Needs Assessment of Sex Education in the US

Needs Assessment of Sex Education in the US 

Abstract

In 2016, Florida rejected the 2016 Sex Education Legislation, which would have required public schools to offer programs regarding human sexuality (National Conference of State Legislatures [NCSL], 2016). Moreover, this legislation would have helped to provide adolescent education on sexual health topics including family planning, pregnancy, and STI/HIV/AIDS prevention that would have considerable influence on student mental health while maintaining that educational materials be comprehensive, medically precise, factual, developmentally and age appropriate (NCSL, 2016). Florida is a state that seemingly has a regressive attitude about sex education within the school system. Sexual education has remained a debated issue, with many believing that it should be a subject that parents address with their children at home. As it remains, in the 21^st-century children are more informed about actual sexual acts than their parents were at the same ages, partly due to social and mass media, but at what cost? This project is set to conduct a needs assessment showcasing current student knowledge on current sex education topic components and assess from a student perspective if there is an actual need for sex education within the school system. Finally recommendations will be made as it applies to sex education within the school setting.

Needs Assessment of Sex Education in the US 

In 2011, a CDC survey showed that 47% of all high school students indicated they had sex, with 15% of them having had four or more sexual partners in their lifetimes (NCSL, 2016). Only 60% reported using a condom, and 23% stated they were taking birth control pills (NCSL, 2016). Research has shown that those who become teen parents are less likely to finish school, usually depend on public assistance, live in poverty, and tend to be in poor mental and physical health (NCSL, 2016). Further, children of these teen parents are more likely to suffer from cognitive health issues, come in contact with correctional facilities and the welfare system, live in low social-economic conditions, dropout of school, and become teen parents themselves (NCSL, 2016). All of these factors send the teen childbearing costs into the billions of dollars, which taxpayers must then be responsible for (NCSL, 2016).Youth are also disproportionately affected by STIs as well. Even though young people represent 25% of the sexually active population, they acquire half of all new STIs, with about 10 million new cases a year (NCSL, 2016). Female youth have the highest rates of gonorrhea, chlamydia, and the human papillomavirus. This is because young males, who are also contracting STIs, often go unreported and diagnosed due to being less likely to seek medical care and/or show signs and symptoms of infection (NCSL, 2016). In 2011 alone, adolescents aged 13 to 24 accounted for 24% of new HIV diagnoses (NCSL, 2016).Nationally, most parents/guardians are in favor of their children learning about pregnancy prevention and sex, with two-thirds of parents suggesting schools “definitely” cover emotional/mental health issues and how to use the health care system (Scudellari, 2016). Yet, for so long, stigma has prevented adolescents from seeking treatment and talking about the mental health problems that come along with sex and sexual health. The youth encountered in the Summer/Fall 2018 Florida Department of Health in Broward County (FDOH-B), Florida’s  field experience have stated their schools have either not provided or adequately provided sexual health education curriculum within the school setting. Many of these youths stated they have had an assembly once a year, but they are often left with many unanswered questions. The issue is how can the spread of HIV and STIs be stopped if schools and adults are not speaking and educating the youth about the subject? There have been countless instances where the age of the individuals having sexual intercourse are younger and younger. Moreover, the FDOH-B presents an opportunity to not only provide information about STIs to the community in general– a current practice — but to also provide this material directly to the youth who are living through and experiencing them. The FDOH-B’s field experience has shed light to the magnitude of the lack of sexual education among the youth in Broward County. For instance, one of the encountered youth who had been perinatally infected with HIV and did not know what they had or what it meant. Further this particular youth aged 14, passed the infection to a partner without even understanding the consequences of engaging in unprotected sex. Such situations only further emphasize the apparent need to provide better sexual health education to Broward County youth.

Learning Objectives

Sexual activity has consequences which can affect adolescents both physically and mentally. When youth find out they have an STI, it affects their mental stability, whether or not what is contracted is curable. Young people experiencing mental health concerns such as anxiety, depression, or low self-esteem, often face impaired risk management capacity and they are more likely to engage in risky behaviors, which can sometimes be risky sexual behaviors (YEAH Aware, n.d.). By conducting a needs assessment, data was collected to give youth a platform to express concerns that stem from insufficient knowledge. This needs assessment gave youth a voice that helped to define the health problem, set implementation priorities, and establish a baseline for evaluating program impact on the community (McKenzie, Neiger, & Thackeray, 2017).

