This is a definition of what the topic of sexual health encompasses.
Why is sexual health an issue?Statistics from research carried out by the World Health Organization show that over 30% of 15year olds in the UK are sexually active, (World Health Organization, 2006) and therefore sexual health is a topic that has relevance to the school children in our country. There are various tensions and debates surround the question of whether children should be taught sex education in school or at home by their parents; but this presentation will focus on the resources available and the debates surrounding them in schools today. Research carried out by the Health Protection Agency two years ago also shows that this topic is an important area to address, because statistics also reveal that students have what could be seen as a poor perception of their sexual health; with the same report showing that under 30% of sexually active teenagers used the pill as contraception. Condoms were shown to be the most common form of contraception used, but still only around 77% of teenagers surveyed were using them. (Health Protection Agency, 2010)An awareness of sexual health is of importance to anyone who is sexually active, due to the fact that many sexually transmitted infections don’t present signs or symptoms, and equally, left untreated can cause severe effects. Recent research shows that STI levels amongst young people have escalated in recent years. From 2008-2010, the numbers of cases of chlamydia in young people aged 20- 24 increased by 43%, and the number of cases of gonorrhoea increased by 6.4%. Therefore, in light of this data it can be seen that an issues surround this area to investigate are a study of what resources are available in promoting good sexual health and preventing the spread of disease, and on the other hand, whether empowering schoolchildren with knowledge of this area is an effective means of achieving this.
There many resources supporting the education of young people in relation to sexual health, particularly sexually transmitted infections (STIs). We are going to briefly look at what some of them are and assess their effectiveness.
Sex and relationships education lessons can give young people the opportunity to talk about and discuss issue regarding sex and STIs, and also sometimes to practise tactics such as how to use condoms properly; such lessons may seem to be a positive method of ensuring that all children have access to it but schools are not actually obliged to teach anymore than the biology of reproduction (Saner, 2011), although it is advised that it can be incorporated within the personal, social and health education (PSHE) programme. However, because schools are already under a lot of pressure to fulfil the statutory requirements of the National Curriculum, it is quite possible that many may decide to exclude further sex and relationships education from their curriculum.
Research from the sexual health advice service (Brook, 2011) shows that just over a quarter of secondary school pupils are not educated about sex and relationships at school, and just over a quarter of those who are educated believe that their teachers are not proficient in doing so. What’s more only ‘13% of 14-18 year olds learn most about sex from their SRE teacher, and just 5% from Mum and 1% from dad at home’ (Brook, 2011); these numbers are surprising, but they could give us useful information to be able to improve services. Ideas expanding from this research in order to improve SRE will be discussed later on, in recommendations for future practice.
There are many websites available to young people, but it is deciding which ones are most useful and reliable that is important. As Sharp (2009: 32) identified, ‘the internet is unregulated and many of the websites it will take you to contain information that is inaccurate or simply not true’. So it is the educator’s responsibility to ensure that young people know which websites may be considered reliable and where to go for further advice (away from the internet) if needed. Websites on their own cannot be enough to teach young people all that they need to know about STIs.
In recent years ‘The Sex Education Show’ has become an increasingly popular television programme, particularly for young people. It contains open and honest discussion from people with real experiences, which aims ‘to improve understanding and remove self-doubt’ (Sexperience, undated). The programme is certainly accessible and most probably encourages young people to talk about the show with their peers, but does it open up their conversation enough to allow them to talk about themselves with others? At least it is a starting point.
Adverts such as ‘Want Respect? Use a Condom’ aim to show young people how they can make safer choices without losing respect from their peers. Although adverts like this on their own are not enough to properly educate people about STIs.
Magazines, posters and leaflets may contain varying levels of information and messages, some being more detailed than others. Magazines give the opportunity for young people to write in and ask questions that they would not feel comfortable to do with a teacher, parent or peer. Posters can give short, sharp messages about dangers of or methods of prevention from STIs. Leaflets may contain more information regarding dangers or methods of prevention. Although again, they are not enough on their own to fully educate young people.
Gp surgeries offer one-to-one discussion with professionals, posters possibly around the environment and leaflets covering many subjects and issues, so there is plenty of information in varying forms and styles. GP surgeries may offer free condoms and screenings for STIs, although if they do not then they can give details of other settings of services that do. For example, the National Chlamydia Screening Programme (NCSP, 2010) has made it possible for people under the age twenty-five to access free Chlamydia tests more easily, by carrying out and sending urine or swab samples through the post. This method eliminates the embarrassment for young people having to be examined or talking to people. However, this test may not encourage people to practise safe sex, it may only ensure that they get tested when it could already be too late.
