SEXUAL HEALTH PROMOTION IN THE SCHOOL AGE POPULATION

 

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SEXUAL HEALTH PROMOTION IN THE SCHOOL AGE POPULATION

INTRODUCTION

Sexual health promotion is the course of allowing the youth in school to enhance their power and develop their sexual wellbeing. This is to acquire a condition of total physical, mental and social wellbeing, and to be able to discover and appreciate ambitions, to gratify wants and to transform or adapt to their upbringing. School health promotion has attracted a wide range of study and training over the last 50 years parallel to health promotion in different backgrounds (US Department of Health 2006). It is a multidimensional subject that involves teaching knowledge and skills in the classroom, modifying the public and physical settings of the school and developing connections with the broader society. This combination seeks to establish the value of health promotion in schools and the contribution of the different stakeholders both in the government and the society towards achieving a sustainable and informed future generation (Hubley and Copeman 2008). The names and places mentioned in this paper may not refer to anyone whatsoever.

CONTEXT

Sexual health promotion has the benefit of concern for health and equity, accountability for health impact and putting health as a priority for policy makers in the education sectors. The values of a healthy location focus on creating an accommodating environment in schools and by addressing learning ethnicity, composition, roles and values. It also ensures comprehension and devotion to sexual health is incorporated into daily actions and practices (Armitage 2006, 2007). The latest developments among learners concerning sexual health in the past twenty years include the various aspects of human sexuality, HIV epidemic and increased consciousness of other sexually transmitted infections, the concepts of masculinity and femininity and the consolidation of reproductive health (WHO-2011).

Other developments concerns identification of sexual brutality against children, women and sexual minorities as a grave health public subject, sexual rights as human rights, protection of minorities privileges and improvement of efficient and sound medication to transform the functioning of sexual system of individuals (Krueger et al 2002). Effective sensitization therefore needs to be conducted to ensure a sound understanding of the subject of sexual health to promote the ethical concerns in the learning institutions. In this context, the risk of pregnancy among the youth will be analysed and addressed in details.

Sexual health promotion

According to Health protection Agency (2011) Sexual health promotion denotes to strengthening the health protection programs and evaluating the capacity and impact of all intervention strategies to reduce the levels of high risk sexual behaviour and the emerging new strains of HIV and sexually transmitted infections. The main framework is to monitor the HIV and sexually transmitted infections prevention programmes and to evaluate them in finding which programs are more effective and make amendments where these activities failed (Armitage 2002, 2004). The major area of concern in this assignment is to evaluate the prevention programs of sexually transmitted infections and under 18 conceptions and to recommend on the best ways available to reduce these risks among the vulnerable groups.

 

 

 

Sexual Health concerns and Problems

Young girls all over the world are at risk of having unplanned pregnancy which is a critical sexual health concern among parents, guardians, administrators and the government.  According to the National Campaign to prevent Teen Unplanned Pregnancy (2007) United States had approximately 50% of the 6.4 million pregnancies in 2001 unplanned. Out of the 50% unplanned pregnancy 43 % ended up in abortion while the rest were live births. Among these we had miscarriages and intended abortions. This poses a risk of sexual health to both the mother and the child. It is therefore necessary for the community and the government to determine ways of reducing these risks of teen pregnancies through the learning institutions to enhance future prosperity of the generation to come.

Human Sexuality

Crooks (2010) defines human sexuality as the main aspect of being human which comprise of sex, gender, gender identity, sexual orientation, eroticism, love, emotions and reproduction. It is normally shown in thinking, desires, dreams, beliefs, attitudes, principles, actions, roles and affiliations. Sexuality comes about due to psychological factors, social factors, and biological factors, cultural, spiritual and moral factors. Young teens are likely to get confused about their sexuality. This is because they are undergoing various developments in the adolescent stage. This stage normally requires keen guidance of the teenagers to prevent risks of unintended pregnancy and the hazards accompanied to it. Most teens will feel attracted to the opposite sex in the pretence of love. Some will engage in unprotected sexual intercourse as a way of showing love and emotions. The impact of all these is usually confusion as the teenagers responsible for the pregnancies take off. The love and affiliation no longer exist hence the young teen girls may opt for abortions or suicides. Through the school programmes and curriculum, they will be taught and guided on various methods of birth controls and how to differentiate between love and lust (Corcoran 2007).

