Sexually transmitted infections and the HPV-related burden: evolution of Italian epidemiology and policy.

Sexually transmitted infections (STIs) are a major public health problem worldwide, with a high prevalence between the ages of 15 and 25 in most Western countries. High notification rates of chlamydia, gonorrhea, and syphilis are reported in the WHO European Region, with differences between countries. In Italy, the total number of STIs alerts increased by 18% from 2020 to 2021. HPV is the most common sexually transmitted infection; globally one in seven women is infected by this virus, and certain sexual behaviors are important risk factors for HPV-related cancers, particularly cervical cancer (CC), anogenital cancers and cancers of the head and neck. The burden of CC is relevant worldwide, in particular in Europe CC is the third leading cause of cancer-related deaths in women aged 15-44. This HPV-related tumor is preventable through a combined strategy of vaccination and screening for precursor lesions. In Italy, the coverage of organized screening varies from region to region and the average HPV vaccination rate is still far from the expected optimal threshold of 95% at the age of 12. To address the challenges of health promotion and HPV prevention, priority actions are needed such as: promoting education and information at every level, from schools to healthcare professionals. In Italy, education of adolescents on sexual and reproductive health, still remains critical, regionally inhomogeneous and much lower than in other European countries. Equitable measures need to be taken, and schools are an important place for health promotion activities.

A Missing Piece of Occupational Therapy Education: Attitudes About Sex.

Following a lecture on sexual health and function, occupational therapy students were surveyed regarding their past sex education and their comfort level with the topic of sex. Students indicated a lack of sexual education received from parents/guardians and a prevalence of fear-based education from formal or informal sources. Results reflected a significant increase in students' perceived comfort level with the topic following the lecture from a provider trained and certified in sexual health. As sexuality falls within the domain of occupational therapy, these results suggest a need for comprehensive sex education taught to students by qualified instructors.

Reproductive Justice as an Alternative to the Pregnancy Planning Paradigm for Teens.

In this critical commentary, we describe the many limitations of the pregnancy planning paradigm as applied to pregnant and parenting teens. We describe how this paradigm, in characterizing pregnancies as intended or unintended, has shaped campaigns to prevent teen pregnancy and remains largely embedded in formal sex education and family planning programs in the United States. We argue that a paradigm shift is long overdue and describe how the reproductive justice framework addresses the limitations of the pregnancy planning paradigm. Although reproductive justice is endorsed by a growing number of organizations, recommended policies face formidable obstacles given that comprehensive sex education, contraception, and legal abortion are increasingly at risk in a post-Dobbs world.

Mendelian randomization analyses for the causal relationship between early age at first sexual intercourse, early age at first live birth, and postpartum depression in pregnant women.

Introduction: There are insufficient epidemiological studies on the impact of age at first sexual intercourse (AFS) and age at first live birth (AFB) on postpartum depression (PPD) in pregnant women, and the conclusions of these studies are inconsistent. Methods: We performed a Mendelian randomization (MR) study to determine the causal relationship between AFS or AFB and the risk of PPD. The summary data were extracted from genome-wide association study (GWAS) summary datasets. We selected the instrumental variables according to the P value of exposure-related single nucleotide polymorphisms (P<5 ×10-9 for AFS and P<5 ×10-8 for AFB) and estimated the linkage disequilibrium using the clump parameter (10,000 kb, r2 < 0.001). Single nucleotide polymorphisms were considered instrumental variables that were significantly associated with exposure factors without linkage disequilibrium. The F-statistics of the instrumental variables should all be larger than 10. A random-effects model of IVW was constructed as the main method in our study. Results and discussion: MR studies based on GWAS data revealed that both AFS (OR = 0.4, P <0.001) and AFB (OR = 0.38, P <0.001) were negatively correlated with the risk of PPD. Early AFS and early AFB should be studied as possible risk factors for PPD in the future. Public health departments should attach importance to sex education for young girls. The results of our TSMR should be verified by high-quality prospective epidemiological studies in the future.

