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Background: Violent behaviors have devastating impacts on youth and adolescents. National standards offer a framework for age and developmentally appropriate health education expectations. This study provides findings from a systematic review and analysis of teen dating violence (TDV) prevention curricula using National Sexuality Education Standards (NSES) and National Health Education Standards (NHES)., Methods: Evidence-based and/or practice informed interventions for TDV prevention were compiled and analyzed. We used a standardized review instrument to analyze each curriculum (N = 11); each curriculum was reviewed independently and results met inter-rater agreement requirements. Data were analyzed to determine NSES and NHES inclusion., Results: This study provides findings from the TDV prevention curriculum analysis using the NSES. Five NSES topic areas were addressed in the TDV prevention curriculum and included personal safety, healthy relationships, identity, sexually transmitted diseases and human immunodeficieny virus, and pregnancy and reproduction. Personal safety was the most included topic and ranged from 37% to 77%. Healthy relationships were the second most included NSES and ranged from 11% to 53%. Inclusions of NHES skills, as they are embedded within the NSES, are identified., Conclusions: Curricula decision-makers gain insight by conducting reviews before recommendations are made or the adoption process is complete. The NSES and NHES support expectations for TDV prevention and can guide curricula adoption for a school or district. School professionals should work together to ensure TDV prevention curricula complements sexuality education units. While TDV curricula may cover critical topics, a singular focus on one content area cannot replace comprehensive sexuality education., (© 2019, American School Health Association.)

Background: Intrapersonal and external factors, including social pressures and the desire for acceptance from peers, influence sexual activity among adolescents. This study examined how personal characteristics, risky behaviors, normative beliefs, household factors, and engagement in extracurricular activities were related to high school freshman girls' reported reasons for having sexual intercourse., Methods: Baseline data were analyzed from 158 girls enrolled in high school-based abstinence-only-until-marriage education programs during their freshman year. Binary logistic regression was performed to identify factors associated with Pressures and Reasons for Engaging in Sex Scale (PRESS) scores., Results: Results indicate that girls with high PRESS scores were significantly more likely to have had sex (OR = 4.29), consumed alcohol within the previous year (OR = 6.13), reported strict household rules (OR = 1.49), and thought more girls their age had sex (OR = 1.67)., Conclusion: School- and family-based interventions should be developed to encourage and strengthen parent-teen communication within the household and reinforce self-worth and positive self-perceptions among adolescent girls., (© 2014, American School Health Association.)

Background: Teaching sexuality education to support young people's sexual development and overall sexual health is both needed and supported. Data continue to highlight the high rates of teen pregnancy, sexually transmitted disease, including human immunodeficiency virus (HIV) infections, among young people in the United States as well as the overwhelming public support for sexuality education instruction. In support of the implementation of the National Sexuality Education Standards, the current effort focuses on better preparing teachers to deliver sexuality education., Methods: An expert panel was convened by the Future of Sex Education Initiative to develop teacher-preparation standards for sexuality education. Their task was to develop standards and indicators that addressed the unique elements intrinsic to sexuality education instruction., Results: Seven standards and associated indicators were developed that address professional disposition, diversity and equity, content knowledge, legal and professional ethics, planning, implementation, and assessment., Conclusions: The National Teacher-Preparation Standards for Sexuality Education represent an unprecedented unified effort to enable prospective health education teachers to become competent in teaching methodology, theory, practice of pedagogy, content, and skills, specific to sexuality education. Higher education will play a key role in ensuring the success of these standards., (© 2014, American School Health Association.)