In the next few slides I am going to be focusing on looking at different sides of a particular debate within the arena of promoting good sexual health amongst young people. Teaching sex education in schools has often come under debate and discussion, both in the areas of what content should then be covered in school, what approaches should be taken, what resources and methods of contraception children should be made aware of; and whether the subject should be taught by teachers or left completely to parents to educate their children in this area.The table on the screen (European Centre for Disease Control and Protection, 2011) shows data on the rates of chlamydia, the most common sexually transmitted infection, in different European countries. You can see that there are variations; and there are also variations in what children are taught in regard to their sexual health between these countries. Teaching children to abstain from sexual activity has been seen to have different results in different countries. Statistics show that in some cases, this approach has facilitated a good level of sexual health amongst young children, where this has resulted in them not engaging in sex at a young age; but on the other side of the debate is the conclusion that children who are ill- informed about sexual heath will not be enabled to make wise decisions for their lifestyles. From the statistics on the screen you can see the variety in the results of these methods in different countries.
On the other hand, there is evidence through the statistics we have looked at which lead to the conclusion that not to teach children the facts through sex education in school actually leads to a decline in the standards of sexual health amongst young people. As this quote highlights, a main area of contention from this point of view is the issue of ignorance. The argument is that children who are well-informed with accurate information taught in a way that empowers them to make healthy decisions in their sexual lives through the use of various resources (which Danni has just discussed). This point is backed up through the statistics we compared of countries who take these different approaches to teaching their school children about sexual health, and the conclusions drawn from data which analyse the different outcomes.
The other side of this debate is the view that abstinence should not be taught as part of sexual health education. The first quote on the screen is from an author who’s personal experience of an all encompassing, informative education about sexual health in school led to a positive outcome in her case. In an article for the Guardian entitled ‘Good Sex Education is not about Teaching Abstinence’ Edelstein explains why she thinks the recent withdrawal of Nadine Dorries’ abstinence bill is a positive outcome, with reference to her own experiences at school; beginning her article by stating: ”it was comprehensive sex education that stopped me having sex at school. Nadine Dorries’ abstinence bill is a waste of time” (ibid.)Equally, much research has been carried out with conclusions drawn that teaching abstinence doesn’t necessarily lead to abstinence. This research that was carried out between different states in the USA drew conclusions that teaching abstinence only sexual health education did not result in better sexual health in comparison to states who’s sexual health curriculum informed students of various methods of contraception (Sciencedaily: 2011).Finally, this quote is from a comment on a debate hosted by the Guardian following the article Edelstein wrote about Teaching abstinence as part of sexual health. Although the phrasing of this statement may seem a bit extreme, nevertheless the principle underneath it, that in reality, teenagers will take part in sex, leads to the conclusion that it is best to realise this and, through use of those resources we underlined earlier, take action so that teenagers are enabled through information to them to make their own well- informed choices.
The health belief model (Ogden, 2007: 24) was originally developed by Rosenstock in 1966 in order to predict an individuals behavioural response to a health related-behaviour. The model beliefs that is a result of an individual beliefs which include their perceived susceptibility, perceived severity, perceived costs and benefits and finally the cues to action. The model suggests that these beliefs can be used to predict a the possibility of a behaviour occurring.
However the model faces some problems when trying to predict the use of condoms. The Health Belief Model fails to predict the use of condoms for a number of reasons:The attitude of ‘it won’t happen to me’ is extremely common and people therefore fail to acknowledge personal susceptibility, so it is difficult to measure this personal attitude through the Health Belief Model. Safer sex requires long term maintenance but the Health Belief Model is only a good predictor for short term changes.High levels of arousal in a person during sexual activities may make them reject their normally rational information-process shown in the Health Belief Model.Sex involves two people, whereas the Health Belief Model only accounts for the thought processes of one person.
