Katie Buston

Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial

Abstract Objective: To determine whether a theoretically based sex education programme for adolescents (SHARE) delivered by teachers reduced unsafe sexual intercourse compared with current practice. Design: Cluster randomised trial with follow up two years after baseline (six months after intervention). A process evaluation investigated the delivery of sex education and broader features of each school. Setting: Twenty five secondary schools in east Scotland. Participants: 8430 pupils aged 13-15 years; 7616 completed the baseline questionnaire and 5854 completed the two year follow up questionnaire. Intervention: SHARE programme (intervention group) versus existing sex education (control programme). Main outcome measures: Self reported exposure to sexually transmitted disease, use of condoms and contraceptives at first and most recent sexual intercourse, and unwanted pregnancies. Results: When the intervention group was compared with the conventional sex education group in an intention to treat analysis there were no differences in sexual activity or sexual risk taking by the age of 16 years. However, those in the intervention group reported less regret of first sexual intercourse with most recent partner (young men 9.9% difference, 95% confidence interval −18.7 to −1.0; young women 7.7% difference, −16.6 to 1.2). Pupils evaluated the intervention programme more positively, and their knowledge of sexual health improved. Lack of behavioural effect could not be linked to differential quality of delivery of intervention. Conclusions: Compared with conventional sex education this specially designed intervention did not reduce sexual risk taking in adolescents.

Difficulty and Diversity: The context and practice of sex education

The amount and nature of sex education provided varies from school to school. Teachers regard it as fraught with difficulties. It is a sensitive subject, there is no statutory training, no set curriculum or examinations to work towards, and it is one of many areas to be dealt with in an increasingly crowded Personal and Social Education programme by teachers who often also have a guidance role and a subject commitment. Drawing on data from 25 schools in Scotland, this paper considers how teachers talk about sex education, and looks at the factors that shape provision, at the school and teacher levels. The broad priorities of the senior management team, and the views and experience of key individuals, shape programme design. Within schools, the values, experiences and characteristics of individual classroom teachers are important in understanding what sex education is actually delivered, particularly where the Guidance Team lacks cohesion.

The salience and utility of school sex education to young men

This paper focuses on young mens views on the school sex education they have received, the influence of this sex education on their intended or actual behaviour, and the extent to which other sources of information complement or supplement school sex education. Thirty‐five in‐depth interviews and eight group discussions were conducted with male pupils from six schools in the east of Scotland. Most of those interviewed did cite school as a useful source in learning about sex. The most commonly named highlights were learning more about what girls think about sexual matters and learning how to use a condom. Nine described how something they had learned in school sex education had changed the way they had behaved in a sexual encounter. A further eight, who had not experienced sexual intercourse, talked about how they thought sex education would influence their behaviour in a positive way in the future. The most common criticism of sex education was that it was not explicit enough. Although friends and/or television were named by the majority of young men as useful, for most young men school sex education appeared to be the only substantive source of information they had received on sexual matters.

Young women and limits to the normalisation of condom use: a qualitative study

Abstract Encouraging condom use among young women is a major focus of HIV/STI prevention efforts but the degree to which they see themselves as being at risk limits their use of the method. In this paper, we examine the extent to which condom use has become normalised among young women. In-depth interviews were conducted with 20 year old women from eastern Scotland (N=20). Purposive sampling was used to select a heterogeneous group with different levels of sexual experience and from different social backgrounds. All of the interviewees had used (male) condoms but only three reported consistent use. The rest had changed to other methods, most often the pill, though they typically went back to using condoms occasionally. Condoms were talked about as the most readily available contraceptive method, and were most often the first contraceptive method used. The young women had ingrained expectations of use, but for most, these norms centred only on their new or casual partners, with whom not using condoms was thought to be irresponsible. Many reported negative experiences with condoms, and condom dislike and failure were common, lessening trust in the method. Although the sexually transmitted infection (STI) prevention provided by condoms was important, this was seen as additional, and secondary, to pregnancy prevention. As the perceived risks of STIs lessened in relationships with boyfriends, so did condom use. The promotion of condoms for STI prevention alone fails to consider the wider influences of partners and young womens negative experiences of the method. Focusing on the development of condom negotiation skills alone will not address these issues. Interventions to counter dislike, method failure, and the limits of the normalisation of condom use should be included in STI prevention efforts.

Young women under 16 years with experience of sexual intercourse: who becomes pregnant?

Background: The UK has the highest rate of teenage pregnancies in western Europe. Although there is a large body of literature focusing on predictors of conception among this age group, almost all the work compares those young women who have become pregnant with their peers, regardless of whether or not their peers have experienced sexual intercourse. Objective: To compare 16-year-old young women who have become pregnant with their peers who also have experience of sexual intercourse, but who have not conceived. Design: Analysis of data from the baseline and follow-up surveys conducted as part of a trial of sex education. Setting and participants: Female school students aged 14–16 years from the East of Scotland. Main results: Young age of self and partner, and non-use of contraception, all at first intercourse, are most strongly associated with pregnancy. Conclusions: Those who engage in sexual intercourse at a relatively young age will often have had more opportunity to become pregnant than those whose sexual debut comes later. Similarly, the fact that those who use contraception at first intercourse have been less likely to conceive than those who do not could reflect the overall patterns of contraceptive use: young women who have used contraception at each occasion of intercourse will have had less chance to conceive than those who have not. Having a young partner at first intercourse suggests that, if this pattern continues, the couple may lack the resources needed to prevent a pregnancy due to the immaturity of both partners.