Background: The ways in which adolescents define and view sex, abstinence, and virginity impact the efforts of sexuality educators and sexual health professionals. This study examined terminology used by nonsexually active high school students to define abstinence and virginity and identified words students associate with these terms. Purposes included (1) describing words/phrases associated with abstinence; (2) describing phrases for "being abstinent until marriage" and "being a virgin;" (3) assessing concordance between word dyads associated with abstinence; and (4) assessing concordance between phrases defining "abstinent until marriage" and "a virgin.", Methods: In this study, 216 freshmen provided information about beliefs, behaviors, and perceptions. Pearson chi-square tests and Wilcoxon sign-rank tests assessed sex-based differences, definitions, and levels of concordance were conducted., Results: Girls' friends took an abstinence pledge (p = .004) and their parents (p = .025) and best friends (p < .001) think they should abstain. Male counterparts reported being dissatisfied with current sex status (p = .002) and high acceptance of sex before marriage (p = .011). Boys were more likely to endorse "negative" words than girls., Conclusions: Professionals need to use relevant materials incorporating terminology that resonates with adolescents and programs that engage coherent participant discussions., (© 2013, American School Health Association.)

Background: Given the growing scientific evidence against abstinence-only-until-marriage education, health educators are supporting an evidence-based approach to teaching sexuality education. However, there is still an abundance of federal support and funding streams allocated to sustain abstinence-only programs. This study assessed indicators that influence the adoption of abstinence-only-until-marriage education as well as school teachers' likelihood of adopting such programs., Methods: Predictors included relative advantage, compatibility, complexity, and observability and were assessed with a self-administered, validated questionnaire. Additional questions were asked related to demographics, professional history, and abstinence-only-until-marriage education policies and funding. The relationships were tested with multiple regression analysis., Results: A trend became apparent in which most teachers would allow a state- or federally funded program to be offered and presented in their schools, but most did not know if their school received funding to support abstinence-only-until-marriage education. Attendance at religious services, complexity of abstinence-only-until-marriage programs, and abstinence-only-until-marriage curriculum emerged as important predictors of the likelihood to adopt abstinence education., Conclusions: Trends in political agendas, policy development, and state and federal funding have supported abstinence-only-until-marriage education programs. In order to ensure an understanding about the inclusion of sexuality education in the classroom, insight into the teacher's role in the integration of sexuality education in the classroom is important.

Authors examined the logic (or the implicit theory) underlying 16 abstinence-only-until-marriage programs in Texas (50% of all programs funded under the federal welfare reform legislation during 2001 and 2002). Defined as a set of propositions regarding the relationship between program activities and their intended outcomes, program staff's implicit theories were summarized and compared to (a) data from studies on adolescent sexual behavior, (b) a theory-based model of youth abstinent behavior, and (c) preliminary findings from the national evaluation of Title V programs. Authors interviewed 62 program directors and instructors and employed selected principles of grounded theory to analyze interview data. Findings indicated that abstinence education staff could clearly articulate the logic guiding program activity choices. Comparisons between interview data and a theory-based model of adolescent sexual behavior revealed striking similarities. Implications of these findings for conceptualizing and evaluating abstinence-only-until-marriage (or similar) programs are examined.

The authors reviewed the content, methods, and overall quality of 21 curricula used in abstinence-only-until-marriage programs. Only materials designed for use in middle school grades (fifth to eighth) or with middle school-aged audiences (9-13 years of age), which presented the abstinence message in at least 40% of their content, were included. A rating instrument adapted from 2 sets of education guidelines structured the assessment of each curriculum. Four experienced teachers rated each curriculum. Curricula exhibited considerable variability in overall quality ratings. While on average, materials scored a 3.33 on a 1-to-5 scale (1 = Unacceptable; 5 = Excellent), 12 curricula received summative scores above the average, with 4 scoring 4.0 or higher. Eight curricula, however, received a below-average rating. While abstinence materials vary considerably in terms of overall quality, the values and world views underlying this sample of curricula were clear and consistent: those who develop abstinence education curricula value nonsexual antecedents of sexual behavior such as skills (goal setting, decision making, and assertiveness), ideals (fidelity, friendships), and psychological factors such as self-esteem.