The choice of individuals to use condoms is affected by a number of factors. These factors can be grouped into background, interpersonal, interpersonal and situational factors.Research claims that condom use increases with age and is more favoured with females. Research also suggested that a person of white British ethnicity is more likely to use condoms and is also more frequently used by those who have experienced a higher education. However it is unclear whether these factors directly affect a user choices to use a condom or whether other factors also play a part. The presense of intraperesoanl, interpresoanl and situation factors may play more of an role in influeinign condom use. Fisher carried out a study in 1984 into the attitudes towards contraception and in particular the use of condoms. He found that positive attitudes were parallel to actual use. However he also found that a high majority of participants held the view that condoms ‘kill spontaneity’. In relation to personality, a person who is agreeable and conscientious is less likely to show riskier sexual behaviour (Goldberg, 1999)Another factor in the choice of whether to use condoms or not is the role of the partner. The use is likely to be higher if the couple have an ability to hold discussions about protection methods. The use of condoms is also influenced by the duration of the relationship, whether the relationship is steady or causal and the exclusivity of the relationship. Research has found that parents play a key factor in decision making and show that increased communication between parent and child is related to higher contraception use. (Herold and Mcnamee, 1982). The third factor under interpersonal factors is the role of peers. Peer influence can alter an individuals own decisions in respect of condom use and research has shown that peers own contraception behaviour influences individuals choices. (Herold, 1981) Other factors which relate to the decision of whether to use a condom or not is the spontaneity of the sex, which is often given as a reason for not using a condom. Substance use before sex may also alter an individuals decision of participating in safe sex. And the final factor is accessibility. Research has shown that easy access increases the use, therefore the provision of condom machines in pubs and clubs has shown to increase the use of condoms.
Many people practice risky sexual behaviour because they wrongly estimate their susceptibility to catching an STI or HIV and believe they are not vulnerable. This inaccurate perception is known as unrealistic optimism. This term was coined by Weinstein in 1983 and 84, and he suggested that one of the reasons that people continue to practice unhealthy behaviours is due to inaccurate perceptions of risk and susceptibility. The are four main reasons why people wrongly estimate their susceptibility. The first is that they have a lack of personal experience of problems. The second is the belief that the problem is preventable by individual action. The third is the belief that the problem is not yet appeared and will not appear in the future. And the forth reason is the belief that the problem is infrequent. This theory can be related to risky sexual behaviour and individuals perceived invulnerability to STI’s. Individuals have unrealistic optimism to contracting an STI because they may not have experienced an infection before or do not know of anyone who has experienced a sexually transmitted infection. There is also a tendency for individuals to underestimate the frequency of specific sexually transmitted infections. Another problem is that individuals tend to select their focus by ignoring their own risk taking behaviour and focusing on their risk reducing behaviour. Therefore individuals may focus on their non risk taking behaviour in respect of not taking drugs in order to allow themselves to practice unsafe sex. Or an individuals who understands the necessity to practice safe sex may focus on the amount of times they have used a condom rather than the few times they have not practiced safe sex and made themselves and others vulnerable to infection.
There is a tendency for younger individuals to practice unsafe sex due to low self-efficacy in respect of condom use. This relates to low confidence in buying condoms, using condoms and confidence in suggesting they should be used. This may be the result of embarrassment of obtaining condoms or self confidence in using them or suggesting their use to their partner. Data has shown that obtaining condoms in a private area is more successful than the chemist or supermarket and therefore in recent years the use of condom machines has risen significantly. However, We as educationalists can change the problem of confidence in using and suggesting the use of condoms. Through sex education workshops in the classroom, younger generations can be introduced and gain confidence in the use of condoms in order to break the barrier between use. These classes may be more productive if done in friendship groups as this may take away the embarrassment of the whole class. By conducting these classes it may encourage individuals to suggest the use of condoms by removing the stigma attached towards them.
As seen from the data shown earlier there is a need fro educationalists to improve the knowledge of the younger generation in respect of the risks of practicing unsafe sex. However health education campaigns assume that improving knowledge will change attitudes and therefore result in changing the behaviour. However it may not be this simple. Increasing the knowledge of individuals may not have the desired effect. Sometimes increasing the knowledge results in creating fear in the individual which in time turns into denial, resulting in no effect on behaviour change. Therefore teaching young people on the severity of STI’s may result in these individuals fearing the possibility of infection and may result in denial and cause the individual to believe they are invulnerable to infection. However improved knowledge could have the desired effect by teaching individuals the severity of the problem but avoiding creating fear and panic which is likely to result in consciously changed behaviour. However the other problem with increasing knowledge and what may be common in school sex education classes is that increasing the awareness of the severity of risk taking sexual behaviour ay result in victim bullying, this means that individuals who have experienced a STI before may be bullied by their peers.
