Transcript Slide 1

Sexual health and relationships: What are the
experiences and the needs of Scotland’s most
vulnerable children and young people?
Dr Marion Henderson
MRC Social & Public Health
Sciences Unit
Moray Paterson
Programme Leader
NHS Health Scotland
What’s state of the art sex education
in mainstream schools achieving?
SHARE: teacher-delivered sex ed
Longitudinal RCT in Scotland (N~8,000)
Representative of young people 14-20yrs
SOME POSITIVE OUTCOMES
Knowledge
Attitudes
Quality of relationships
Less regret of sex
BUT NO DIFFERENCE
Rates of sexual experience
Contraceptive use
Conceptions (NHS linked data)
Terminations (NHS linked data)
Defining sexual risk?
• experiencing sexual intercourse at an earlier
age
• coercion
• non-use of condoms
• STIs
• regret
Earlier sex a risk?
• Younger sex is associated with:
• poor quality and non-consensual nature of much
early sexual activity, particularly for girls
• not practising contraceptive use
• thus exposure to conceptions and STIs
• higher levels of regret
Regret of sexual intercourse comparing those who
experienced 1st intercourse at
different ages (%)
80
70
60
50
40
boys
girls
30
20
10
0
13
years
or less
14
years
15
years
16
years
What does influence early
sexual debut?
• not living with both biological parents
• Living in a care or foster home
• mother aged less than 40 yrs
• manual (blue collar) parental social class
• lack of religious belief
• limited educational or career aspirations
• low parental monitoring
• high spending money
• friends’ smoking (peer influence)
• neighbourhood deprivation
What does influence non-use
of condoms?
• not talking about contraception before
intercourse
• not planning to have intercourse
• pressure to have sex
• relationship less than 1 month duration
• friends’ non-use of condoms
• negative intentions, attitudes, norms and lack
of anticipated regret
Trying to improve ‘respect’ and
social skills
• An RCT of Zero Tolerance Respect taught in Primary 6/7
• Increased ‘respect’ among boys at an age it was
decreasing among the comparison group
• No significant difference for girls
Sexual risk factors and
exclusion from school
• Most of these risk factors are also associated with
exclusion from school (Raffaele Mendez 2003)
• Suspension increases social exclusion and engagement
in subsequent anti-social and risky behaviour (Hemphill
1996)
Vicious circle…
• disrupted family life
• poor educational access and attainment
• lack of information and support around sexual health
relationships (not at school to get sex education or sex
education disrupted)
• having practical and psychological barriers to accessing
sexual health and contraceptive services
• All of the above are associated with the likelihood of
experiencing a teenage pregnancy!
How schools with different pupil compositions\risk
factors look in terms of conceptions and
terminations at age 16 - NHS recorded objective
data
How schools with different pupil
compositions\risk factors look in terms of sexual
experience reported at age 16
Figure 2
Comparison of models 1, 2 & 7 - girls (re-weighted)
60%
Predicted % sexually experienced
55%
50%
45%
40%
35%
30%
25%
20%
12
9
6
19
24
8
20
21
3
22
16
25
13
5
17
11
School
Model 1
Model 2
Model 7
18
1
2
10
7
14
23
15
Research messages
• Teenage pregnancy only likely to be influenced by
broader social initiatives
• tackling social exclusion
• neighbourhood cultures and resources
• raising aspirations
• most promising programmes v. long term, broader
than SRE and change future life opportunities
• SRE might improve emotional wellbeing
• challenge is to deliver targeted programmes at right
time
From SHARE to where?
