Sexual Health Education from the Perspective of School Staff: Implications for Adoption and Implementation of Effective Programs in Middle School

Introduction: US teens are having sex early; however, the vast majority of schools do not implement evidence-based sexual health education (SHE) programs that could delay sexual behavior and/or reduce risky behavior. This study examines middle school staff’s knowledge, attitudes, barriers, self-efficacy, and perceived support (psychosocial factors known to influence SHE program adoption and implementation). Methods: Professional school staff from 33 southeast Texas middle schools completed an internet or paper-based survey. Prevalence estimates for psychosocial variables were computed for the total sample. Chi-square and t-test analyses examined variation by demographic factors. Results: Almost 70% of participants were female, 37% white, 42% black, 16% Hispanic; 20% administrators, 15% nurses/counselors, 31% non-physical education/non-health teachers, 28% physical education/health teachers; mean age = 42.78 years (SD = 10.9). Over 90% favored middle school SHE, and over 75% reported awareness of available SHE curricula or policies. More than 60% expressed confidence for discussing SHE. Staff perceived varying levels of administrator (28%-56%) support for SHE and varying levels of support for comprehensive sex education from outside stakeholders (e.g., parents, community leaders) (42%-85%). Overall, results were more favorable for physical education/health teachers, nurses/counselors, and administrators (when compared to non-physical education/non-health teachers) and individuals with experience teaching SHE. Few significant differences were observed by other demographic factors. Conclusions: Overall, study results were extremely positive, which may reflect a high level of readiness among school staff for adopting and implementing effective middle school SHE programs. Study results highlight the importance of several key action items for schools.

Skills training and social influences for violence prevention in middle schools: A curriculum evaluation

This pilot study evaluated the effect of skills training and of social influences on self-reported aggressive behavior in a sample of 239 sixth-grade students. The effect of two intervention groups and one control group were compared. In the first intervention group, a 15-session, violence-prevention curriculum was taught by the teacher. In the second intervention group, the same curriculum was taught by the teacher with the assistance of peer leaders trained to modify social norms about violence. The control group was evaluated but did not receive any training. The design included four schools. In two schools, three classes were assigned to one of the two interventions or to the control group. In the other two schools, two classes were assigned to either intervention (teacher only) or control. Students were evaluated before and after the implementation of the curriculum using a standardized questionnaire.^ The primary outcome was the effect of the curriculum and peer leaders on self-reported aggressive behaviors. The secondary outcome was their impact on intervening variables: knowledge about violence, conflict-resolution skills, self-efficacy, and attitudes.^ The intervention had a moderate effect on reducing self-reported aggressive behaviors among boys in two of the six classes that received the curriculum. Both classes with peer leaders reduced their aggressive behavior, but this reduction was significant in only one. A peer leader selection problem could probably explain this lack of effect.^ In three of the four schools, both interventions had an overall significant effect on increasing knowledge about violence and skills to reduce violence. Students also developed a more negative attitude toward violence after the intervention. As hypothesized, attitude change was stronger among students from the teacher plus peer leader group. No intervention effect was observed on self-efficacy nor on attitudes toward skills to reduce violence. Limitations of the study and implications for violence prevention in schools are discussed. ^

Design and evaluation of the parent education component of a comprehensive violence prevention project in middle schools

