Pandora Pound

What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people's views and experiences

Objectives Although sex and relationship education (SRE) represents a key strand in policies to safeguard young people and improve their sexual health, it currently lacks statutory status, government guidance is outdated and a third of UK schools has poor-quality SRE. We aimed to investigate whether current provision meets young peoples needs. Design Synthesis of qualitative studies of young peoples views of their school-based SRE. Setting Eligible studies originated from the UK, Ireland, the USA, Australia, New Zealand, Canada, Japan, Iran, Brazil and Sweden. Participants Studies of students aged 4–19 in full-time education, young adults ≤19 (not necessarily in full-time education) or adults ≤25 if recalling their experiences of school-based SRE. Results –69 publications were identified, with 55 remaining after quality appraisal (representing 48 studies). The synthesis found that although sex is a potent and potentially embarrassing topic, schools appear reluctant to acknowledge this and attempt to teach SRE in the same way as other subjects. Young people report feeling vulnerable in SRE, with young men anxious to conceal sexual ignorance and young women risking sexual harassment if they participate. Schools appear to have difficulty accepting that some young people are sexually active, leading to SRE that is out of touch with many young peoples lives. Young people report that SRE can be negative, gendered and heterosexist. They expressed dislike of their own teachers delivering SRE due to blurred boundaries, lack of anonymity, embarrassment and poor training. Conclusions SRE should be ‘sex-positive’ and delivered by experts who maintain clear boundaries with students. Schools should acknowledge that sex is a special subject with unique challenges, as well as the fact and range of young peoples sexual activity, otherwise young people will continue to disengage from SRE and opportunities for safeguarding and improving their sexual health will be reduced.

Locating and applying sociological theories of risk-taking to develop public health interventions for adolescents

Sociological theories seldom inform public health interventions at the community level. The reasons for this are unclear but may include difficulties in finding, understanding or operationalising theories. We conducted a study to explore the feasibility of locating sociological theories within a specific field of public health, adolescent risk-taking, and to consider their potential for practical application. We identified a range of sociological theories. These explained risk-taking: (i) as being due to lack of social integration; (ii) as a consequence of isolation from mainstream society; (iii) as a rite of passage; (iv) as a response to social constraints; (v) as resistance; (vi) as an aspect of adolescent development; (vii) by the theory of the ‘habitus’; (viii) by situated rationality and social action theories; and (ix) as social practice. We consider these theories in terms of their potential to inform public health interventions for young people.

Exploring the feasibility of theory synthesis: A worked example in the field of health related risk-taking

The idea of synthesising theory is receiving attention within public health as part of a drive to design theoretically informed interventions. Theory synthesis is not a new idea, however, having been debated by sociologists for several decades. We consider the various methodological approaches to theory synthesis and test the feasibility of one such approach by synthesising a small number of sociological theories relevant to health related risk-taking. The synthesis consisted of three stages: (i) synthesis preparation, wherein parts of relevant theories were extracted and summarised; (ii) synthesis which involved comparing theories for points of convergence and divergence and bringing together those points that converge; and (iii) synthesis refinement whereby the synthesis was interrogated for further theoretical insights. Our synthesis suggests that serious and sustained risk-taking is associated with social isolation, liminality and a persons position in relation to the dominant social group. We reflect upon the methodological and philosophical issues raised by the practice of theory synthesis, concluding that it has the potential to reinvigorate theory and make it more robust and accessible for practical application.

Developing a Collaborative Agenda for Humanities and Social Scientific Research on Laboratory Animal Science and Welfare

Improving laboratory animal science and welfare requires both new scientific research and insights from research in the humanities and social sciences. Whilst scientific research provides evidence to replace, reduce and refine procedures involving laboratory animals (the ‘3Rs’), work in the humanities and social sciences can help understand the social, economic and cultural processes that enhance or impede humane ways of knowing and working with laboratory animals. However, communication across these disciplinary perspectives is currently limited, and they design research programmes, generate results, engage users, and seek to influence policy in different ways. To facilitate dialogue and future research at this interface, we convened an interdisciplinary group of 45 life scientists, social scientists, humanities scholars, non-governmental organisations and policy-makers to generate a collaborative research agenda. This drew on methods employed by other agenda-setting exercises in science policy, using a collaborative and deliberative approach for the identification of research priorities. Participants were recruited from across the community, invited to submit research questions and vote on their priorities. They then met at an interactive workshop in the UK, discussed all 136 questions submitted, and collectively defined the 30 most important issues for the group. The output is a collaborative future agenda for research in the humanities and social sciences on laboratory animal science and welfare. The questions indicate a demand for new research in the humanities and social sciences to inform emerging discussions and priorities on the governance and practice of laboratory animal research, including on issues around: international harmonisation, openness and public engagement, ‘cultures of care’, harm-benefit analysis and the future of the 3Rs. The process outlined below underlines the value of interdisciplinary exchange for improving communication across different research cultures and identifies ways of enhancing the effectiveness of future research at the interface between the humanities, social sciences, science and science policy.

What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders’ views

Objectives Sex and relationship education (SRE) is regarded as vital to improving young people’s sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation. Design This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations. Settings Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide. Results Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a ‘life skills’ approach and not focus on abstinence. Young people advocated a ‘sex-positive’ approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence. Conclusions We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE.

