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This article traces the transnational circulation of socialist reforms in the field of sex education through the work of Monika Krause, a citizen of the German Democratic Republic (GDR) who migrated to Cuba and became the "Cuban Queen of Condoms." For Krause, the overarching goal of sex education was to "teach tenderness" to the people. The socialist state's mission to prepare the population for love, marriage, partnership, and family in Cuba and the GDR involved using complex measures. This paper describes these, contextualizes them in transnational debates, and explains some of the internal reasoning behind their institutionalization. It also explains why looking at state-level efforts to "teach tenderness to the people" matters for a transnational history of sex education.

Objective: To assess the relationship between knowledge of long-acting reversible contraception (LARC) and intention to use LARC among female students. Participants: Participants consisted of a convenience sample of 292 female undergraduate and graduate students at a large midwestern university. Methods: We conducted a cross-sectional in-person survey and multivariate analysis of LARC knowledge and intention to use LARC. Results: Total response rate was 84.9%. Among contraceptive users, 13.3% were using a LARC method. On average, respondents scored 4.8/10 (SD 2.5) on a 10-item LARC knowledge assessment. Higher levels of LARC knowledge were associated with the intent to use LARC in the future in our multivariate analysis (RR 1.7, 95% CI 1.14-2.54: p = 0.01). Common reasons for LARC hesitancy were a need for more information, safety concerns, and risk of undesirable side effects. Conclusions: Low LARC knowledge and students' self-identified need for further LARC information represent an opportunity for campus contraceptive interventions which empower students to make informed reproductive decisions.

Because most parent-adolescent sex communication studies are from the perspectives of sexual and gender minority (SGM) adolescents rather than their parents, we surveyed 54 parents of SGM adolescents in the Southern region in the U.S. about their HIV-related parent-adolescent sex communication (PASC) practices. We compared topics discussed between the sexual activity and sexual orientation/gender identity of their adolescent. We found significant differences between parents having a sexually-active adolescent or not and parents discussing the importance of using condoms and what their adolescent should do if the adolescent contracts HIV. We provide future directions to further examine and improve PASC between parents and their SGM adolescents.

Sexual health education should meet the needs of all students. One strategy educators can use to ensure instruction meets students' needs is to encourage the submission of anonymous questions, allowing students to gain information without fear of instructor or peer reactions. We investigated anonymous questions submitted by middle school (7th-grade, ages 12-13) students during a sexual health education curriculum in Ohio, USA. Questions (n=893) were organised into 12 categories: reproductive anatomy (n=186), LGBTQ+ topics (n=130), sexual behaviour (n=120), class-related questions (n=99), pregnancy (n=78), slang (n=52), STIs (n=44), protection/birth control (n=33), relationships (n=19), consent (n=14), health services (n=9), abstinence (n=1), and unrelated questions/comments (n=108). After categorising questions, we conducted thematic analysis with the three largest categories (reproductive anatomy, LGBTQ+ topics, sexual behaviour). Results revealed students wanted to know about the normality of the processes and functions of their bodies. Students also expressed concern and had internalised social norms about LGBTQ+ topics. Student questions about sexual behaviour suggested they wanted to learn more about the purposes and processes of sex, e.g., how people have intercourse. Findings underscore the need for inclusive, comprehensive and medically accurate sexual health education for early adolescents. We discuss implications for student health/well-being, educator development, and school staff.

The aim of this qualitative study was to explore desired ways to deliver comprehensive sexuality education (CSE) and topics, among secondary school students in a low-resource setting in Western Kenya. One school (n = 440) has received 8-9-h CSE intervention, while the other school (n = 496) served as a control. After one-year follow-up the students were asked (one open-ended question) to suggest desired topics of CSE, with a response rate of 93% (n = 867). The following topics were suggested by the students: abortion, contraception, sexual rights, abstinence and STI/HIV, and preferred CSE delivery means were school-based teaching, online resources and social media, community-based elements or trusted individuals. The students who had not received the intervention were more in favor of an abstinence-only approach and demonstrated more negative attitudes toward abortion.

Teenage pregnancy is a phenomenon that causes concern due to its consequences. In this context, sex education has been considered as a good means of prevention. However, while teenage pregnancy prevails, sex education perspectives from the voices of teenage fathers and mothers remain under-explored. This qualitative study aimed at exploring sex education needs from the perspectives of teenage fathers and mothers at Cuenca, Ecuador. Semi-structured interviews were conducted with 19 young people aged 16 to 19 years, ten of whom were mothers. Following thematic analysis, three themes were identified: (1) pregnancy does not necessarily occur by accident; (2) inconsistencies exist in the use of contraceptive methods; and (3) current forms of sex education ignore the needs of adolescents. Findings are discussed in light of research addressing teenage pregnancy, focusing on adolescents as well as their developmental characteristics. The study identifies limitations in sex education when it comes to meeting the real needs of adolescent mothers and fathers.

