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Courage To Say Know
Courage To Say Know
Courage To Say Know
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Courage To Say Know

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    • 1. The C ou rage to Say KNOW: Unlocking the Doors to Asset-Building HIV/STD Education for Youths <ul><li>CH  RTS </li></ul><ul><li>University of Oklahoma Health Sciences Center </li></ul><ul><li>Dept. of Medicine, Section of Infectious Diseases </li></ul><ul><li>Dept. of Pediatrics, Section of Adolescent Medicine </li></ul><ul><li>Jana B. Knol, M.Ed </li></ul><ul><li>Robert Settles, L.C.S.W. </li></ul>
    • 2. The C ou rage to Say KNOW Mission… <ul><li>To promote optimal physical, emotional, cognitive and social well-being for adolescents with the belief that all adolescents deserve the best education and skills possible to stay healthy and risk-free </li></ul>
    • 3. Learning Objectives: <ul><li>Learn how to overcome barriers to youth sexual health education </li></ul><ul><li>Gain understanding and learn the importance of utilizing an evidenced-based, medically accurate course of study </li></ul><ul><li>Learn to build and integrate quality prevention strategies through effective coalitions of partnership and collaboration </li></ul><ul><li>Develop understanding of how to help youths reduce at-risk behaviors through asset-building skills and knowledge </li></ul>
    • 4. When is it OK to kiss someone? <ul><li>“ When they’re rich.” </li></ul><ul><ul><li>Pam, age 7 </li></ul></ul><ul><li>“ The law says you have to be 18, so I wouldn’t want to mess with that.” </li></ul><ul><ul><li>Curt, age 7 </li></ul></ul><ul><li>And the number one response is… </li></ul><ul><li>“ I don’t know, but I’ll tell you one thing, I’m never going to have sex with my wife. I don’t want to be all grossed out.” </li></ul><ul><ul><li>Theodore, age 8 </li></ul></ul>
    • 5. Real Talk from Oklahoma Teens… <ul><li>“ We don’t have sex. Oral sex is not sex so what’s the big deal. I’m safe.” </li></ul><ul><ul><li>15 year-old female </li></ul></ul><ul><li>“ My girlfriend takes birth control pills so there is no way I could get infected.” </li></ul><ul><ul><li>19-year-old male </li></ul></ul><ul><li>“ I’d never talk to my girlfriend about sex. How embarrassing! We just do it.” </li></ul><ul><ul><li>15-year-old male </li></ul></ul><ul><li>“ If it gets around I have herpes, no one will even talk to me. I’m not telling anyone, especially my boyfriend.” </li></ul><ul><ul><li>17-year-old female </li></ul></ul><ul><li>“ It really burns down there so I put alcohol on it. That will kill anything.” </li></ul><ul><ul><li>13-year-old male </li></ul></ul><ul><li>“ He gives me great gifts. I owe him something to keep him happy.” </li></ul><ul><ul><li>16-year-old female </li></ul></ul>
    • 6. How’s Your Teen Sexual Terminology? <ul><li>Tossed salad </li></ul><ul><li>Oral-Anal Sex </li></ul><ul><li>Outercourse </li></ul><ul><li>Oral sex </li></ul><ul><li>Rainbow party </li></ul><ul><li>Oral sex with different colors of lipstick, creating a rainbow around the male penis </li></ul><ul><li>Pretty boy </li></ul><ul><li>Sexually active boy </li></ul><ul><li>Hoovering </li></ul><ul><li>Abortion </li></ul><ul><li>“ Dirty” vs “clean” </li></ul><ul><li>Diseased vs disease-free </li></ul><ul><li>High Five </li></ul><ul><li>HIV – HIV’ed by Jack </li></ul><ul><li>Booty call </li></ul><ul><li>Have sex for sex and leave – no commitment </li></ul><ul><li>Juiced-up </li></ul><ul><li>Get together for sex with multiple sex partners </li></ul><ul><li>Friends with benefits </li></ul><ul><li>Having sex with casual friends just for the fun of it. No commitment or emotional relationship </li></ul>
    • 7. While the debate continues over a comprehensive versus an abstinence-until-marriage or ABC approach to sex education… <ul><li>HIV infects 2 young people every hour of every day in U.S. </li></ul><ul><li>1 out of every 4 sexually active youths acquire an STD – many show no symptoms and go undiagnosed </li></ul><ul><li>Over 800,000 unintended pregnancies/year in U.S. </li></ul><ul><li>One-half of the 40,000 new HIV infections each year occurs in individuals under age 25 </li></ul><ul><li>HIV incidence among young males and females in U.S. has risen more than 130% </li></ul>