Sexual Knowledge, Sexual Attitudes, and the Need for Sex Education Among Adolescent Defectors From North Korea.

INTRODUCTION: Adolescent North Korean defectors are vulnerable due to harmful environments during defection, limited access to sex education in North Korea, and exposure to different sexual norms in South Korea. The purpose of this study was to investigate the sexual knowledge, attitudes, and sex education needs of North Korean refugee adolescents. METHODS: A cross-sectional, descriptive survey was administered to 102 North Korean refugee adolescents. RESULTS: The correct answer rate for questions on genital anatomy, physiology, masturbation, and contraception was less than 20%. The participants exhibited conservative attitudes toward female contraception, masturbation, and having friends of the opposite sex. A significant positive correlation was found between knowledge and the need for sex education. DISCUSSION: These results highlight the importance of tailored sex education in providing accurate information, improving sexual knowledge, fostering positive attitudes, and enabling healthy behaviors among adolescent North Korean defectors.

Strategies to develop an LGBTQIA+-inclusive adolescent sexual health program evaluation.

Introduction: Adolescent sexual health interventions are increasingly incorporating content that is inclusive of LGBTQIA+ youth (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other marginalized sexualities and genders). Evaluations of such programs must also be inclusive to enhance the validity of evaluation results and avoid further marginalization. We present strategies for increasing LGBTQIA+-inclusivity based on our evaluation of SafeSpace, a sexual health curriculum. Methods: To design an LGBTQIA+-inclusive program evaluation, we leveraged LGBTQIA+ research staff's insights, pursued a parental consent waiver, developed an inclusive recruitment plan, and crafted demographic and sexual behavior survey measures with input from youth and equity experts. We conducted a pilot study with 42 youth ages 14-17 to assess the feasibility and efficacy of our strategies. Results: We obtained a parental consent waiver and recruited a majority LGBTQIA+ pilot study sample (62%). Using themes from cognitive interviews with youth and experts regarding inclusive framing and use of plain language, we refined demographic measures and expanded sexual behavior measures. Conclusion: Findings suggest that the strategies used to enhance LGBTQIA+-inclusivity in our evaluation of SafeSpace were effective in respectfully and more accurately capturing a fuller range of experiences and identities of LGBTQIA+ and cis-straight youth. The strategies and survey measures developed for this study can be applied to increase LGBTQIA+-inclusivity in other adolescent sexual health program evaluations.

Using Unannounced Standardized Patients to Assess Clinician Telehealth and Communication Skills at an Urban Student Health Center.

PURPOSE: As the COVID-19 pandemic forced most colleges and universities to go online, student health centers rapidly shifted to telehealth platforms without frameworks for virtual care provision. An urban student health center implemented a needs assessment involving unannounced standardized patients (USPs) to evaluate the integration of a new telehealth workflow and clinicians' virtual communication skills. METHODS: From April to May 2021, USPs conducted two video visits with 12 primary care and four women's health clinicians (N = 16 clinicians; 32 visits). Cases included (1) a 21-year-old female presenting for birth control with a positive Patient Health Questionaire-9 and (2) a 21-year-old male, who vapes regularly, with questions regarding safe sex with men. Clinicians were evaluated using a checklist completed by the USP immediately following the visit and a systematic chart review of the electronic health record. RESULTS: USP feedback indicates most clinicians received high ratings for general communication skills but may benefit from educational intervention in several key telemedicine skills. Clinicians struggled with using nonverbal signals to enrich communication (47% well done), acknowledging emotions (34% well done), and using video for information gathering (34% well done). Low rates of standard screenings (e.g., 63% administered the PHQ-2, <50% asked about alcohol use) suggested protocols for in-person care were not easily incorporated into telehealth practices, and clinicians may benefit from enhanced care team support. Performance reports were shared with clinicians and leadership postvisit. DISCUSSION: Results suggest project design and implementation is scalable and feasible for use at other institutions, offering a structured methodology that can improve general student health care.

Differences in the sexual health information parents/guardians give their adolescent sexual minority sons by outness.

