Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis.

CONTEXT: School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS: Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS: Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS: Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.

Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis.

CONTEXT: School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS: Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS: Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS: Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.

RESUMEN Contexto: Las intervenciones en entornos escolares dirigidas a modificar los conocimientos, actitudes y conductas de salud sexual tienen efectos mixtos y, con frecuencia, insostenibles en los resultados de salud sexual de los adolescentes. Sin embargo, la evidencia observacional sugiere que hay factores más amplios relacionados con la escuela, como el clima escolar y el logro educativo, que pueden influir en los resultados. Métodos: En julio de 2017, se realizaron búsquedas en nueve bases de datos de evaluaciones aleatorias y cuasi experimentales de intervenciones que abordan el entorno escolar o los activos educativos de los estudiantes, para examinar si dichas intervenciones pueden promover la salud sexual de los jóvenes. Las búsquedas se limitaron a estudios publicados a partir de 1990, pero no se restringieron por idioma. Los estudios se evaluaron para determinar el riesgo de sesgo y se sintetizaron de forma narrativa y metaanalítica. Resultados: Las búsquedas produjeron 11 evaluaciones de intervenciones relacionadas con el entorno escolar o los activos educacionales de los estudiantes, publicadas de 1999 a 2016. Debido a inconsistencias en los informes, el riesgo de sesgo no fue claro para la mayoría de los estudios, por lo que el metaanálisis solo fue posible para un resultado. El metaanálisis de tres ensayos aleatorios proporcionó cierta evidencia de que las intervenciones en el entorno escolar podrían retrasar el debut sexual (razón de probabilidades agrupada, 0.5). La síntesis narrativa de los resultados restantes encontró resultados mixtos, pero sugiere que las intervenciones que abordan el entorno escolar pueden retrasar el debut sexual y que aquellas que abordan los activos educacionales a nivel de los estudiantes pueden reducir el riesgo de embarazo y de ITS. Conclusiones: Se necesita evidencia adicional y más rigurosa para evaluar la probabilidad de que las intervenciones que abordan los factores relacionados con la escuela sean efectivas y para proporcionar una mejor comprensión de los mecanismos mediante los cuales pueden trabajar para mejorar la salud sexual de los adolescentes.

RÉSUMÉ Contexte: Les interventions en milieu scolaire qui cherchent à modifier les connaissances, les attitudes et les comportements en matière de santé sexuelle ont des effets mitigés et souvent éphémères sur les résultats de santé sexuelle des adolescents. L'observation donne cependant à penser que des facteurs plus larges liés à la scolarité, comme le climat à l'école et le niveau atteint, peuvent influencer ces résultats. Méthodes: Neuf bases de données ont été consultées en juillet 2017 à la recherche d'évaluations randomisées et quasi-expérimentales d'interventions concernant l'environnement au niveau de l'école ou les actifs éducatifs au niveau de l'élève, afin d'examiner si ces interventions peuvent favoriser la santé sexuelle des jeunes. La recherche s'est limitée aux études publiées depuis 1990, sans restriction de langue toutefois. Outre une évaluation du risque de biais, les études ont fait l'objet d'une synthèse narrative et méta-analytique. Résultats: La recherche a produit 11 évaluations, publiées de 1999 à 2016, d'interventions relatives à l'environnement scolaire ou aux actifs éducatifs de l'élève. Faute d'uniformité des rapports, le risque de biais n'a pas pu être évalué clairement pour la plupart des études et la méta-analyse ne s'est avérée possible que pour un résultat. La méta-analyse de trois essais randomisés tend à indiquer que les interventions en milieu scolaire peuvent différer les premiers rapports sexuels (RC groupé, 0,5). Pour le reste, la synthèse narrative a produit des résultats mitigés, donnant toutefois à penser que les interventions relatives à l'environnement scolaire peuvent différer les premiers rapports sexuels et que celles ayant trait aux actifs éducatifs de l'élève peuvent amoindrir le risque de grossesse et d'IST. Conclusions: Des données supplémentaires et plus rigoureuses sont requises pour évaluer la probabilité d'efficacité des interventions touchant aux facteurs scolaires et permettre de mieux cerner les mécanismes par lesquels elles peuvent être utiles à l'amélioration de la santé sexuelle des adolescents.