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Sex Education as Health Promotion: What Does It Take?

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 December 2020) | Viewed by 93608

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Special Issue Editors

Dr. María Lameiras Fernández

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Guest Editor

Análise e intervención psicosocioeducativa, Universidade de Vigo, Circunvalación ao Campus Universitario, 36310 Vigo, Pontevedra, Spain
Interests: sexual education; sexual health; gender studies; gender violence; HIV prevention; health promotion

Prof. Dr. Yolanda Rodríguez Castro

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Assistant Guest Editor

Análise e intervención psicosocioeducativa, Universidade de Vigo, Circunvalación ao Campus Universitario, 36310 Vigo, Pontevedra, Spain
Interests: sexual education; sexual health; HIV prevention; gender violence; dating violence; sexting, porn revenge

Prof. Dr. Maria Victoria Carrera-Fernández

E-Mail Website
Assistant Guest Editor

Faculty of Education and Social Science, University of Vigo, 36310 Vigo, Spain
Interests: bullying and cyberbullying; vulnerable youth; cisheteronormativity; gender-related violence; queer sexual education; lesbian, gay, bisexual and transgender studies

Special Issue Information

Dear Colleagues,

The 2030 Agenda for sustainable development show us how good health and wellbeing are intrinsically intertwined with progress and development (UN, 2015). Unfortunately, promotion of sexual health has been over-centered in the prevention of risks and diseases more than the positive aspects of wellbeing. This gap is being overcome by Comprehensive Sexual Education (CSE) programs allowing us to go beyond education about reproduction, risks and disease, which reaffirms the position of sexuality education within a framework of human rights and gender equality (Unesco, 2018). However, sex education appeared as a range of different practices that were held together by the label “comprehensive sex education”, and despite the extensive evidence on the effectiveness of CSE Programmers, there are several issues to face. First, CSE programs are described as an evidence-informed approach, but this approach of sex education as realistic and neutral, connected to science and facts, forgets the crucial role of the social and political context in which sex education programs are implemented (Schaalma et al., 2014). Second, CSE highlights the individualistic, neoliberal approach to sexuality, which reduces the attention to crucial issues such as power differences, sexual agency, and sexual pleasure (Krebbekx, 2018). In addition, we need to know more about the role of pornography inside real world sexual encounters (Sun et al., 2014), and how advances in communication technologies and social media provide emergent modalities to engage adolescents in comprehensive sexual education (Kalke, et al., 2018; Todaro et al., 2018). The key questions are: What is being done? What obstacles are holding back the promotion of sexual health? What are the challenges? Papers addressing these topics are invited for this Special Issue, especially those combining a high academic standard coupled with a practical focus on innovative and successful sex education experiences.

Dr. María Lameiras Fernández
Prof. Yolanda Rodríguez Castro
Prof. Maria Victoria Carrera-Fernández
Guest Editors

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Keywords

comprehensive sexual education
female sexual pleasure
gender equality
gender stereotypes
gender violence
gender and power
sexuality
sexual agency
sexual education
sexual health
sexual pleasure
sexual risks

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Published Papers (11 papers)

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Research

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15 pages, 375 KiB

Open AccessArticle

How to Provide Sexual Education: Lessons from a Pandemic on Masculinity, Individualism, and the Neoliberal Agenda

by Sharon Lamb, Marta Pagán-Ortiz and Sara Bonilla

Int. J. Environ. Res. Public Health 2021, 18(8), 4144; https://doi.org/10.3390/ijerph18084144 - 14 Apr 2021

Cited by 7 | Viewed by 3695

Abstract

Sex education in the United States is often approached through an individual lens that focuses on personal protection, safety, and rights. This focus on personal responsibility and care-for-self reflects national values and permeates governmental systems and actions, including generalized public health approaches. This issue has been most recently highlighted in the individual and systemic attitudes, beliefs, and responses towards the recent, ongoing crisis following the global surge of COVID-19. In this paper, we provide examples and discuss lessons gleaned from the public health response to this crisis, particularly in the areas and intersections of gender, individualism, and neoliberalism, and the parallels of these issues in sex education. We make an appeal for a collectivist and community-oriented approach to sex education, which would focus not only on prevention and protection, but on inequities, ethics, and care for others. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