Sample, Statistical Methods & Materials

Through quantitative research, data was taken from surveys presented to 9th and 10th grade students at Dillard High School in Broward County, Florida. Further a random sampling method was utilized to obtain a total of 58 student participants. Many of the teenagers who present to the FDOH’s Communicable Disease Department hail from Dillard High School. After consent was acquired, 18 total questions were asked of participating students in effort to gauge the knowledge each student had of sex education and sexual matters. Each question administered in the survey helped to collect categorical data. Students where either asked yes/no, multiple choice, or checkbox questions– students had multiple options for answer selection. The questions were worded plainly with no room for ambiguity. The responses were assigned numerical values ranging from one to four before inserting them for use in the statistical tool. The statistical tool used to generate the tables and figures was version 21 of IBM SPSS. The statistical methods employed include descriptive statistics, frequency distribution, and pie-charts. These tools helped illustrate the results in a plain, straightforward manner.

As Table 1 depicts, that the mean age of participants was 15.37 with a standard deviation of 0.8.

   Note. This table contains details about the age distribution of survey participants.
 

Table 2’s dataset contains gender information about 58 individuals– of which 43.1% were males and 56.9 % were females.

Note. This table contains details about participants’ gender.

Demographic information is important because it provides data regarding research participants that is necessary for the determination of whether the individuals in a particular study are a representative sample of the target population for generalization purposes (Encyclopedia of Research Design, 2010).

Results

The students were asked if they’re satisfied with the sexual education provided in their school curriculum to gauge their perspective on the issue. As Table 3 shows the majority of the students’ believe that the sexual education provided to them is insufficient. Results indicated that only 27.6 students believe that adequate education is being provided to them in school.

Note. This table contains details about students perspective on the sufficiency of sexual education provided in their school.

When asked about their knowledge on sexual matters, 44.8% said that they are somewhat knowledgeable, while 20.7 % think they are adequately knowledgeable about sexual matters. Moreover what has proven to be troublesome is the first metric of Table 4 where it shows 34.5% of students professing that they have zero to no knowledge on sexual matters. This statistic proves dangerous because these may be the individuals that are more likely to engage in risky sexual activities in the near future.

Note. This table shows student belief about sexual acts and related matters. 

The next question, as shown in Table 5, was inputted as a way to ask students about their preferred source of receiving sexual education, 34.5% preferred school, 10.3 preferred their parents, nearly 40 % preferred the internet, and 15.5% preferred getting their sexual education from their friends. When comparing Table 5 and 6, students preferred sources are completely different from where they are actually obtaining sexual education.  

Note. This table contains details of students preferred source of sexual
education information.

Note. This table contains details about students’ actual source for sexual
education.

The next question asks about students’ knowledge of STIs and prevention. Only 15.5 % of students’ stated that they were adequately introduced to effects of STIs and prevention methods. Of the remaining, 32.8 % stated they have had acquired some form of knowledge of STI’s and prevention, while 51.7 % claim to have had no knowledge on the subject. These results are depicted in Table 7.

Note. This table shows students’ perceptions on how much they know about STI’s.

The next results shown on Table 8, looks at the methods of prevention students assume or believe others should use in order not to acquire an STI. Many of the students (50%) answered that they would use a condom as a means of prevention, followed by monogamy at 25.9% and lastly abstinence (24.1) as a form of STI prevention.

Note. This table shows details about student perceived STI prevention methods.

The next table assess student knowledge of the two most common bacterial STIs known to spread throughout Broward County’s school system. At 69 %, majority of students answered that they had no knowledge that gonorrhea and chlamydia are sexually transmitted infections. The results can be seen in Table 9.  

The students were asked to mark the statement shown in Table 10 as true or false, 72.4 % of the students answered incorrectly. The result indicates that student have limited knowledge on the subject of STI’s.