Developing methods for locating and synthesising theory for application in public health: a pilot study

Abstract Background Despite published work suggesting that public health interventions will probably be more effective when underpinned by relevant theory, this is often missing from their design and development. This absence might be because the theoretical published work is not easily accessible, because its sheer volume is overwhelming, or because the theories are not always clearly articulated. There is a need to develop ways of accessing and synthesising bodies of theory for use in public health. We use the area of health-related risk taking as an example and explore the feasibility of locating and synthesising sociological theories in this area. Sociological theories are underused in public health, but are necessary to help to shift the focus towards the social structures that affect behaviour, ensuring that responsibility for change is not placed solely on the individual. We aimed to search for sociological theories of health-related risk taking and to explore the feasibility of theory synthesis as an instrument for public health. Methods We hand searched the abstracts of all volumes of the journals Sociology of Health and Illness (volume 1, 1979, to May, 2012) and Social Science and Medicine (volume 1, 1982, to mid-June, 2012) and checked the references of selected papers for relevant publications. Papers were included if they were sociological, relevant to risk taking, and theoretical. After a method outlined by sociological theorist Jonathan Turner, we undertook a synthesis of four of the theories that were related in terms of their subject matter and theoretical perspective. The process of theory synthesis includes the following steps: (1) synthesis preparation, which involves clarifying theories, abstracting them to make them comparable, and extracting what is viewed as most plausible and useful to the question at hand; (2) synthesis, which is the systematic comparison of theories for points of convergence and divergence; and (3) synthesis refinement, which involves closer analysis of the theories with a view to the production of a more robust theory for practical application, including a clarification of causal processes. Findings We found 16 different theories that we grouped into seven broad categories according to their theoretical perspective: (1) theories that draw a link between culture and risk taking; (2) theories that conceptualise risk taking as social practice; (3) theories that regard risk taking as a response to dominant social forces; (4) situated rationality and social action theories that place risk taking within wider power relations; (5) the theory of habitus, which helps explain how patterns of risk taking persist over generations and according to social class; (6) theories that stress the positive functions of risk taking; and (7) theories that link serious risk taking with social exclusion. A synthesis of theories in this last category resulted in a new theoretical proposition: that serious and persistent risk taking occurs on the margins of mainstream society and might be related to powerlessness and a liminal social status. Interpretation A limitation of the study was that papers were not independently screened by two people and this shortcoming would need to be addressed in future studies. By suggesting that risk taking might have social causes and functions, the sociological theories form a valuable counterbalance to prevailing theoretical perspectives that focus on individual behaviour and, in so doing, have the potential to inform a broader range of public health interventions. Further work will explore the possibility of applying these methods on a larger scale and of incorporating the results of theory syntheses into logic models to provide a practical instrument for use in the design of complex public health interventions. Funding The study was funded by DECIPHer, a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council ( RES-590-28-0005 ), Medical Research Council, the Welsh Government, and the Wellcome Trust ( WT087640MA ), under the auspices of the UKCRC, is gratefully acknowledged.

Data from: Retrospective harm benefit analysis of pre-clinical animal research for six treatment interventions

Background The harm benefit analysis (HBA) is the cornerstone of animal research regulation and is considered to be a key ethical safeguard for animals. The HBA involves weighing the anticipated benefits of animal research against its predicted harms to animals but there are doubts about how objective and accountable this process is. Objectives i. To explore the harms to animals involved in pre-clinical animal studies and to assess these against the benefits for humans accruing from these studies; ii. To test the feasibility of conducting this type of retrospective HBA. Methods Data on harms were systematically extracted from a sample of pre-clinical animal studies whose clinical relevance had already been investigated by comparing systematic reviews of the animal studies with systematic reviews of human studies for the same interventions (antifibrinolytics for haemorrhage, bisphosphonates for osteoporosis, corticosteroids for brain injury, Tirilazad for stroke, antenatal corticosteroids for neonatal respiratory distress and thrombolytics for stroke). Clinical relevance was also explored in terms of current clinical practice. Harms were categorised for severity using an expert panel. The quality of the research and its impact were considered. Bateson’s Cube was used to conduct the HBA. Results The most common assessment of animal harms by the expert panel was ‘severe’. Reported use of analgesia was rare and some animals (including most neonates) endured significant procedures with no, or only light, anaesthesia reported. Some animals suffered iatrogenic harms. Many were kept alive for long periods post-experimentally but only 1% of studies reported post-operative care. A third of studies reported that some animals died prior to endpoints. All the studies were of poor quality. Having weighed the actual harms to animals against the actual clinical benefits accruing from these studies, and taking into account the quality of the research and its impact, less than 7% of the studies were permissible according to Bateson’s Cube: only the moderate bisphosphonate studies appeared to minimise harms to animals whilst being associated with benefit for humans. Conclusions This is the first time the accountability of the HBA has been systematically explored across a range of pre-clinical animal studies. The regulatory systems in place when these studies were conducted failed to safeguard animals from severe suffering or to ensure that only beneficial, scientifically rigorous research was conducted. Our findings indicate a pressing need to: i. review regulations, particularly those that permit animals to suffer severe harms; ii. reform the processes of prospectively assessing pre-clinical animal studies to make them fit for purpose; and iii. systematically evaluate the benefits of pre-clinical animal research to permit a more realistic assessment of its likely future benefits.

How should mandatory sex education be taught

Can sex and relationships education be effective if it’s not delivered in a way that is acceptable to young people?