Simon Forrest

Pupil-led sex education in England (RIPPLE study): cluster-randomised intervention trial

BACKGROUND Improvement of sex education in schools is a key part of the UK governments strategy to reduce teenage pregnancy in England. We examined the effectiveness of one form of peer-led sex education in a school-based randomised trial of over 8000 pupils. METHODS 29 schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). In intervention schools, peer educators aged 16-17 years delivered three sessions of sex education to 13-14 year-old pupils from the same schools. Primary outcome was unprotected (without condom) first heterosexual intercourse by age 16 years. Analysis was by intention to treat. FINDINGS By age 16 years, significantly fewer girls reported intercourse in the peer-led arm than in the control arm, but proportions were similar for boys. The proportions of pupils reporting unprotected first sex did not differ for girls (8.4% intervention vs 8.3% control) or for boys (6.2% vs 4.7%). Stratified estimates of the difference between arms were -0.4% (95% CI -3.7% to 2.8%, p=0.79) for girls and -1.4% (-4.4% to 1.6%, p=0.36) for boys. At follow-up (mean age 16.0 years [SD 0.32]), girls in the intervention arm reported fewer unintended pregnancies, although the difference was borderline (2.3% vs 3.3%, p=0.07). Girls and boys were more satisfied with peer-led than teacher-led sex education, but 57% of girls and 32% of boys wanted sex education in single-sex groups. INTERPRETATION Peer-led sex education was effective in some ways, but broader strategies are needed to improve young peoples sexual health. The role of single-sex sessions should be investigated further.

Gay men and tourism: destinations and holiday motivations.

Abstract Little research attention has been given to the gay tourist market, the destinations most commonly visited by gay men, or their holiday motivations and experiences. This paper presents findings on the tourist destinations and holiday motivations of 562 gay men resident in southern England, who took part in a self-completion questionnaire survey to assess sexual activity and sexual risk behaviours in holiday settings. The study was aimed at informing HIV prevention intiatives for gay men with a tourism focus. Samples of men were recruited through contact in bars/clubs in Brighton and via a postal survey conducted in association with a local lesbian/gay magazine. The bar sample was younger than the postal sample but similar in terms of partnership status, income, holiday motivations and travel patterns. The two samples were thus combined for the purpose of analysis. The sample cannot be regarded as representative of gay men in general but does constitute a broad cross-section of gay men, mainly below the age of 40 on the commercial gay scene, supplemented by consumers of a local gay magazine. Gay men in the sample had travelled very widely in the previous five years, with southern European destinations and the United States, in particular, attracting substantial proportions of men. Three dimensions of gay tourist motivation were identified: ‘gay social life and sex’, ‘culture and sights’ and ‘comfort and relaxation’. Men who had visited southern European gay resorts (Gran Canaria, Ibiza and Mykonos) had significantly higher scores on the first dimension; whereas men who had visited European cities (Amsterdam, Paris and Prague) and had travelled further afield (sub-Saharan Africa and Australia) had higher scores on the second dimension. The implications of the findings for the development of tourism services for gay men, further research on gay tourism, and sexual health promotion aimed at gay men on holiday are discussed.

What do young people want from sex education? The results of a needs assessment from a peer-led sex education programme.

This paper presents data on the need for sexual health information and advice of 4353 students aged 13/14 years in 13 English secondary schools. Data were collected by peer educators as part of a sex education programme, and through a questionnaire survey administered by researchers. Data illustrate young peoples need for concrete information and advice on issues related to physical development and puberty; transmission of sexually transmitted diseases; accessing and using condoms and other contraception; using sexual health services; managing relationships and dealing with jealousy, love and sexual attraction; how people have sex; sexual pleasure; masturbation; and homosexuality. Differences between the concerns and interests raised by young people and current UK guidance on sex and relationships education are examined, and the implications of these findings for designing future policy and effective school based sex education programmes are discussed. The paper highlights some of the wider social norms around sex and sexuality that influence young peoples understanding and sexual behaviour, and the importance of addressing these within sex education is noted. Factors influencing the processes of expressing and assessing needs are explored.