Introduction: Parents and guardians are a potentially valuable source of sexual health information for adolescent sexual minority males (ASMM). The current study examines what sexual health topics ASMM report discussing with a parent/guardian and whether topics differ by outness about sexual attraction to other males. Methods: ASMM (N=154; ages 14-17) in the United States completed the baseline of an online sexual health intervention pilot in 2020. They reported which of twelve sexual health topics they discussed with a parent/guardian and if they had disclosed their sexual attraction to other males. Associations between topics discussed and outness to a parent/guardian were examined with Firth logistic regression. Results: Eighty-eight (57%) participants reported being out to a parent/guardian. Six sexual health topics were significantly more likely to be discussed if participants were out. The three categories with the largest differences by outness were how to: discuss with a partner what they would not like to do sexually (aOR = 7.0, 95% CI: 2.0-24.6), use condoms (aOR = 5.9, 95% CI: 2.3-15.1), and prevent HIV/AIDS (aOR = 3.5, 95% CI = 1.4-8.7). Conclusions: Interventions on parental/guardian provision of sexual health information are needed to ensure ASMM receive relevant sexual health knowledge.

A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors.

BACKGROUND: Sexual difficulties and vaginal pain are common following treatment for breast cancer. AIM: The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. METHODS: Breast cancer survivors (n = 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. OUTCOMES: Assessments were repeated at posttreatment and 6 months after the completion of the group. RESULTS: There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. CONCLUSION: Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. STRENGTHS AND LIMITATIONS: We used a randomized methodology. Future studies should seek to diversify participants. CLINICAL IMPLICATIONS: These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.

Parents' attitudes towards the content of sex education in the USA: Associations with religiosity and political orientation.

While most parents support their adolescents receiving school-based sex education, there is variability in which sex education topics receive the most support from parents. Conservative political orientation and greater religiosity have been independently associated with parents' lack of support for school-based sex education; however, no studies have examined the intersection of these two factors. The three goals of this study were to: 1) identify how specific sexual education topics cluster together to form content areas; 2) examine if religiosity and political orientation are uniquely associated with these content areas; and 3) examine if political orientation moderates the relationship between parents' religiosity and their perceived importance for the specific sex education content areas. Participants were a national sample of 881 US parents. The sex education topics clustered into three content areas: Factual Knowledge (e.g., STI transmission), Practical Skills (e.g., how to access condoms), and Pleasure and Identity (e.g., pleasurable aspects of sex). Politically conservative and more religious parents reported the lowest perceived importance for each content area. Importantly, these main effects were qualified by a significant interaction: parents who reported both political conservativism and high levels of religiosity reported the lowest perceived importance for these three content areas being taught.

Sexual experiences and knowledge of people with moderate intellectual disability.

BACKGROUND: This study addresses the sexuality of people with moderate intellectual disabilities (PMID), a topic that has been little studied. Understanding romantic and sexual experiences is highly relevant for reducing stigma and prejudice related to their sexuality. Additionally, comprehending the level of sexual knowledge of PMID contributes to the development of preventive and sexual health education programmes tailored for this group. Our aim is to explore the sexual history (relationships, sexual behaviour, condom use and sexual abuse), sex education received and the level of sexual knowledge of PMID. METHOD: The total of 142 PMID completed questionnaires about sexual knowledge and experiences, and their support staff provided additional information. Data were analysed using chi-square test (χ2) and descriptive statistical analysis. RESULTS: Masturbation was the most common sexual behaviour (75.7%), especially among men (χ2 = 5.81, P < 0.05). Sexual intercourse was rare, and only 30.5% reported using condoms. Women reported a higher prevalence of self-reported sexual abuse (27.3% vs. 6% in men). The study also highlighted misconceptions about sexual intercourse risks and contraceptive methods. CONCLUSION: The results suggest that PMID need sexual education to ensure healthy sexual experiences and prevent risky behaviour.

In the Know: A Cluster Randomized Trial of an In-person Sexual Health Education Program Integrating Digital Technologies for Adolescents.

