Guiding Principles for Sexual Health Education for Young People
Sexual health education is responsive to the specific needs of young people and allows young people the opportunity to be active participants in the development and delivery of sexual health education.
A core premise of youth development/sexual health programming is that young people gain more from an experience when they are actively involved. Research also suggests that programs that are developed through a partnership of youth and adults may be highly effective in building young people's skills and reducing their sexual risk-taking behaviors. Such programs benefit the youth who help to develop them and also have a greater impact on the young people served.1
Community-based organizations may engage in a planning activity (e.g., work group) to examine the organization's structure and culture, and to identify any barriers that might prevent the active involvement of youth to help develop and deliver sexual health education. Examples of how to overcome these barriers include the following:
- Schedule meetings during times when young people are not in school or work (e.g., late afternoon, evening, weekend);
- Ensure meeting locations are accessible to adolescents who do not have personal vehicles or consider the provision of travel vouchers or reimbursement methods to cover transportation costs;
- For meetings that occur during meal times, provide food to young people; and,
- Ensure that youth are involved in programs in a meaningful way2:
- Begin by involving young people in planning, facilitating, mentoring and implementing specific projects or tasks (e.g., community development project, community health fair, HIV prevention education program, youth mentorship);
- After youth have participated in these specific projects or tasks, begin to obtain their opinions and perspectives on particular issues (e.g., focus groups, ongoing advisory groups); and,
- Finally, involve young people in decision-making roles (e.g., voting members of Board of Directors, deciding how funding is used, chairing community councils).
Sexual health education is most effective when it takes a positive youth development approach that builds on young people's existing strengths, skills and external assets.
Positive youth development is a way to think abut young people which focuses on their assets (capacities, strengths and developmental needs) and not on their deficits (risk, negative behaviors and problems). This approach calls for the shifting of attention away from a focus on the elimination of problems. It develops strategies that increase young people's exposure to positive and constructive relationships and activities that promote healthy, responsible and compassionate choices. A program that uses a positive youth development approach works with young people to help them realize their fullest potential.3
Community-based organizations may adopt strength-based approaches, including the following examples:
- Employ youth development principles and program tools, such as an assets survey, to identify and build on the strengths and assets of youth participants;4 and
- Incorporate program activities that focus on enhancing protective factors5, such as strengthening connections to families and communities, strengthening academic achievement (e.g., tutoring, service learning) and developing life and career skills (e.g., mentoring program).
Sexual health education provides a full range of scientifically accurate information and options for sexual health and for reducing the negative outcomes of sexual behavior.
The integration of HIV, sexually transmitted disease (STD) and pregnancy prevention involves the blending of messages and programs, networking among service providers and holistic methods for addressing sexual health issues. An integration of efforts provides many benefits for youth and for community-based organization that serve young people.6
One example of comprehensive approach to adolescent sexual health education would be to include topics such as the relationship of substance use to sexual risk, differences associated with gender-related sexual behavior/attraction/identity issues, adolescent health care rights (including reproductive rights) and sexual violence (including rape and sexual abuse).
Community-based organizations may develop an environment in which organizations (e.g., family planning, HIV/STD clinics, teen pregnancy, HIV/AIDS service) collaborate with youth, parents, communities and government agencies to promote adolescent sexual health. The following are examples of how to develop an integrated approach:
- Create a community coalition to support the integration of HIV, STD and pregnancy prevention;
- Invite staff members from sexual health organizations to meetings and conferences to provide presentations and share materials;
- Cross-train staff in HIV, STD and pregnancy prevention; and,
- Develop integrated messages and materials that address common risk factors.
Effective sexual health education interventions are those that have been proven effective by demonstrating positive effects on behavior with the intended participants.
Recent research on programs to reduce teen pregnancy and STDs shows that effective programs change adolescent sexual behavior by acting on the risk and protective factors that influence such behavior.7 The research studies identify the characteristics of effective programs and curricula.7,8 A listing of programs proven effective by rigorous research was published in 2006 by Advocates for Youth.9 A listing of curriculum-based programs that prevent teen pregnancy was published in 2009 by the National Campaign to Prevent Teen and Unplanned Pregnancy.10
Community-based organizations may consider the following when choosing a sexual health education intervention:
- Conduct a literature search and review interventions that have been published in peer-reviewed journals and shown to be effective;
- Identify interventions that have demonstrated behavior changes among youth (e.g., delayed sexual activity, reduced number of sexual partners, increased use of condoms, decreased unprotected sex); and,
- Identify interventions that have been proven effective in reducing the rates of HIV, STDs and pregnancy among adolescents.
