The impact of the Affordable Care Act on health education: perceptions of leading health educators.

The health care system in the United States is being overhauled by major legislation, the Patient Protection and Affordable Care Act (ACA). This study's goal was to provide insight into the perceived impact and changes that could occur within the health education profession as a result of this health care reform legislation. Seven leaders of the health education profession participated in this qualitative research study. Six semistructured, exploratory interviews were conducted, and one participant provided written responses to the interview questions. A thematic analysis of the content of the interviews yielded five themes: (a) a fragmented sick-care system, (b) ACA becomes law: the participants' reactions, (c) ACA becomes law: the profession's reactions, (d) impact on the profession, and (e) health education in 2020. This article describes the fourth theme, the impact of the ACA on the health education profession. Leaders of the health education profession believed that the ACA creates a more favorable environment for health education practice. The positive elements of this legislation, however, will need to be protected, strengthened, and verified, through the work of health education professionals. As more mandates within the law are enacted over time, the impact on the profession, more than likely, will shift.

Is abstinence education theory based? The underlying logic of abstinence education programs in Texas.

Authors examined the logic (or the implicit theory) underlying 16 abstinence-only-until-marriage programs in Texas (50% of all programs funded under the federal welfare reform legislation during 2001 and 2002). Defined as a set of propositions regarding the relationship between program activities and their intended outcomes, program staff's implicit theories were summarized and compared to (a) data from studies on adolescent sexual behavior, (b) a theory-based model of youth abstinent behavior, and (c) preliminary findings from the national evaluation of Title V programs. Authors interviewed 62 program directors and instructors and employed selected principles of grounded theory to analyze interview data. Findings indicated that abstinence education staff could clearly articulate the logic guiding program activity choices. Comparisons between interview data and a theory-based model of adolescent sexual behavior revealed striking similarities. Implications of these findings for conceptualizing and evaluating abstinence-only-until-marriage (or similar) programs are examined.

A review of 21 curricula for abstinence-only-until-marriage programs.

The authors reviewed the content, methods, and overall quality of 21 curricula used in abstinence-only-until-marriage programs. Only materials designed for use in middle school grades (fifth to eighth) or with middle school-aged audiences (9-13 years of age), which presented the abstinence message in at least 40% of their content, were included. A rating instrument adapted from 2 sets of education guidelines structured the assessment of each curriculum. Four experienced teachers rated each curriculum. Curricula exhibited considerable variability in overall quality ratings. While on average, materials scored a 3.33 on a 1-to-5 scale (1 = Unacceptable; 5 = Excellent), 12 curricula received summative scores above the average, with 4 scoring 4.0 or higher. Eight curricula, however, received a below-average rating. While abstinence materials vary considerably in terms of overall quality, the values and world views underlying this sample of curricula were clear and consistent: those who develop abstinence education curricula value nonsexual antecedents of sexual behavior such as skills (goal setting, decision making, and assertiveness), ideals (fidelity, friendships), and psychological factors such as self-esteem.

Defining abstinence: views of directors, instructors, and participants in abstinence-only-until-marriage programs in Texas.

This study examined how program directors, instructors, and participant youth from a sample of federally funded abstinence-only-until-marriage education programs in Texas define the term "abstinence" and its object (from what one abstains). A sample of eight programs, from the 32 federally funded programs in the state (funded in fiscal year 2000-2001), were selected for indepth case studies. Interviews were conducted with 29 program staff (10 directors and 19 instructors). Six focus group sessions were held with youth participating in the programs. Interview and focus group transcripts were analyzed qualitatively, with salient themes being coded and counted. Results are presented in terms of frequency of mention of each theme/code. Most respondents (80% of program directors, 89% of instructors, 83% of focus groups) provided definitions of abstinence containing both positive and negative elements. Positive-patterned definitions emphasized specific attitudes and behaviors that must be internalized by youth (Internal Management; Values/Attitudes Incorporation; Abstinence as an Option; Investment in the Future). Negative definitions stressed restraint and avoidance, and focused on the objects of abstinence (Sexual/Vaginal Intercourse; Oral Sex; Anal Sex; Pre-Coital Behaviors; Behaviors with Purpose of Sexual Arousal; Non-Sexual Behaviors). Each element was mentioned by at least 26% of program staff and in at least 17% of youth focus groups. Results indicated substantial variability in how the term "abstinence" is defined. Such variability has implications for development of abstinence education programs, as well as for implementation of valid, equitable, and useful evaluations.

A meta-analysis examining effects of school sexuality education programs on adolescents' sexual knowledge, 1960-1997.

This study analyzed and synthesized findings from selected studies conducted from 1960 through 1997 regarding effects of school sexuality education on adolescents' sexual knowledge. This purpose was achieved using meta-analysis. Sixty-seven studies that met the selection criteria were included in the meta-analysis. The 67 studies reported 72 outcomes regarding sexual knowledge, which were grouped into six independent variables related to knowledge about sexuality. A weighted effect size method developed by Hedges and Olkin was calculated using all studies. For all studies, 97% of weighted effect sizes were positive. The weighted average effect size on sexual knowledge across all studies of 0.41 was statistically significant, indicating a significant difference occurred between control and experimental groups' mastery of objectives related to sexual knowledge. It was concluded that sexuality education programs positively affect overall sexual knowledge.

