Effects of the school environment on early sexual risk behavior: A longitudinal analysis of students in English secondary schools.

INTRODUCTION: The theory of human functioning and school organization proposes that schools promote health by strengthening students' educational engagement. Previous studies have relied on proxy measures of engagement and not examined sexual health. This paper addresses these gaps. METHODS: Longitudinal data came from the control arm of a randomized trial involving female and male students ages 12-14 in English secondary-schools (n = 3337 students). Exposures measured at baseline included a proxy measure of school-level engagement (value-added education, VAE: the difference between observed absence and attainment rates and those predicted based on student characteristics) and direct measures of school- and student-level engagement (commitment, belonging, relationships and participation). Sexual behavior was measured at 24- and 36-months, including sexual debut and contraception use at first sex. RESULTS: Higher school-level VAE was associated with an increased risk of early sexual debut at 24-months. Students attending schools with higher overall levels of commitment and belonging were less likely to report sexual debut at 36 months. Students reporting stronger personal commitment to learning and teacher relationships at baseline were less likely to report sexual debut at both follow-up points. Associations involving participation and contraception use were largely nonsignificant. CONCLUSIONS: Direct measures of the school environment are more strongly associated with reduced sexual risk behavior in early adolescence than the proxy measure, VAE. Results provide some support for the theory and suggest that personal disposition towards school as well as attending a school with high levels of student commitment and belonging are important for subsequent sexual decision making.

Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis.

CONTEXT: School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS: Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS: Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS: Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.

School experiences and young women's pregnancy and parenthood decisions: A systematic review and synthesis of qualitative research.

Schools are considered high-potential environments for promoting adolescent sexual and reproductive health outcomes among young women. Qualitative studies provide context and meaning to how school experiences and systems contribute to pregnancy and parenthood decisions from the perspectives of youth. This systematic review screened 24,711 references from 8 databases, yielding 28 qualitative studies. Included studies were assessed for quality and synthesised using meta-ethnographic approaches. Reciprocal translation revealed that young women's education and life trajectories were at least partially shaped by a commitment to school values and expectations for academic achievement, influenced by structural and relational factors within the school. These findings resonate with Markham and Aveyard's theory of human functioning and school organisation. Future policy and practices might seek to improve teacher-student interactions, leverage young women's developing autonomy, and ensure physically and psychologically safe spaces for students.

Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis.

CONTEXT: School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS: Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS: Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS: Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.

RESUMEN Contexto: Las intervenciones en entornos escolares dirigidas a modificar los conocimientos, actitudes y conductas de salud sexual tienen efectos mixtos y, con frecuencia, insostenibles en los resultados de salud sexual de los adolescentes. Sin embargo, la evidencia observacional sugiere que hay factores más amplios relacionados con la escuela, como el clima escolar y el logro educativo, que pueden influir en los resultados. Métodos: En julio de 2017, se realizaron búsquedas en nueve bases de datos de evaluaciones aleatorias y cuasi experimentales de intervenciones que abordan el entorno escolar o los activos educativos de los estudiantes, para examinar si dichas intervenciones pueden promover la salud sexual de los jóvenes. Las búsquedas se limitaron a estudios publicados a partir de 1990, pero no se restringieron por idioma. Los estudios se evaluaron para determinar el riesgo de sesgo y se sintetizaron de forma narrativa y metaanalítica. Resultados: Las búsquedas produjeron 11 evaluaciones de intervenciones relacionadas con el entorno escolar o los activos educacionales de los estudiantes, publicadas de 1999 a 2016. Debido a inconsistencias en los informes, el riesgo de sesgo no fue claro para la mayoría de los estudios, por lo que el metaanálisis solo fue posible para un resultado. El metaanálisis de tres ensayos aleatorios proporcionó cierta evidencia de que las intervenciones en el entorno escolar podrían retrasar el debut sexual (razón de probabilidades agrupada, 0.5). La síntesis narrativa de los resultados restantes encontró resultados mixtos, pero sugiere que las intervenciones que abordan el entorno escolar pueden retrasar el debut sexual y que aquellas que abordan los activos educacionales a nivel de los estudiantes pueden reducir el riesgo de embarazo y de ITS. Conclusiones: Se necesita evidencia adicional y más rigurosa para evaluar la probabilidad de que las intervenciones que abordan los factores relacionados con la escuela sean efectivas y para proporcionar una mejor comprensión de los mecanismos mediante los cuales pueden trabajar para mejorar la salud sexual de los adolescentes.

RÉSUMÉ Contexte: Les interventions en milieu scolaire qui cherchent à modifier les connaissances, les attitudes et les comportements en matière de santé sexuelle ont des effets mitigés et souvent éphémères sur les résultats de santé sexuelle des adolescents. L'observation donne cependant à penser que des facteurs plus larges liés à la scolarité, comme le climat à l'école et le niveau atteint, peuvent influencer ces résultats. Méthodes: Neuf bases de données ont été consultées en juillet 2017 à la recherche d'évaluations randomisées et quasi-expérimentales d'interventions concernant l'environnement au niveau de l'école ou les actifs éducatifs au niveau de l'élève, afin d'examiner si ces interventions peuvent favoriser la santé sexuelle des jeunes. La recherche s'est limitée aux études publiées depuis 1990, sans restriction de langue toutefois. Outre une évaluation du risque de biais, les études ont fait l'objet d'une synthèse narrative et méta-analytique. Résultats: La recherche a produit 11 évaluations, publiées de 1999 à 2016, d'interventions relatives à l'environnement scolaire ou aux actifs éducatifs de l'élève. Faute d'uniformité des rapports, le risque de biais n'a pas pu être évalué clairement pour la plupart des études et la méta-analyse ne s'est avérée possible que pour un résultat. La méta-analyse de trois essais randomisés tend à indiquer que les interventions en milieu scolaire peuvent différer les premiers rapports sexuels (RC groupé, 0,5). Pour le reste, la synthèse narrative a produit des résultats mitigés, donnant toutefois à penser que les interventions relatives à l'environnement scolaire peuvent différer les premiers rapports sexuels et que celles ayant trait aux actifs éducatifs de l'élève peuvent amoindrir le risque de grossesse et d'IST. Conclusions: Des données supplémentaires et plus rigoureuses sont requises pour évaluer la probabilité d'efficacité des interventions touchant aux facteurs scolaires et permettre de mieux cerner les mécanismes par lesquels elles peuvent être utiles à l'amélioration de la santé sexuelle des adolescents.

Dual Contraceptive Method Use Among Youth in Alternative Schools.

Dual contraceptive method use, or using a highly effective contraceptive method plus a barrier method like condoms, is gaining attention as a strategy for preventing unplanned pregnancy and sexually transmitted diseases. We investigated rates of dual method use among a sample of youth in urban alternative schools, and explored the relationship between dual method use and sexual partner type. The study analyzed data from 765 students enrolled in 11 district-run continuation high schools in northern California. We explored the association between dual method use and sexual partner type (steady only, a mix of steady and non-steady, and non-steady only) using logistic regression. Differences in dual rates by partner type were statistically significant, with higher rates of dual methods use reported among young people reporting non-steady sexual partners only, as compared to those with steady partners only. The data illustrate that young people in alternative school settings could gain from further intervention on the benefits, skills, and challenges of using two methods of contraception as opposed to one with both steady and non-steady sexual partners.