While most parents support their adolescents receiving school-based sex education, there is variability in which sex education topics receive the most support from parents. Conservative political orientation and greater religiosity have been independently associated with parents' lack of support for school-based sex education; however, no studies have examined the intersection of these two factors. The three goals of this study were to: 1) identify how specific sexual education topics cluster together to form content areas; 2) examine if religiosity and political orientation are uniquely associated with these content areas; and 3) examine if political orientation moderates the relationship between parents' religiosity and their perceived importance for the specific sex education content areas. Participants were a national sample of 881 US parents. The sex education topics clustered into three content areas: Factual Knowledge (e.g., STI transmission), Practical Skills (e.g., how to access condoms), and Pleasure and Identity (e.g., pleasurable aspects of sex). Politically conservative and more religious parents reported the lowest perceived importance for each content area. Importantly, these main effects were qualified by a significant interaction: parents who reported both political conservativism and high levels of religiosity reported the lowest perceived importance for these three content areas being taught.

Parent-child communication concerning sexual and reproductive health (SRH) has significant potential to reduce children's risky sexual behaviour. Despite these benefits, few parents communicate with their children about SRH issues in Uganda. Using multi-stage stratified sampling in a cross-sectional survey, we estimated the prevalence and investigated the factors that were associated with recent parent-child communication among 600 children (10-17 years) in border districts of Uganda (Busia and Tororo). Results indicated that 61% of children reported to having received parent-child communication on SRH. Communication was more likely to happen among children living in urban areas (OR=4.88; 95% CI=1.79-13.33), boys (OR=1.84; 95% CI=1.13-3.00), those aged 15-19 years (OR=2.59; 95% CI=1.51-4.46) and among children from households that owned a mobile phone (OR=2.11; 95% CI=1.05-4.21) than their counterparts. Parent-child communication was also higher among children who were comfortable discussing SRH issues (OR=27.12; 95% CI=16.02-45.89) and children from Tororo district (OR=2.34; 95% CI=1.36-4.01). The findings provide a rich understanding of the factors associated with Parent-child communication in the border districts of Uganda. These results provide a basis for policy enactment or revision regarding the encouragement of parent-child communication about SRH in Uganda.

Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.

Reproductive interconception care provided at maternal postpartum visits may help reduce unintended pregnancies and elongate birth intervals for women experiencing homelessness. To improve interconception care uptake, this qualitative study aimed to identify barriers and facilitators to reproductive interconception care from the perspectives of women who were recently pregnant and homeless. A semi-structured interview guide and demographic survey were developed based on epidemiological findings, Information-Motivation-Behavioral Skill framework components, and a review by community health workers for content validity. After conducting 12 interviews with women recently pregnant and homeless in a local continuum of care in 2022, audio-recorded interviews were transcribed, iteratively coded using a priori and emerging codes, and thematically analyzed. Key themes were identified to determine implications and next steps to improving reproductive interconception care uptake. Interrelated themes focused on information (e.g., knowledge and misconceptions about pregnancy, birth intervals, contraception), motivation (e.g., attitudes about interconception care experiences, perinatal social influences), behavioral skills (e.g., objective ability to obtain interconception care and perceived self-efficacy related to attending maternal postpartum visits and increasing birth intervals), and macro-level factors (e.g., obtaining housing, contextualizing socioeconomic factors, navigating COVID-19). The findings suggest the need for flexible, streamlined, and personalized interconception care delivery that acknowledges pressing housing and relationship considerations and supports women's autonomy. Improvements to reproductive interconception care may reduce future unintended pregnancies, increase birth intervals, and improve birth outcomes among women experiencing homelessness.

Sex and fertility education is essential to enable people to make informed choices. School is an important source of education, so we examined the current curriculum relating to sex and fertility education in England and compared it with students' accounts of their experiences. We analysed the Awarding Body GCSE science and biology specifications (for 14-16 year-olds) and the A-level biology specifications (for 16-18 year-olds), as these related to relationships, sexuality and fertility. An online survey was conducted with 221 16-17 year-old school students to evaluate their views about their sex and fertility education. We found significant variation between the specifications of the Awarding Bodies at both GCSE and A level. Most of the specifications specify sexually transmitted infections (STIs), hormonal aspects of reproduction and contraception. In the school survey, students indicated that topics such as puberty, contraception and STIs were more likely to be learnt in school. However, topics such as endometriosis, menopause and miscarriage were more likely to be learnt outside school. From both our curriculum analysis and student survey we conclude that there are significant gaps in the curriculum with many important topics being neglected.

Although sexual and reproductive health is critically important for women with intellectual and developmental disabilities (IDD), there is limited research elucidating the role of family caregivers in assisting women with IDD access sexual and reproductive health services and information. Understanding the family caregivers' attitudes and perspectives is essential to improving access to sexual and reproductive health services and information for women with IDD. A cross-sectional online survey of family caregivers of women with IDD was administered between June and October 2018. Quantitative analysis was conducted for closed-ended responses, and qualitative analysis was conducted for open-ended responses. The analytic sample included 132 family caregivers. Most participants were parents and reported being closely involved in their family member's access to sexual and reproductive health services and information. Although most participants expressed that sexual and reproductive health services and information are essential for women with IDD, qualitative analysis of participants' open-ended responses revealed both supportive and restrictive attitudes and perspectives on sexual and reproductive health services and information for women with IDD. Supportive attitudes and perspectives included (1) "knowledge is power;" (2) supported decision-making; and (3) protection against sexual abuse. Restrictive attitudes and perspectives included (1) dependent on the individual; (2) lack of autonomy; and (3) placing responsibility on disability. Greater attention from policymakers and practitioners to systems-level changes, including universal and accessible sexual education for women with IDD, supported decision-making, and sexual abuse prevention measures, are urgently needed.