Reproductive Sexual Health

Reproductive sexual health involves three interrelated fields which comprise of the universal rights, empowering women and provision of health services.  In the schools’ curriculum this is a main area of study which seeks to inform and educate the youth about the strategic issues in reproductive sexual health. It enables the youth to appreciate their reproductive system and empower them with the necessary mechanisms to manage the challenges that accompanies the subject (Corcoran, 2011). The teenagers are in a position to understand the composition and structure of their reproductive system hence assimilating the various facts about conception and pregnancy. This subject will equip them with the necessary knowledge of preventing unintended pregnancies in schools and colleges (Gururaja 2001).

Singh (2008) observes on a sad note about the report on the alarming rate of teen pregnancy in the United States Massachusetts schools. The report that shows many teenagers under the age of 16 years are teen mothers. The teens have higher hormonal growth compared to adult women making the young girls more sexually active and energetic. He says that the increased fertility rates and strong body metabolism are not strong enough to sustain the physiological and emotional stress in pregnancy. These pregnant teens are a threat to mankind as they practice sexual experimentation at a tender age due to peer pressure. U.S has a higher teenage pregnancy rates than any other developed or undeveloped country according to the report. The main stumbling block of being a mother at teen age is the responsibility that accompanies it as many of them are normally terrified on how to go about the whole issue. Furthermore, there are major concerns of unwanted pregnancy which involve various risks associated with the teen pregnancy. These include: Risk to the foetus where the teen mother’s body metabolism cannot nourish the foetus effectively hence resulting into underweight babies. The body organs of the child may also under develop leading to disorder in childhood and higher rates of infant mortality. The teenage mothers usually have problems in delivering normally owing to their body shape and size hence most go for caesarean method which may be dangerous as it can lead to excessive bleeding and death.

Negligence of the mother is another possible risk where the teenage mothers are normally helpless when it comes to caring for the baby. Some will have unsystematic eating habits and malnutrition as a result of excessive smoking and intake of alcohol or intake of drugs during the pregnancy which might jeopardize the health of the mother and the infant. At the same time due to lack of proper prenatal care the babies born may not survive for long.

Social negligence is another hindrance to the young teen’s mother which puts more pressure on the mother as she cannot be accepted in the society due to the baby. This may affect psychological status of the teenage mother leading to possible cases of suicides in the extreme measures. Other repercussions as a result of the societal denial include inability to run a family on very low income status hence posing a danger to the daily running of life. Consequently, being a mother needs a lot of planning, firm decision and a stable financial background for the mother which then requires effective sexual health promotion strategies to prepare the mother psychologically and physically.

 

 

HIV/AIDS epidemic

The sexual health apprehensions affect different sectors of human actions at personal level and societal level. For instance, the worldwide spread of HIV/AIDS through vulnerable sexual interaction has led to over 35 million people being infected and 19 million people dying worldwide since the inception of the pandemic (U. S. Department of Health and Human Services. 2006). The Pan American Health organization estimates that there are approximately 13 million children and youth orphaned due to HIV caused death of one or both of their parents and that 2.5 million people are currently infected with HIV in the American region. There is great public awareness of the extreme seriousness of sexually spread infectivity where one million people pass on from sexual tract illness. Most affected are the sexually active youth. The teenagers engage in experimental sexual intercourse without prior knowledge of the aftermath of their behaviour. This increases the chances of contracting HIV and other sexually transmitted infections.

