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Study objective: To examine whether attitude to school is associated with subsequent risk of teenage pregnancy. To test two hypotheses that attitude to school is linked to pregnancy via pathways involving young people having ''alternative'' expectations or deficits in sexual health knowledge and confidence. Design: Analysis of longitudinal data arising from a trial of sex education. Examination of associations between attitude to school and protected first sex, unprotected first sex, unprotected and protected last sex, and pregnancy, both crude and adjusting in turn for expectation of parenting by age 20, lack of expectation of education/training at age 20, and sexual health knowledge and confidence. Setting: Schools in central and southern England. Participants: Girls of median age 13.7 years at baseline, 14.7 years at follow up 1, and 16.0 years at follow up 2. Main results: In unadjusted analysis, attitude to school was significantly associated with protected and unprotected first sex by follow up 1, protected first sex between follow up 1 and 2, unprotected last sex, and pregnancy. Dislike of school was more strongly associated with increased risk of these outcomes than was ambivalence to school. These associations remained after adjusting for socioeconomic status and for expectation of parenting, lack of expectation of education/training, and various indicators of knowledge and confidence about sexual health. Conclusions: Dislike of school is associated with subsequent increased risk of teenage pregnancy but the mechanism underlying any possible causal link is unlikely to involve ''alternative'' expectations or deficits in sexual health knowledge or confidence. P revious studies report that low educational attainment predicts teenage pregnancy.1 However, few studies have examined the association between attitude to school and teenage pregnancy and those that have provide inconsistent findings. [2][3][4] We have previously reported associations between dislike of school and cognitive/behavioural indicators of risk of teenage pregnancy among 13/14 year olds in baseline data from a randomised trial of sex education.5 After adjusting for socioeconomic disadvantage, dislike of school was associated with heterosexual intercourse, expecting heterosexual intercourse by age 16, and expecting parenthood by age 20, but not with low knowledge of contraception or low confidence negotiating sex.From these findings, we developed an ''alternative expectation'' hypothesis regarding how dislike of school might increase risk of teenage pregnancy: some young people who dislike school consequently do not develop ''conventional'' expectations about involvement in education/training in their late teens and view parenting as an acceptable alternative. We concluded that another hypothesis, namely that some young people dislike and are disengaged from school and consequently do not develop the knowledge and confidence necessary to avoid teenage pregnancy (the ''knowledge and confidence deficit'' hypothesis), was not supported by our...

Students from lone parent families or having mothers who were teenagers when they were born are more likely to report early sexual debut and conceptions by age 15/16, but this is not generally explained by parenting style.

Objectives: To examine various models of integrated and/or one stop shop (OSS) sexual health services (including general practice, mainstream specialist services, and designated young people's services) and explore their relative strengths and weaknesses. Methods: Literature review and interviews with key informants involved in developing the National Strategy for Sexual Health and HIV (n = 11). Results: The paper focuses on five broad perspectives (logistics, public health, users, staff, and cost). Contraceptive and genitourinary medicine issues are closely related. However, there is no agreement about what is meant by having ''integrated'' services, about which services should be integrated, or where integration should happen. There are concerns that OSSs will result in over-centralisation, to the disadvantage of stand alone and satellite services. OSS models are potentially more user focused, but the stigma that surrounds sexual health services may create an access barrier. From staff perspectives, the advantages are greater career opportunities and increased responsibility, while the disadvantages are concern that OSSs will result in loss of expertise and professional status. Cost effectiveness data are contradictory. Conclusion: Although there is a policy commitment to look at how integrated services can be better developed, more evidence is required on the impact and appropriateness of this approach.