The life orientation programme (LOP) was introduced to all schools in South Africa to help learners to, among others, take cognisance of their sexual lives. Before the programme was introduced in the 2006, many learners had become infected with human immunodeficiency virus (HIV). The programme was introduced based on the perceptions that some learners were struggling as a result of the epidemic. The main aim of this study was to evaluate educators' perceptions of their ability to successfully implement the objectives of the programme. In the study we used open-ended questions to explore 8 educators' perceptions on the programme. Of the 8 educators who responded to the questions in the questionnaire, only 2 were interviewed based on their willingness and commitment to life orientation (LO) in schools. The findings suggest that only 1 of the 8 educators had the relevant training and qualification to teach LO at school. Although the educators considered the programme to have a moderate influence on the learners' sexual behaviour, we highlight compromise and uncertainty about the veracity of such claims. The introduction of LO to South African schools cannot be underestimated because of its well-timed intervention. However, all involved must be committed to ensure successful implementation of the programme.

Innovative approaches addressing the elevated human immunodeficiency virus (HIV) risk among men who have sex with men (MSM) or transgender women (TGW) migrants in South Africa are urgently needed. We sought to present the acceptability, feasibility and preliminary efficacy of 'Externalize and Mobilize!', a multi-session arts- and theatre-based HIV prevention group intervention for MSM and TGW migrants in South Africa. Fourteen participants--MSM (n = 7; 50%), genderqueer/nonbinary persons (n = 4; 29%) and TGW (n = 3; 21%)--in Cape Town were recruited and enrolled in the intervention and administered pre- and post-intervention assessments of HIV knowledge, HIV risk-reduction self-efficacy, stigma and resilience. The intervention, delivered over 4 days, was completed by all 14 participants. Scores on HIV knowledge and HIV risk-reduction self-efficacy were statistically significantly higher at post-intervention compared with pre-intervention. Additionally, participants responded affirmatively (i.e. 'Agree' or 'Strongly agree') on all items assessing intervention acceptability. Findings demonstrate the high acceptability, feasibility and preliminary efficacy of an arts- and theatre-based intervention for increasing HIV knowledge and HIV risk-reduction self-efficacy among MSM and TGW migrants in South Africa. This study provides further support for the use of creative and innovative interventions to address entrenched HIV disparities in South Africa.

Although the rate of sexual intercourse among adolescents has increased in Asian countries, including Korea, many sexually active adolescents still do not use contraception. The aim of this study was to identify the risk factors for contraceptive nonuse among adolescents using decision tree analysis of the 2018 Korea Youth Risk Behavior Survey data from 2,460 high school students who had an experience of sexual intercourse. The findings indicated that the highest risk group who did not use contraception during sexual intercourse did not receive sexual health education in school and was involved in habitual or purposeful drug use. The experience of ever receiving treatment due to violence and the experience of sexual intercourse after drinking were also identified as risk factors for contraceptive nonuse. To encourage contraceptive use, development of standard sexual health education, counseling, and educational intervention intended to prevent risky behaviors is needed.

Background: Early sexual reproductive health (SRH) education is linked to a reduction in risky sexual behaviors. Sexually transmitted infections (STIs) are rising at alarming rates. Risky sexual behaviors, including initiation of sex before age 13, having more than four sexual partners, and lack of use of condoms, increase the chance of infection and cancer. Informing students about the link between risky behaviors and cancer is vital to reduce morbidity and mortality. Methods: A trend analysis of the Youth Risk Behavior Surveillance System (YRBSS) data between 2001 and 2019 was conducted. Results from four survey responses related to sexual risk behaviors among 9th to 12th grade in Mississippi students are compared with their US peers. Results: Between 2001 and 2019, favorable declines in 3 out of 4 sexual risk behaviors were observed. Declining prevalence was reported for "ever had sexual intercourse," "age of sexual initiation at age 13 or younger," and "having 4 or more sexual partners in their lifetime" are promising. However, fewer students report using condoms. The adjusted prevalence rates for Mississippi students in all 4 measures were higher than the national responses. Conclusions: Our analysis supports the need for early skill-based sex education to promote health. States with increased behavioral risk among students should consider trends in data to improve education and policy.

Recent international documents and educational standards have recommended Science Education be based on three dimensions (Scientific Practices, Crosscutting Concepts, and Disciplinary Core Ideas). This has resulted in an increased interest in research involving Scientific Practices in Science Education. The objectives of this article are to: I) Identify the scientific practices that high school students engaged in during a thematic workshop; and II) Discuss the use of thematic workshops as an approach to promote Scientific Practices. The workshop was developed based on the Science, Technology and Society approach and aimed at discussing the composition, properties and effectiveness of male contraceptives. The workshop was conducted in a public school in Southern Brazil and the workshop footage and student questionnaires were analyzed according to Content Analysis. Three transcriptions of classroom situations are presented to discuss the promotion of Scientific Practices in specific classroom contexts. The analyses show that students engaged in six of the eight Scientific Practices discussed by the National Research Council. The results contribute to international discussions on Scientific Practices and discussions regarding the use of thematic workshops as an approach to promote Scientific Practices.

