BEST PRACTICES IN SEX ED FOR ADOLESCENTS Adolescent Health Symposium Middleton, WI February 8, 2018

LEARNING OBJECTIVES Describe current adolescent sexual and reproductive health outcomes and trends, including a lack of equity in these outcomes based on gender, race, and sexual orientation. Explain the components and types of sex education programs that have demonstrated success in preventing negative sexual and reproductive health outcomes among adolescents. Recognize strategies and approaches to making sex education inclusive of all adolescents in school and community settings. Identify effective tools and resources for implementation of effective sex education programs for adolescents. While rates of teen pregnancy across the U.S. – including in Wisconsin – have decreased to an all-time low, rates of sexually transmitted infections (STIs) among adolescents are on the rise. Additionally, adolescents in recent years continue to report experiences of sexual harassment, sexual assault, dating violence, exposure to sexually explicit materials, sexism, homophobia, and transphobia. Some adolescents – such as girls, youth of color, and LGBTQ youth – experience negative sexual and reproductive health outcomes at much higher rates than their peers. Sex education that is comprehensive, inclusive, and based on research can prevent these negative health outcomes. This presentation will review a variety of resources and tools – for example, the National Sexuality Education Standards – that can be used to ensure that the most effective sex education programs for adolescents are being offered in school and community settings. In this session, participants will: Describe current adolescent sexual and reproductive health outcomes and trends, including a lack of equity in these outcomes based on gender, race, and sexual orientation; Explain the components and types of sex education programs that have demonstrated success in preventing negative sexual and reproductive health outcomes among adolescents; Recognize strategies and approaches to making sex education inclusive of all adolescents in school and community settings; Identify effective tools and resources for implementation of effective sex education programs for adolescents.

TEEN BIRTH RATES 22.3/1,000

WHY IS THE TEEN BIRTH RATE DECLINING? Number of high school students engaging in sexual intercourse is on the decline Use of birth control by teens – especially highly effective methods – is on the rise National and community-based efforts to improve and increase effective sex education Not due to an increase in teen abortion rate, which is also declining

HOWEVER… Guttmacher (2011)

TEENS AND YOUNG ADULTS HAVE THE HIGHEST RATES OF STIs

…AND ON THE RISE CDC. (2017). Chlamydia — Rates of Reported Cases by Sex, United States, 2000–2016. Accessed at https://www.cdc.gov/std/stats16/figures/1.htm.

DISPARITIES IN STI RATES Chlamydia — Rates of Reported Cases by Race/Ethnicity and Sex, United States, 2016 ALSO increasing rates of gonorrhea, HIV, and syphilis – some increases primarily among MSM * AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders. NOTE: Includes 50 states and the District of Columbia reporting race/ethnicity data in Office of Management and Budget compliant formats in 2016.

LACK OF EQUITY IN OUTCOMES Those at the highest risk of experiencing negative outcomes are not necessarily engaging in risker behavior + For those who are engaging in riskier behaviors, consider the root causes

CONTEXT OF HEALTH BEHAVIORS

TEEN DATING & SEXUAL VIOLENCE

PROTECTIVE BEHAVIORS Increasing number of high school students who are sexually active are using birth control, including highly effective methods of birth control Increasing number of sexually active high school students are also using condoms

PROTECTIVE BEHAVIORS Recommendations that all sexually active individuals under age 25 (and others) get tested for chlamydia and gonorrhea Rates of HPV vaccination among adolescents remains lower than other recommended vaccines for this age group

CURRENT DOSAGE RECOMMEDATIONS - 2 doses for ages 9-14 (0, 6-12 months) and 3 for 15-26 (0, 1-2 months, 6 months)

This is why…

LARGE GROUP DISCUSSION What are your goals for sex education for middle school and high school students?