Drug and substance abuse

Drug and substance abuse is the misuse of prescribed medication or use of the illegal substances such as cocaine, bhang and other types of narcotics (Lynach 2011). Drug and substance abuse is growing at an alarming rate among the youth all over the world. Most teenagers have the information about the side effects of the drugs and substances they use but due to ignorance they still press on with the behaviour. Most of the abusers finally develop a craving for the drugs which affects their health immensely. Some drugs are injected; others are inhaled while others are swallowed as tablets. Most of the injectables contribute highly to the HIV pandemic. The predominance of HIV spread among the drug users who injects has reached between 60 to 90% within a period 6 months to a year since it the first case appeared according to the World Health Organization (2007). Most drug users share the injections hence increasing the risk of contracting HIV when sharing with infected persons. Moreover, most teenagers who abuse alcohol may involve themselves in irresponsible and unprotected sexual intercourse increasing their vulnerability to infection of sexually transmitted infections, HIV and Teenage pregnancy. Some may develop behaviours that may lead to sexual violence as a result of excessive use of the drugs as mentioned earlier. The drugs abused disorient their mind and rational thinking exposing them to adverse brutality in the societal environment. Teenagers use drugs due to reasons such as; Influence of the commercials and adverts especially alcohol and tobacco, pressure from role models for example a singer or an actor who consumes alcohol, curiosity hence they want to try it out, to feel relaxed, to enjoy themselves, to prevent physical or psychological issues like teenage pregnancy, to make one energetic or stimulate ones libido among the teenage boys, to stimulates one’s muscles and physical power and to stay a wake.

However, drugs normally come with consequences; they make a teenager become more dependant on the drug, some may lead to education interference, troubles with the law enforcement agencies due to illegal drug consumption, loss of societal image, friends and families. Some drugs may lead to loss of good health, depression and suicidal tendencies while others may lead to increased risk of HIV infection especially the injectables. Similarly, some drugs will lead haphazard sexual activities for example having sex for money to buy the drugs. Some drugs like cocaine and ecstasy make sex better and heighten the emotions WHO 2011). Therefore proper guidance in schools should be given to the teenagers to restrain this behaviour (Wilson et al 2003).

 

BEHAVIOUR CHANGE MODELS

These are models channelled towards modifying the conduct and sexual health activities of the teenagers to transform from high risk to less risk in a bid to reduce the prevalence of HIV and under 18 conceptions. There are various theories which support behaviour change while others try to explain why some behaviour occurs. There are four models of behaviour change as reviewed by Family Health International (2004). But in this context two of the models will be discussed to observe on their impact on behaviour among the teenagers.

Theory of planned behaviour

The theory was advanced by Icek Ajzen in (1985). The theory is an extension of the theory of reasoned action in dealing with behaviours that people do not have complete desire to control. The fundamental feature in the theory of planned behaviour is the person’s intent to perform a given behaviour. It shows the factors that motivate teenagers’ willingness to experiment unprotected sexual behaviour. The performance of the behaviour is more likely with increased intention to try the behaviour. In most cases the individuals are usually in command of the behaviour. Hence intentions of the person would be required to manipulate the performance to the point the individual is inspired to try.

However, in relation to sexual health decisions there is no choice for teenagers except to abstain from sexual intercourse. Though there are available options concerning sexual health subject for example use of condoms and other birth control methods teenage should not be encouraged to try any of the methods. This is because the time is not right for them hence this model is not relevant for the behavioural change for teenage concerning the sexual relation actions.

Health Belief Model

It is a psychological model that tries to explain and foretell health behaviours by spotlighting on the individual’s belief and mind set. The health belief model is modified to address both long term and short term health behaviours inclusive of transmission of HIV/AIDS and other risky sexual behaviours. The main variables include; observed vulnerability which addresses individuals understanding of the risk of being infected or being affected by a health condition. It also considers the recognized severity which is a feeling of concern for the consequences of the illness.