Information about state and local education policies regarding sexually transmitted infections, including human immunodeficiency virus, and unintended pregnancy prevention is available, yet less is known about school-level implementation of such policies. We examine trends in the percentage of US secondary schools teaching sexual and reproductive health (SRH) topics in a required course in Grades 6-8 and 9-12, including healthy relationships, sexual abstinence, condoms and condoms with other contraceptive methods. We analyze representative data from 38 states across six cycles of School Health Profiles (2008-18) assessed through self-administered questionnaires completed by lead health teachers. Logistic regression models examined linear trends in the percentages of schools teaching topics for Grades 6-8 and 9-12, separately. Trends were calculated for states having representative data for at least three cycles, including 2018. During 2008-18, it was more common to have increases in teaching how to obtain condoms, correct condom use and use condoms with other contraceptive methods in Grades 6-12 than decreases. More states showed decreases in teaching abstinence in Grades 6-12 than increases. Most states had no change in teaching SRH topics across grades. Findings suggest some improvement in school-based SRH education, yet efforts are needed to improve comprehensive, developmentally appropriate content.

Transgender individuals are disproportionately affected by HIV in the United States. Given increased risk of HIV among youth, there is a need to understand HIV risk and protective factors among transgender individuals who are 18 years and younger. Patterns of HIV testing, HIV education, and condom use have known associations with HIV outcomes among youth in general, but are understudied among transgender youth. This study assessed these outcomes by developing a series of sex-stratified multivariable logistic regression models using pooled Youth Risk Behavior Survey data. Results indicate female and male transgender youth as well as males who were not sure they were transgender were more likely have tested for HIV compared with their not transgender peers. Male transgender youth were significantly less likely to have received HIV education compared with not transgender males. Females not sure if they were transgender and male transgender youth were significantly less likely to have used condoms compared with, respectively, not transgender female and not transgender male counterparts. In sum, condom use and HIV education both remain lower among transgender individuals relative to their not-transgender peers. This highlights the need for the promotion of culturally appropriate HIV education and HIV prevention supports among transgender youth.

This study investigated whether youth involved with the child welfare system in the USA are receiving formal and informal sex education. Data come from the Second National Survey of Child and Adolescent Wellbeing, a nationally representative sample of children and adolescents in contact with child protective services. Participants included young people (n = 1093, aged 11-21) involved with the child welfare system. Participants reported whether they had received formal sex education about a) abstinence only; b) contraceptives/condoms only; c) abstinence and contraceptives/condoms; or d) none. They also reported whether they knew where to access family planning services. We examined the prevalence of sex education experiences and differences in sex education access and knowledge based on participants' pregnancy history and sociodemographic characteristics. Only half (49%) of participants had received any form of formal sex education. Pregnant youth were less likely to have received any sex education compared to non-pregnant youth . 72% of adolescents who had received sex education about contraceptives/condoms reported knowing where to access family planning services compared to only 46% of adolescents who had not received this sex education . There is a pressing need for comprehensive sex education among youth involved with the child welfare system.

Objective: To determine whether university students are aware of the sexual health services offered by the student health center. Participants: 522 undergraduate students at a southeast public university. Methods: Students were given a list of 19 sexual health services and tests and were instructed that for each one to check "offered," "not offered," or "I'm not sure." Results: Students were generally unaware that the health center offered testing for a variety of sexually transmitted infections (13-27.4% aware), the Gardasil vaccine for human papillomavirus (HPV) (15.5% aware), the IUD (8.8% aware), emergency contraception (18.6% aware), and breast (24.9% aware) and pelvic examinations (16.5% aware). The only exceptions were for free male condoms (63% aware) and women's awareness of birth control pills (55.3% aware) and pregnancy testing (50.3% aware). Nearly half the students were not aware that parents/guardians could not obtain health center medical records without the student's permission. Conclusions: Student health centers cannot be effective in reducing unwanted pregnancies and the spread of STIs if students are unaware of the services provided. Health centers must do a better job of educating students.

Objectives: To determine the impact of fraternity and sorority membership on condom use during sex. Methods: Utilizing data from The American College Health Association (ACHA) National College Health Assessment from 2016-2018, we estimated a linear probability, logistic, and instrumental variable model to determine the relationship between fraternity and sorority membership and the frequency of condom use during sex. Results: Compared to non-fraternity members, fraternity members experience an increase in sex without a condom for both oral sex (13.5%, 95% ci= 0.048, 0.221) and anal sex (28.5%, 95% ci= 0.174, 0.396). Compared to non-sorority members, sorority members are more likely to engage in oral sex without a condom. This result is not robust to single sorority members. Conclusions: Fraternity membership increases the probability of risky oral and anal sex. Policy Implications: The reduced use of condoms has implications on sexual health including an increased risk of contracting or spreading sexually transmitted infections.

