Enhancing Teacher Health Literacy Through Evidence-Based Learning

Presenters: Fred L. Peterson, Tammy J. Jordan, and Erin Floyd-Bann, The University of Texas at Austin; J. Terry Parker, Waxahachie Independent School District, TX

This session is presented in separate parts. Use the buttons at the end of the transcription to navigate between each part.

III. Terry Parker

TERRY PARKER: Thank you, Tammy. To follow-up on what Dr. Peterson said earlier about Richard Jessor's risk-taking model — and we use that specifically with sexuality education — Jessor believes that behaviors such as smoking, drinking, risky driving, drug use, or early sexual activity — which is our focus at this point — should be considered purposeful, meaningful, goal-oriented, and functional, rather than arbitrary or perverse. As such, problem behaviors in adolescents can be instrumental in gaining peer acceptance and respect, in establishing autonomy from parents, in repudiating the norms and values of conventional authority, in coping with anxiety, frustration and the anticipation of failure, in confronting for self and significant others certain attributes of identity, or in affirming maturity and making a transition out of childhood and toward adult status. In other words, ladies and gentlemen, adolescent risk-taking behavior is normal and is to be expected among our young people.

School-based sexuality education: Implications for the 21st century. So why do we need sexuality education in our schools? First of all, the majority of American young people will engage in sexual risk-taking behavior prior to high school graduation, 40 percent of 9th graders to 65 percent of high school seniors. Twenty percent of our young people have four or more lifetime sexual partners. Twenty-five percent of our young people engaged in drug and alcohol use at their last sexual intercourse. Twenty-five to 80 percent engage in oral sex. Anal intercourse is becoming increasingly common among adolescent females. It functions for some to preserve their virginity and prevent pregnancy. Possibly as high as 25 percent of adolescent females may be engaging in this behavior.

Disturbingly, an increasing number of young people believe that neither oral nor anal intercourse are really sex. Now, for those of you in the audience who work with middle school students — how many would that be?

More than half of you.

I think it is real important that you understand that this behavior, or both of these behaviors, are becoming increasingly common among this population. So many of you may have this going on in your selected school districts.

Forty percent of adolescent females between the ages of 15 and 19 become pregnant each year. Our latest data show that is approximately 900,000 young people. This represents the highest rate of adolescent pregnancy in the entire Western industrialized world.

Three million American adolescents acquire an STD annually. This represents the highest rate of infection nationally and in all industrialized nations worldwide.

Ladies and gentlemen, these are not things we should be proud of.

Each year, 20,000 young people between the ages of 13 and 25 are infected with HIV. This represents 25 percent of all new infections among young people under 21 and half of new infections among those 25 years of age and younger. Currently, there are more than 123,000 young adults in their twenties who have full-blown AIDS.

Now, to follow on our topic of evidence-based prevention programs, I would like to identify for the audience five programs that have all been identified by the CDC as programs that work, those that have been evaluated and those which have shown effectiveness over time. The first one I would like to introduce to you is Reducing the Risk. This 1991 study found that RTR significantly reduced the number of students who became sexually active and increased the frequency of contraception use among females and low-risk youth. It also increased the use of contraceptives among sexually active youth and increased positive parent/student communication.

Several years later, in 1998, the replication study found that RTR significantly reduced the number of students who become sexually active and increased the number of students who use condoms at first sexual intercourse. Again, it also improved communication between parents and students.

Another evidence-based program is Safer Choices. The initial study of this particular curriculum took place in 1999. The study found that Safer Choices significantly reduced the frequency of sexual intercourse without a condom in the three months prior to the survey. It also increased condom use at last sexual intercourse and increased the use of selective contraceptives at last sexual intercourse.

Two years later, in 2001, the study found that, after more than two years, Safer Choices significantly increased the use of condoms at last sexual intercourse and the use of other contraceptives at last sexual intercourse. It also decreased the frequency of sexual intercourse without condom use and the number of partners without condom use.