Another main variable is the identified benefits which touches on the efficiency of the plans formulated to reduce the vulnerability. Besides, there is the recognized obstacles which is the potential drawbacks as a result of taking specific health actions inclusive of financial needs, physical demands and psychological requirements. This model also addresses the signals to action either bodily or environmental which persuades individuals to take action. Lastly, Bandura (1977) introduced the self efficacy a belief in being in a position to execute the needed behaviour successful. This model has been used to acquire a better knowledge of risky sexual behaviours among adolescents and pregnant women. However, this model only limit to only some identified health behaviour models leaving other factors such as economic, environmental, peer pressure and other social customs which is a concern especially when dealing with the youth.

Abstinence

Under the Health Belief Model, some of the ways of reducing the vulnerability may involve complete abstinence from any sexual activities. Abstinence refers to voluntary act or practice of refraining from sex and any alcohol or drugs. According to Nycole (2008) Abstinence education involves indiscriminative reasoned teaching of social, psychological and health benefits realized by abstinence from sexual activity, teaching abstinence from sexual actions out of marriage which is required of all school-age children, to avoid unplanned pregnancy, sexually transmitted infections and other related health problems, it also involves teaching teenagers how to restrain from any sexual advances and how alcohol and drug abuse puts one at risk of sexual advances vulnerability. This is because the teenage under this model understand the risk and consequences of engaging in unprotected sex and drug abuse at their age it time (Tones & Green 2010) Abstinence is the only sure way of prevention of teenage pregnancy and other sexual health related problems.

Some studies on abstinence conducted in U.S exemplified a positive behavioural change. Some of these studies include: Abstinence-only intervention which is a study by the journal of medicine Archives of Paediatrics and Adolescent Medicine that was published by the American Medical Association. The study shows that abstinence -only intervention program reduced the rate of sexual initiation by one third. Furthermore, the members who participated in the program and became sexually active less likely used contraception.

Reasons of the Heart program taught 20 class periods which was conducted by the certified trained health peer educators to focus on the character of the individual development and taught adolescents the gains in abstinence until one was married. The program reported that the participants who were mainly from suburban northern Virginia public schools half of which were likely to initiate sexual activity. The conclusion was that a reduction in the initiation process was obtained by some of the programs in the abstinence.

Sex can wait program offers lessons on building character, vital life skills and reproductive biology. The 2006 study program compared the impact on the adolescent sexual behaviour and the effects of sex can wait curriculum to the present performance rather than the real control situations. The researchers found that high school students had reduced sexual activity in the short term.

Not Me, Not Now is a community based abstinence program which aimed at children between age of 9 and 14 in the county of Monroe, New York. It devised a mass communication plan to encourage abstinence message through the mass media such as television, radio adverts, billboards, posters and interactive website (Rice & Atkins 2001). The objectives were to raise awareness of the problem of teenage pregnancy, to increase the comprehension of the adverse consequences of teen pregnancy, to develop peer pressure resistance, to promote communication between parent- children and generally to promote teenage abstinence programs. During the program there was a significant positive change in perceptions among pre-teenagers and teenagers in the country.

Another program was HIV Risk reduction Intervention was delivered to some 200 African-American middle school students in Philadelphia. The volunteers participated in a weekend health promotion program where they were subjected randomly to abstinence program, safe sex education program and delivered to trained adult and peer educators. It was found that the students who were in the abstinence program were likely less to engage in recent sexual actions in comparison to students in control group than the students in the safer sex program.

Virginity pledge studies program using the national longitudinal study of Adolescent Health where the studies revealed that adolescent virginity pledged was related to delayed teen sexual performance and other sexual related risky behaviours among the teenagers. Virginity pledging was discovered to lower the rates of sexually transmitted infections among young adults.