Future research plans…
Vulnerable
young
people
Media
influence
SHARE: teacher-delivered sex ed
Longitudinal RCT in Scotland (N~8,000)
Representative of young people 14-20yrs
SOME POSITIVE OUTCOMES
Knowledge
Attitudes
Quality of relationships
Less regret of sex
School
ethos
BUT NO DIFFERENCE
Rates of sexual experience
Contraceptive use
Conceptions (NHS linked data)
Terminations (NHS linked data)
Neighbourhood
culture
Multi-component interventions
Social marketing
Parents
Enhanced SHARE
Community based youth friendly services
Examples of outcomes for
most vulnerable (LAYP) vs
average young people
• Young people through care
system
• Young people not
experienced care system
• More likely to leave school
early
• Leave school later
• 1 in 4 have a child by age
16
• Half of female care leavers
are mothers within 24
months of leaving care
• 38% of female prostitutes
had experienced care
• 60% of male prostitutes
had experienced care
• 1 in 10 gives birth to at
least one child by age 20
• 1 in 5 experience at least
one teenage conception by
age 20
• 1 in 10 terminate at least
one conception by age 20
What is SRE?
Curriculum for Excellence: Health & Wellbeing Outcomes
• make informed decisions in order to improve their
mental, emotional, social and physical wellbeing
• experience challenge and enjoyment
• experience positive aspects of healthy living and activity
for themselves
• apply their mental, emotional, social and physical skills
to pursue a healthy lifestyle
• make a successful move to the next stage of education
or work
• establish a pattern of health and wellbeing which will be
sustained into adult life, and which will help to promote
the health and wellbeing of the next generation of
Scottish children.
What is SRE?
Secondary
School
Personal
& Social
Education
Health
Education
Catholic
Secondary
School
Religious
Education
Relationships
& Moral
Education
Alternative
Education
Life Skills
Sex &
Relationships
Education
Rights & Responsibilities
•
UN CRC
•
WHO
•
European CHR
•
Scottish Government
•
LTS
•
NHS
•
Local Authority
(Learning Teaching)
Age & Stage
End of
Nursery
End of
Primary P7
End of
Secondary S4
•Making friends
•Physical – babies,
body parts, puberty
•Knowledge – STIs,
pregnancy, services
•Emotional – feelings,
emotions, friendships
•Values – rights,
responsibilities,
equality
•Healthy bodies
•Keeping safe
•Social – gender
roles, media,
independence
•Skills – negotiation,
condom use,
Possible Issues for Young People in
Alternative Education Settings
Possible Issues for Staff in
Alternative Education Settings
Challenges for alternative
education settings
Shy
Literacy problems
Upset
Attention problems
Aggressive
Motivation
Embarrassed
Wide range of functioning
Anti-authority
Sensitivity
Doesn’t want to participate
Too difficult
Solutions/suggestions?
• Literacy problems - minimise need for pupils’ reading
• Attention – lots of 5-10 minute sessions
• Shy – be reassuring
• Upset – be reassuring and have support options
available before starting a session
• Aggressive – be patient
• Embarrassed – don’t be embarrassed yourself
• Motivation – bring in creativity to the exercises, perhaps
also quizzes, games and drama
• Wide range of functioning – make a pack that teachers
who know their pupils can adapt appropriately
Solutions/suggestions?
• Sensitivity – be aware of it and have support options
available before starting a session
• Anti-authority – interactive and respectful teaching
methods, not didactic
• Doesn’t want to participate – try to motivate, perhaps
best to respect the pupils wishes?
• Too difficult – reassure, patience and assess whether it
is appropriate for this pupil
SRE Programmes for Alternative Education Settings
Cover
absolute
basics
Individually
tailored
On-going
not one-off
Cross age
& stage
Aim to
reduce
harm
Drugs &
alcohol
Recovery as
a journey
not a
destination
Interactive
& fun
Antihomophobic
Feedback from young people
based in an alternative
education (AES) setting
The young people would like:
• nearby and friendly sexual health services
• staff from these services to meet them in their AES
setting (think it’d make them more likely to visit them
afterwards)
• to be respected by adults teaching them and talking to
them
• to be listened to by adults teaching them and talking
‘with’ them
• fun and participative lessons
An Example
• Think . . .
• Feel
...
• Do . . .