The attitudes of use of condoms is very difficult to research and the issues sensitivity proves to be a problem. The first problem is that the act of sex involves two people and therefore involves two judgements when deciding on condom use. This is difficult as it includes two beliefs, emotions and behaviours. Sexual behavioural is also hard to research as for some individuals it can cause embarrassment and is often considered a sensitive and personal area and therefore many individuals like to keep the sexual behavioural to themselves. Sex can also hold a sense of pride, especially with younger generations who may see having sex as a prize and therefore their experiences may hold a degree of dishonesty especially in relation to the use of condoms. Another factor which makes risky sexual behaviour hard to research is any researcher bias. The research may hold bias in the area of research, data selection, funding, or interpretational and presentation of their work, an example of this would be if the research is against homosexual behavioural, they may present researcher which may be damaging to this group of people.
According to the Department for Children, Schools and Families (DCSF, 2009) some other countries are tackling the issue of much more appropriately through educational campaigns and services. The Netherlands for example, have a compulsory sex and relationships education programme for all, which is based on ‘respect, openness and personal responsibility’ (DCSF, 2009: 20), whereas in Britain people appear to be more ‘embarrassed’ and ‘shamed’ by the subject so they tend to not talk so openly. New Zealand has a ‘Only When You’re Ready’ campaign, which tackles social norms, challenges the myths and misplaced beliefs and even has signposted areas for parents and teachers (DCSF, 2009: 21). Again this involves much open conversation with others. Finally, the Massachusetts’ ‘Healthy Talk’ campaign aims to teach people ‘how’ to talk by giving them appropriate language and conversation starters (DCSF, 2009: 21); so, other countries seem to be more successful in tackling sexual health issues by promoting open conversation between people. This seems to be what The Sex Education Show is attempting to do, but by itself it cannot be successful. Consideration needs to be given to the training of teachers and the education programme within schools.
So, given everything we’ve discussed through our presentation, the apparent lack of sufficient effective sex education and the rising number of young people contracting STI’s, it is clear we need to think about the role of education and us as future educators and the difference we can make. Although there are numerous information resources out there such as TV shows and websites, the statistics we’ve seen show that people who are better educated are more likely to take part in safer sexual practices. But all of this said, what we are doing at the moment in schools clearly isn’t working, so how do we change it? As discussed, the Netherlands and other European countries have compulsory SHE in their school curriculum, and consequently have lower numbers of STIs and teenage pregnancies and abortions. If the UK were to adopt this in their curriculum they could too see the same effects. Their ‘respect, openness and personal responsibility’ is something that we think is key to young people changing the way they view sex, we need to remove the taboo surrounding sex that the UK’s population seem to have. In line with the taboo, there are misconceptions among parents that SHE can have a negative effect on students, and rather than lowering sexual activity it would in fact encourage early sexual activity. We propose that schools would involve parents in the SHE they are providing, and work with them to resolve their concerns and provide accurate and authoritative information, with the aim of getting the parents to support and further develop any education the children receive in schools. To do that we would have to involve the parents and get them to believe that their involvement and cooperation is extremely important. There are many debates currently about the age at which schools should be teaching SHE in order for it to be fully effective without compromising the innocence of childhood, and this is something that as a group we can’t decide, however, children are becoming sexually active at much younger ages today and lack awareness of contraception and the dangers of sex. We thought that by bringing in independent specialists to schools to discuss these issues with the children could possibly be more effective than teachers covering it in their PSHE lessons. Teachers are often undertrained in how to approach the subject, sometimes they are embarrassed, and students find it comical to be talking about sex with their teachers. By having a visitor approach these topics with more informed training and better resources they might better communicate with the children and give them the confidence to talk about issues and confront the potentially scary truths about the dangers of sex. As we also discussed sex is about two people, and both need to be equally educated. By doing it in schools rather than at other organisations it ensures that everyone gets the same information and opportunities to learn about sex. Creating a fundamental change in the UK culture will not be easy, but by normalising safer sexual practices (and promoting open and honest discussion about them), a broader culture change could play an important role in tackling teenage pregnancy and poor sexual health in England. All of this said, the curriculum was reviewed in 2010, with the proposed changes to take effect starting next year, however, sex education is not due to change at all, so the decisions about the specific content of the PSHE sex programmes at school is still up to the individual institutions.