PURPOSE: Integrating digital technologies into sexual health education can offer advantages for connecting with adolescents, particularly populations who may be underserved through common school-based approaches. This study assessed the effectiveness of In the Know, an in-person, group-based sexual health education program integrating digital technologies, codesigned with adolescents. METHODS: The study design was a cluster randomized trial with 1,263 adolescents aged 13-19 in 95 cohorts, implemented in community-based organizations and schools throughout Fresno County, California. Participants completed a baseline survey and a follow-up survey 3 months later. Two-level mixed-effects regression models with random intercepts for cohort were used to estimate the intervention's impact on unprotected sex, use of clinical health services, knowledge of local sexual health services, technology use to find or schedule services, and sexual health knowledge at the 3-month follow-up. RESULTS: The average age of participants was 15.7 years, and the majority identified as Hispanic (71%). In adjusted analyses, intervention group participants were more likely to use clinical services (42.7% vs. 33.2%, p = .009) and reported greater sexual health knowledge at 3 months (57.6% of items answered correctly vs. 50.7%, p = .001). No significant differences were observed in the other outcomes by study group. DISCUSSION: In the Know participants demonstrated greater use of clinical health services and sexual health knowledge at 3 months. The study findings show the potential for incorporating user-centered design and technology into sexual health education to better support adolescents who may have limited access to this important information.

[Survey to know the perception of sexual education in adolescents]. / Encuesta para conocer la percepción sobre la educación sexual en adolescentes.

OBJECTIVE: Sex education is essential for an accurate approach of sexuality in adolescents, being more effective when it is carried out at early ages. This study aimed to estimate the sexual health knowledge and the information in this regard perceived by adolescents, as well as where it came from. METHODS: A cross-sectional observational study was performed in students from two public high schools in Castilla-La Mancha who were surveyed about sexual knowledge. Comparisons were made by using the Student's t test or Mann Whitney U test, the Chi-square test (or Fisher's exact test) depending on the variables. RESULTS: 248 students were included (68.1% from Madridejos and 31.9% from Herencia) with a mean age of 14.67±1.1 years. The 47.2% were women. Only 4.8% of the participants affirm to talk about sexuality with their parents. The 56% declared had consumed pornographic content, with a mean first access age of 12.8±1 years. Significant statistically differences were found between the information received in schools and in the familiar surroundings, being alcohol and drug intake, sexually transmitted infections (STI), and contraceptive methods more frequently treated at the educational centers. A 25% of the surveyed students who reported having performed sexual relations stated not having used condom. Approximately, half of the participants did not perceive a high risk of getting STIs (HIV, herpes and chlamydia) in the case of having sex without condom. CONCLUSIONS: There is a lack of sexual knowledge in adolescents, perceiving a noteworthy heterogeneity in the offered information depending on it is received in high school or in familiar surroundings.

OBJECTIVE: La educación sexual es un pilar fundamental para un correcto enfoque de la sexualidad en los adolescentes, siendo más efectiva si se realiza en edades tempranas. El objetivo de este trabajo se fundamentó en estimar los conocimientos de salud sexual y la información percibida por los adolescentes, así como de dónde provenía. METHODS: Se realizó un estudio observacional transversal en estudiantes de dos centros educativos públicos de Castilla-La Mancha a los que se les realizó una encuesta sobre conocimientos de sexualidad. Se hicieron comparaciones mediante t de student o U de Mann Whitney, o test de Chi-cuadrado (o test exacto de Fisher), según variables. RESULTS: Se incluyeron 248 encuestados/as (68,1% de Madridejos y 31,9% de Herencia) con una edad media de 14,67±1,1 años. El 47,2% fueron mujeres. Solo un 4,8% de los/as encuestados/as afirmaron hablar sobre sexualidad con sus progenitores. Un 56% afirmaron haber consumido contenido pornográfico, siendo la edad media de la primera visualización de 12,8±1 años. Se encontraron diferencias estadísticamente significativas entre la información recibida en los centros educativos y el ámbito familiar, tratándose más frecuentemente el consumo de alcohol y drogas, las infecciones de transmisión sexual (ITS) y los métodos anticonceptivos en los centros. Un cuarto de los/as encuestados/as que afirmaron haber tenido relaciones sexuales no habían utilizado preservativo. Aproximadamente, la mitad de los/as participantes no percibieron un riesgo alto de contraer ITS (VIH, herpes y clamidia) en el caso de mantener relaciones sexuales sin preservativo. CONCLUSIONS: Existe una falta de educación sexual en los/as adolescentes, percibiendo gran heterogeneidad en los conocimientos ofrecidos en los centros educativos y el ámbito familiar.