Effect of social exclusion on the risk of teenage pregnancy: development of hypotheses using baseline data from a randomised trial of sex education

Study objective: The UK government argues that “social exclusion” increases risk of teenage pregnancy and that educational factors may be dimensions of such exclusion. The evidence cited by the government is limited to reporting that socioeconomic disadvantage and educational attainment influence risk. Evidence regarding young people’s attitude to school is not cited, and there is a lack of research concerning the UK. This paper develops hypotheses on the relation between socioeconomic and educational dimensions of social exclusion, and risk of teenage pregnancy, by examining whether dislike of school and socioeconomic disadvantage are associated with cognitive/behavioural risk measures among 13/14 year olds in English schools. Design: Analysis of data from the baseline survey of a study of sex education. Setting and participants: 13/14 year old school students from south east England. Main results: The results indicate that socioeconomic disadvantage and dislike of school are associated with various risk factors, each with a different pattern. Those disliking school, despite having comparable knowledge to those liking school, were more likely to have sexual intercourse, expect sexual intercourse by age 16, and expect to be parents by the age of 20. For most associations, the crude odds ratios (ORs) and the ORs adjusted for the other exposure were similar, suggesting that inter-confounding between exposures was limited. Conclusions: It is hypothesised that in determining risk of teenage pregnancy, the two exposures are independent. Those disliking school might be at greater risk of teenage pregnancy because they are more likely to see teenage pregnancy as inevitable or positive.

A school-based randomized controlled trial of peer-led sex education in England

This article discusses the design of an ongoing cluster-randomized trial comparing two forms of school-based sex education in terms of educational process and sexual health outcomes. Twenty-nine schools in southern England have been randomized to either peer-led sex education or to continue with their traditional teacher-led sex education. The primary objective is to determine which form of sex education is more effective in promoting young peoples sexual health. The trial includes an unusually detailed evaluation of the process of sex education as well as the outcomes. The sex education programs were delivered in school to pupils ages 13-14 years who are being followed until ages 19-20. Major trial outcomes are unprotected sexual intercourse and regretted intercourse by age 16 and cumulative incidence of abortion by ages 19-20. We discuss the rationale behind various aspects of the design, including ethical issues and practical challenges of conducting a randomized trial in schools, data linkage for key outcomes to reduce bias, and integrating process and outcome measures to improve the interpretation of findings.

Evaluating Processes A Case Study of a Randomized Controlled Trial of Sex Education

This article explores the rationales offered in the evaluation literature for studying the processes involved in programme implementation, and their relationship with current arguments about the use of experimental designs to evaluate social interventions. It describes, as a case study, a process evaluation carried out as an integral part of a randomized controlled trial of peer-led sex education. The process evaluation was designed to answer important questions about the implementation of the intervention, the social context of the trial, and the experiences of trial participants. The article describes the methods used to collect process data, and some of the challenges involved. It concludes by arguing that process evaluation is necessarily complex, but essential to the task of understanding why and how interventions and outcomes may be related.

Supporting international medical graduates’ transition to their host‐country: realist synthesis

Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs’ transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective.

Young men in love: the (re)making of heterosexual masculinities through “serious” relationships

In this paper I examine how young mens experience of what they termed “serious” relationships are contexts in which they were engaged in the processes of exploring and, in some important ways, remaking their masculine identities. I refer to data drawn from in-depth interviews with eight middle-class, white young men who are reaching the end of their studies in a Scottish secondary school and planning to enter higher education. I identify and explore aspects of the intimate relationship in which these young men contest culturally patterned discourses of gender difference and show how, in trying to resolve these differences, their sense of masculine identities is altered. I suggest that familiar gendered differences – relating to the ways that sex and love, commitment and independence and emotional expressiveness are linked to heterosexual masculinity and femininity – are three of the distinct fields of which these young men are aware and via which they engage in “gender” work. I argue that how this work is done, the resources employed and the meanings that are generated are independent on specific local and temporal realities of these young men lives.

‘Hieroglyphs of the Heterosexual’: Learning about Gender in School

This chapter addresses some encounters with and observations of groups of young people during the course of a brief, exploratory fieldwork study in which the authors were looking at boys’ experiences of school. The chapter draws on material from three secondary schools, focusing particularly but not exclusively on the boys. The three schools were in many senses a special sample. They had all the indices of deprivation and poverty: a high percentage of pupils having free school dinners, a high rate of absenteeism and teacher turnover, and a very low rating in the previous year’s Department of Education and Employment ‘league tables’ of examination results. Their catchment areas were rundown housing estates with well above average levels of male unemployment and a high proportion of one-parent families. Altogether we spoke to about 100 young people between the ages of 12 and 15, the majority of them boys.1

A Needs Assessment in South Wales Schools for a Novel Medical Student-Led Sex Education Programme.

The rationale behind using medical students as sexual health educators in light of current UK governmental policy agenda and research on effective interventions is described in this paper, which also examines the results of a cross‐sectional survey of the sexual health knowledge and attitude of 14–15 year‐olds in some South Wales schools. Major current sources of sexual health information include school, magazines and other young people. Young people are generally well informed about contraception but ill informed of contraceptive services while tending to have a negative attitude towards their utilisation. Reasons for this include insufficient information and education on services, inaccurate perceptions of the levels of confidentiality of services and embarrassment towards general practitioners. The implications of these results are discussed in the context of the development of an effective sexual health education programme using medical students as educators in South Wales secondary schools.