Off to a Good Start: A Practical Tool for Sexual Health Education

Introduction

Although widely supported, sex education programming in schools varies across the United States. Only 38% of high schools and 14% of middle schools provide programming addressing all 19 critical sex education topics identified by the Centers for Disease Control and Prevention (Brener et al., 2017). There is a need for early sexuality education as the incidence of sexually transmitted infections (STIs) continues to rise (Sexuality Information and Education Council of the United States, 2018).

We were part of a group of community health educators at University of Illinois Extension in Cook County who developed Off to a Good Start: Physical, Emotional, and Sexual Development of Youth Grades 5–8 (OTAGS) and were fundamental in implementing and evaluating the program. The OTAGS curriculum provides middle school students with a foundation for future sex education. Middle school youths need a basic understanding of anatomy and reproduction to appropriately benefit from subsequent sexuality education and access to contraceptives. Providing youths with honest and timely sex education allows them to have a base for healthful lifestyle choices and exemplifies Extension's efforts to advance educational attainment and promote social justice.

Curriculum Description

The OTAGS curriculum consists of three modules that cover puberty, healthful relationships, and HIV/STIs. OTAGS aligns with the National Sexuality Education Learning Standards (Future of Sex Education Initiative, 2012). In general, fifth and sixth graders receive the puberty module, sixth and seventh graders receive the healthful relationships module, and seventh and eighth graders receive the HIV/STIs module. The puberty module consists of four 45-min lessons on body changes, the male and female reproductive systems, and menstruation. The healthful relationships component consists of two 45-min lessons that cover healthful and unhealthful relationship traits and assertive communication skills. The HIV/STI module consists of three 45-min lessons on modes of transmission and risk reduction.

Implementation

During 3 school years, from October 2015 to February 2018, 13 public schools and two private schools in Chicago and the surrounding suburbs received the OTAGS curriculum. School teachers, counselors, and administrators requested OTAGS according to their students' needs. Extension educators taught the curriculum during school hours. Ten schools obtained the puberty module, three schools obtained the healthful relationships module, and five schools received the HIV/STIs module (some schools requested multiple modules). Refer to Table 1 for additional information on the implementation of OTAGS.

Evaluation

Extension educators collected parent consent and student assent prior to program initiation. Students completed a pretest before the first lesson and a posttest after the last lesson. The puberty module questionnaire included 20 items (11 matching and nine multiple choice), the healthful relationships module questionnaire included eight true/false items, and the HIV/STIs module questionnaire included 16 items (10 true/false and six multiple choice). For all modules, the posttest included the open-ended question "After being in this program, I learned. . . ."

The evaluation results for the three modules were favorable, indicating that students' knowledge improved (Table 2). These findings do not include data for students who participated in OTAGS but opted out of the evaluation. Additionally, the data presented do not include data collected via an earlier version of the evaluation questionnaire. Refer to Table 2 for additional information about the OTAGS evaluation.

OTAGS was designed to offer students a continuous learning experience in preparation for sexuality education in high school and beyond. However, none of the schools that participated in the initial implementation of the curriculum received the curriculum in its entirety. A more common scenario was teaching of one module to the same grade level over a series of years. This presented both programming and evaluation challenges. The program did not reach the same students over multiple years as was the original vision, and a long-term evaluation was not feasible given limited resources and challenges with the informed consent process.

Conclusion

The OTAGS curriculum can improve student knowledge about puberty, healthful relationships, and HIV/STIs. As Hockersmith (2013) expressed, not every Extension agent is comfortable with or should be teaching sexuality education; however, OTAGS is a practical tool for those agents who are ready and able to help ease youths' transition into adulthood. OTAGS complements family life and 4-H youth development programs and aids outreach in both rural and urban settings. Extension professionals working with family life and 4-H programs that are cemented in communities may be able to implement the curriculum in its entirety, making a long-term evaluation more feasible.

Extension professionals can use augmented reality to teach portions of the OTAGS curriculum. Examples of this approach already exist within Extension, as in the case of the Let's Talk About It publication—a guide to help parents navigate conversations about sex and puberty with their children (Wallace, 2018). Wallace (2018) used images in the publication to connect the user to topic-related videos, websites, and resources. Using augmented reality to link OTAGS participants to websites with expanded content on developmental changes during puberty or visuals of anatomical structures could make learning about the reproductive system a more interesting and engaging experience.

Opportunities for integrating the OTAGS curriculum into existing Extension programs are plentiful. At a time of stagnated prevention efforts and resurgence of HIV and STI rates due to diminishing resources for sex education programs (Howard, 2018), Extension can play an important role in making timely and accurate sex education accessible to youths. To learn more about OTAGS, email Author Lopez at slopez2@illinois.edu.

Acknowledgments

Thank you, Tammi A. Tannura, former Extension educator, for contributing to the development, implementation, and evaluation of the OTAGS curriculum. Thank you, Michele Crawford, Extension educator, and Ashley L. Phillips, former Extension educator, for the implementation and evaluation of OTAGS. Thank you, Elizabeth Jarpe-Ratner, clinical assistant professor in the Division of Health Policy and Administration at the University of Illinois at Chicago School of Public Health, for evaluation consultation. Thank you, Dr. Michael C. Fagen, associate professor, chief of the Public Health Practice Division's Department of Preventive Medicine, and director of the Program in Public Health, Institute for Public Health and Medicine at the Northwestern University Feinberg School of Medicine, for evaluation consultation. Thank you, Hilda Raigoza, former Extension program coordinator, and James McCombs, Extension program coordinator, for assistance with data collection and data entry.

References

Brener, N. D., Demissie, Z., McManus, T., Shanklin, S. L., Queen, B., & Kann, L. (2017). School health profiles 2016: Characteristics of health programs among secondary schools. Retrieved from https://www.cdc.gov/healthyyouth/data/profiles/pdf/2016/2016_Profiles_Report.pdf

Future of Sex Education Initiative. (2012). National Sexuality Education Standards: Core content and skills, K-12 [a special publication of the Journal of School Health]. Retrieved from https://advocatesforyouth.org/wp-content/uploads/2019/09/josh-fose-standards-web.pdf

Hockersmith, L. (2013). Sextension? Journal of Extension, 51(1), Article v51-1comm1. Available at: https://www.joe.org/joe/2013february/comm1.php

Howard, J. (2018, August 28). Rates of three STDs in US reach record high, CDC says. Retrieved from https://www.cnn.com/2018/08/28/health/std-rates-united-states-2018-bn/index.html

Sexuality Information and Education Council of the United States. (2018). Advancing sex education [Fact sheet]. Retrieved from https://siecus.org/resources/advancing-sex-education-state/

Wallace, H. (2018). Augmented reality: Exploring its potential for Extension. Journal of Extension, 56(5), Article v56-5a1. Available at: https://www.joe.org/joe/2018september/a1.php