Sexual health education provides young people with opportunities to learn, practice and apply the skills required to maintain optimal sexual health.
Life skills are behaviors that allow individuals to adapt to and effectively deal with the opportunities and challenges of life. Core life skills include decision-making, problem-solving, critical and creative thinking, analyzing and clarifying values, communication (listening, empathy-building, assertiveness and negotiating), emotional coping and self-awareness. These skills are effective in delaying initiation of sexual intercourse, and for youth who have experienced sexual activity, in increasing condom use and decreasing their number of sexual partners.11
Community-based organizations may conduct a range of activities that include skills-driven practice opportunities, such as:
- Use decision-making worksheets and problem-solving exercises to help adolescents consider their sexual health choices;
- Develop role-playing exercises that allow youth to practice how they would react to real-life situations in a non-threatening environment (e.g., refusing to have sex with a partner who does not have a condom, initiating a conversation regarding STDs with a partner);
- Develop activities that help young people to experience key skill areas, such as an activity that allows individuals to summarize or discuss the process involved with searching the internet for a STD testing site and considering steps needed to make an appointment and obtain services (e.g., contraception, condom demonstration);
- Provide links to simulated decision-making games on the internet that allow youth to make sexual health-related choices and to obtain feedback on the related consequences; and,
- Provide opportunities to apply learned skills in community settings (i.e., provide presentations, conduct advocacy activities).
Sexual health education provides information and skills that are appropriate to the physical, intellectual and emotional development, as well as the sexual orientation, of the intended participant.
During adolescence, physical changes happen at an increased rate. At the same time, young people experience cognitive, social, emotional and interpersonal changes. During growth and development, adolescents must deal with the influences of outside factors such as parents, peers, community, culture, religion, school, world events and the media. Although each adolescent is an individual with an individual personality and interests, there are many developmental issues that almost every adolescent faces during early, middle and late adolescent years.12,13
Sexual orientation is one component of a young person's identity. This component is made up of other components, including culture, ethnicity, gender and personality traits. Sexual orientation is something that develops across a person's lifetime, with realization varying at different stages of people's lives. Gay, lesbian and bisexual youth may face prejudice, discrimination, violent behavior and negative messages in their families, schools and communities.14 The "Sexual Education Library" provides a comprehensive list of sources of information on adolescent sexual behavior.15
Realizing that adolescents are at varying stages of cognitive and sexual development, community-based organizations may consider the following when communicating with adolescents:13
- Use non-threatening questions that help adolescents define their identities;
- Listen without judgment so that adolescents know that you value their opinions;
- Ask open-ended questions to assist adolescents with thinking through their ideas;
- Avoid asking "why" questions, which may put adolescents on the defensive; and,
- Provide examples of how you or someone you know made a decision (e.g., how to handle a personal conflict).
Sexual health education is tailored to the cultural and community norms of the intended participants.
Culture can be defined as a particular form of civilization, especially the beliefs, customs, arts and institutions of a society at a given time. Cultural competence refers to an ability to interact effectively with people of different cultures, including but not limited to people of different races and ethnicities. Developing cultural competence is a process that develops over a period of time.16
Community-based organizations may build a culturally-appropriate education program that provides opportunities for educators to develop their cultural competency skills, through:16
- Learning about culture in general and its components;
- Conducting a self-assessment of their cultural assumptions, values and perspectives (e.g., language and communication style, health beliefs, family relationships, sexuality, gender role, faith/religion, immigration status, racism, economic concerns);
- Learning about the adolescents being served, including their sexuality-related issues; and,
- Identifying the cultural norms and practices of the target community.
Sexual health education recognizes the larger context in which sexual behaviors occur and encourages the involvement and support of all people who have relationships with young people (e.g., parents, family members, peer and social networks, service providers, school personnel).
Parents' actions and attitudes greatly effect adolescents' development. Community-wide youth development efforts need the engagement of parents and other significant adults. Community is commonly defined as a locality where people live (e.g., a city or neighborhood). A community can also be seen as a group of people who identify themselves as such because of shared experiences, background, values, faith/religion, orientation, culture or interests. Adolescents thrive when all segments of the community contribute to their well-being.17
Community-based organizations may do the following to better assure successful collaboration between schools, parents/care givers and community members:17
- Assist schools to become familiar with the various organizations in their community (e.g., organizations' names, what they do and how they can help);
- Ask schools to invite community groups to participate in or co-sponsor school events, to ensure a feeling of shared responsibility and relationship-building;
- Sponsor a media campaign focused on parent/adolescent communication;
- Promote inter-generational events to foster and strengthen communication (e.g., mother/daughter, father/son, grandparents and other adults); and,
- Engage in an assessment process with the community to evaluate the accessibility of sexual health information and services for young people.
