Background Comprehensive sexuality education (CSE) is an integrated approach to sexual health and wellbeing promotion, especially effective when performed in school settings, but it is not included in Italian school curricula. This study describes the creation and early results of a pilot experience targeting students attending 20 lower secondary schools (LSS) in 4 Italian regions within EduForIST project, funded by the Ministry of Health. Methods A literature review and a national survey were used to collect guidelines and best practices in the field of sexuality education (SE), along with focus groups and multisectorial expert consultations. The results informed the development of 4 modules of 2 hours each, addressing: changes in adolescence; emotions and relationships; sexual identities and diversity; sexual consent, pregnancy and sexually transmitted infection (STI) prevention, sexual health services. A final session was dedicated to evaluation. Results The pre-test results referred to 14 classrooms of 5 schools within 2 Regions, for a total of 266 students. A high level of uncertainty was reported, regarding the topics of personal identity development (37,4%), experiencing intense emotions during adolescence (18,1%), the definitions of gender identity, sexual orientation and stereotype (42,1%), STI symptoms (58,7%) and prevention (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p<.05) for 12/15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with positive results. Conclusions Preliminary results revealed knowledge gaps and high levels of uncertainty among LSS students. Early pre/post evaluation suggested that the pilot activity was effective in enhancing knowledge and decreasing uncertainty in all domains. Evidence collected through this study will foster awareness among policy makers on the value and urgency of introducing CSE in Italian school curricula. Key messages

Introduction School-based sexuality education (SBSE) is the most effective way to positively impact young people's behaviour and attitude towards sexuality. This study describes the development of a SBSE pilot activity targeting lower secondary schools (LSS) within the context of EduforIST project funded by the Italian Ministry of Health. Methods A desk review was carried out to collect information about national policies, international literature and guidelines on SE and STIs prevention. An online survey was developed to collect information on SBSE activities implemented in Italy during 2016-2020. Focus groups among project partners and open consultations with a multisectorial expert advisory board were organised. SBSE pilot activity was developed by an interdisciplinary team of pedagogists, public health and SE experts, educators. Results and discussion The SBSE was structured in: a) 5 interactive interventions of 2 hours each with students (4 theoretical and practical modules; 1 final intervention for students-led discussion and evaluation); b) introductory and closing meetings with teachers and with parents. The modules addressed the following dimensions: changes in adolescence; emotions and relationships; sexual identities and diversity; sexual consent, STIs/pregnancy prevention, sexual health services. Additional materials were developed: a. pre/post evaluation tools for educators and students; b. pre-implementation checklist for schools; c. materials for teachers’ and parents’ engagement before/after the SBSE activity. Conclusions This pilot activity represented a first step towards the development of a standardised, evidence-based and comprehensive approach to SBSE, for future implementation across the country.