Correct, consistent condom use

Condom usage can also be emphasized in this model. By the belief of the negative consequences of engaging in unprotected risky sexual behaviours the teenagers may be encouraged to use condoms in their sexual actions. Correct and consistent condom use is highly effective in averting the transmission of HIV during anal or vaginal sexual intercourse. Latex condoms also avert pregnancy effectively including preventing other sexually transmitted infections. In young teenage girls it will reduce the risk of contracting cervical cancer associated with HPV. According Centres for Disease Control and Prevention (CDC 2002) studies reveal that rigorous steps and measures in consistent condom use is most effective in HIV transmission prevention. Besides, the studies also show that condoms are efficient in protection from some sexually transmitted infections for example Gonorrhoea, syphilis, Chlamydia, and trichomoniasis as most of these infections are transmitted through semen and vaginal fluids which are blocked from exposure to the other partners contact by the latex condom (CDC 2002).  (CDC 2002) studies also reveal that condoms are very efficient unwanted pregnancy prevention when used consistently and correctly. The studies show that 98% of the teenage girls who rely on male condoms remain pregnant free. Condom use contributes to about 79-85 % protection against pregnancy. Condoms are effective barriers to sexual transmission of HIV. The studies also show that incorrect use of latex condoms may lead to breakage which is less than 2% in United States. (CDC 2002) studies show that the availability of condom programs contribute immensely to high reduction of barriers that prevent the youth from using the condoms. These programs operate in schools and teen clinics where the adolescents converge where the condoms are provided to teens at low cost in a way that minimizes the discomfort among the teens in obtaining the condoms. The programs also encourage teens who are sexually active to oftenly use condoms consistently than their counterparts who lack such programs according to the studies. These studies furthermore reveal that the condom availability programs do not motivate the teens to instigate sex and that do not make the sexually active teenagers to engage in more sexual actions (Albarracin et al 2001).

Use of Other contraceptives

            In the U.S the use of different methods of contraceptives among the teens averaged 1.8 million. These contraceptives are funded by family planning clinics in the U.S. the common types of contraceptives used include combined pills, three month injectable, IUD calendar, ovulation method, patch, spermicides, no method and one month injectable. Some of the contraceptives used by the teens are normally misused in the sense that they are not used according to the requirements. The commonly misused contraceptive is the emergency pills among the teens where the teenage girls use it regularly and not for emergency purpose. However, the use of the contraceptives highly reduces the cases of teen pregnancy if correctly used. Use of other contraceptives a part from condoms does not prevent infection of sexually transmitted infections (Family Health International). The teens that rely on these contraceptives are therefore highly exposed to HIV/AIDS and sexually transmitted infections. This is because the contraceptives affect only the hormonal balance of the reproductive system to prevent fertilization or ovulation process. They can not alter the passage of bacteria, fungi and viruses into the body system hence high risk of infection.

 

 

The strength and weaknesses of the models discussed

The models may not meet the needs of marginalized groups which comprises of teenagers residing in remote areas of the country. This may increase the level of inequality as such programs that are conducted over the mass media may fail to reach teens not accessed to the media (Nadioo & Wills 2009). Besides the settings may not be neutral, it may have the influence of teens being obliged to show what the researchers want to see. The settings should be natural and the participants must not be told what is expected of them. There may be complex relationships and power issues as the volunteers may feel that they are being watched and so they ought to display the relevant behaviours so as to avoid being detected (Evans et al 2009). Another drawback is the issue to do with peer influences, such model like health belief model and reasoned actions may be affected by excess peer influence which makes the model of behaviour change impossible. Moreover, the programs is based on limited evidence base which fails to prove the outcomes observed were fair and true presentations of the happenings. Some teens will hide some of their sexual escapees until the impacts are felt is when the truth is felt.  Furthermore, lack of resources to carry out a country wide program like the Reasons of the Heart may be too expensive. Hence such programs may end up be marginalised. Last but not least, (Thorogood, Coombes, 2006) the programs are difficult to evaluate hence it requires extensive partnerships with different community based organization to accurately evaluate how effective they are (Hubley 2008).

Strength

The main strength of the model is that it has offered some insight to the international health organization in some of the ways given the resources which can reduce the teen pregnancy and sexually transmitted infections. It gives a way forward for the professions, technicians, government agencies and various stakeholders to adapt the best method that is cost efficient to help in combating the sexual health problem.