Objective: College students make many important decisions related to sexual health, but little is known about their reproductive health knowledge. The purpose of the study was to examine health literacy and knowledge of female reproduction, contraception, and sexually transmitted infections (STIs) in college students. Participants: Undergraduate students (n = 323) completed a survey in November 2017. Methods: The survey included the Newest Vital Sign (NVS), Knowledge of the Female Body (KFB) scale, contraceptive questions, STI prevention questions, and sexual history questions. Results: NVS and KFB scores were positively correlated (p < 0.01). Male participants demonstrated significantly lower KFB scores than female participants (p < 0.001). Transgender participants demonstrated lower health literacy and lower knowledge of basic female reproduction than cisgender participants. Participants demonstrated low knowledge of the menstrual cycle, early physical signs of pregnancy, and certain contraceptives. Conclusions: Undergraduate students have major reproductive knowledge gaps. Healthcare providers need to consider health literacy and knowledge level when educating college students.

This systematic review aimed to understand the effects of self-esteem on risky sexual behavior (RSB) among adolescents and young adults. We followed the procedures outlined in the Cooper's five-step approach, and used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 reporting requirements. Published studies were identified using nine electronic databases. Studies were included based on (a) a focus on populations aged between 10 and 25 years; (b) an examination of the association between self-esteem-related factors, in line with RSB outcomes among adolescents and young adults; and (c) early sexual debut before 16 years, having multiple sex partners, and unprotected sex. In total, 11,216 studies were identified, of which nine studies met the inclusion criteria. All articles received high quality ratings. Despite methodological limitations, results showed that early sexual debut positively associated with self-esteem among female participants; condom use showed a negative association with lower self-esteem among female participants, while condom use decreased with decreasing self-esteem. Several sexual partners were found not to be associated with self-esteem. Intervention programs to increase the self-esteem of adolescents are recommended by educators to reduce risky sexual behavior among adolescents and young adults. Moreover, subsequent studies should develop instruments that assess self-esteem using subscales and educational programs that enhance healthy self-esteem development and correct sexual norms in peer groups and local communities.

Purpose: The aim of this study was to gain insight into the sexual beliefs of African American adolescent females and yield greater evidence for reframing the methods used to communicate sexual health education information to educators. Design and methods: This is a secondary data analysis of a qualitative descriptive study. One-on-one interviews were conducted with 36 African American females ages 12-14. The qualitative data were analyzed using exploratory deductive thematic analysis. Results: Three themes emerged from the analysis: (a) perceptions of sexual health education, (b) threat of adverse sexual health outcomes, and (c) perceptions of condom usage. Overall, adolescents had basic sexual health knowledge and accurately appraised their risk for adverse sexual health outcomes. Many adolescents perceived the biggest disadvantage of condom usage was condom ineffectiveness. The greatest barrier to condom usage was male opposition. Adolescents perceived the threat of adverse sexual health outcomes, but the perceived benefits of condom usage in preventing pregnancies and STIs may not outweigh the disadvantages and barriers described by the adolescents. Conclusion: The adolescents in this study had knowledge about pregnancies and STIs but lacked the skills necessary to enact safer sex practices.

Internet-based platforms present vital new venues for sex education. However, research is limited on the ways adolescents utilize these resources, particularly within user-generated content contexts. This study assesses the sexual health content adolescents seek online through a qualitative, directed content analysis of 365 user-generated posts in an open sexual health community forum. An adapted version of the National Sex Education Standards, a comprehensive, evidence-based sexual health framework, was used as the schema for this data analysis. Collectively, our results highlight and confirm the importance of providing comprehensive, medically accurate sexual health information to adolescents. Our analysis further supports the need to provide information on pleasure in sexual health and well-being, as well as guidance on social and emotional aspects of sexual health, and for education to be supportive and inclusive of all individuals. Ultimately, our results can help guide effective public health interventions, including sex education efforts, aimed at promotion of adolescent sexual health by offering direct insight into adolescents' perceived information needs.

Peer education is a widely used strategy in sexual reproductive health and rights (SRHR) programmes for young people, yet measurement of its effectiveness often focuses on a narrow set of outcomes. This qualitative study explored how peer education was integrated into the "Get Up, Speak Out for Youth Rights!" (GUSO) programme in Kisumu and Siaya Counties, Kenya and the contribution it made to measured and unmeasured outcomes. Findings indicate that whilst peer educators were a central part of the GUSO theory of change, the intentionality of design varied between partners and sites, and their contributions were formally measured only in relation to two of five outcome areas. In addition to their contributions to these measured outcomes, the study found that peer educators also contributed to a range of other, unmeasured outcomes related to community support and mobilisation; gender norms; and economic empowerment. Findings show that peer educators may contribute to many unmeasured -- and sometimes unexpected -- outcomes that go beyond traditional measurement of their contributions. These merit further exploration in the literature and in programming. Programme developers are encouraged to be more intentional in the design and measurement of peer education, ensuring that the breadth of its contribution to programming are recognised.