A rural interprofessional primary care team develops a school-based sex education program / Une maison de santé pluriprofessionnelle coordonne un plan de prévention sexuelle pluridisciplinaire en milieu scolaire

Introduction: In French rural areas, getting information about sexual health and identifying health actors on the topic is difficult for teenagers. Despite national and international guidelines, school-based sex education programs remain insufficient in France. The aim of this project was to develop a school-based psycho-affective and sexual health program (PASHP) for teenagers, led by an interprofessional primary care team (IPCT) in Montval-sur-Loir (Sarthe) and to coordinate local stakeholders. Method: The IPCT developed the PASHP using a community-based participatory research method. The first step identified the target population and its needs for sex education. The second step was to create a steering group to tailor PASHP interventions in a participatory way and to define the PASHP's aims and execution arrangements. The third step aimed at carrying out the PASHP and getting stakeholders' and the target population's feedback. Results: The PASHP, carried out in the 2020­2021 and 2021­2022 school years, included an intervention about contraception and sexually transmitted infections, artistic workshops on consent or gender stereotypes, group discussions, and an intervention about pornography to assist parents. Conclusion: The PASHP developed and coordinated by the Montval-sur-Loir IPCT is innovative because of its organization. It coordinates local stakeholders, teenagers, and their parents in a disadvantaged rural area, respecting national guidelines on sex education.

Introduction: En milieu rural français, s'informer sur la santé sexuelle et identifier des acteurs de santé dans ce domaine s'avère difficile pour les adolescents. Malgré les recommandations nationales et internationales, les programmes de prévention en milieu scolaire restent insuffisants en France. L'objectif du projet mené par la maison de santé pluriprofessionnelle (MSP) de Montval-sur-Loir (Sarthe) était de proposer un plan de prévention psychoaffective et sexuelle (PPAS) en milieu scolaire en coordonnant des acteurs locaux. Méthode: La MSP a élaboré le PPAS par une méthode de recherche-intervention. La première étape évaluait les besoins en santé sexuelle du territoire et identifiait la population cible. La deuxième étape était la création d'un comité de pilotage pour l'élaboration participative du PPAS et la définition du cadre conceptuel et des modalités d'intervention. La troisième étape correspondait au déroulement du PPAS et au retour d'expérience des intervenants et des participants. Résultats: Le PPAS s'adressait aux élèves de quatrième des deux collèges de Montval-sur-Loir durant les années scolaires 2020-2021 et 2021-2022. La co-construction du PPAS a abouti à une intervention sur la contraception et les infections sexuellement transmissibles, des ateliers artistiques à propos du consentement et des stéréotypes de genre, des groupes de parole, une intervention sur la pornographie visant les parents d'élèves. Conclusion: Le PPAS créé par la MSP de Montval-sur-Loir est novateur car il coordonne les acteurs de santé locaux autour des adolescents et de leurs parents, dans un milieu rural défavorisé, en respectant les recommandations nationales sur l'éducation à la santé sexuelle.