This study examined how program directors, instructors, and participant youth from a sample of federally funded abstinence-only-until-marriage education programs in Texas define the term "abstinence" and its object (from what one abstains). A sample of eight programs, from the 32 federally funded programs in the state (funded in fiscal year 2000-2001), were selected for indepth case studies. Interviews were conducted with 29 program staff (10 directors and 19 instructors). Six focus group sessions were held with youth participating in the programs. Interview and focus group transcripts were analyzed qualitatively, with salient themes being coded and counted. Results are presented in terms of frequency of mention of each theme/code. Most respondents (80% of program directors, 89% of instructors, 83% of focus groups) provided definitions of abstinence containing both positive and negative elements. Positive-patterned definitions emphasized specific attitudes and behaviors that must be internalized by youth (Internal Management; Values/Attitudes Incorporation; Abstinence as an Option; Investment in the Future). Negative definitions stressed restraint and avoidance, and focused on the objects of abstinence (Sexual/Vaginal Intercourse; Oral Sex; Anal Sex; Pre-Coital Behaviors; Behaviors with Purpose of Sexual Arousal; Non-Sexual Behaviors). Each element was mentioned by at least 26% of program staff and in at least 17% of youth focus groups. Results indicated substantial variability in how the term "abstinence" is defined. Such variability has implications for development of abstinence education programs, as well as for implementation of valid, equitable, and useful evaluations.

We compared sexual/reproductive health services and sexuality education topics provided in Texas alternative high schools (AHSs) with the prevalence of sexual risk behaviors among students in AHS. Using cross-sectional data from convenience samples of 14 principals, 14 lead health educators, and 515 students, we calculated descriptive statistics for 20 services and 15 sexuality education topics provided by AHSs and seven sexual risk behaviors among students in AHS. AHSs provided few sexual/reproductive health services and limited educational content, despite high levels of sexual risk taking among students. For example, no AHSs taught students about proper condom use, yet 84% of students have had sex. Findings provide preliminary evidence of unmet needs for school-based sexual/reproductive health services and comprehensive sexuality education in AHS settings. Future investigation with larger, representative samples is needed to assess the provision of sexual/reproductive health services and sexuality education in AHSs and monitor sexual risk behaviors in the AHS population.

The Sexual Health And Peer Education (SHAPE) program implemented in middle schools in Oklahoma County utilizes a hybrid adult and peer educator model to deliver sexual health programming. While peer educators have been incorporated into school-based sexual health programs in the past, this program is unique in its approach to preparing and engaging peer educators. Researchers synthesized data from interviews with program implementers and focus group discussions with teenage peer educators and middle school students who recently participated in the program to understand the process elements that contribute to the benefit of the SHAPE program model. Interviews with program implementers described the thorough peer educator recruitment and training process. Teenage peer educators felt well-prepared to deliver lessons, and through this program, they developed leadership skills, confidence, and grew personally. Middle school students revealed that peer educators were relatable and provided a positive experience where they could engage and ask questions. The application of a hybrid adult and teenage peer educator model proved useful for delivering sexual health topics and benefited students and teenage peer educators. This study's findings highlight elements that can be utilized in future sexual health programming to prepare and engage teenage peer educators in more meaningful ways.

Game-based learning offers an interactive and effective way to teach health content and skills. This article discusses feasibility testing of "Using the Connect" ("UTC"), an innovative, game-based sexuality education program to evaluate its acceptability among youth. Utilizing mixed methods in a single case study design, qualitative and quantitative data was collected from youth (surveys, facilitated discussions, and observations). Qualitative data triangulated quantitative findings that youth liked the program design, felt the games and content were relatable, and learned knowledge and skills around adolescent development, accessing information, communication, and making healthy decisions through playing the games. Overall, "UTC" was highly acceptable to the youth; they had fun and learned information and skills. Not only would most participants recommend the program to friends, all reported they would participate in the program again and use the information they learned in the future.