    • 8. The Courage to Say KNOW is an Asset-Building Curriculum… <ul><li>Assets are knowledge, attitudes, behaviors, beliefs, and skills that will strengthen youths’ abilities to make healthy responsible choices; thereby reducing risk behaviors through self-efficacy </li></ul>
    • 9. Adolescents and Sex in OKC and Surrounding Area High Schools (2002) <ul><li>Source: CH  RTS/ OU HSC – Focus Groups </li></ul><ul><ul><li>1,000 high school students </li></ul></ul><ul><li>68% are sexually active by age 17 </li></ul><ul><li>In high school youth, 50% have had sexual intercourse </li></ul><ul><li>Think that oral sex is safe and is not sex – Over half have had oral sex. Misconceptions: Can’t get pregnant; Can’t get STDs; Maintains virginity </li></ul><ul><li>In sexually active youth: </li></ul><ul><ul><li>74% say they have sex for fun </li></ul></ul><ul><ul><li>20% have multiple partners </li></ul></ul><ul><ul><li>50% do not use condoms </li></ul></ul><ul><ul><li>23% unprotected sex while under influence </li></ul></ul><ul><ul><li>33% report binge drinking is a common event </li></ul></ul>
    • 10. Oklahoma Youth Risk Behavior Survey- 2003 <ul><li>Polled 1,384 students in grades 9-12 from 36 schools </li></ul><ul><li>Source: Centers for Disease Control and Prevention. In: Surveillance Summaries, May 21, 2004. MMWR 2004:53 (No. 22-2) </li></ul><ul><li>51% of males and 49% of females said they’ve had sex </li></ul><ul><li>15.6% had more than 4 partners </li></ul><ul><li>6% said had sex before age 13 </li></ul><ul><li>Almost ½ of all students (47.8%) said they drank alcohol in the previous 30 days </li></ul><ul><li>One-third drank 5 or more drinks within 2 hours </li></ul>
    • 11. 2005 (2003) National Youth Risk Behavior Survey <ul><li>Minimal changes in sexual behavior compared to 2003 </li></ul><ul><li>Source: www.cdc.gov/yrbss </li></ul><ul><ul><li>46.8% (46.7%) sexually active </li></ul></ul><ul><ul><li>14.3% (14.4%) sexual intercourse with more than 4 partners during life </li></ul></ul><ul><ul><li>33.9% (34.3%) currently active </li></ul></ul><ul><ul><li>62.8% (63%) used condoms at last sexual intercourse </li></ul></ul><ul><ul><li>23.3% (25.4%) alcohol or drug use before intercourse </li></ul></ul>
    • 12. And the cost… <ul><li>9 million cases of new STDs occurred among adolescents in 2000, totaling $6.5 billion </li></ul><ul><li>Viral STDs accounted for 94%, totaling $6.2 billion </li></ul><ul><li>Nonviral STDs: 6%, totaling 0.4 billion. Genital herpes and chlamydia, accounting for medical costs of $293 million and $248 million, respectively </li></ul><ul><li>HIV and HPV most costly, accounting for $5.9 billion </li></ul><ul><li>These figures underscore the enormous financial burden of STDs, illustrating potential savings that could be achieved through effective sexual health education </li></ul><ul><li>Source: “Perspectives in Sexual and Reproductive Health, Jan./Feb., 2004 </li></ul>
    • 13. Sex Education in U.S. Public Schools
    • 14. Kaiser Family Foundation, Sex Education in America: Americans overwhelmingly favor broader sexual health education
    • 15. Most school district policies promote abstinence (Family Planning Perspectives, 1999, 31(6):280-286
    • 16. School district sex education policies vary widely by region
    • 17. Fastest growth rate of HIV infection is in the South <ul><li>South accounts for only 38% of U.S. population, but 40% of its AIDS cases in 2002 </li></ul><ul><li>Oklahoma is included in the south </li></ul><ul><ul><li>50% of high school students sexually active (national average is 46.8% </li></ul></ul><ul><ul><li>Many teens have multiple partners, few use condoms </li></ul></ul><ul><ul><li>8 th highest birth rate in nation for females, 15-19 </li></ul></ul><ul><ul><li>7,415 babies born to females under age 20 in 2002 </li></ul></ul><ul><ul><li>Source: 2004 Healthy Transitions for OK Youth </li></ul></ul><ul><li>Abstinence only education predominates in schools </li></ul><ul><li>Parents/Adults less likely to talk to kids about sexual health </li></ul><ul><li>No Youth Councils – Youth have no voice </li></ul>
