1. Implementing Sexual Health Education Policies and Programs in Challenging Environments Kendra LeSar, MPH, CHES Marsha Broussard, DrPH Kelley McDonough, MPH Taslim van Hattum, LMSW, MPH Brittany Booker, MPH American Public Health Association Annual Meeting November 4, 2013 Boston, MA

2. Presenter Disclosures Marsha Broussard, DrPH 1. The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No Relationships to Disclose

3. Objectives  Discuss how state laws, and how they are locally interpreted, can affect the teaching of comprehensive sexual health education in schools  Describe strategies for implementing comprehensive sexual health education in politically conservative school environments  Identify the key needs and challenges of school administration and faculty in implementing comprehensive sexual health programming

4. Sexual Health Education Law in Louisiana  Must emphasize abstinence  Can include other risk-reduction methods (i.e., contraception/condoms)  Sexual health education not required  Sexual health education allowed in grades 7–12  Surveying students about sexual behavior is not permitted

5. Common Misconceptions  Many school personnel have indicated that they believed that Louisiana only permitted abstinence-only education  Therefore, many schools only offer abstinence- based instruction in sexual health education

6. Statistics  56% of high school students reported ever having sexual intercourse (New Orleans, 2007)  1 st highest syphilis rate in US (Louisiana, 2009)  2 nd highest HIV infection rate in US (Louisiana, 2011)  4 th highest AIDS rate (Louisiana, 2011)  4 th highest Chlamydia rate (Louisiana, 2009)  4 th highest gonorrhea rate (Louisiana, 2009)  6 th highest teen birth rate in US (Louisiana, 2011)  Estimated teen pregnancy rate of 80 pregnancies per 1,000 girls aged 15–19 (Louisiana, 2008)

7. Health Education Needs Assessment  Surveyed high school health teachers across New Orleans  Sexual health was among the topics that teachers believed were most important for their students to learn  However, few teachers were teaching sexual health, and those who were, predominantly used abstinence-only curricula

8. Select School/District Based on Readiness  Through needs assessment and school-specific health assessment, an urban public charter high school identified sexual health education as priority  Developed school-specific comprehensive sexual health education policy  Policy approved by charter board

9. Curriculum Selection  Becoming a Responsible Teen (BART) was chosen as curriculum  Charter board approved BART  Parent Teacher Student Organization approved BART

10. Program Implementation  Health teachers were unprepared to teach comprehensive sexual health education and were unwilling to lose 8 class sessions to outside presenters  A local CBO was contracted to offer BART after school

11. Monitoring & Evaluation  Pre- and post-test to measure change in knowledge  Fidelity monitoring  Participant satisfaction surveys  Interviews with facilitators

12. Findings  Pre-/post-tests showed increased student knowledge of HIV transmission and prevention  Fidelity monitoring showed BART was implemented with fidelity in the on-campus afterschool setting  Participant satisfaction surveys and key informant interviews showed that more instruction is needed on other STDs, unintended pregnancy, and reproductive anatomy

13. Lessons Learned  Schools often unclear of what is allowed under state law  Schools and parents generally supportive of comprehensive sexual health education  Evidence-based ≠ comprehensive  Comprehensive sexual health education should be integrated into required course (e.g., health) in order to reach all students  Teachers should be included in curriculum selection process & trained to deliver comprehensive sexual health education

14. Roadmap for Successful Implementation of Comprehensive Sexual Health Education in Schools 1. Identify and clarify state and local policies surrounding sexual health education in schools 2. Assess school/charter/district readiness 3. Develop school/charter/district policy that reflects community values and expectations 4. Adoption of policy by governing board 5. Identify person(s) responsible for teaching sexual health education

15. Roadmap for Successful Implementation of Comprehensive Sexual Health Education in Schools 6. Identify curriculum 7. Obtain curriculum approval by governing board & parent committee 8. Train teachers about comprehensive sexual health education & approved curriculum 9. Implement curriculum in classroom 10. Monitor implementation & evaluate program success

16. References  La. Rev. Stat. Ann. §17:281, 1993.  SIECUS. Louisiana state profile fiscal year 2011. Sexuality Information and Education Council of the United States. [Online] [Cited: May 30, 2013.] http://www.siecus.org/document/docWindow.cfm?fuseaction=docu ment.viewDocument&documentid=139&documentFormatId=157. http://www.siecus.org/document/docWindow.cfm?fuseaction=docu ment.viewDocument&documentid=139&documentFormatId=157  Centers for Disease Control and Prevention. HIV Surveillance in Adolescents and Young Adults. Centers for Disease Control and Prevention (CDC). [Online] [Cited: May 29, 2013.] http://www.cdc.gov/hiv/pdf/statistics_surveillance_2011_HIV_Adole scents.pdf.

17. References  Office of Adolescent Health. Louisiana Adolescent Reproductive Health Facts. United States Department of Health and Human Services. [Online] August 23, 2013. [Cited: September 13, 2013.] http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive- health/states/la.html. http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive- health/states/la.html  Kost, Kathryn and Henshaw, Stanley. U.S. Teenage Pregnancies, Births and Abortions, 2008: State Trends by Age, Race and Ethnicity. Guttmacher Institute. [Online] March 2013. [Cited: May 29, 2013.] http://www.guttmacher.org/pubs/USTPtrendsState08.pdf.

18. Acknowledgements  Warren Easton Charter High School  Louisiana Department of Education  4Real Health  Communities in Schools  W.K. Kellogg Foundation