School-based sexuality education provides a means of disseminating valuable information about decision making and avoidance of risky behaviors that may result in an unplanned pregnancy or sexually transmitted infection; however, effective teacher training is required for efficacious sexuality education programs. The purpose of this paper is to describe changes in participants' perceptions and adoption of evidence-based sexuality education after attending a unique professional development opportunity for teachers of sexuality education using a Diffusion of Innovation Theory framework. Methods: A non-representative sample of 20 public school health education teachers (85% female) from across the state of Texas participated in the Sexuality Education Academy (SEA), and completed pre-, post-, and six-month follow-up Web-based surveys. Descriptive statistics and Wilcoxon signed-rank tests were used to measure change in perceptions and adoption of evidence-based sexuality education. Results: Statistically significant changes were found between pre- and post-test scores in "relative advantage," "compatibility," "complexity," and "observability." At six-month follow-up, participants indicated increased advocacy for and implementation of evidence-based sexuality education practices. Conclusions: Teacher training can improve sexuality education teachers' understanding, confidence and effectiveness in delivery of evidence-based sexuality education within school settings.

In the USA, persons of Hispanic ethnicity experience higher rates of adolescent pregnancy and STIs than non-Hispanic white youth and there exists a lack of research concerning the sexuality education preferences of Hispanic adolescents. This study describes sexual health education preferences by Hispanic ethnicity among a high-risk sample of young people aged 14-20 years in Texas. Data were collected from participants in a teenage pregnancy prevention programme. Questions included preferred topics, provider of information and learning modality. Just over half of the participants was Hispanic (60%), nearly all participants were sexually experienced (96%) and more than half had been pregnant or caused a pregnancy (66%). Hispanic participants were significantly less likely to want to learn about sexual health from parents compared to non-Hispanic participants. Hispanic participants were also significantly less likely to prefer to learn about puberty and adolescent development, or to select role-playing as a preferred learning modality. Findings from the study provide evidence about the kind of sexual health topics US Hispanic adolescents are interested in as well as from who they prefer to receive sexuality education. Understanding these educational preferences can be useful to inform future policy and programming.

Would You Rather (WYR), with a Sexual Health Twist! teaching technique uses two youth games, "Would you rather…" and Twister®, to actively engage students in developing decision-making skills regarding human sexuality. Utilizing the "Would you rather" choices, the teacher provides a short scenario with two difficult choices. Student groups identify the choice they believe is best, provide three reasons for the group choice, and offer one pro and con for the choice. Additionally, student groups provide one source of credible health information related to their choice. The lesson incorporates the game Twister® to facilitate student movement when reporting the "Would you rather…" choice their group selected. Student assessment includes an interactive discussion identifying which choice was most challenging, the importance of considering the pros and cons prior to making decisions, and common characteristics of credible health information sources.

State policy and curriculum standards establish general guidelines regarding sexuality education while local school boards decide how teachers provide sexuality education. Local school districts may utilize programs and speakers from outside organizations and locally produced materials for sexuality education. Purpose: This article examines Texas curricular materials that commonly rely on scare and shaming tactics to teach students sexuality education. Methods: Materials provided by 990 Texas school districts were evaluated. The information related to the content of sexuality education was catalogued and entered into an SPSS database. Results: Problems with fear-based instruction about sexuality fell into three broad categories: 1) exaggerating negative consequences of sexual behavior; 2) demonizing sexually active youth; and 3) cultivating shame and guilt to discourage sexual activity. Conclusions: Informing students about realistic consequences of sexual activity is a vital element of sexuality education; however, in their eagerness to scare students away from a behavior (i.e. sexual activity), teachers use exaggerated, misleading, and misinterpreted facts. Recommendations: Young people need scientific, medically accurate information about sexuality to help them make healthy decisions. The use of fear, shame and guilt are not supported educational strategies in sexuality education.

