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Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A booster round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

Through considerable efforts and investments of resources, adolescent pregnancy and birth rates in the United States have decreased significantly over the past two decades. Nonetheless, large disparities persist for many populations of youth. Reducing unintended adolescent pregnancies is considered a “winnable public health battle,” but one that will require innovative thinking and continued persistence. This paper reviews the recent research literature and innovative programmatic efforts to identify six promising strategies that address the challenge of adolescent pregnancy in new ways. These strategies aim to: (1) understand and address the complexity of adolescent lives; (2) expand the provision of quality sexual health education; (3) engage youth through technology and media; (4) increase access to contraceptives and other sexual health services; (5) create tailored interventions for populations with special needs; and (6) create a supportive policy environment. By building upon lessons learned from past efforts, we can move the field toward the development, strengthening, and promotion of future strategies that enhance the sexual well-being of all adolescents.

Despite national guidelines advocating a comprehensive, age-appropriate, and sequential approach to sexual health education in schools, many young people in the USA do not receive sexual health information until high school. To date, there has been little research on the need for a supplemental round of sexual health education – a 'booster' – later in adolescence to reinforce and expand upon information and skills previously provided. In rural California, we conducted six focus groups with young people (N = 22, ages 14–20) and key informant interviews with youth-serving professionals (N = 10) to examine the sexual health education needs of youth as they complete high school. Five themes were identified, indicating a need for booster education that 1) reinforces existing sexual health knowledge; 2) expands beyond traditional areas of sexual health education; 3) addresses community stigma about adolescent health; and 4) prepares young people for the transition to adulthood. In addition, booster education should 5) be established within the school system to promote an environment that addresses and normalises health issues throughout the school year. Providing booster sexual health education may meet critical gaps in efforts to support the healthy sexual development of young people, especially those living in rural communities. [ABSTRACT FROM AUTHOR]

To understand the diverse reasons why some young women choose contraceptive methods that are less effective at preventing pregnancy, including condoms, withdrawal, and emergency contraception pills, even when more effective contraceptive methods are made available to them. In-depth interviews with young women at family planning clinics in July-November 2016. Interview data were thematically coded and analyzed using an iterative approach. Two youth-serving family planning clinics serving predominantly Latinx and African American communities in the San Francisco Bay Area, California. Twenty-two young women ages 15-25 years who recently accessed emergency contraception to prevent pregnancy. None. Young women's experiences using different methods of contraception, with specific attention to methods that are less effective at preventing pregnancy. Young women reported having previously used a range of higher- and lower-efficacy contraceptive methods. In interviews, they described affirmative values that drive their decision to use lower-efficacy methods, including: a preference for flexibility and spontaneity over continual contraceptive use, an emphasis on protecting one's body, and satisfaction with the method's effectiveness at preventing pregnancy. Some young women described using a combination of lower-efficacy methods to reduce their pregnancy risk. Young women make contraceptive decisions on the basis of preferences and values that include, but are not limited to, effectiveness at preventing pregnancy. These reasons are salient in their lives and need to be recognized as valid by sexual health care providers to ensure that young women receive ongoing high-quality care. [ABSTRACT FROM AUTHOR]

Background: The study aimed to understand the influence of predisposing, enabling and need-for-care factors on adolescents' intention to use sexual health services, using Andersen's Behavioural Model of Health Service Utilisation to organise and test these factors.Methods: A sample of predominantly Hispanic teens (n=600) in Los Angeles, California completed a self-report survey about their sexual health knowledge, beliefs, intentions, and behaviours. Hierarchical regression modelling was used to examine the incremental influences on adolescents' intention to use sexual health services of: 1) predisposing sociodemographic factors; 2) predisposing knowledge and beliefs about sexual health; 3) enabling factors regarding perceived access to sexual health services; and 4) a need-for-care factor (sexual experience).Results: Adolescents reported high intentions to use sexual health services (3.25 on a 4-point scale), yet only 42% reported knowing where to access services. Sexual health knowledge and beliefs significantly predicted adolescents' intention to use services beyond the effect of sociodemographics (P<0.001). Enabling factors indicating awareness of and importance attributed to accessibility significantly predicted intention to use services incremental to predisposing factors (P<0.001). However, need for care - that is, sexual experience - was not statistically associated with intention to use services (P=0.402).Conclusions: Sexual health interventions are needed to provide sexual health information, promote positive beliefs about health care, and ensure adolescents' awareness of and access to sexual health services. [ABSTRACT FROM AUTHOR]

Background: An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. Methods: A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. Results: Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. Conclusions: Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. [ABSTRACT FROM AUTHOR]

This article offers an empirically grounded contribution to scholarship exploring the ways in which pleasure is 'put to work' in sex and sexuality education. Such research has cautioned against framing pleasure as a normative requirement of sexual activity and hence reproducing a 'pleasure imperative'. This paper draws on interviews with sexual health and education practitioners who engaged with Pleasure Project resources and training between 2007 and 2016. Findings suggest that practitioners tend to understand pleasure within critical frameworks that allow them to avoid normalising and (re)enforcing a pleasure imperative. Accounts also show negotiations with, and strategic deployments of, values surrounding sexual pleasure in society and culture. While some accounts suggest that a pleasure imperative does run the risk of being reproduced by practitioners, notably this is when discussing more 'contentious' sexual practices. Interviews also demonstrate that practitioners attempting to implement a pleasure agenda are faced with a range of challenges. While some positive, holistic, and inclusive practice has been afforded by a pleasure approach, we argue that the importance of a critical framework needs to be (re)emphasised. The paper concludes by highlighting areas for further empirical research. [ABSTRACT FROM AUTHOR]