School-based health clinics (SBHCs) offer convenient, free, and much-needed health services to adolescents who have been shown to lack access to preventative care and treatment. With high rates of risky sexual behavior and associated negative health outcomes, SBHCs are particularly effective in providing sexual health services. This article presents results of a survey assessing support for such services through SBHCs. Data were collected using computer-assisted telephone interviewing (CATI) software. With significant differences found for each demographic variable assessed, findings document that the majority of participants supported offering all four sexual health services in both middle and high schools: STI/HIV testing, STI/HIV treatment, pregnancy testing, and providing condoms. These findings may be used to reduce barriers in providing SBHCs, advocate for policy change regarding SBHCs, add or expand current SBHCs, and support others in conducting similar studies hoping to document local support to implement these and other sexual health services. Although limited research shows that using local data can impact policy and facilitate local change, more studies are needed to explore the impact of using local data to implement change and further evaluate the impact of sexual health services through SBHCs.

The protective effects of talk with parents about sex in delaying sex and reducing young people's risky sexual behaviour may extend from adolescence to emerging adulthood. However, little is known about the content and process of this communication, or how parents and their emerging adult children perceive their conversations about sex and relationships. This study offers a novel exploration of family talk about sex during emerging adulthood and addresses topics that are not typically assessed as part of communication research, such as consent and positive talk about sexuality. This study uses thematic analysis to investigate perceptions of family talk about sex in a qualitative sample of 16 pairs of parents and their emerging adult children in the USA, and includes talk about protection, sexual behaviour, pregnancy and parenting; the positive aspects of sex; consent; and sexual orientation. Findings identified variation across topics in terms of 1) similarities and differences in parents' and emerging adults' comfort in talking with each other about sexual topics; and 2) how they perceive this communication across a range of sexual issues. Findings can inform the development of resources to support parents on how to talk with their emerging adult children about sexual issues in a developmentally appropriate way.

Respecting the Circle of Life (RCL) is a teen pregnancy prevention program that was evaluated for effectiveness on sexual health risk behaviors through a two-arm randomized control trial (RCT) with American Indian (AI) youth ages 11-19. The objective of this study is to investigate the effects of RCL compared to a control group on items of condom and contraception self-efficacy. Linear regression analysis was used to compare differences in each item that included condom and contraception self-efficacy scales among the intervention and control participants at baseline, 3 and 9 months post intervention. Youth enrolled in the intervention reported higher levels of condom and contraception self-efficacy across almost all individual items. Exceptions include items related to partner negotiation of condom self-efficacy at 3 months (p = 0.227) and 9 months (p = 0.074) post intervention. Findings indicate RCL is effective at improving overall condom and contraception self-efficacy but did not impact the specific component of partner negotiation for either condom or contraception self-efficacy. This inquiry provides rationale to further explore components of RCL related to partner negotiation.

This study aims to investigate whether Girl2Girl, a text messaging-based pregnancy prevention program for cisgender LGB+ girls, had different effects on subgroups based on age, sexual identity, and experience with penile-vaginal sex. A total of 948 girls, 14-18 years old, were recruited nationally via social media and enrolled over the telephone. Once they completed the baseline, they were randomized to either Girl2Girl or an attention-matched control program that discussed "healthy lifestyle" topics (e.g., self-esteem). Both programs were 5 months long: Girls received daily messages for 8 weeks, and then went through a "latent" period of 3 months, and finished with a 1-week review. Outcome measures included condom-protected sex, uptake of other types of birth control, abstinence, and pregnancy. Measures were collected at baseline; 3-month, 6-month, 9-month, and 12-month post-intervention end, which was 17 months after enrollment. Effect modification was examined using longitudinal mixed effects models. Overall, results suggested significant moderating effects of age, (f[superscript 2] = 0.12), sexual identity (f[superscript 2] < 0.14), and sexual experience (f[superscript 2] = 0.11) on rates of condom use and use of other contraception. Although there were no significant moderating effects on pregnancy, abstinence, or intentions to use condoms, use birth control, or be abstinent, (p's > 0.16), patterns of effects were in the same direction as for significant findings. For example, at 9-month post-intervention, among those who identified as bisexual, the incidence rate of protected sex events was 39% higher for intervention vs. control (IRR = 1.39, 95% CI: 1.06--2.70), adjusting for baseline rate of condom use and sexual experience. Similarly, at 12 months, among bisexual participants, intervention participants had a significantly higher IRR of condom-protected sexual events (IRR = 2.65, 95% CI: 1.31-5.34). There were also higher odds of uptake of birth control use other than condoms for intervention vs. control at 6- (OR = 1.10, 95% CI: 1.01-1.77), 9 m (OR = 1.11, 95% CI: 1.07-1.89), and 12-month (OR = 1.13, 95% CI: 1.07--1.78) follow-up. Girl2Girl appears to be particularly effective for older adolescents, bisexual girls, and those who have already had penile-vaginal sex. No one single approach is going to affect teen pregnancy. Instead, it is more likely that different intervention content and delivery methods will be more accessible and salient to some but not other youth. Understanding for whom the intervention works is just as important as understanding for whom the intervention does not, as this can inform opportunities for future intervention development. Clinical Trial Registration: ClinicalTrials.gov ID# NCT03029962.

Objective: Community college students engage in more risky sexual behavior compared to their four-year counterparts, yet have access to fewer reproductive health services. The study's purpose was to examine whether California Community College student health centers' participation in Family PACT, a state publicly-funded family planning program, increased reproductive health services to community colleges students. Participants: California community college student health centers. Methods: Bivariate analyses of student health centers with and without Family PACT participation and qualitative analysis of five participating campuses. Results: Among the 60 colleges in the study, 25 student health centers participated in the Family PACT program. Family PACT campuses reported greater provision of sexual and reproductive health services and higher levels of staffing and revenue. Conclusions: Key benefits of Family PACT participation among community colleges include expansion of sexual and reproductive health services to an underserved population and increased student health centers' financial sustainability.