At-risk adolescents may experience Social Determinants of Health (SDoH) that lead to higher rates of risky sexual behavior, including increased risk of pregnancy and sexually transmitted infections. These SDoH may include components such as unstable family structures, incomplete education, and poverty. Targeting at-risk youth for sexuality education is one way to work toward decreasing sexual health disparities. However, preferences for sexuality education approaches may differ among at-risk youth by additional factors including sex and sexual orientation. The purpose of this study was to describe sexuality education preferences among at-risk youth and how sexuality education preferences differ based on sex and sexual orientation in an at-risk sample of high school-aged youth in Texas. Results indicate sexuality education preferences differ based on sex and sexual orientation when examined by sexual health topics and methods of delivery. Implications of this study indicate including at-risk youth in sexual health programs may be a way to target those at-risk of adverse SDoH, but these groups also have specific preferences for sexuality education.

Background: We examine personal characteristics, alcohol consumption, normative beliefs, household factors, and extracurricular engagement associated with intentions to have intercourse before marriage among abstinent students. Methods: Data were analyzed from 245 freshmen enrolled in a school-based abstinence-only-until-marriage program. Two binary logistic regression analyses identified factors associated with intentions to engage in intercourse before marriage and within the next year. Results: Approximately 21% and 14% of participants reported intentions to have intercourse. Respondents participated in 2.2 (standard deviation [SD] = 1.2) extracurricular activities. Freshmen who were male, perceived their friends to approve of premarital sex, and consumed alcohol were more likely to report intentions to have intercourse. For every additional extracurricular activity in which freshmen participated, they were less likely to report intentions to have intercourse within the next year (odds ratio [OR] = 0.56). Conclusions: Factors such as extracurricular activities provide youth with opportunities to build supportive relationships, connect with peers and role models, and positively engage in schools and communities. Extracurricular activities typically already exist, have funding, and are generally well-supported. School-based strategies can increase teenagers' autonomy by providing a variety of activities to participate in and reduce unsupervised time. This, in turn, has the potential to decrease sexual risk taking behaviors.

Authors examined self-efficacy to motivate abstinent behavior (among youth) in a sample of instructors teaching abstinence-only-until-marriage education in Texas (N = 104). Sixty-one percent of the sample had been trained/certified to teach abstinence education. Instructors (mostly female and White) were more confident motivating students to maintain abstinent behavior than motivating change from sexual activity to abstinence (t = 9.354, df = 97). Regression modeling revealed "age" and "beliefs that abstinence education is theory-based" as significant predictors of confidence to motivate both abstinence maintenance and change. Additionally, ethnicity [being non-white ([beta] = -0.234, p = 0.030)] significantly predicted confidence to motivate behavior "change". (Contains 7 tables.)

Background: Curriculum issues in sexuality exceed typical content scope and many individuals are involved in the adoption process. Purpose: his descriptive study investigates characteristics of individuals in school districts that do or do not implement a abstinence-plus sexuality education curriculum. Methods: Authors investigated characteristics of districts utilizing a web-based survey. Descriptive statistics and tests of association between implementation status and other characteristics were utilized. Results: A significantly larger proportion of those implementing reported teachers being most influential (39.4% compared to 8.5% not implementing). Discussion: Individuals involved in curricular adoption should be trained regarding factors influencing sexuality education, challenges and barriers. [ABSTRACT FROM AUTHOR]

This study examined the association of demographic and other factors with acceptance of sex before marriage among 262 male and female freshmen attending Missouri high schools who reported they had never experienced sexual intercourse. The students completed the 7-item Acceptance of Sex Before Marriage Scale. Just under half (48.5%) of the students strongly agreed or agreed that 'People should have sex only if they are married,' 22.5% were unsure, and 29% strongly disagreed or disagreed. Multinomial logistic regression was performed to identify factors significantly associated with acceptance of sex before marriage by tertile (higher scores on the 7-item scale indicate more acceptance of sex before marriage). Results indicate freshmen who were female (OR=0.39), satisfied with their sexually activity status (OR=0.18), and received parent support when needed (OR=0.16) were significantly less likely to have high acceptance of sex before marriage. Conversely, those who reported strict household rules (OR=7.05) were significantly more likely to have high acceptance of sex before marriage. [ABSTRACT FROM AUTHOR]