Encuesta para conocer la percepción sobre la educación sexual en adolescentes / Survey to know the perception of sexual education in adolescents

Fundamentos: la educación sexual es un pilar fundamental para un correcto enfoque de la sexualidad en los adolescentes, siendo más efectiva si se realiza en edades tempranas. El objetivo de este trabajo se fundamentó en estimar los conocimientos de salud sexual y la información percibida por los adolescentes, así como de dónde provenía. Métodos: se realizó un estudio observacional transversal en estudiantes de dos centros educativos públicos de castilla-la mancha a los que se les realizó una encuesta sobre conocimientos de sexualidad. Se hicieron comparaciones mediante t de student o u de mann whitney, o test de chi-cuadrado (o test exacto de fisher), según variables. Resultados: se incluyeron 248 encuestados/as (68,1% de madridejos y 31,9% de herencia) con una edad media de 14,67±1,1 años. El 47,2% fueron mujeres. Solo un 4,8% de los/as encuestados/as afirmaron hablar sobre sexualidad con sus progenitores. Un 56% afirmaron haber consumido contenido pornográfico, siendo la edad media de la primera visualización de 12,8±1 años. Se encontraron diferencias estadísticamente significativas entre la información recibida en los centros educativos y el ámbito familiar, tratándose más frecuentemente el consumo de alcohol y drogas, las infecciones de transmisión sexual (its) y los métodos anticonceptivos en los centros. Un cuarto de los/as encuestados/as que afirmaron haber tenido relaciones sexuales no habían utilizado preservativo. Aproximadamente, la mitad de los/as participantes no percibieron un riesgo alto de contraer its (vih, herpes y clamidia) en el caso de mantener relaciones sexuales sin preservativo. Conclusiones: existe una falta de educación sexual en los/as adolescentes, percibiendo gran heterogeneidad en los conocimientos ofrecidos en los centros educativos y el ámbito familiar.(AU)

Background: sex education is essential for an accurate approach of sexuality in adolescents, being more effective when it is carried out at early ages. This study aimed to estimate the sexual health knowledge and the information in this regard perceived by adolescents, as well as where it came from.methods: a cross-sectional observational study was performed in students from two public high schools in castilla-la mancha who were surveyed about sexual knowledge. Comparisons were made by using the student’s t test or mann whitney u test, the chi-square test (or fisher’s exact test) depending on the variables.results: 248 students were included (68.1% from madridejos and 31.9% from herencia) with a mean age of 14.67±1.1 years. The 47.2% were women. Only 4.8% of the participants affirm to talk about sexuality with their parents. The 56% declared had consumed pornographic content, with a mean first access age of 12.8±1 years. Significant statistically differences were found between the information received in schools and in the familiar surroundings, being alcohol and drug intake, sexually transmitted infections (sti), and contraceptive methods more frequently treated at the educational centers. A 25% of the surveyed students who reported having performed sexual relations stated not having used condom. Approximately, half of the participants did not perceive a high risk of getting stis (hiv, herpes and chlamydia) in the case of having sex without condom.conclusions: there is a lack of sexual knowledge in adolescents, perceiving a noteworthy heterogeneity in the offered informa-tion depending on it is received in high school or in familiar surroundings.(AU)

Knowledge and attitudes regarding contraceptive methods and sex education in students and parents of eight Colombian schools 2020-2021: a mixed methods study.

Background: In Colombia, the average age of first sexual intercourse is between 14 and 15, and it has one of the highest fertility rates among adolescents in Latin America, which reflects poor access to health services and a lack of knowledge about contraception. Some laws support comprehensive sex education as a learning process that families and schools should provide. The objective of this work was to assess the frequency of adequate knowledge and attitudes of acceptance towards contraception in students, their associated factors, sexual behaviours in sexually active students, and experiences with sex education. Methods: Mixed methods study consisting of an analytical cross-sectional study and a qualitative hermeneutic phenomenological study. The former included students who completed a questionnaire with sociodemographic variables, surveys on knowledge and attitudes toward contraception, and questions about sexual behaviour. Focus groups were used in the qualitative study to evaluate students' and parents' sex education experiences. Findings: 827 students were surveyed, of whom 52.3% had adequate knowledge about contraceptives and 80.1% had attitudes of acceptance. Talking with parents about sex education, receiving sex education, and being in the eleventh grade increased the likelihood of having adequate knowledge. Each year of age, being male, being a victim of forced displacement, and studying in a public school were associated with lower possibilities of attitudes of acceptance. Using condoms, compared to other contraceptives, was associated with less adequate knowledge and attitudes of acceptance (p < 0.05). Experiences with sex education, contraception, and sexual and reproductive rights were three emerging categories in the focus groups. Interpretation: In a group of Colombian high school students, half of them had adequate knowledge, eight out of 10 had attitudes of acceptance about contraception, and both were associated with having received sex education. Nevertheless, different types of barriers to sexual education were identified at home and in schools. The results will allow the generation of educational policies that modify the educational model as well as new strategies by health professionals to raise awareness about responsible sexuality. Funding: This project was financed by internal research of the Fundación Universitaria de Ciencias de la Salud-FUCS (DI-I-0392-20).

