Sexual Health Services in Schools: A Successful Community Collaborative.

School-based health centers (SBHCs) are an essential part of a comprehensive approach to address the health needs of youth. SBHCs that provide sexual health services (SHS) show promising results in improving reproductive health outcomes among youth. Despite the positive impact SBHCs can have, few school districts have SBHCs, and even fewer provide SHS. This article describes a successful 5-year project to provide SHS through SBHCs in a large county in the southeast United States. A community collaborative, including the schools, health department, community agencies and a local university, was created to address the project goals and objectives. Various steps were taken to plan for the SBHCs, including documenting community support for SHS offered through SBHCs, identifying school sites for SBHCs, and the process for offering pregnancy, STD (sexually transmitted disease), and HIV testing, treatment, and referrals. Protocols for clinic flow, testing, staffing, training, and student recruitment were developed. The staff at the SBHCs were successful in recruiting students to attend educational sessions and to receive testing and treatment. Student feedback was overwhelmingly positive. Lessons learned about the importance of the partnership's collaboration, using recommended clinic protocol, ensuring clear communication with school staff, and employing youth friendly recruitment and clinic practices are shared.

Depression in High School: Lesbian, Gay, and Bisexual Identity as a Moderator of Sexual Assault.

BACKGROUND: Depression continues to be a public health crisis for young adults. For high school students, past research has identified trauma as a significant predictor of depression. Congruent with the theory of cumulative stress, the present study hypothesized that the effect of sexual assault on depression would be stronger among lesbian, gay, and bisexual (LGB) students than among their straight peers. METHODS: Using the Youth Risk Behavior Survey completed by students attending Duval County Public Schools in Florida (N = 3053), this study used secondary data analysis to conduct 2 regression analyses, one for boys and one for girls. RESULTS: LGB status was associated with 3-fold increase in the odds of reporting depression for both boys and girls. History of sexual assault was associated with a significant increase in reporting depression. There was also a significant interaction effect between sexual orientation and history of sexual assault among male students only (p < .05). Contrary to the hypothesis, the effect was stronger among straight boys than among LGB boys. CONCLUSION: Minority students continue to evidence greater risks for depression. Opportunities for systemic changes to address these include training teachers, banning conversion therapy, and implementing comprehensive sex education.

Support for Offering Sexual Health Services Through School-Based Health Clinics.

BACKGROUND: Numerous studies document support for sexuality education in the schools. However, there is a dearth of research assessing support for sexual health services offered through school-based health clinics (SBHCs). The purpose of this study was to assess voter support for offering 3 sexual health services (STI/HIV testing, STI/HIV treatment, condom distribution) through SBHCs. METHODS: The survey was developed after review of existing surveys on support for sexuality education and sexual health services. The university's Public Opinion Research Laboratory used random-digit-dialing to administer the survey to participants (N = 311) including residential and cell phone numbers. RESULTS: Most participants were supportive of offering sexual health services at both middle schools (MS) and high schools (HS): testing for STIs/HIV (61% MS, 76% HS), treatment for STIs/HIV (60% MS, 75% HS), and provision of condoms (44% MS, 63% HS). Analyses showed significant differences in support for sexual health services by a few demographic variables, opinions about sexuality education, and the percentage of students perceived to have had sexual intercourse. CONCLUSIONS: Results document support for offering sexual health services through SBHCs. These findings may benefit other communities looking to implement similar clinics. Such services have great potential for positively impacting the sexual health of youth.

Improving sexuality education: the development of teacher-preparation standards.

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.

New evidence: data documenting parental support for earlier sexuality education.

BACKGROUND: Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. METHODS: As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). RESULTS: Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. CONCLUSIONS: Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education.

Sexual behaviors of middle school students: 2009 Youth Risk Behavior Survey results from 16 locations.

BACKGROUND: The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS: In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey-Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t-tests were calculated for these 5 items by gender, age, and race for each location. RESULTS: Data show that 5-20% of sixth graders and 14-42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION: Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.