    • 18. Chlamydia — Rates by state: United States and outlying areas, 2002 Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 293.6 per 100,000 population. Source : CDC/NCHSTP 2002 STD Surveillance Report Epidemiology
    • 19. Chlamydia — Age- and sex-specific rates: United States, 2002 Source : CDC/NCHSTP 2002 STD Surveillance Report Epidemiology
    • 20. Gonorrhea — Rates by state: United States and outlying areas, 2002 Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 123.4 per 100,000 population. The Healthy People 2010 objective is 19.0 cases per 100,000 population. Source : CDC/NCHSTP 2002 STD Surveillance Report Epidemiology
    • 21. Gonorrhea — Age- and sex-specific rates: United States, 2002 Source : CDC/NCHSTP 2002 STD Surveillance Report Epidemiology
    • 22. Levels of teenage sexual activity across developed countries are similar…
    • 23. … but U.S. teenagers have higher rates of STDs and unintended pregnancy because… <ul><li>Do not receive clear and unambiguous evidenced-based, medically accurate education from parents or through school health classes </li></ul><ul><li>Sexual health curricula is fractured – Does not link sexual and reproductive health and HIV/AIDS </li></ul><ul><li>Are less likely to use protection and contraceptives, when they choose to become sexually active </li></ul><ul><li>Have shorter relationships </li></ul><ul><li>Have more sexual partners </li></ul><ul><li>Few “youth-friendly” clinics </li></ul><ul><li>Lack of youth advisory councils </li></ul><ul><li>Less access to education about barrier protection, contraceptive and reproductive health services </li></ul>
    • 24. Discussions with Parents about Sex <ul><li>At least 1/3 rd of teens (15-19) say they have not discussed sex with their parents, including how to say, “No” </li></ul><ul><li>Source: Freeze Frame: A Snapshot of America’s Teens. National Campaign to Prevent Teen Pregnancy, 2005 </li></ul>
    • 25. Parental Awareness of Teen Sexual Activity… <ul><li>Many parents not aware that child has had sex </li></ul><ul><li>One-half of parents of sexually active 8 th – 11 th graders were unaware that their sons or daughters had started to have sex </li></ul><ul><li>Source: Bruckner H., Bearman, P. Dating behavior and sexual activity of young adolescents: Analysis of the National Longitudinal Study of Adolescent Health, 2003 </li></ul>
    • 26. It just happened… <ul><li>78% of females, ages 13-19 report that the first time they had sex, “It just happened.” </li></ul><ul><li>There was no discussion, no planning, and no conversation about the consequences… </li></ul><ul><li>“ It just happened!” </li></ul>
    • 27. The Effectiveness of Sexual Health Education…
    • 28. Evidenced-Based Practice (EBP) <ul><li>Refers to the Development , Implementation and Evaluation of effective programs through the application of evidence </li></ul><ul><li>Program, policies or service can be directly linked with evidence that demonstrates effectiveness. For example: </li></ul><ul><ul><li>Self-efficacy to refuse sex or peer pressure </li></ul></ul><ul><ul><li>Delay of sexual initiation </li></ul></ul><ul><ul><li>Frequency of sex </li></ul></ul><ul><ul><li>Use of barrier protection, if sexually active </li></ul></ul><ul><ul><li>Impact on STDs, HIV, pregnancy rates </li></ul></ul><ul><ul><li>Reducing risk behaviors, i.e. multiple partners, substance abuse, IV drug use, alcohol </li></ul></ul>
    • 29. What does the research say… Source: Kirby, D, et al. The Impact of Sex Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. ETR Associates. Jan. 2006 8 15 1 1 1 0 # of Sexual Partners -Reduced # -No significant impact Increased # 5 14 1 2 1 1 Frequency of Sex -Reduced frequency -No significant impact -Increased frequency Comprehensive N=50 14 12 1 Abstinence-Only N=6 0 3 0 Initiation of Sex -Delayed initiation -No significant impact -Hastened initiation