Comprehensive Sexual Health Educational Learning Modules for College Students.

Sexual health education in the United States continues to be a controversial topic of discussion with no federal regulations. Due to this, the sex education students receive before college varies greatly. Our team discovered that no mandatory, comprehensive sexual health education is required for students once they enter the California State University system. At Cal Poly specifically, it was found that students were engaging in risky sexual behaviors. For example, the 2021 American College Health Association-National College Health Assessment III Fall 2021 Data Report revealed that less than half (42.1%) of students reported regularly using condoms during vaginal sex, and a mere 5.1% of students reported barrier method use during oral sex. To fill in the noticed gaps in our students' sexual health education, our team developed a set of 10 comprehensive sexual health educational learning modules. The modules cover topics ranging from condom use and STIs to pleasure, porn literacy, and having difficult conversations with a partner. This anonymous online resource provides students with easy-to-read written material and engaging graphics. Future research will focus on user engagement and the effect of the resource on sexual health best practices across our campus.

Implementation of a Booster Sexual Health Education Curriculum for Older Adolescents in Rural Communities.

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A "booster" round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

Insights from a Qualitative Exploration of Adolescents' Opinions on Sex Education.

BACKGROUND: Adolescence is a crucial time in the development of young people's identity, and sexuality is a key issue. Comprehensive sex education provides the knowledge and skills to help adolescents protect their sexual and reproductive health and rights. Policies on sex education in secondary schools are highly influential in the development of quality programmes that support comprehensive sex education. The aim of this study was to explore, describe and understand adolescents' experiences of sex education. METHODS: A qualitative study based on Gadamer's phenomenology was used. Two focus groups and four in-depth interviews were conducted with 12 private school students, followed by inductive data analysis using ATLAS.ti software 9.0. RESULTS: Two main themes were identified in the analysis: (1) sex education is a challenge for secondary schools and (2) student expectations of sex education. CONCLUSION: It is essential for adolescents to have access to comprehensive sex education that is adapted to the different stages of their development, is provided by specialised teachers, and involves their families in the process.

'Like fumbling around in the dark': Young people's perceptions and realities of healthy relationships.

Learning to negotiate relationships is a key feature of adolescence, yet insight into young people's perspectives on what constitutes healthy relationships is lacking. In this study, therefore, insights were sought on healthy relationship qualities, common issues encountered, and relevant educational experiences. Semi-structured interviews were undertaken with 18 young people (11 self-identified as female, 5 male, and 2 trans/gender-diverse) aged 14-20 years, residing in Adelaide, South Australia. Relationships with parents, siblings, peers and intimate partners were topics for discussion. Reflexive thematic analysis was utilised to generate codes and themes. The Five Cs of Positive Youth Development were used to aid understanding of findings. Young people's accounts suggested a disjuncture between desired relationship qualities, realities and education on relationships and sexual health. Young people articulated tensions navigating peer norms and societal expectations in relation to dating and sex, including unrealistic representations, gender stereotyping and strong 'sexpectations'. Participants in this study relied more heavily on personal experience and observation than formal education to develop an understanding of healthy relationships. Achieving healthy relationships was generally perceived to be complex and requiring skills or understanding informants were unsure about. Positive Youth Development could provide a framework for meeting the needs expressed by young people, notably by building communication skills, confidence and agency.