Sexual health education facilitates young people's access to needed health and support services.
Comprehensive adolescent sexual health education programs include information on the availability of a wide range of health and support services. It is best to have referral networks in place so that staff can help adolescents identify and access appropriate local resources and services when needed. Although confidentiality is critical, this can be challenging related to the role of adolescents' parents and guardians. The American Medical Association (AMA) encourages physicians to involve parents when it is in the best interest of the adolescent.18
In New York State, most young people under the age of 18 who understand the risks and benefits involved, may consent to and obtain sexual and reproductive health care services for the following without their parent's involvement or knowledge:19
- Reproductive services (including prescription contraception, emergency contraception and abortion);
- Prenatal care and care during labor and delivery;
- STD testing and treatment;
- HIV testing; and,
- Sexual assault (including counseling).
For HIV-related treatment, in general, minors must have parental consent. Exceptions include minors who are married, as well as minors who are pregnant/parenting.
Community-based organizations may consider the following to facilitate youth's access to health and support services:
- Develop referral networks with local service agencies that can assist adolescents in identifying appropriate resources and services;
- Create or modify local service directories that feature youth-friendly services, including hours of operation, location, directions and payment options (e.g., free/sliding scale, options for uninsured); and,
- Develop materials/messages that explain adolescents' rights associated with access to health care services.
Sexual health education programs have clear and measurable intended outcomes and regularly monitor their progress in achieving those outcomes.
In identifying intended outcomes, it is important to first define what needs to be assessed (e.g., what adolescents are learning). A baseline should be collected regarding each key measure at the start of the program so that there is a beginning point against which to measure a level of change. The intended outcome should be measurable so that evidence can be provided that the outcome was achieved. The outcome should be something that is important and there should be a method identified as to how progress will be assessed.20
Community-based organizations may do the following when creating their intended outcomes:20
- Select verbs (e.g., create, develop, evaluate) to specify the trait, ability or behavior to be assessed;
- Plan to measure the trait with quantitative or qualitative data (e.g., pre and post-tests, knowledge and attitude surveys, structured interviews, logs/journals);
- Ensure that the information to be measured is connected to the issues or questions that are useful and meaningful to stakeholders and that it can be classified into various categories (e.g., program outcomes, learning outcomes and developmental outcomes); and,
- Include expected outcomes such as:
- Increased perceived risks/costs of becoming pregnant or contracting HIV/STDs if sexually active
- Increased practice of sexual risk reduction behaviors
- Increased self-efficacy and skills to abstain from sex
- Increased number of adolescents who know how to access HIV/STD testing
- Increased self-efficacy and skills to obtain and use contraception
Some of the web addresses in the reference list below have changed since the "Guiding Principles for Sexual Health Education for Young People" was authored. Please see the Resources page for a complete list of updated links.