COMPREHENSIVE SEX EDUCATION Comprehensive sexuality education refers to K-12 programs that cover a broad range of topics related to: Human Development (including reproduction, puberty, sexual orientation, and gender identity) Relationships (including families, friendships, romantic relationships and dating)

COMPREHENSIVE SEX EDUCATION (Continued) Personal Skills (including communication, negotiation, and decision-making) Sexual Behavior (including abstinence and sexuality throughout life) Sexual Health (including sexually transmitted diseases, contraception, and pregnancy) Society and Culture (including gender roles, diversity, and sexuality in the media)

RECOMMENDATIONS FOR SEX ED National Sexuality Education Standards http://www.futureofsexed.org/nationalstandards.html National Teacher Preparation Standards http://www.futureofsexed.org/teacherstandards.html Sexuality Information and Education Council of the United States (SIECUS) http://www.futureofsexed.org/nationalstandards.html

SEX ED RESOURCES Rights, Respect, Responsibility curriculum http://advocatesforyouth.org/3rs-curriculum FLASH curriculum https://www.kingcounty.gov/depts/health/locations/family-planning/education/FLASH.aspx

SEX ED RESOURCES 8-session PPWI Embody curriculum https://www.plannedparenthood.org/planned-parenthood-wisconsin/education/community-education-programs/embody-comprehensive-sexuality-curriculum PPWI Maurice Ritz Resource Center https://www.plannedparenthood.org/planned-parenthood-wisconsin/education/resources-for-professionals

EVIDENCE-BASED TEEN PREGNANCY & STI PREVENTION PROGRAMS Developed with health behavior theory In studies, contributed to very specific behavioral and health outcomes Because of the research process, some of these programs are (a) decade(s) old

EVIDENCE-BASED TEEN PREGNANCY & STI PREVENTION PROGRAMS Ongoing program evaluation continues to demonstrate some success, and adaptations may be important https://www.hhs.gov/ash/oah/grant-programs/teen-pregnancy-prevention-program-tpp/evidence-based-programs/index.html

PAIR & SHARE With a partner, discuss your suggestions for how to address sensitive topics with adolescents, and list your top 2-3 to share with the larger group.

CHARACTERISTICS OF EFFECTIVE SEX EDUCATORS Trained Possesses cultural humility Aware of available resources Respects students, their identities, and their experiences Stays up-to-date Open to new information Ability to develop authentic and ongoing relationships with students Provides factual answers Unbiased Nonjudgmental Creates a safe space

“THINK BEFORE…” Messages that… Sound like… Leave out… Focus on heterosexual sexual behaviors (specifically vaginal sex) “Having unprotected sex puts you at risk for pregnancy.” Gay and lesbian students, students engaging in other sexual behaviors Are judgmental about teens engaging in sex or sex outside of marriage “Abstinence is the best choice for teens.” * OR “People should wait to have sex until they are married.” ** Sexually active students, students in single-parent households and/or with divorced parents Discuss how to reword these messages in a more inclusive way. Acknowledge that *you* have given many of these messages before. Being an effective sex educator includes being aware about and honest to yourself, open to feedback, and willing to change in order to improve. * Messages may instead reflect that abstinence can be the best choice for any individual at any point in their lives and for many different reasons. ** Messages like this may be appropriate in community and cultural contexts. Health educators may not want to make these judgements.

“THINK BEFORE…” Messages that… Sound like… Leave out… Are not trauma-informed “Having sex with a lot of people is risky.” Victims and survivors of sexual assault and sexual abuse Criticize teen parents “Many teen parents don’t graduate.” Pregnant and parenting teens Reinforce unhealthy gender stereotypes “Boys will say they love you to get you to have sex.” AND “Girls are more emotional than boys.” Trans and gender nonconforming students (and may be harmful to everyone)

SHARING IDEAS Name one thing you are already doing or will do to make sex education more inclusive for the youth you work with.

“IT TAKES A VILLAGE…” Involve parents, guardians, and other important adults in young peoples’ lives Offer ongoing opportunities in multiple settings for young people to learn about sex, sexual health, relationships, and more Consider school and organizational policies as well as state and federal legislation

ADDITIONAL RESOURCES FOR EDUCATORS PPWI annual Safe Healthy Strong Conference in Milwaukee March 20-22 https://www.plannedparenthood.org/planned-parenthood-wisconsin/education/resources-for-professionals/safe-healthy-strong Other PPWI professional trainings Answer online trainings http://answer.rutgers.edu/

ADDITIONAL RESOURCES FOR YOUTH Youth-friendly educational websites www.plannedparenthood.org www.bedsider.org www.amplifyyourvoice.org PPWI text line Lots of apps available through the websites above

Meghan Benson, MPH, CHES Director of Community Education Planned Parenthood of Wisconsin 608-345-7277 meghan.benson@ppwi.org