Alex Mellanby

School sex education: an experimental programme with educational and medical benefit

Abstract Objective:To develop and teach a school sex education programme that will lead to a decrease in sexual activity. Design:A matched internal and external control experiment, comparing control populations which received their own sex education programmes with populations which received a novel sex education intervention that included medical and peer led teaching. Setting:Comprehensive secondary schools; control and intervention populations within Devon, and distant controls from rural, semiurban, and urban areas of England excluding major conurbations. Subjects:Schoolchildren were taught from age 12 to 16; three successive cohorts of students were evaluated in school year 11 (mean age 16.0) Main outcome measures:Questionnaire conducted under “examinationconditions” and invigilated by the research team and other trained medical staff. Results:In the intervention population, progressive increase in knowledge related to contraception, sexually transmitted diseases, and prevalence of sexual activity (χ2 (trend) P<0.001 for all three series); relative increase between intervention and control populations in knowledge, relative decrease in attitudes suggesting that sexual intercourse is of itself beneficial to teenagers and their relationships, relative decrease in sexual activity, and relative increase in approval of their “sex education” (relative risk >1.00 with 95% confidence limits not including 1.00 for all series and for comparisons with both control populations); odds ratio (control v programme) for sexual activity of 1.45, controlling for sociodemographic variables. Conclusion:School sex education that includes specific targeted methods with the direct use of medical staff and peers can produce behavioural changes that lead to health benefit.

Sex education: more is not enough

Increasing demands for sex education have been associated with a plethora of recommendations, regulations and resources with resulting variability of content, strategy, quality and outcome. While numerous studies confirm that the health behaviour of teenagers is not altered by the teaching of facts alone, other data suggest that appreciation of personal risk and learned assertiveness skills are associated with changes in population behaviours. Peer led teaching is a powerful and probably essential component of school health and sex education. Evaluated interventions with agreed purpose and acceptable methodologies are essential if there is to be any real expectation of health benefit from sex education.

A method for determining rates of sexual activity in schoolchildren.

This report details a novel methodology for determining rates of sexual activity in schoolchildren. The method has been found to be acceptable to schools, parents and students, it receives a high level of co-operation, a low (1%) parental withdrawal, and a low number (3%) of inadequate responses. A marked advantage of this method is the absence of direct questioning about first intercourse which is often considered inappropriate within schools. Validation conducted by interview at the time of the questionnaire and one year postal questionnaire follow-up indicates that this method gives a good estimate of sexual activity for school populations.

Added Power and Understanding in Sex Education (A PAUSE): a sex education intervention staffed predominantly by school nurses

The National Health Service (NHS) Centre for Reviews and Dissemination (Dickson et al., 1997) has suggested that despite the best efforts of education and medicine, school-based sex education programmes that result in behaviour change continue to be rare. Indeed, there is a growing body of evidence to suggest that traditional approaches to sex education are failing to meet the needs of young people. Added Power and Understanding in Sex Education (A PAUSE), reported by Mellanby et al. (1995a), is a programme now staffed predominantly by school nurses, which has shown positive medical and educational benefits that are, we believe, unique in Europe (Mellanby et al., 1995b).