Addressing sexual health in Florida youth: improving communication, collaboration, and consensus building among providers.

The purpose of this article is to describe (a) the Finding Common Ground Summits conducted in Florida during 2005-2006 with the objective of improving communication, collaboration, and consensus building among organizations interested in reducing sexual health risk behaviors among youth; (b) the attitudes of Summit participants; and (c) the impact of this exploratory initiative. The 196 participants, invited to participate by the Florida Department of Education, included individuals working in both school and community human sexuality education and promotion programs. Participants completed an initial survey just before the one-day Summits identifying attitudes and beliefs toward sexuality education. They were sent a Web survey approximately 6 months after the Summit to assess outcomes (n = 64). Frequencies and MANOVAs were conducted to assess differences on the attitude scale items between those identifying as supporters of abstinence-only, abstinence-based, and comprehensive sexuality education. The majority of participants believed sexuality education should be taught, gained an understanding of providers with varying philosophies, and wanted to continue collaborative efforts. This initial pilot project was successful in improving communication, collaboration, and consensus building among sexuality education providers, although future efforts are needed and encouraged as risky sexual behaviors among youth remain high.

Learning from a community action plan to promote safe sexual practices.

The well-being of a community is only as good as the well-being of the individuals who reside in the community. A group ofcitizens, concerned about the welfare of their community, recognized the high rates of HIV/AIDS and teenage pregnancy in their south Florida county and decided to take action. Supported by community leaders and using available resources within the county, this HIV/AIDS committee began a community-based participatory action project. Following a phone survey of over 1,000 residents, the committee determined that county residents were ready for change as well. Committee members developed and distributed a DVD to educate county residents about the importance of HIV testing and prevention. To reach the youths of their county, the committee members worked to change the high school curriculum to include more comprehensive sex education for students. The purpose of this article is to describe a community-based participatory action project to decrease the spread of HIV/AIDS and to discuss important lessons learned in the process.

The mediating role of adolescent self-efficacy in the relationship between parental practices and adolescent alcohol use.

This study investigated the mediating role of adolescent self-efficacy in the relationship between parental practices and adolescent alcohol use. Resistance self-efficacy was a perfect mediator in the relationship between parental monitoring and lower alcohol use. Resistance self-efficacy may determine the effect of parental monitoring on deterring alcohol use in adolescents.

Teacher beliefs, professional preparation, and practices regarding exceptional students and sexuality education.

Sexuality education, part of the comprehensive school health education component of a Coordinated School Health Program, interests many health educators as well as special education teachers. In this study, Florida special educators reported their beliefs about teaching sexuality education to educable mentally disabled students, the range of sexuality topics they teach, and their professional preparation in sexuality education. Respondents (n = 494) completed a mailed instrument that included the 36 sexuality content areas identified by the Sexuality Information and Education Council of the United States. Respondents believed strongly that many of the sexuality topics and content areas should be taught to educable mentally disabled students. However, most reported delivering only a modest amount of sexuality education, and they rated their professional preparation as inadequate. Regression analyses documented that respondents' beliefs predicted the topics they actually taught within 5 of the 6 key concepts. This study supports collaboration between health educators and special education teachers to adapt existing sexuality curricula for students with special needs, improve professional preparation of special education teachers to teach sexuality education, and to more effectively implement comprehensive school health education through the Coordinated School Health Program model to special education students.

Advocacy to action: addressing coordinated school health program issues with school boards.

As the need for Coordinated School Health Programs (CSHP) increases, so does recognition of the importance for advocating with local school boards for their support. Identifying the diversified make up of school board members and implementing effective strategies to advocate for coordinated school health can help facilitate the successful inclusion of such a program. With increasing emphasis placed on standardized testing and the "basic" curriculum, school board members need to become aware of specific benefits a CSHP can provide their district. With the relationship between health status and academic achievement confirmed in scientific research, school boards may begin paying more attention to providing high-quality health services and health instruction for students. This article presents items to consider and steps to take before, during, and after addressing a local school board for their support in implementing a CSHP.