    • 30. What does the research say… Source: Kirby, D, et al. The Impact of Sex Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. ETR Associates. Jan. 2006 13 9 0 1 2 0 Sexual Risk -Reduced risk -No significant impact Increased risk 4 5 1 1 0 0 Contraceptive Use -Increased use -No significant impact -Decreased use Comprehensive N=50 17 17 0 Abstinence-Only N=6 1 2 0 Condom Use -Increased condom use -No significant impact -Decreased condom use
    • 31. Effectiveness of Abstinence-Only Curricula… <ul><li>Four programs being studied by Mathmatica Policy Research, Inc. </li></ul><ul><ul><li>3 in middle schools </li></ul></ul><ul><ul><li>1 elementary school </li></ul></ul><ul><li>2,310 students </li></ul><ul><li>Final report to be issued in 2006 </li></ul><ul><li>Source: First-year impacts of four Title V, Section 510 abstinence education programs. Mathmatica Policy Research, Inc., Princeton, NJ (2005) </li></ul><ul><li>Initial Key Findings: </li></ul><ul><ul><li>8% more likely to take a positive view of abstinence; 7% more likely to hold a negative view of teen sex </li></ul></ul><ul><ul><li>Youth in 3 of 4 programs were more likely to pledge abstinence </li></ul></ul><ul><ul><li>No evidence of impact on dating and expectations to abstain from sex. </li></ul></ul><ul><ul><li>Programs had no effects on other outcomes potentially related to teen risk behaviors, i.e. long-term commitment until marriage; self-image; perceptions of peer pressure to have sex </li></ul></ul>
    • 32. Many Abstinence Programs Misleading Teens… <ul><li>Contradicting the government’s own scientific findings: </li></ul><ul><li>11 of 13 most commonly used curricula contain medically inaccurate information: </li></ul><ul><ul><li>½ of U.S. gay male teenagers have tested positive for HIV </li></ul></ul><ul><ul><li>A 43-day-old fetus is a “thinking person” </li></ul></ul><ul><ul><li>Condoms fail to prevent HIV as often as 31% of the time in heterosexual intercourse </li></ul></ul><ul><ul><li>HIV can be spread through sweat and tears </li></ul></ul><ul><li>Source: The Content of Federally Funded Abstinence-Only Education Programs. U.S. House of Representatives, Committee on Gov. Reform, Special Investigations Division, Congressional Staff Report (Dec., 2004) </li></ul>
    • 33. Just Saying No: Teens Wonder if Abstinence-Only Sex Education Realistic… <ul><li>Sexual activity had doubled among its junior-high students after participating </li></ul><ul><li>“ A lot of students aren’t waiting, even if they checked a box that says they will,” referencing the “yes” box on virginity pledge cards instructors passed out to students </li></ul><ul><li>Source: Minnesota State Dept. of Health, Independent Evaluation of Abstinence-Only Pilot Program, “Education Now and Babies Later” (ENABL) </li></ul>
    • 34. “We didn’t find what many would like us to find…” <ul><li>TX A&M found that students in nearly all high school grades throughout TX were more sexually active after participating in abstinence-only. </li></ul><ul><ul><li>Source: TX A&M Univ., Jan., 2005 </li></ul></ul><ul><li>After taking abstinence-only courses: </li></ul><ul><ul><li>Of 9 th grade females, 23% had already had intercourse prior to abstinence-only enrollment. That rate grew to 28% after program. </li></ul></ul><ul><ul><li>Rates of sexual activity grew for 10 th grade boys from 24% before program exposure to 39% after program exposure. </li></ul></ul>
    • 35. The Potential for Harm <ul><li>Virginity pledges may deter young people from using protection when they become sexually active </li></ul><ul><li>Virginity pledges may increase risk of oral and anal sex </li></ul><ul><li>HIV prevention messages that promote only abstinence and not protection may result in more unprotected sex and more oral and anal sex than do safer-sex messages </li></ul>
    • 36.  
    • 37.  
