Randomized Evaluation of a Multi-Component, Rights-Based Sexuality Education Initiative for High School Students
Condition: Pregnancy; Sexually Transmitted Diseases
MeSH terms: Sexually Transmitted Diseases
Study type: Interventional

Summary: 
      This study examines the effectiveness of the Sexuality Education Initiative (SEI), a
      comprehensive, multi-component, rights-based sexuality education program developed and
      implemented by Planned Parenthood Los Angeles for high school students. The primary goal of
      the SEI is to improve the sexual and reproductive health of youth attending Los Angeles high
      schools. The SEI consists of four intervention components: (1) a 12-session gender-sensitive,
      rights-based, comprehensive sexuality education curriculum, (2) a peer education and advocacy
      component, (3) a parent education component, and (4) clinical services linkages. It is
      hypothesized that the 12-session classroom curriculum is more effective than a 3-session
      control sex education curriculum. It is also hypothesized that the full SEI package (all four
      components) is more effective than the control condition (control curriculum and clinical
      services only).
    

Detailed description: 
      This study examines the effectiveness of the Sexuality Education Initiative (SEI), a
      comprehensive, multi-component, rights-based sexuality education program developed and
      implemented by Planned Parenthood Los Angeles for high school students. The primary goal of
      the SEI is to improve the sexual and reproductive health of youth attending Los Angeles high
      schools. The SEI consists of four intervention components: (1) a 12-session gender-sensitive,
      rights-based, comprehensive sexuality education curriculum, (2) a peer education and advocacy
      component, (3) a parent education component, and (4) clinical services linkages.

        -  The 12-session gender-sensitive, rights-based classroom curriculum covers anatomy,
           abstinence, contraception and protection, STIs and HIV/AIDS, media messages, gender,
           relationships, rights and responsibilities, pregnancy, sexuality, peer pressure,
           negotiation and coercion, and decision making.

        -  The peer education and advocacy component recruits, trains and supervises students
           through an after-school leadership program to serve as school-wide resources to their
           peers, organize health events at school, and refer students to school-based clinic
           services.

        -  The parent education component consists of a series of sessions for parents, covering
           reproductive health, teen pregnancy, and parent-teen communication, together with a
           parent education booklet for widespread use.

        -  The in-school clinical services component provides "clinic without walls" health
           services on campus, including pregnancy and STI testing, contraceptive consultation and
           prescriptions, condom distribution, counseling, and referrals. It also trains teachers
           and school staff to distribute condoms to students as needed.

      The evaluation design involves two levels of randomization: First, all schools are randomized
      into one of two conditions: receiving all three SEI school wide components (peer, parent,
      clinical services) or receiving only one of these three school wide components (clinical
      services). Schools are randomized within matched pairs of demographically similar schools.
      Second, within each school, classrooms are randomized into one of two conditions: a basic
      3-session sex education curriculum (control) or the 12-session SEI curriculum (intervention).
      Thus, all participating 9th grade students will receive at least three sexuality education
      curriculum sessions and access to on-site clinic services.

      The primary research questions for the evaluation are:

        1. Is the 12-session SEI gender-sensitive, rights-based sexuality education curriculum more
           effective than a 3-session comparison curriculum in reducing risk of unwanted pregnancy
           and sexually transmitted infections (STIs) among high school students?

        2. Is the full comprehensive program (all four components as a package) more effective than
           the two-component comparison condition (only the 3-session comparison curriculum and the
           clinical services linkages) in reducing risk of teen pregnancies and STIs?

      The first hypothesis is that the 12-session SEI gender-sensitive, rights-based curriculum is
      more effective than the 3-session comparison curriculum in improving sexual health outcomes
      (as defined in section 7) among program participants one year after participation in the
      program. The second hypothesis is that the full SEI program (all four components as a
      package) is more effective than the comparison condition (only the 3-session comparison
      curriculum and the clinical services linkages) in improving sexual health outcomes one year
      after participation.

      In addition to addressing these questions using the designated primary and secondary
      outcomes, this study will examine changes in the following short-term outcomes that measure
      critical concepts being addressed by the curriculum and serve as the hypothesized mediators
      in the SEI theory of change:

        -  Attitudes about rights in sexual relationships

        -  Communication about relationships, rights and sexuality with partners

        -  Communication about relationships, rights and sexuality with parents/ guardians

        -  Access to accurate information about sexuality and sexual health

        -  Knowledge about sex, sexuality and sexual risk protection

        -  Self-efficacy to assert sexual limits and manage risky situations

        -  Intentions to protect self from sexual risk

        -  Awareness of sexual and reproductive health services
    

Intervention name(s): SEI Classroom Curriculum; Control Classroom Curriculum; SEI Curriculum + 3 School Components; Control Curriculum + 1 School Component
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Participants receive the 12-session Sexuality Education Initiative (SEI) classroom curriculum. The SEI classroom curriculum covers anatomy, abstinence, contraception and protection, STIs and HIV/AIDS, media messages, gender, relationships, rights and responsibilities, pregnancy, sexuality, peer pressure, negotiation and coercion, and decision making. These sessions are delivered over a two-month period. Each curriculum session is about 45 minutes in length.; Participants receive the 3-session basic control curriculum. The control curriculum includes 3 sessions on sexually transmitted infections, anatomy and birth control delivered over a two- or three-week period. Each curriculum session is about 45 minutes in length.; Participants receive SEI classroom curriculum and all three school wide components. The peer education/advocacy component recruits, trains and supervises students through an after-school leadership program to serve as resources to peers, organize health events, and refer students to school-based clinic services. The parent education component provides sessions for parents of students, covering reproductive health, teen pregnancy, and parent-teen communication, together with a parent education booklet for widespread use. The clinical services linkages includes health services on campus, including pregnancy/STI testing, contraceptive consultation and prescriptions, condom distribution, counseling, and referrals. It includes training for teachers and staff to distribute condoms as needed.; Participants receive control classroom curriculum and one of the three school wide components, the clinical services linkages. This component includes health services on campus for students, including pregnancy and STI testing, contraceptive consultation and prescriptions, condom distribution, counseling, and referrals. It also includes training for teachers and school staff to distribute condoms to students as needed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Adolescent; Sex education; Sexuality education; Sexually transmitted diseases; Pregnancy; Sexual behavior; Sexuality; Relationship rights; Gender norms; Human rights; Intervention studies; Parent intervention; Peer intervention