Note. This table shows results for student knowledge about STI contraction rates

The students were asked to mark the statement shown in Table 11 as true or false, 82.8 % of the students answered incorrectly. They didn’t know that STI could be fatal majority selected the wrong option.

Note. The table shows student’s reactions to a question about STI’s.

The next question judges the student’s knowledge on symptoms of STIs. As seen in Table 12 a large majority, 74.1 % of participants have no idea that sometimes STIs do not display any visible symptoms in an infected individual.

Note. The table shows results of student’s knowledge on symptoms of STI’s.

The students were asked about the effects of STIs on the human reproductive system. Only 29.3 % claimed to understand that an STI has the ability to have an adverse effect on the human reproductive capabilities.

Note. The table shows results of student’s knowledge that STIs can adversely affect the
human reproductive system.

The students were asked to mark the statement shown in Table 14 as true or false, 79.3 % of the students answered incorrectly. The students are unaware of the fact that an individual can have more than one STI at the same time.

Note. The table shows results of student’s knowledge on the number
of STIs that can be contracted at the same time.

The students were asked to mark the statement shown in Table 15 as true or false, 75.9 % of the students answered incorrectly. The students are unaware of the fact that an STI can be passed onto a child from the mother during birth.

 Note. The table shows results of student’s knowledge transmission of STIs
during childbirth.

 The students were asked to mark the statement shown in Table 16 as true or false, 81.0 % of the students answered incorrectly. HIV is a disease that has other known methods of transmission so this statement is false.

Note. The table shows results of student’s knowledge on the modes of
STIs transmission.

One of the most important question of this survey was the last question that will highlight student’s perspective on the need for sexual education at schools. An overwhelming number of students believe that sexual education should be provided at schools.

Note. The table shows results of student’s perspective on the provision of
sexual education in schools.

Discussion

This study helps to identify the need for imparting sexual education to the students of Florida. The results show that student’s in Broward County, Florida are lacking the basic knowledge that will protect them against STIs and help with their physical and mental health homeostasis. Further concluded within these results are student’s unhappiness with their current sexual education. Majority of student are receiving sex information from informal sources and are not satisfied with their knowledge on sexual matters. 72.1% of students acknowledge the need to be adequately informed on sexual health topics which include family planning, pregnancy, transmission, STI phenetics, and most of all STI/HIV/AIDS prevention.  

Barriers and Limitations

This needs assessment was done to identify, analyze, and prioritize the needs of a priority population, in this case, school-age children, between the ages of 11 and 18, and  analyze their knowledge and perceptions of the need for school-based sexual health education. The first barrier was acquiring the sample age of 11-18, only 14-16 year olds were accessible at the time of survey distribution. Further, the original proposed study was all encompassing of Broward County’s middle and high school students, yet due to the many school shootings across the nation, particularly Parkland, Florida; Broward County’s Stoneman Douglas High School, entry and access became limited to conduct research. To mitigate this setback of not acquiring student’s hailing from different Broward County schools, a verbal agreement was enacted for a one day, 2 hour administered survey, at Dillard High School.

Further, a needs assessment is also focused on identifying the possible barriers to successful program intervention in a community and possibly finding solutions to these challenges. The barriers to implementing sex education are similar to barriers encountered in other school innovation efforts. The fear of controversy is, however, unique to sex education, and can be a barrier, notwithstanding widespread public support. There are also potential infrastructure barriers– the availability of sex education training, funding, and curriculum as well as the time and staffing resources to implement sex education.

Recommendations

In Florida there is a disparity between the need for sexual health education and the existence of it. Adolescents experience dating violence, bullying, academic difficulties, unhealthy relationships, early sexual initiation, unplanned pregnancy, STIs/HIV, and other sexual health disparities in large quantities (National Association of School Nurses, 2018). It is believed that when young people receive comprehensive, factual, age-appropriate sexual health information, it reduces mental and health risk factors and increases developmental success. Because of this it is recommended that Florida schools implement Working to Institutionalize Sexuality Education (WISE) in order to stir up policy reformation. Taken from the WISE program, school and community leaders can reach goals of implementing and sustaining effective sexual health education practices for youth. The FDOH in collaboration with the Regional Comprehensive Sexuality Education (CSE) Networks can help to provide Florida’s various school districts with health educators, peer support, and partnerships with community-based organizations, which will help to empowered school districts to make significant improvements to their sexual education curriculums and help to acquire any additional needed resources.