Non-clinical and extra-legal influences on decisions about compulsory admission to psychiatric hospital

Background: On the eve of reform of the 1983 Mental Health Act (MHA), little is known about how decisions to admit people under its powers are made. Aims: To describe non-clinical and extra-legal influences on professionals’ decisions about compulsory admission to psychiatric hospital. Method: Participant-observation of MHA assessments, including informal and depth interviews with the practitioners involved, and follow-up interviews with the people who had been assessed. Results: A candidate patient’s chance of being sectioned is likely to increase when there are no realistic alternatives to in-patient care. This typically occurs when staff have insufficient time to set such alternatives in place and are unsupported by other professionals in doing this. Outcomes may also be affected by local operational norms and the level of professional accountability for specific MHA decisions. Conclusion: Non-clinical and extra-legal factors explain some of the geographical variation in MHA admission rates. If compulsion is to be used only in the ‘last resort’, administrators and policy makers should look beyond legislative change to matters of resource allocation and service organisation.

Parenting interventions for male young offenders: A review of the evidence on what works

Approximately one in four incarcerated male young offenders in the UK is an actual or expectant father. This paper reviews evidence on the effectiveness of parenting interventions for male young offenders. We conducted systematic searches across 20 databases and consulted experts. Twelve relevant evaluations were identified: 10 from the UK, of programmes for incarcerated young offenders, and two from the US, of programmes for young parolees. None used experimental methods or included a comparison group. They suggest that participants like the courses, find them useful, and the interventions may improve knowledge about, and attitudes to, parenting. Future interventions should incorporate elements of promising parenting interventions with young fathers in the community, for example, and/or with older incarcerated parents. Young offender fathers have specific developmental, rehabilitative, and contextual needs. Future evaluations should collect longer-term behavioural parent and child outcome data and should use comparison groups and, ideally, randomization.

The experiential impact of head injury on adolescents: individual perspectives on long term outcome

Thirty-one young people, who were experiencing chronic sequelae of a head injury sustained at least 1 year previously, were interviewed in-depth about the impact head injury had had on their lives. Their functioning was also assessed using the Offer Self-Image Questionnaire (OSIQ-R). The main theme raised by subjects was that they had not received adequate explanation of the emotional problems associated with head injury and relevant support in coming to terms with their condition. Head injury had had a devastating effect on their lives, causing limitations in day-to-day activities, employment, education and relationships, and they scored significantly below norms on the OSIQ-R scale of Self-Confidence. However, these young people had a predominantly positive attitude towards life, which appeared to be related to their appreciation of how fortunate they had been to survive. They scored significantly above norms on the OSIQ-R scale of Social Functioning. Markers of poor functioning were identified and, in clinical practice, could be used as a method of highlighting those head-injured young people who potentially are most in need of support. The findings have implications for future research directions, service delivery and planning, in that particular weaknesses of current provision are demonstrated and recommendations made for improvements.

Self-reported sexually transmitted infection testing behaviour amongst incarcerated young male offenders: findings from a qualitative study

Introduction Sexually transmitted infections (STIs) are a major public health problem in the UK. Here we describe young mens self-reported STI testing behaviour, and explore why testing is and is not sought in two locales: the community and the Young Offender Institute (YOI). Methods In-depth interviews were conducted with 40 men, aged 16–20 years, whilst incarcerated in a Scottish YOI. The participants were purposively sampled using answers from a questionnaire administered to 67 inmates. Results The majority (n = 24) of those interviewed reported having undergone STI testing: eight in the community, 12 within the YOI, and four in both the community and the YOI. The extent to which they were worried about STIs and perceived themselves ‘at risk’ was important in understanding openness to testing. The convenience of testing within the YOI boosted the numbers seeking testing once incarcerated. Not getting tested in the YOI was due to not realising that it was available or not getting around to it rather than objecting to, or being embarrassed about, testing. Discussion Increasing awareness of the availability of STI testing within YOIs would be likely to result in higher uptake. An opt-out YOI STI screening programme would probably result in very high testing rates. Accessibility and convenience are key elements of testing procedures for this group, in both the YOI and community settings.

High and low contraceptive use amongst male young offenders: a qualitative interview study

Objectives There are high rates of fatherhood and sexually transmitted infections (STIs) among young incarcerated men. Here we focus on a sample of men incarcerated in a Scottish Young Offender Institution, analysing their accounts of their contraceptive use. Those who report low or no use of contraception are compared with those who report high use. Methods Semi-structured interviews with 40 young male offenders, aged 16–21 years. Participants were purposively sampled using answers from a questionnaire administered to 67 inmates. Data from those men (n=31) reporting either high (n=14) or low/no use (n=17) of contraception are analysed here. Results Low users emphasise their desire for pleasure and appear fatalistic about both pregnancy and disease prevention. High users report a strong desire to protect themselves and their ‘manliness’ by using condoms to avoid the risk of STIs and, to a lesser extent, pregnancy. Both sets of men present themselves in a traditionally masculine way, with high users emphasising power, authority and self-control to justify their non-risk-taking contraceptive behaviour. Conclusions The masculine narrative regarding self-protection, utilised by the high users, may be an effective method of intervention with potential and actual low users. Conventional masculinity valorises risk-taking but if particular forms of risk avoidance – condom use – can be legitimised as confirming ones masculinity it may be possible to persuade low users to adopt them. The opportunity to work with young men whilst incarcerated should be grasped.