School violence: prevalence and intervention strategies for at-risk adolescents.

This study investigated the effects of social-cognitive group intervention on violence avoidance beliefs among at-risk adolescents. Fifty high school students were randomly assigned to an experimental or a control group. The experimental group participated in ten, 2-hour weekly sessions of a social-cognitive intervention. Both groups were administered a questionnaire before, immediately following, and 3 months after the intervention. Findings showed that the social-cognitive intervention did not result in significant differences between the groups on violence avoidance beliefs at posttest or follow-up. In addition, drug/alcohol users and nonusers, fighters and nonfighters, and students threatened at school and those not threatened were compared. Students who used drugs/alcohol and fought in school had significantly lower scores (i.e., a greater belief in using violence as a coping technique) than did students who did not engage in those behaviors.

A profile of rural Texas adolescents who carry handguns to school.

Students in randomly selected eighth and 10th grade English classrooms (n = 1,072) in central Texas schools were surveyed in fall 1994 regarding carrying weapons to school and associated risk factors. Students who carried a handgun to school one or more times during the preceding 12 months were compared to those who had not done so, using discriminant analysis and chi-square. Gun carrying at school increased 138% from seven years earlier in the same area using the same survey procedures. Most students reported they carried a gun out of fear or anger. Those who carried a gun at school had extremely elevated rates of repeated victimization of several types during the previous year: 589% higher for attack at school, 552% higher for attack outside school supervision, 576% higher for attempts to force sex at school, and 216% higher for rape. They also were more likely to enter dangerous situations repeatedly, were 17 times more likely to have used crack cocaine, had less instruction on preventing violence, less knowledge about means of avoiding fighting, and felt an obligation to fight under a wider variety of situations. Study variables accurately classified 78.4% of gun carriers as such. Researchers concluded that efforts at prevention of handgun violence in schools should include interventions to increase the safety of a select group of vulnerable students, while providing psychological counseling to assist them in overcoming emotional effects of victimization as part of larger violence prevention efforts.

Violence and illegal drug use among adolescents: evidence from the U.S. National Adolescent Student Health Survey.

The relationships between violence, drug use, and victimization were examined in a representative sample of American adolescents. The commonly used illegal drugs (marijuana, amyl/butyl nitrites, psychedelics, amphetamines, and cocaine) and alcohol were considered. Drug users, compared to nonusers, fought more, took more risks which predisposed them to assault, and were assaulted more both at school and outside school supervision. Adolescents who were victims at school were also more likely to be victimized outside of school supervision. This study clearly demonstrates that the aggressor may also be the victim, and that illegal drug/alcohol use is related to victimization.

Sources of drug information among adolescent students.

A sample of 1023 eighth and tenth grade students in small to medium-sized central Texas school districts was assessed to determine the amount of information they receive from ten sources about six categories of drugs. The amount of information males reported receiving about each drug category was significantly greater than what females reported, and the amount of information that eighth graders reported receiving about each drug category was significantly greater than what tenth graders reported. Television was the primary source of drug information for all categories of drugs except inhalants, for which friends and television were equally important sources. Parents and printed media (magazines or newspapers) were of secondary importance, followed by friends and teachers. Adolescents were less likely to receive drug-related information from experience, siblings, church, doctors, and police. The reliance on the mass media for drug information in smaller school districts is a pattern which has been previously observed in larger urban districts. This consistency suggests that mass media approaches to drug education are likely to be as effective in rural areas and smaller towns as they are among urban adolescents. Implications for television programming are discussed.

Peer influence and drug use among adolescents in rural areas.

A sample of 1,004 eighth and tenth grade students in twenty-three small Central/East Texas communities was assessed to determine 1) their perception of the number of their friends who use drugs, 2) the amount of information they received about drugs from their friends, and 3) the connection between those perceptions and drug use. A multiple regression model which included grade, gender, the degree to which friends are perceived to use drugs and the amount of information about drugs received from friends explained 39 percent of the variance in the degree to which rural adolescents were involved in drug use. An item specific analysis of the subcomponents of these composite variables explained 44 percent of the variance in the degree to which rural adolescents were involved in drug use. This same four-factor model accurately classified over 81 percent of non-drug-users and 67 percent of users using discriminant analysis. Students who perceived a higher degree of drug use among their friends and who received more information about drugs from their friends used drugs more frequently. Lower marijuana use in these rural areas as compared to the nation, both as a peer perception and as a fact, may protect these students to a degree from broader patterns of drug use. The findings of this study support the theory that peer pressure is related to drug abuse, even in rural areas.

Survey of contraceptive services available to college students.

PIP: Questionnaire were sent to 187 directors of college student health services; 71% returned usable replies. 3 sources of contraceptive services were identified: local family planning agencies, the student health service, and private physicians. It was found students had easy access to information, the pill, the IUD, over-the-counter methods, diaphragms, and referral services. Sterilizations were difficult to obtain and generally not available through a student health center. Every questionnaire noted that at least some contraceptive services were available, if not through the student health service, then through the family planning agency or a physician.^ieng