Chinese universities have been conducting a variety of sexuality education programs, including a sexuality curriculum (SC) to increase sexual and reproductive health (SRH) knowledge and improve sexual attitudes and practices among college students. However, little is known regarding the effect of SC on students' sexual attitudes and behaviors. The purpose of this study was to evaluate the effect of SC on SRH knowledge, sexual attitudes, and practices among college students of Shandong University. To assess these issues, an online cross-sectional survey was conducted via a WeChat applet. Four hundred and forty-nine freshmen were recruited from Shandong University, including 209 students with SC and 240 students without SC. We assessed their SRH knowledge, sexual attitude, and practice. We found that 15.8% engaged in sexual activities, while 59.2% had viewed nonscientific books or videos describing sexual behavior within the past 2 weeks. Regarding the initial source of their SRH information, 65.9% taught themselves through reading or viewing SRH content in the media, and 46.8% participated in school lectures on SRH, while only 31.2% of the participants discussed SRH matters with their parents. As compared with students without SC, students with SC had significantly greater total scores with regard to reproductive health knowledge (P < 0.001) and sexual health knowledge (P < 0.001). Students without SC showed a significant degree of prejudice against sexually transmitted disease patients and were more resistant to interact with acquaintances infected with human immunodeficiency virus (P < 0.001). Exposure to a school-based SC had a beneficial effect on increasing the SRH knowledge of these students as well as mitigating risky sexual attitudes and behaviors.

This study attempts to design effective messages to promote condom negotiation self-efficacy and safer sex intent among young women in China. An online experiment with 2 (descriptive norm: present versus absent) × 2 (traditional sexual value: high versus low) between-subjects factorial design was conducted on a purposive sample of 241 female Chinese college students. The results demonstrated that culturally tailored messages incorporating descriptive norms information on the popularity of condom negotiation can increase participants' self-efficacy (F(1,237) = 9.01, partial [eta-squared] = 0.04, P = 0.003) but not safer sex intent (F(1,237) = 2.80, partial [eta-squared] = 0.01, P = 0.096). Participants with a lower level of traditional sexual values had similar levels of condom negotiation self-efficacy as those with a higher level of values: F(1,237) = 2.85, partial [eta-squared] = 0.01, P = 0.09. There were no significant interaction effects of traditional sexual value and descriptive norm on condom negotiation self-efficacy and safer sex intent. The findings contribute to the cultural sensitivity perspective in health education in an Eastern context and have implications for public health practitioners and policymakers.

Background: Social media platforms have become a popular source for health information despite concerns about the quality of content shared. We examined how oral contraceptive pills and intrauterine devices are framed on the platform Pinterest using the Health Belief Model (HBM), as well as how fertility awareness methods are portrayed as an alternative to hormonal contraception. Methods: We collected pins in February 2021 using searches for birth control, oral contraceptives, and intrauterine devices. After excluding paid ads and pins not relevant to contraceptive use, we conducted a content analysis of 404 pins using a coding framework grounded in the HBM. We carried out descriptive statistics for all variables in the final sample. Results: Following coding, we found that 54.7% of pins mentioned oral contraceptive pills, 41.58% mentioned intrauterine devices, and 11.63% mentioned fertility awareness methods. Fertility awareness pins had the highest percentage of benefits conveyed (70.21%), followed by intrauterine devices (44.05%), then oral contraceptive pills (38.91%). Pill pins had the highest percentage of barriers conveyed (52.94%) and fertility awareness had the least (25.53%). Side effects were the most mentioned barrier among pill (37.10%) and intrauterine device pins (23.21%). Very few pins were made by (2.48%) or originated with medical institutions (5.45%). Conclusions: Oral contraceptive pills are often negatively framed on Pinterest, whereas intrauterine devices and fertility awareness methods are more positively framed. This suggests a need for clear communication from clinicians regarding all contraceptive options and their relative merits and risks.

In order to know the reasons why the pregnancy phenomenon is increasing at schools, this study focused on early pregnancy determining and repercussion analysis at schools in Benin. The principal data have been collected from three public secondary schools in Benin. Descriptive analysis and frequencies using have been used to analyze the data. After the analysis of collected data, results show that having sex without condoms, parents' poverty are the principal causes of early pregnancy. The majority (48.4%) of pregnant girls are 15 or 17 years old and all the pregnancies concern the girls of first cycle (first form to fourth form) based on non-desire pregnancy. The consequences of this phenomenon are on the health, society and schools. [Note: The issue number (1) indicated on the PDF is incorrect. This article is published in the v3 n2 2020 issue.]