Conclusion

With numerous research to support, sexual education again has the potential to foster positive mental and physical health that is key to an individual’s personal health and social welfare. The needs assessment performed further met professional goals, objectives, and competencies, learned from two years’ worth of course materials provided by the University of South Florida’s Master of Science in Child Adolescent Behavioral Health on the mental/behavioral health of youth and identifying an issue that gravely affects the youth of Broward County—the need for solid and consistent sex education in schools. Further, this needs assessment met guidelines because it not only incorporated producing an actual needs assessment with results, but also further incorporated concepts of strategic planning, program development, research, and evaluation that would lead to potential program implementation and policy change. There is a whole department within the FDOH-B dedicated to helping youth who have or have come in contact with another youth who has an STI and/or HIV. Moreover, the research hypothesis was correct with results indicating the need for Florida to make or sign off on a policy that would efficiently promote sexual health education, through prevention and intervention practices.

The identified child/adolescent behavioral health issue of the lack of sexual health education within the K-12 school system—which in turn produces a surplus of adolescents experiencing mental illness, stress, and transmitting STIs—helps to bring the issue to the forefront. Moreover this needs assessment helps both the FDOH-B and the Broward County community to push those in power to realign their mission, vision, and goals of protecting, promoting, and improving the health of all people in Florida in the quest to become the “Healthiest State in the Nation,” (FDOH-B, 2018). This project not only targeted youth but also allowed them a platform to express concerns that stem from insufficient sexual knowledge. Ultimately, what seems to be a simple needs assessment can blossom into program implementation for the betterment of South Florida youth.

Implications for Child Adolescent

Formal sex education in schools that includes instruction about healthy sexual decision-making and STI/HIV prevention helps to reduce mental illnesses, stress, and the transmission of STIs. As young people grow up they face important decisions about sexuality, sexual behavior, and relationships (Advocates for Youth, 2015). The study population of this research has indicated that the adolescents of Florida are in need of sex education being a part of their yearly curriculum delivered in a consistent manner. Future research needs to be based in more than just the opinions of parents, teachers, and professionals—yielding collected insight from youth. Once Florida acknowledges that comprehensive sexual health information is lost among their youth they will being to see that such occurrences lead to risky sexual behaviors, mental instability, and the continuous spread of preventable STIs. Further research based in the collection of a lack adolescent sexual health knowledge will impact future policy decisions. A student’s experience in school with sex education can vary a great deal, yet adolescents agree that school-based programs need to be an important source of formal education for adolescent sexual health (Breuner & Mattson, 2016).

References

• Advocates for Youth. (2015). Sexuality education building an evidence- and rights-based approach to healthy decision-making. Retrieved from http://www.advocatesforyouth.org/publications/publications-a-z/2390-sexuality-education
• Breuner, C. C., & Mattson, G. (2016). Sexuality education for children and adolescents. Pediatrics, 138(2), e20161348. doi:10.1542/peds.2016-1348
• Encyclopedia of Research Design. (2010). Demographics. Retrieved from http://methods.sagepub.com/reference/encyc-of-research-design/n108.xml
• Florida Department of Health in Broward. (2018). About us. Retrieved from http://broward.floridahealth.gov/about-us/index.html
• McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2017). Planning, implementing, and evaluating health promotion programs: A primer (7th ed.). Pearson.
• National Conference of State Legislatures. (2016). State policies on sex education in schools. Retrieved from http://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx
• Scudellari, M. (2016, September 26). Most parents of teens support sex ed, plus education on mental health. Boston Globe. Retrieved from https://www.bostonglobe.com/‌lifestyle/2016/09/25/most-parents-teens-support-sex-plus-education-mental-health/OY8Zr5QqPXZqniKJka1lPL/story.html
• YEAH Aware. (n.d.). How mental health affects sexual health [Blog post]. Retrieved from https://www.yeah.org.au/blogs/mental-health-sexual-health-and-young-people/