- Klindera, K. and Menderweld, J. “Youth Involvement in Prevention Programming”, Advocates for Youth, Washington, D.C., Revised Edition, August 2001. Accessed on October 10, 2008 at: http://www.advocatesforyouth.org/publications/iag/involvement.htm
- Dotterweich, J. “Youth Involvement”, Positive Youth Development Resource Manual, pp. 64-66, 83-87. ACT for Youth Upstate Center of Excellence, Cornell University, Ithaca, N.Y., September 2006. Accessed on March 12, 2009 at: http://www.actforyouth.net/?ydManual
- New York State Department of Health (NYSDOH). “Youth Development”, NYSDOH, Albany, N.Y., June 2007. Accessed on March 11, 2009 at: http://www.nyhealth.gov/community/youth/development/
- Search Institute. “40 Developmental Assets for Adolescents (ages 12-18)”, Search Institute, Minneapolis, M.N., 2006. Accessed on March 12, 2009 at: http://search-institute.org/system/files/40AssetsList.pdf
- Kirby, D. and Lepore, G. “Executive Summary: Sexual Risk and Protective Factors”, ETR Associates, 2007. Accessed on March 30, 2009 at: http://etr.org/recapp/theories/RiskProtectiveFactors/ExecutiveSummary200712.pdf
- Rogers, J., Augustine, J. and Alford, S. “Integrating Efforts to Prevent HIV, Other Sexually Transmitted Infections and, Pregnancy among Teens”, Advocates for Youth, Washington, D.C., January 2005. Accessed on October 10, 2008 at: http://www.advocatesforyouth.org/publications/iag/integrating.htm
- Kirby, D., Laris, B. and Rolleri, L. “Sex and HIV Education Programs for Youth: Their Impact and Important Characteristics”, ETR Associates, 2006. Accessed on October 10, 2008 at: http://www.etr.org/recapp/programs/SexHIVedProgs.pdf
- The National Campaign to Reduce Teen Pregnancy. “Emerging Answers, 2007 Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases”, 2007. Accessed on October 10, 2008 at: http://www.thenationalcampaign.org/EA2007/
- Alford, S. and Hauser, D. “Science and Success, Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections”, Advocates for Youth, Washington, D.C., 2006. Accessed on October 10, 2008 at: http://www.advocatesforyouth.org/programsthatwork/intro.htm
- The National Campaign to Prevent Teen and Unplanned Pregnancy. “What Works. Curriculum-Based Programs That Prevent Teen Pregnancy”, The National Campaign, Washington, D.C., 2009. Accessed on March 30, 2009 at: http://www.thenationalcampaign.org/resources/pdf/pubs/whatworks09.pdf
- Moya, C. “Life Skills Approaches to Improving Youth’s Sexual and Reproductive Health”, Advocates for Youth, Washington, D.C., 2002. Accessed on October 10, 2008 at: http://www.advocatesforyouth.org/publications/iag/lifeskills.htm
- Spano, S. “Research, Facts and Findings: Stages of Adolescent Development”, ACT for Youth Upstate Center of Excellence, May 2004. Accessed on April 13, 2009 at: http://www.actforyouth.net/documents/faCT%20Sheet05043.pdf
- American Psychological Association. “Developing Adolescents – A Reference for Professionals”, 2002. Accessed on October 10, 2008 at: http://www.apa.org/pi/cyf/develop.pdf
- Gay, Lesbian and Straight Education Network (GLSEN). Just the Facts about Sexual Orientation and Youth: A Primer for Principals, Educators and School Personnel”, GLSEN, 1999. Accessed on December 11, 2007 at: http://www.glsen.org/binary-data/GLSEN_ATTACHMENTS/file/123-1.pdf
- Sexuality Information and Education Council of the United States (SIECUS). “Sexual Education Library, Adolescent Sexual Behavior”. Accessed on October 10, 2008 at: http://www.sexedlibrary.org/adolescentsexualbehavior.html
- Messina, S. “A Youth Leader’s Guide to Building Cultural Competence”, Advocates for Youth, Washington, D.C., 1994. Accessed on October 10, 2008 at: http://www.advocatesforyouth.org/publications/guide/
- Mastro, E. and Grenz Jalloh, M. “Enhancing Service through Effective School/Community Collaboration”, Advocates for Youth, Washington, D.C., June 2005. Accessed on October 14, 2008 at http://www.actforyouth.net/documents/prACTice_June05.pdf
- Loxterman, J. “Adolescent Access to Confidential Health Services”, Advocates for Youth, Washington, D.C., 1997. Accessed on October 10, 2008 at: http://www.advocatesforyouth.org/publications/iag/confhlth.htm
- Labor, N., Kaplan, D. and Graff, K. “Healthy Teens Initiative: Seven Steps to Comprehensive Sexual and Reproductive Health Care for Adolescents in New York City”, New York City Department of Health and Mental Hygiene, New York, N.Y., 2006. Accessed on March 12, 2009 at: http://home2.nyc.gov/html/doh/downloads/pdf/ms/ms-hti-guide.pdf
- Brescianni, M. “Writing Measurable and Meaningful Outcomes”, Division of Undergraduate Affairs, North Carolina State University, Raleigh, N.C., 2001. Accessed on October 24, 2008 at: http://www.uga.edu/studentaffairs/assess/pdf/200708/Session_2/Writing%20Measurable%20and%20Meaningful%20Outcomes-%20Bresciani%20Article.pdf
* This guide is the product of the New York State Department of Health's Adolescent Sexual Health Work Group, a joint committee of the AIDS Institute, Center for Community Health and Office of Health Insurance Programs. New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237. February 2010.