Low parental monitoring is related to youth risk behaviors such as delinquency and aggression. The purpose of this dissertation was to describe the development and evaluation of a parent education intervention to increase parental monitoring in Hispanic parents of middle school children.^ The first study described the process of intervention mapping as used to develop Padres Trabajando por la Paz, a newsletter intervention for parents. Using theory, empirical literature, and information from the target population, performance objectives and determinants for monitoring were defined. Learning objectives were specified and a staged social-cognitive approach was used to develop methods and strategies delivered through newsletters.^ The second study examined the outcomes of a randomized trial of the newsletter intervention. Outcome measures consisted of a general measure of monitoring, parent and child reports of monitoring behaviors targeted by the intervention, and psychosocial determinants of monitoring (self-efficacy, norms, outcome expectancies, knowledge, and beliefs). Seventy-seven parents completed the randomized trial, half of which received four newsletters over an eight-week period. Results revealed a significant interaction effect for baseline and treatment for parent's reports of norms for monitoring (p =.009). Parents in the experimental condition who scored low at baseline reported increased norms for monitoring at follow-up. A significant interaction effect for child reports of parental monitoring behaviors (p =.04) reflected an small increase across baseline levels in the experimental condition and decreases for the control condition at higher baseline scores. Both groups of parents reported increased levels of monitoring at follow-up. No other outcome measures varied significantly by condition.^ The third study examined the relationship between the psychosocial determinants of parental monitoring and parental monitoring behaviors in the study population. Weak evidence for a relationship between outcome expectancies and parental monitoring behaviors suggests further research in the area utilizing stronger empirical models such as longitudinal design and structural equation modeling.^ The low-cost, minimal newsletter intervention showed promise for changing norms among Hispanic parents for parental monitoring. In light of the importance of parental monitoring as a protective factor for youth health risk behaviors, more research needs to be done to develop and evaluate interventions to increase parental monitoring. ^

A dose-response analysis of a school-based nutrition intervention in middle school children

Childhood obesity in the US has reached epidemic proportions. Minority children are affected the most by this epidemic. Although there is no clear relationship between obesity and fruits and vegetables consumption, studies suggest that eating fruits and vegetables could be helpful in preventing childhood obesity. A few school-based interventions targeting youth have been effective at increasing fruits and vegetables intake.^ In Austin, Texas, the Sustainable Food Center delivered the Sprouting Healthy Kids (SHK) program that targeted low socio-economic status children in four intervention middle schools. The SHK program delivered six intervention components. This school-based intervention included: a cafeteria component, in-class lessons, an after-school garden program, a field trip to a local farm, food tasting, and farmers' visits to schools. This study aimed to determine the effects of the SHK intervention in middle school students' preferences, motivation, knowledge, and self-efficacy towards fruits and vegetables intake, as well as the actual fruits and vegetables intake. The study also aimed to determine the effects of exposure to different doses of the SHK intervention on participants' fruits and vegetable intake.^ The SHK was delivered during Spring 2009. A total of 214 students completed the pre-and-posttest surveys measuring self-report fruits and vegetables intake as well as intrapersonal factors. The results showed that the school cafeteria, the food tasting, the after school program, and the farmers' visits had a positive effect on the participants' motivation, knowledge, and self-efficacy towards fruits and vegetables intake. The farmers' visits and the food tasting components increased participants' fruits and vegetables intake. Exposure to two or more intervention components increased participants' fruits and vegetables intake. The statistically significant dose-response effect size was .352, which suggests that each intervention component increased participants' fruits and vegetables consumption this amount. Certain intervention components were more effective than others. Food tasting and farmers visits increased participants fruits and vegetables intake, therefore these components should be offered in an ongoing basis. This study suggests that exposure to multiple intervention components increased behaviors and attitudes towards fruits and vegetables consumption. Findings are consistent that SHK can influence behaviors of middle school students.^

A cohort study of body fatness and coronary mortality in middle -aged men

Data from the Chicago Western Electric Study were used to investigate whether central fat distribution, as estimated by the ratio of subscapular-to-triceps skinfold, was associated with 25-year risk of death from coronary heart disease in a cohort of 1,945 middle-aged employed men. Subscapular-triceps skinfold ratio was found positively and significantly associated with risk of coronary death after adjustment for age and body mass index. The age-adjusted proportional hazards regression coefficient was 0.2078 with 95% confidence interval of 0.0087 to 0.4069. A difference of 1.1 in the subscapular-triceps skinfold ratio (the difference between the mean of the fifth quintile and of the first and second quintiles combined) was associated with a relative risk of 1.31 with 95% confidence interval of 1.06 to 1.62. The coefficient was decreased to 0.1961 (95% confidence interval of ($-$0.0028 to 0.3950) after adjustment for diastolic blood pressure, serum cholesterol and cigarette smoking as well as age and body mass index. At least some of the effect of central fat on coronary risk is probably mediated by blood pressure and serum lipids, but whether all of the effect can be accounted for blood pressure and serum lipids is uncertain.^ This study supports the concept that central fat distribution is a risk factor for 25-year risk of coronary death in middle-aged men. ^