on positive sexuality and relevant contemporary issues has been identified by teachers and students. The Curtin RSE Project provides training for teachers and preservice teachers and supports schools through training and advice to implement comprehensive school health promotion (CSHP) focusing on RSE allowing schools to develop programmes relevant to their school community. To examine contemporary phenomenon within a real word context, a case study design will be used to measure implementation. This paper will describe the protocol for a multiple, embedded case study to measure the implementation of CSHP focusing on RSE in a purposive sample of Western Australian schools. Methods and analysis This mixed methods study will include a multiple, embedded case study. Schools (n=3-4) will be purposively selected from within Western Australia based on their capacity to commit to implementing RSE as a case study school. Data will be collected from students (Grade 6 for primary school; Grades 7-12 for secondary school); teachers and other key staff and parents. Methods include school climate and school curriculum audits, documentation (collected with key staff at baseline and annually), interviews (parents and teachers at Year 2), focus groups (students at Year 2) and an online student survey (collected with students baseline and annually). Ethics and dissemination School principals will provide consent for school participation and staff and parents will provide individual consent. Student assent and parental consent will be obtained for student participants. Results will be disseminated through open-access reports, peerreviewed journals and conference presentations. [ABSTRACT FROM AUTHOR]

Summary: Background and purpose: Despite decades of research, development and evaluation of educational and promotional strategies to prevent teenage pregnancy, we have only a limited understanding of the strategies that are effective and why. This study sought to explore female teenagers’ attitudes, perceptions and experiences of contraceptive use, and describe the influence of this on pregnancy risk. Methods: A qualitative approach was used to explore the contraceptive behaviour in a purposive sample of sexually active Australian females aged 14–19 years. Teenagers were drawn from three sub-groups: antenatal and postnatal services (pregnant-continuing); termination services (pregnant-terminating); and sexual health clinics (never-pregnant). Sixty-eight individual, semi-structured interviews were conducted. Thematic analysis was employed to analyse the data and generate a rich, description of contraceptive behaviour. Results: Whilst participants were familiar with contraception, many used it inconsistently. Commitment to pregnancy prevention was firmly located within participants’ attitudes toward teenage pregnancy and parenthood, perceptions of pregnancy risk and perceptions of the costs and benefits of using contraception. Further, motivation to use contraception fluctuated in different contexts, such as romantic relationships. Conclusions: Our research highlights the importance of attitudes toward contraception, pregnancy and parenthood in shaping teenagers’ motivation to use contraception. Educational and prevention programs must address the spectrum of attitudes underlying teenagers’ contraceptive and reproductive decisions in order to alter pathways to teenage pregnancy and early parenting. [Copyright &y& Elsevier]

Men who have sex with men (MSM) and transgender women (waria) in Indonesia experience stigma and discrimination. The prevalence of stigma and discrimination experienced by 416 MSM and waria living in Bali, Indonesia and associations with socio-demographic characteristics are described. High levels of stigma were reported by 50.5% of MSM and 62.7% of waria. Discrimination was reported by 35.5% of MSM and 72.4% of waria. Family rejection, or no family awareness of MSM status, equated to higher levels of stigma compared to those where MSM status was accepted. Homosexual and bisexual waria reported lower odds of experiencing stigma compared to heterosexual waria. MSM who were not single were twice as likely to experience discrimination compared to single participants. Non-Hindu MSM were nearly three times as likely to experience discrimination compared to Hindu participants. Waria who were studying were less likely to experience discrimination compared to those who reported regular employment jobs. Specific policy and practice to reduce experiences of stigma and/or discrimination specific to MSM and waria are needed.

Objective: To determine individual- and country-level factors associated with self-reported changes in solo and partnered sexual behaviors in an international sample of adults during COVID-19., Methods: Data were from the International Sexual Health And REproductive Health during COVID-19 study (I-SHARE)-a cross-sectional, multi-country study ( N  = 26 countries) assessing adult ( N  = 19,654) sexual/reproductive health before and during the first wave of COVID-19. We examined self-reported changes (three-point scale: decreased, no change, increased) in solo masturbation, hugging/holding hands/cuddling with a partner, sex with a primary partner, sex with a casual partner, sexting with a partner, viewing sexually explicit media and partnered cybersex. Ordinal regression assessed the impact of individual (age, gender- and sexual-identity, romantic partnership status, employment and income stability, household change and content, mental well-being, changes in alcohol use, and changes in marijuana use) and country-level (e.g., Oxford Stringency Index, Human Development Index, and the Palma Ratio) factors on behavior change., Results: The most common behavior to increase was hugging, kissing, or cuddling with a partner (21.5%), and the most common behavior to decrease was sex with a main partner (36.7%). Household factors like job/income instability and having children over the age of 12 years were significantly associated with decreased affectionate and sexual partnered sexual behaviors; more frequent substance use was linked to significantly increased solo, partnered, and virtual sexual behaviors., Conclusions: Understanding changes in sexual behaviors-as well as the factors that make changes more or less likely among adults around the world-are important to ensure adequate sexual health support development for future public health emergencies., Competing Interests: Dr. Hensel is a paid research consultant with For Goodness Sake, LLC. The authors alone are responsible for the content and writing of the paper., (© 2023 Taylor & Francis Group, LLC.)

