Invited Commentary: Broadening the Evidence for Adolescent Sexual and Reproductive Health and Education in the United States

Abstract

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies—particularly sexuality health education policies and programs—have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the “tier 1” funding of the Office of Adolescent Health’s Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as “evidence-based” interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.

Implementing an LGBTQ Training for Teen Pregnancy Prevention Facilitators

“…Although many evidence-based TPPs exist, they have not consistently considered issues related to LGBTQ sexual health (Schalet et al, 2014). Furthermore, many sexual health programs are experienced as non-inclusive of their sexual health needs by LGBTQ youth (Gowen & Winges-Yanez, 2014).…”

“…Heteronormative sexual education programs run the risk of stigmatizing LGBTQ youth, excluding crucial information related to LGBTQ sexual health, and missing an opportunity to promote more inclusive school and community contexts for LGBTQ youth (Schalet et al, 2014). However, programs that specifically consider LGBTQ sexual issues, can be effective in reducing sexual risk factors, such as decreasing numbers of sexual partners and decreasing substance use before sex (Blake et al, 2001).…”

Informed Consent in Pediatric Research

“…It is of particular importance when issues such as sexual health remain taboo subjects between adolescents and their parents/caregivers, and the encounter with the health worker is the adolescent's only way to receive up-to-date information. The failure of the 'abstinence only until marriage' (AOUM) educational programs (an attempt to reduce the rate of teen pregnancies in the US) can serve as a stimulus to encourage youths to seek confidential counselling from health practitioners [30]. As participation in research is founded on these same principles of trust and cooperation, it is imperative to grant adolescents who are part of a clinical study the same degree of confidentiality.…”

“…The American Academy of Pediatrics submits that waiver of parental permission should be considered only if the risk is minimal, if the research addresses questions that can only be answered in this population, and that the treatment for the medical condition could be given to the minors based on their consent only [31]. For example, a new antibiotic treatment for gonorrhea in adolescents meets the above criteria [30].…”

Top or Bottom? Varsity youth talk about gay sexuality in a Stepping Stones Workshop: Implications for sexual health

“…The current study was undertaken as a means of addressing such an important gap by focusing on an LGBTI-identified population group and applying principles and processes of the training manual with this group. In so doing, the article contributes to the growing body of work on sexual health and behaviour amongst LGBTI youth (Knight et al 2014;Mustanski, Ryan and Garofalo 2014;Nel 2009;Schalet et al 2014;Tat, Marrazzo and Graham 2015;Waldman and Stevens 2015) by exploring aspects of sexual behaviour practice and relationships.…”