Conclusion

Sexual Health promotion is therefore, an area of concern which requires critical analysis and evaluation of all the programs targeting the sensitive topic of Teen pregnancy. The main behaviour change model of Health Belief model need to be critically analyzed to ensure the teens are involved in active programs of forming peer education groups to encourage their counterparts towards adopting positive sexual health strategies like abstinence and condom use to avoid compromising conditions such as teen pregnancy due to the negative consequences that accompany them. The limitations should be adequately addressed to ensure efficiency in implementation of the sexual promotion choices discussed.

 

 

 

 

 

 

 

 

 

References List

Albarracin, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A., (2001) Theories of

Reasoned action and planned behaviour as models of condom use: A meta-analysis. Psychological Bulletin

Albert Bandura (1977) Theory of Behavioural change,

Armitage, C. J. (2004), Evidence that implementation intentions reduce dietary fat

 Intake: A randomized trial. Health Psychology

Armitage, C. J. (2006) Evidence that implementation intentions promote transitions

Through the stages of change, Journal of Consulting and Clinical Psychology

Armitage, C. J. (2007a) Effects of an implementation intention-based intervention on

Fruit consumption, Psychology and Health

Armitage, C. J. (2007b). Efficacy of a brief worksite intervention to reduce smoking:

The roles of behavioural and implementation intentions; Journal of Occupational Health Psychology

Armitage, C. J., & Arden, M. A. (2002). Exploring discontinuity patterns in the trans-

Theoretical model: An application of the theory of planned behaviour. British Journal of Health Psychology

CDC, 2002, Male Latex Condoms and Sexually Transmitted Diseases, G.A: CDC, Atlanta

Corcoran, N. (2007), Communicating Health. Strategies for health promotion,

Sage, London

Corcoran, N. (2011), Working on Health Communication Sage, London.

Evans, WD, Uhrig, J, Davis, K & McCormack, L. (2009) Efficiency methods to evaluate

Health communication and marketing campaigns, Journal of Health Communication

Family Health International, 2004, Behaviour Change- A Summary of Four Major Theories,

Accessed 20/8/2011, http://www.fhi.org/nr/rdonlyres/ei26vbslpsidmahhxc332vwo3g233xsqw22er3vofqvrfjvubwyzclvqjcbdgexyzl3msu4mn6xv5j/bccsummaryfourmajortheories.pdf

Gururaja, S. (2000), Gender dimensions of displacement on Reproductive Health

Health protection Agency, (2011), sexual health Promotion, London

Hubley, J & Copeman, J. (2008), Practical Health Promotion Polity Press, Cambridge

Icek Ajzen, (1985), the theory of planned behaviour, University of massacheuttes, Amherst.

Krueger et al., (2002), World report on violence and health. Geneva, World Health

Organization, accessed 14 August 2011

(http://whqlibdoc.who.int/hq/2002/9241545615.pdf,

Lynach M, Schofield J, Sanson-Fisher R. (2011), School heath promotion programs over the

Past decade: a review of the smoking, alcohol and solar protection literature. Health Promotion International, accessed 14 August 2011 http://heapro.oxfordjournals.org/cgi/reprint/12/1/43,

National Campaign to prevent Teen Unplanned Pregnancy (2007) Contraception U.S Health

Department

Nadioo, J & Wills, J. (2009) foundations for Health promotion, BailliereTindall, London

Nycole, 2008, 8- point Definition of Abstinence-Only Education, Advocates for Youth.

Robert L. Crooks, (2010). Our sexuality Wads worth Publishing 11 Ed.

Rice, R.E &Atkins, C.K (2001) Public communication campaigns 3rd edition. Sage,

London

Thorogood, M & Coombes, Y. (2006), Evaluating Health Promotion Oxford University

Press, Oxford

Tones, K. & Green, J. (2010) Health Promotion: Planning and Strategies. 2nd edition,

London: Sage.

U. S. Department of