Background: There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium., Methods: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence., Results: Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy., Conclusions: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Introduction: There are a high prevalence of ovulatory-menstrual (OM) dysfunction and low levels of menstrual health literacy in adolescents, yet few evidence-based OM health education resources for schools., Method: This two-phase study used an online Delphi methodology to build consensus across thirty-five purposively selected professionals from the diverse professions of health and education. The panellists were tasked to inform the development of a school-based OM health literacy resources., Results: In Round One, 86% of panellists determined the scope of these resources using guided and open-ended questions. The study then split into two phases which ran concurrently. In the first phase informing the intervention's development, 57% of panellists participated in Round Two, and 29% reviewed selected lessons. In the second phase informing the questionnaire's development, 51% of panellists participated in Round Two, and 69% in Round Three. The overall consensus reached for the intervention phase and questionnaire phase were 82% and 84%, respectively. The Panel's recommendations included a strengths-based position to counter menstrual stigma, teaching accurate self-report of cycle biomarkers, addressing multiple menstrual dysfunctions and adopting a whole-school approach., Conclusion: Although time-consuming and requiring a sustained interest, this two-phase Delphi methodology offered anonymity to panellists from distinct professions which facilitated their independent contribution to developing OM health literacy school resources., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Roux, Burns, Chih and Hendriks.)

Since the global onset of COVID-19 in early 2020, the disease has significantly impacted mental health. This impact is likely to be further exacerbated for groups who were already marginalized. This paper shares results from a broader study of men who have sex with men (MSM) and transgender people in Bali, Indonesia and includes a focus on psychological distress and happiness during the COVID-19 pandemic; applying sociodemographic and epidemiological characteristics as potential mediators. Psychological distress and the level of happiness were measured by The Kessler Psychological Distress (K10) and the Subjective Happiness Scale (SHS). A cross-sectional survey was conducted from July to September 2020. Of the 416 participants, complete data were available for 363 participants. The majority of participants were aged 26-40 years, currently single, were born outside Bali, were currently living in an urban area, and over one-third were living with HIV. While all were MSM, the majority identified as homosexual/tend to be homosexual (71.3%), however 54 (14.9%) identified themselves as heterosexual. The majority (251, 69.1%) reported moderate to very high psychological distress during the COVID-19 pandemic. The binary logistic regression analysis identified five factors to be significantly associated with higher psychological distress: being a student, reporting higher levels of stigma, had ever experienced discrimination, felt better prior to the COVID-19 pandemic, and less happy than the average person. When homosexual were compared with heterosexual participants, those who identified themselves as being homosexual reported significantly lower psychological distress compared to those identified themselves as heterosexual, which may be associated with these participants not disclosing their status as MSM and the stigma around MSM. Those who considered themselves to be less happy than the average person (316, 87.1%) were more likely to live with a partner and to report moderate to very high psychological distress. Based on the findings, interventions should focus on strategies to reduce stigma, provide non-discriminatory services, and improve access to essential health services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Septarini, Hendriks, Maycock and Burns.)

Background: Measurement scales seeking to quantify latent traits like attitudes, are often developed using traditional psychometric approaches. Application of the Rasch unidimensional measurement model may complement or replace these techniques, as the model can be used to construct scales and check their psychometric properties. If data fit the model, then a scale with invariant measurement properties, including interval-level scores, will have been developed., Aims: This paper highlights the unique properties of the Rasch model. Items developed to measure adolescent attitudes towards abortion are used to exemplify the process., Method: Ten attitude and intention items relating to abortion were answered by 406 adolescents aged 12 to 19 years, as part of the "Teen Relationships Study". The sampling framework captured a range of sexual and pregnancy experiences. Items were assessed for fit to the Rasch model including checks for Differential Item Functioning (DIF) by gender, sexual experience or pregnancy experience., Results: Rasch analysis of the original dataset initially demonstrated that some items did not fit the model. Rescoring of one item (B5) and removal of another (L31) resulted in fit, as shown by a non-significant item-trait interaction total chi-square and a mean log residual fit statistic for items of -0.05 (SD=1.43). No DIF existed for the revised scale. However, items did not distinguish as well amongst persons with the most intense attitudes as they did for other persons. A person separation index of 0.82 indicated good reliability., Conclusion: Application of the Rasch model produced a valid and reliable scale measuring adolescent attitudes towards abortion, with stable measurement properties. The Rasch process provided an extensive range of diagnostic information concerning item and person fit, enabling changes to be made to scale items. This example shows the value of the Rasch model in developing scales for both social science and health disciplines.