Poor physical health is common in people with Severe Mental Illness (SMI). Two-thirds of deaths in SMI could be avoided if patients are offered prompt physical health screening for known risk factors. We aimed to identify SMI patients registered at a General Practice and audit their care in relation to physical health monitoring. We included adult patients with coded diagnoses of SMI. We selected 18 best practice criteria for physical health monitoring, based on Quality and Outcomes Framework (QOF) indicators for mental health, NICE guidelines and other professional guidance. Data was obtained from electronic patient records and examined over a 12-month period. Only 5 out of 18 best practice criteria achieved compliance above the expected standard of 70% (annual record of blood pressure, smoking, alcohol, medication review, prescription on repeat template). Care planning achieved 69%; and most of the remaining parameters (pulse, BMI, weight, QRISK2, serum lipids, glucose, dietary advice, physical activity, drug use) reached levels around 50-60%. Particularly low compliance (<40%) was found for ECG, pregnancy/contraception advice and medication side-effects. There is definite room for improvement regarding physical health monitoring of SMI patients within general practice. We recommend increased attention to annual physical health checks, particularly cardiovascular risk factors, and the consistent offer of targeted interventions. Organisational financial incentives are also effective at increasing compliance results.

Many factors at the individual, relationship, family, and community or environmental levels could predict repeat teen pregnancies or births, but research on certain factors is limited. In addition, few studies have examined whether these factors can accurately predict whether teen mothers will have a repeat pregnancy. This study examined theoretically selected predictors of repeat teen pregnancy among 945 pregnant and parenting teens (M age = 17), most of whom were Hispanic/Latina (86%). Logistic regression with 47 predictors measured at baseline was used to predict repeat pregnancy. Predictors were selected based on backward selection that aimed for a balance between model performance and model complexity. A random forest model was also used to determine how accurately repeat pregnancy could be predicted based on all predictors. Significant predictors of repeat pregnancy were the teen mother having a parent with a serious drinking or drug problem when she was a child, being older, not living with a mother figure, not intending to abstain from sex or use a long-acting reversible contraceptive, and having lower resiliency skills. However, predictors explained limited variance in repeat pregnancy, and their accuracy in predicting repeat pregnancy was low. More research is needed to identify accurate predictors of repeat pregnancy because this could inform program providers or developers about areas that warrant more focus in programming for teen parents, and it could help identify teen mothers at higher risk of a repeat pregnancy so they could be the focus of specific programming.

Purpose: The purpose of this study was to investigate the feasibility and effectiveness of a gender-specific intervention targeted to adolescent males to reduce sexual risks. Method: This study used a randomized clinical trial comparing a broad-based male empowerment curriculum with a no-treatment control group. The sample (N = 580) was recruited from schools and was implemented in community-based settings mostly in an after-school context. Assessments were conducted at baseline, postintervention, and 3 months follow-up time periods. Results: There were significant differences between the two groups favoring the intervention group on several of the outcome indicators, including condom technical skills, attitudes toward women, social skills, peer assertiveness, and attitudes toward consent. Quality of implementation was rated high, and qualitative data suggest themes that reflect key lessons emphasized in the curriculum. Conclusions: Gender-specific programs for adolescent males can help reduce indicators that are related to sexual risk reduction. More long-term follow-up is needed to assess impact on sexual behaviors. Efforts directed at male populations should continue to be researched for potential in reducing sexual risks.

A better understanding of the complex relationships between HIV knowledge, self-efficacy, perception of peer condom use, and condom-use intention is needed for improving HIV prevention among adolescents. The study analyzed survey data collected from high school students (N = 1970) in the Bahamas. Mediation and moderated mediation modeling analyses were used for data analysis. Results showed that self-efficacy mediated the association between HIV knowledge and condom-use intention. Perception of peer condom use moderated the mediation model by modifying the HIV knowledge-self-efficacy and self-efficacy-condom-use intention associations among males, but not for females. Findings of the study suggest the significant impact of perception of peer condom use in competition with HIV knowledge and self-efficacy in promoting condom use. Effective intervention program may consider targeting the modification of adolescents' perception of peer condom use to promote condom use among adolescents.

Few studies have investigated mediator effects of HIV prevention interventions on adolescents in sub-Saharan Africa. Herein, we report on a secondary analysis of an intervention that increased intentions to use condoms, abstain from sexual intercourse, and seek safe male circumcision among adolescents in Botswana. In a study conducted in Botswana, 806 grade 9 students from 21 public Junior Secondary Schools were randomly assigned to either the OWN THE FUTURE: Pulling Together We Will" ( PTWW) intervention group or a health promotion control group. Both conditions consisted of 12 1-h modules, with two modules delivered during each of the six sessions on six consecutive school days. The students in both groups completed confidential computer-based surveys at several time points: pre-, immediately post-, 3, 6, and 12 months post-intervention. Mediation was assessed using the product-of-coefficients approach in a generalized estimating equations (GEE) framework. The analyses showed that condom use beliefs were significant mediators of the intervention effect on the intention to consistently use condoms over time. Also, negative socio-cultural beliefs, prevention beliefs, and HIV/STI knowledge were significant mediators of the intervention's effects on the intention to abstain from sex. Additionally, normative beliefs, prevention beliefs, parental negotiation, and circumcision knowledge were significant mediators of the intervention's effect on intention to seek safe male circumcision. The mediation analysis delineated a theoretical model and isolated activities that positively impact condom use, abstinence from sex, and circumcision intentions of Batswana middle school adolescents.