10 pages, 339 KiB

Open AccessArticle

Educating on Sexuality to Promote Health: Applied Experiences Mainstreaming the Gender and Human Rights Approach

by Ana L. Martínez-Abarca and Ana M. Martínez-Pérez

Int. J. Environ. Res. Public Health 2021, 18(5), 2249; https://doi.org/10.3390/ijerph18052249 - 25 Feb 2021

Cited by 1 | Viewed by 2911

Abstract

In the articulation between research and health intervention, we see the need to situate comprehensive sexuality education in the triangle formed by the salutogenic approach, the mainstreaming of gender and human rights, and the development of competencies in health promotion. For this purpose, we present a set of investigations carried out in Ecuador and Spain through a qualitative methodology with the respective health interventions that seek to obtain significant results of the teaching–learning process on sexuality. The field work contemplates situations of violence as a health problem, orienting the intervention in health empowerment toward pleasure. The health education experiences implemented allow us to conclude that comprehensive sexuality education reinforces the competencies of health personnel to attend to diversity. These findings, and the results expected in ongoing research, allow us to form a competency framework aimed at specifically improving medical education so that medical professionals can generate health processes with a cross-cutting approach to gender and human rights. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

15 pages, 430 KiB

Open AccessArticle

Preventing Violence toward Sexual and Cultural Diversity: The Role of a Queering Sex Education

by Maria Victoria Carrera-Fernández, María Lameiras-Fernández, Nazaret Blanco-Pardo and Yolanda Rodríguez-Castro

Int. J. Environ. Res. Public Health 2021, 18(4), 2199; https://doi.org/10.3390/ijerph18042199 - 23 Feb 2021

Cited by 6 | Viewed by 4821

Abstract

Background: The prevailing sex education (SE) model falls within a neoliberal prevention- and risk-oriented paradigm. This model ignores the identity dimension of sexuality, is based on the cis-heteronormative and ethnocentric matrix and stigmatizes sexual and cultural diversity; this has significant consequences for sexually and culturally diverse adolescents and youth. In this study, we explored the potential of the identity dimension of SE to prevent violence toward sexual and cultural diversity. Specifically, our objective was to identify the influence of heteronormative and ethnocentric variables on violence exerted against trans* and gender-diverse people and people from minority ethnic groups. Methods: A total of 623 Spanish adolescents with a mean age of 14.73 years and an age range of 13 to 18 years participated in the study. Students completed a questionnaire that included measures regarding violence toward sexual and cultural diversity, gender stereotypes, sexist attitudes and rejection of sexual and cultural diversity. We performed two hierarchical linear regression models. Results: Students who exerted the highest amount of violence toward trans* and gender-diverse people were those who showed the lowest endorsement of expressive traits and the highest endorsement of instrumental traits as well as the highest level of hostile sexist, heteronormative and hostile racist attitudes (the five predictor variables explained 29.1% of the variance of gender-bashing). These same variables—except expressiveness—and benevolent sexism explained 46.1% of the variance of rejection of minority ethnic groups. Conclusions: There is a need for a comprehensive, intercultural, critical and queer SE aimed at transforming the classroom into a space that promotes social transformation through an educational practice that is transgressive and critical of cis-heteronormativity and normative ethnocentrism. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

14 pages, 872 KiB

Open AccessArticle

Intimate Partner Cyberstalking, Sexism, Pornography, and Sexting in Adolescents: New Challenges for Sex Education

by Yolanda Rodríguez-Castro, Rosana Martínez-Román, Patricia Alonso-Ruido, Alba Adá-Lameiras and María Victoria Carrera-Fernández

Int. J. Environ. Res. Public Health 2021, 18(4), 2181; https://doi.org/10.3390/ijerph18042181 - 23 Feb 2021