Sexual Health: STIsDanni Butcher, Lydia Payne, Becky Schafer and Kelly Murphy
Today’s presentation• Why is sexual health important?• What is already in place to educate? – The effectiveness of resources• Current debates• Linking it all to theory• Activity• Comparisons to other countries• What can educationalists do? – Future recommendations
Something fun to start off with...http://www.youtube.com/watch?v=7Bd4TpTdwx4 Condoms will be the focus form of contraception in some of our discussion, because it is the only one that protects against pregnancy and STIs.
“Positive, meaningful sexual health is a centralcomponent of overall well-being and a keycomponent of a healthy lifestyle. Sexualhealth is aligned to and includes reproductivehealth” (World Health Organization, 2006).
Why is sexual health an issue?The relevance it has to our countryLack of symptomsPossible outcomes of infertility, death, etc.Increase of spread of STIs
So what is already out there?• Sex and Relationship education lessons (SRE)• Websites• Television programmes• Television adverts• Magazines• Posters and leaflets• GP surgeries• Chlamydia screening
Sex and relationships education “It is compulsory for schools to teach the biology of reproduction, but not sex andrelationships education, although government guidance is that they should as part ofpersonal, social and health education (PHSE).” (Saner, 2011)
Brook (2011)• One in four (26%) secondary pupils get no SRE in school whatsoever.• A quarter (26%) of those who do get SRE say the teacher isn’t able to teach it well.• Only 13% of 14-18 year olds learn most about sex from their SRE teacher, and just 5% from Mum and 1% from dad at home.
Websites• Brook• NHS choices• BBC: Health• World Health Organization• Sexperience And many, many more...
Television programmes• The Sex Education Show - open and honest discussion about sex to improve understanding and remove self-doubt. - captures individual viewpoints on a broad range of sexual issues. - people’s real experiences (Sexperience, undated)
Television adverts• Want Respect? Use a Condom – http://www.youtube.com/watch?v=yKG15lAif28
“Ignorance about sex is the primary cause ofthe spread of sexually transmitted diseases(STDs). The spread of AIDS in the 80s and 90shas shown us that education and informationis more important than ever. Giving sexeducation in schools is crucial to this spread,and may be supplemented by frank discussionat home” (International Debates in EducationAssociation, 2009).
Not teaching abstinence“understanding that it was a huge responsibility with potentially serious consequences, which we did not feel mature enough to handle.... because our health educators did their best to teach us to value and understand safe sex” (Edelstein, H: 2012).“ States that prescribe abstinence-only sex education programs in public schools have significantly higher teenage pregnancy and birth rates than states with more comprehensive sex education programs, researchers from the University of Georgia have determined” (Sciencedaily: 2011).Teaching abstinence as the best way to avoid disease and pregnancy is a bit like teaching that the best way to avoid being run over by a car is never to cross the road. It may technically be true but its not going to help anyone in the real world. (the Guardian, 2012).
Health Belief Model Ogden (2007: 24) Susceptibility Severity CostsDemographic Likelihood of variable Benefits behaviour Cues to action Health motivation Perceived control
Problems with the Health Belief Model The HBM fails to predict the use of condoms for a number of reasons:• Personal susceptibility• Maintenance of behaviour• Sex is emotional and requires a level of high arousal• Sex is interactive and involves negotiation
Factors influencing use of condomsBackground factors Interpersonal factors• Age • Partner• Gender • Parents• Ethnicity • Peers• Socio-economic status• EducationIntrapersonal factors Situational factors• knowledge • Spontaneity of sex• Attitudes • Substance use• Personality • Accessibility
Perceptions of susceptibility•Unrealistic optimism•Invulnerability to HIV is common•Weinstein 1983 & 84’- suggested that one of the reasons thatpeople continue to practice unhealthy behaviours is due toinaccurate perceptions of risk and susceptibility. 1. Lack of personal experience of problems 2. The belief that the problem is preventable by individual action 3. The belief that the problem has not yet appeared and will not appear in the future. 4. The belief that the problem is infrequent.
Self-efficacyRelates to confidence in buying condoms,confidence in using condoms or confidence insuggesting condoms should be used.