The next program, Becoming a Responsible Teen — its nickname is BART — this study was published in 1995. BART was presented to a predominantly low-income minority youth population in a Southern urban area. After one year, students who participated in the BART program were significantly less likely to engage in sexual intercourse. In addition, students were more likely to use condoms and less likely to engage in unprotected vaginal or anal intercourse.

The next program is Making a Difference, an abstinence approach to STD, pregnancy and HIV prevention. This study was published in 1998. At three months post-intervention, students who participated in the abstinence approach were significantly less likely to have initiated sexual intercourse. And at one year, students were more likely to use a condom at their last sexual intercourse.

The modified version of Making a Difference is a safer sex approach to STD, pregnancy and HIV/AIDS prevention. This study also was published in 1998. Students who participated in this approach significantly reduced their frequency of sexual intercourse at the 6- and 12-month follow-up, and increased their use of condoms at 3-, 6- and 12-month follow-up, and increased their use of condoms at 3, 6 and 12 months following the initial intervention. In addition, these students were less likely to engage in unprotected sexual intercourse at 3 and 6 months following the intervention.

So what do these five programs all have in common? First of all, they focus on reducing one or more sexual behaviors that lead to unintentional pregnancy or HIV, STD infection. They are based on theoretical approaches, as has been discussed with you earlier, that have been demonstrated to be effective in influencing other risk behaviors. In other words, this information can be extrapolated to other risk behaviors among our young people.

These programs also have in common that they give a clear message about sexual activity and condom contraceptive use and continually reinforce that message. In other words, this information is not given to these young people one time, but many times, over the course of the instruction.

These programs provide basic information about the risk of adolescent sexual behavior and about methods of avoiding intercourse or using protection against pregnancy and STD's. These programs include activities that address the social pressures that influence sexual behavior. As many of you in the audience know, young people are highly influenced by their peers. These programs have all shown to work with those peer influences.

These programs provide modeling of and practice with communication, negotiation and refusal skills. In other words, ladies and gentlemen, these are not "just say no" programs. Because we know from lots of years of experience, all of which has been negative, that just saying no has no positive effect on young people. So all of these programs teach these young people how to negotiate, how to communicate, and how to say no and mean it the right way.

These programs also employ a variety of teaching methods designed to involve participants and have them personalize the information. In other words, ladies and gentlemen, these programs don't allow a teacher to stand in front of an audience and give them information, as has been talked about earlier in this presentation. It is much more than that.

These programs incorporate behavioral goals, teaching methods and materials that are appropriate to the age, sexual experience and culture of the student population that is being addressed. These programs last a sufficient amount of time to complete important activities adequately. In other words, these programs are not set down for two and three and four days at a time; they may take several weeks in order to bring about the desired behavioral results.

These programs select teachers or peer leaders who believe in the program. And that is extremely important here. They believe in the program they are implementing and then provide them with training. It is foolish for those of us in education to expect teachers and peer leaders to go out and give information to young people without first training those peer leaders or those educators.

As Dr. Peterson and Tammy have alluded to earlier in our presentation, there are several evidence-based sexuality education information sources, one of which is in your handout. It is a publication from the ERIC Digest, December 2001, that talks about School-Based Sexuality Education, A New Millennium Update. There is information in that digest. Many of the resources cited in my presentation are also cited in that ERIC Digest.

Many of those resources can include educational leadership articles, and those are present in your handout, an ERIC Digest that I just mentioned to you, December 2001, the SIECUS guidelines. SIECUS is the Sex Information and Education Council of the United States. And their second edition guidelines were published in 1996. The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. Ladies and gentlemen, many of you know that this made the national news. This came out last July. This is an outstanding publication, and I do use it in my college course as well.

The Centers for Disease Control guidelines, the MMWR, NIH consensus statements, published technical reports from academic centers, a publication from the University of Minnesota in the year 2000, entitled Growing Absolutely Fantastic Youth: A Review of the Research on Best Practices. And published reports from credible professional health organizations such as the American Cancer Society, American Lung Association, American Heart Association, and so on.

Thank you very much.

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