Cited by 31 | Viewed by 14380

Abstract

Background: Within the context of the widespread use of technologies by adolescents, the objectives of this study were to identify the perpetrators of intimate partner cyberstalking (IPCS) in adolescents; to analyze the relationship between IPCS and gender, age, sexting behaviors, pornography consumption, and ambivalent sexism; and to investigate the influence of the study variables as predictors of IPCS and determine their moderating role. Methods: Participants were 993 Spanish students of Secondary Education, 535 girls and 458 boys with mean age 15.75 (SD = 1.47). Of the total sample, 70.3% (n = 696) had or had had a partner. Results: Boys perform more sexting, consume more pornographic content, and have more hostile and benevolent sexist attitudes than girls. However, girls perpetrate more IPCS than boys. The results of the hierarchical multiple regression indicate that hostile sexism is a predictor of IPCS, as well as the combined effect of Gender × Pornography and Benevolent Sexism × Sexting. Conclusions: it is essential to implement sexual affective education programs in schools in which Information and Communication Technologies (ICT) are incorporated so that boys and girls can experience their relationships, both offline and online, in an egalitarian and violence-free way. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

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18 pages, 1736 KiB

Open AccessArticle

Development and Evaluation of an Online Education-Entertainment Intervention to Increase Knowledge of HIV and Uptake of HIV Testing among Colombian Men Who Have Sex with Men (MSM)

by Ana María del Río-González, Maria Cecilia Zea, Sarah K. Calabrese, Fabián Betancourt, Jorge Pacheco-Cabrales, Yacid Estrada-Santiago and Paul J. Poppen

Int. J. Environ. Res. Public Health 2021, 18(4), 1811; https://doi.org/10.3390/ijerph18041811 - 12 Feb 2021

Cited by 6 | Viewed by 5754

Abstract

Using a community-based participatory approach, we developed a film to promote HIV testing among young men who have sex with men (MSM) in Bogotá. Using a 5-step process to develop the intervention, we conducted 11 focus groups with MSM (n = 141) to receive community feedback at each step. To evaluate the intervention we recruited 300 young MSM to complete a baseline survey in December 2017. Between February–June 2018, 63 participants watched the film and completed a post-viewing survey, which showed the intervention was acceptable for the target population. Between August–December 2018, 48 MSM who watched the film and 47 who did not (control group) completed a follow-up survey. To obtain preliminary evidence of the efficacy of the intervention, we assessed the main effect of time (baseline vs. follow-up) and the interaction between time and group (intervention vs. control) on HIV testing uptake and intentions, and knowledge of HIV transmission dynamics and HIV-related rights. Knowledge of HIV rights increased from baseline to follow-up in the intervention group only. HIV Knowledge increased for both groups. HIV testing intentions increased significantly more for non-gay-identified men in the intervention group, but the overall effect of the intervention was not significant. Testing uptake did not change. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

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14 pages, 365 KiB

Open AccessArticle

A Cross-Sectional Community Readiness Assessment for Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan

by Furqan Ahmed, Ghufran Ahmad, Katharina Paff, Florence Samkange-Zeeb and Tilman Brand

Int. J. Environ. Res. Public Health 2021, 18(4), 1497; https://doi.org/10.3390/ijerph18041497 - 4 Feb 2021

Cited by 5 | Viewed by 4036

Abstract

Evidence indicates that school-based sexuality education empowers children and adolescents with the skills, values, and attitudes that will enable them to appreciate their health and well-being, nourish respectful social and sexual relationships, understand their rights, and to make informed choices. Owing to organized community resistance and prevalent misconceptions, promoting sexual and reproductive health has been challenging, especially in conservative settings like Pakistan. This study aimed at systematically exploring communities’ perceptions regarding implementing school-based comprehensive sexuality education by conducting a cross-sectional community readiness assessment in Islamabad, Pakistan. A total of 35 semi-structured interviews were conducted with community key informants. Following the guidelines of the community readiness handbook, the interviews were transcribed and scored by two independent raters. The results indicate that, overall, the Islamabad community is at stage two of community readiness, the denial/resistance stage. Individual dimension scores indicate that knowledge of efforts, resources for efforts, knowledge about the issue, and leadership dimensions are at the denial/resistance stage. Only community climate was rated at stage three of community readiness, the vague awareness stage. This indicates that, for promoting sexuality education in the Pakistani context, it is essential to tackle resistance by sensitizing the community and the stakeholders through awareness campaigns. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