Improving knowledge• Health education campaigns assume that improving knowledge will change attitudes and therefore change behaviour. 1. Increasing knowledge increases fear in the individual, which may cause denial, resulting in no effect on behaviour or even detrimental effects on behaviour. 2. Improved knowledge may increase the individuals perception of reality and their perception of risk, which could therefore cause a change in behaviour as the individual is not experiencing fear. 3. May increase awareness of seriousness of behaviour and cause victim bullying.
Problem with research• Involves 2 people = 2 sets of beliefs, emotions and behaviours.• Sexual behaviour can cause embarrassment and is considered sensitive and personal area• This can cause dishonesty• Research may be researcher biased – Area of research, data selection, funding, interpretation and presentation.
Activity: Discussion• What were your experiences of sex and relationships education when you were growing up?• What works and what doesn’t? – Think about home, school, media and the wider community• What can we do as educationalists to improve risk taking behaviours (in relation to STIs) of young people?
In comparison to other countries... (DCSF, 2009)• Netherlands- Sex and Relationship education (P.20) – ‘respect, openness and personal responsibility’• New Zealand- ‘Only When You’re Ready’ campaign (P.21) – tackles social norms – challenges the myths and misplaced beliefs – signposted areas for both parents and teachers• Massachusetts- ‘Healthy Talk’ campaign (P.21) – people need to be taught ‘how’ to talk – language and conversation starters
WHAT EDUCATIONALISTS CAN DO: RECOMMENDATIONS FOR FUTURE PRACTICE• Make sexual health education compulsory.• Parents and schools work together.• Independent trained visitors.• Get rid of the ‘taboo’ surrounding sex.
And if all this does not work, then maybe we should use lots of scare tactics???http://www.youtube.com/watch?v=3yXthdWtU-A
Reference list• Brook (2011) UK sex and relationships education fails to prepare young people for modern day life. [Online] Available from: http://www.brook.org.uk/professionals/application/brookpr/index.php?option=co m_brookpr&view=article&id=91&Itemid=640 [Accessed 29/03/12].• DCSF (2009) Teenage pregnancy and Sexual Health Marketing Strategy. [Online] Available from: http://www.nhs.uk/sexualhealthprofessional/Documents/Sexual_Health_Strategy _2009.pdf?wt.mc_id=21103 [Accessed 20/04/12].• Dorries, N (2012) Good sex education is not about teaching abstinence.• European Centre for Disease Control and Prevention (2011) Surveillance Report- Sexually Transmitted Infections in Europe Stockholm, ECDC.• Health Protection Agency (2012) Numbers and Rates of Selected STI diagnoses in Genitourinary Medicine Clinics & Community Setting in the UK 2008-2010 [Online] Available from: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317132033760 Accessed 11/4/2012 [Accessed 20/04/12].
• International Debates in Education Association (2009) Should children be given Sex Education in schools, or should this be the responsibility of the parents? How should it be taught? [Online] Available from: http://www.idebate.org/debatabase/topic_details.php?topicID=52 [Accessed 11/4/2012].• NCSP (2010) Get tested- find your local service. [Online] Available from: http://www.chlamydiascreening.nhs.uk/ys/presults.asp?map=Q39 [Accessed 15/04/12].• Ogden, J. (2007) Health Psychology: a textbook. 4th edition. Maidenhead: Open University Press.• Saner, E. (2011) How good is sex education in schools? [Online] Available from: http://www.guardian.co.uk/lifeandstyle/2011/oct/10/how-good-is-sex-education [Accessed 29/03/12].• Sciencedaily (2011) Abstinence- only Education does not lead to Abstinent Behvaiour, Researchers Find [Online] Available from: http://www.sciencedaily.com/releases/2011/11/111129185925.htm [Accessed: 11/4/2012].• Sexperience (undated) Frequently asked questions. [Online] Available from: http://sexperienceuk.channel4.com/faq [Accessed 15/04/12].• Sharp, J. (2009) Success with your Education Research Project. Exeter: Learning Matters Ltd.• Weinstein, N. (1984) Why it won’t happen to me: perceptions of risk factors and susceptibility, Health Psychology, 3: 431-57.• World Health Organization (2006) Young People’s Health in Great Britain and Ireland [online] Available from: http://www.hbsc.org/downloads/YoungPeoplesHealth_GB&Ireland.pdf Accessed: 24/4/2012
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