16 pages, 365 KiB

Open AccessArticle

Viewing Sexual Health Education through the Lens of Critical Pedagogy: A Case Study in Chicago Public Schools

by Elizabeth Jarpe-Ratner and Booker Marshall

Int. J. Environ. Res. Public Health 2021, 18(4), 1443; https://doi.org/10.3390/ijerph18041443 - 4 Feb 2021

Cited by 7 | Viewed by 3075

Abstract

Comprehensive sexual health education (SHE) programs are being implemented in many state and local jurisdictions. Much research has focused on the strength and effectiveness of such programs. However, the experiences of teachers and students in their implementation is underexplored. A case study of the implementation of the SHE policy and curriculum in Chicago Public Schools sought to explore teachers’ and students’ experiences. Sixteen teachers were interviewed and five student focus groups, including 46 students, were conducted. Both teachers and students identified opportunities to improve upon the current program, including to (1) incorporate more student-centered learning opportunities and allow for tailoring to each specific group of students; (2) use discussion and dialogue to encourage students’ exploration of their own opinions and identities and development of a sense of agency over their own learning; (3) shift focus from risk reduction to a more holistic focus on healthy sexual wellbeing; and (4) directly discuss current health inequities, contributing factors, and intersectionality. These findings align with a critical pedagogical approach and underscore the need to understand SHE implementation within its sociopolitical context. Implications of the use of critical pedagogy as a framework for SHE in Chicago and beyond are discussed. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

11 pages, 502 KiB

Open AccessArticle

Cervical Cancer Screening and Human Papillomavirus Vaccination among Korean Sexual Minority Women by Sex of Their Sexual Partners

by Ssirai Kim, Sun-Young Lee and Smi Choi-Kwon

Int. J. Environ. Res. Public Health 2020, 17(23), 8924; https://doi.org/10.3390/ijerph17238924 - 30 Nov 2020

Cited by 3 | Viewed by 2874

Abstract

Cervical cancer-preventive behaviors in Korean sexual minority women (SMW) are underexplored. We aimed to assess the differences in cervical cancer screening uptake and completion of human papillomavirus (HPV) vaccination among Korean SMW by sex of their sexual partners. This cross-sectional study used data from the 2017 Korean Sexual Minority Women’s Health Study; we included Korean lesbian and bisexual women aged ≥20 years. They were divided into three groups: SMW with more than one male sexual partner (male only/both), SMW with only female sexual partners (female-only), or no sexual partner (no partner). Among the 671 participants, 266 (39.6%), 294 (43.8%), and 111 (16.5%) belonged to the male-only/both, female-only, and no partner groups, respectively. Compared to the male-only/both group, the female-only group was significantly less likely to have undergone cervical cancer screening (Adjusted odds ratio (AOR) = 0.24, 95% confidence interval (CI) = 0.15–0.37) and to have completed HPV vaccinations (AOR = 0.58, 95% CI = 0.37–0.91). In conclusion, Korean SMW with only female sexual partners had lower cervical cancer screening and HPV vaccination completion rates than SMW who had male sexual partners. More extensive efforts are needed to improve cervical cancer-preventive behaviors among Korean SMW. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

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15 pages, 1160 KiB

Open AccessArticle

‘Sex Is Not Just about Ovaries.’ Youth Participatory Research on Sexuality Education in The Netherlands

by Marianne Cense, Steven de Grauw and Manouk Vermeulen

Int. J. Environ. Res. Public Health 2020, 17(22), 8587; https://doi.org/10.3390/ijerph17228587 - 19 Nov 2020

Cited by 22 | Viewed by 10988

Abstract

Young people are not satisfied with the sexuality education they receive in Dutch high schools. They rate their sexuality education as mediocre (5.8 on a scale of one to ten). In cooperation with 17 young peer researchers, we explored what good sexuality education looks like from the point of view of young people. The peer researchers collected data in their own high school, using mixed methods, starting with individual interviews, followed by focus group discussions and Photovoice sessions to get more in-depth views on topics, class atmosphere, and teacher skills. In total, 300 pupils aged 12–18 participated in the research. Our findings demonstrate that young people want more sexuality education, during their whole school career. They want sexuality education to move beyond biological functions, sexually transmitted diseases, and reproduction into issues like dating, online behavior, sexual pleasure, relationships, and sexual coercion. Moreover, pupils want sexual diversity integrated and normalized in all content. One of the main issues is that sexuality education should be given in a safe class atmosphere, which demands sensitivity from the teacher. In addition to the findings of the study, this article reflects on the steps to be taken to realize the changes desired by young people. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

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Review

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31 pages, 814 KiB

Open AccessReview

Sex Education in the Spotlight: What Is Working? Systematic Review

by María Lameiras-Fernández, Rosana Martínez-Román, María Victoria Carrera-Fernández and Yolanda Rodríguez-Castro

Int. J. Environ. Res. Public Health 2021, 18(5), 2555; https://doi.org/10.3390/ijerph18052555 - 4 Mar 2021

Cited by 62 | Viewed by 34797

Abstract

Adolescence, a period of physical, social, cognitive and emotional development, represents a target population for sexual health promotion and education when it comes to achieving the 2030 Agenda goals for sustainable and equitable societies. The aim of this study is to provide an overview of what is known about the dissemination and effectiveness of sex education programs and thereby to inform better public policy making in this area. Methodology: We carried out a systematic review based on international scientific literature, in which only peer-reviewed papers were included. To identify reviews, we carried out an electronic search of the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. This paper provides a narrative review of reviews of the literature from 2015 to 2020. Results: 20 reviews met the inclusion criteria (10 in school settings, 9 using digital platforms and 1 blended learning program): they focused mainly on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), whilst obviating themes such as desire and pleasure, which were not included in outcome evaluations. The reviews with the lowest risk of bias are those carried out in school settings and are the ones that most question the effectiveness of sex education programs. Whilst the reviews of digital platforms and blended learning show greater effectiveness in terms of promoting sexual and reproductive health in adolescents (ASRH), they nevertheless also include greater risks of bias. Conclusion: A more rigorous assessment of the effectiveness of sexual education programs is necessary, especially regarding the opportunities offered by new technologies, which may lead to more cost-effective interventions than with in-person programs. Moreover, blended learning programs offer a promising way forward, as they combine the best of face-to-face and digital interventions, and may provide an excellent tool in the new context of the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

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17 pages, 768 KiB

Open AccessReview

How Sexuality Education Programs Have Been Evaluated in Low- and Lower-Middle-Income Countries? A Systematic Review

by Olena Ivanova, Masna Rai, Kristien Michielsen and Sónia Dias

Int. J. Environ. Res. Public Health 2020, 17(21), 8183; https://doi.org/10.3390/ijerph17218183 - 5 Nov 2020

Cited by 15 | Viewed by 4642

Abstract

Background: Complex sexual and reproductive health interventions, such as sexuality education (SE), contain multiple components and activities, which often requires a comprehensive evaluation design and adaptation to a specific context. In this review, we synthetize available scientific literature on types of evaluation designs used for SE programs in low- and lower-middle-income countries. Methods: Two databases yielded 455 publications, from which 20 articles met the inclusion criteria. Narrative synthesis was used to summarize the findings. Evaluation approaches were compared to recommended evaluation frameworks. The quality of articles was assessed by using MMAT 2018. Results: A total of 15 interventions employed in 10 countries were evaluated in the 20 selected articles, with the quality of publications being moderate to high. Randomized controlled trial was the predominant study design, followed by quasi-experimental design. There were seven process evaluation studies, using mixed methods. Main outcomes reported were of public health or behavioral nature—condom use, sexual debut or delay, and number of sexual partners. By comparing evaluation designs to recommended frameworks, few studies fulfilled at least half of the criteria. Conclusions: Evaluations of SE are largely dominated by quantitative (quasi-)experimental designs and use of public health outcomes. To improve understanding of SE program effectiveness, it is important to assess the quality of the program development, its implementation, and its impact, using existing evaluation frameworks and recommendations. Full article

(This article belongs to the Special Issue Sex Education as Health Promotion: What Does It Take?)

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