    • 38. The Potential for Harm <ul><li>For example, a study of teenagers who took a pledge promising to abstain from sex until marriage and subsequently broke their pledge were one-third less likely to use protection than those who had not pledged virginity in the first place. </li></ul><ul><li>Source: Promising the future: virginity pledges and first intercourse. American Journal of Sociology , 2001, 106(4):859-912 </li></ul>
    • 39. The Potential for Harm <ul><li>Of 12,000 teenagers, 88% of those taking a virginity pledge and receiving abstinence-only education reported having sexual intercourse before marriage, were less likely to get tested for STDs and were more likely to have unprotected sex than those who received safer-sex messages </li></ul>
    • 40. The Potential for Harm… <ul><li>“ Most disturbing news was that teens who took pledges were unprepared to start sexual activity. They were irresponsible, as though they were so steeped in shame they really didn’t want to come to terms with the reality of their behavior” </li></ul>
    • 41. 17 Characteristics of Effective Programs… Source: Kirby, D, et al. The Impact of Sex Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. ETR Associates. Jan. 2006 <ul><li>Category 1: Development </li></ul><ul><ul><li>Multiple individuals or groups with expertise to design curriculum </li></ul></ul><ul><ul><li>Assessed relevant needs/wants of youths </li></ul></ul><ul><ul><li>Used logic model (specifies how interventions can affect behavior and achieve health goal(s) </li></ul></ul><ul><ul><li>Designed activities consistent w/community values and available resources </li></ul></ul><ul><ul><li>Pilot-tested the program </li></ul></ul>
    • 42. 17 Characteristics of Effective Programs… Source: Kirby, D, et al. The Impact of Sex Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. ETR Associates. Jan. 2006 <ul><li>Category 2:Design/ Teaching Strategies </li></ul><ul><ul><li>6. Focus on at least 1 of 3 health goals: prevention of HIV, other STDs, and/or unintended pregnancy </li></ul></ul><ul><ul><li>7. Focus on specific behaviors leading to health goals; give clear messages about behaviors; address situations that lead to them; how to avoid </li></ul></ul><ul><ul><li>8. Include multiple instructionally sound activities designed to change each targeted risk </li></ul></ul><ul><ul><li>9. Focus on specific sexual psychosocial factors that affect behaviors and change some factors </li></ul></ul><ul><ul><li>Employ sound teaching methods that actively involve participants, help them to personalize information </li></ul></ul><ul><ul><li>Create a safe environment </li></ul></ul><ul><ul><li>Employ activities, methods, messages appropriate to youths’ culture, age, experience </li></ul></ul><ul><ul><li>Covered topics in logical sequence </li></ul></ul>
    • 43. 17 Characteristics of Effective Programs… Source: Kirby, D, et al. The Impact of Sex Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. ETR Associates. Jan. 2006 <ul><li>Category 3: Implementation </li></ul><ul><ul><li>14. Secure at least minimal support from appropriate authorities </li></ul></ul><ul><ul><li>15. Selected educators with desired traits, trained them, provided monitoring, supervision, and support </li></ul></ul><ul><ul><li>16. Implement needed activities to recruit and retain youth </li></ul></ul><ul><ul><li>17. Implement curriculum with reasonable fidelity </li></ul></ul>
    • 44. The C ou rage to Say KNOW
    • 45. Barriers faced at onset (2002)… <ul><li>Perceived competition from ASOs/CBOs – “Get the numbers” </li></ul><ul><li>Minimal collaboration or cooperation </li></ul><ul><li>Denial among political and religious leadership </li></ul><ul><li>Fractured Education, lacking medically accurate, evidenced based materials, no inclusion of STDs or life-skills instruction </li></ul><ul><li>Multiple ASOs/CBOs, all teaching different, and in many cases, inaccurate information </li></ul><ul><li>Social stigma/Fear </li></ul><ul><li>Discrimination of minority and GLBTQ youth </li></ul>
    • 46. What Oklahoma Teens and Many Other Youths Face across our Nation… <ul><li>High poverty rates – 1 in 5 children </li></ul><ul><li>Many single-parent families and high divorce rates </li></ul><ul><li>Meth use by one or more family members </li></ul><ul><li>Highest incarceration rate for minority women in nation </li></ul><ul><li>Sexual abuse and exploitation </li></ul><ul><li>Increased gang activity </li></ul><ul><li>Adolescent unintended pregnancy </li></ul><ul><li>Lack of sufficient foster homes, youth after school programs, youth-friendly healthcare </li></ul>
    • 47. Teens Physiologically and Emotionally Often Face… <ul><li>Poor impulse control </li></ul><ul><li>Thrill-seeking </li></ul><ul><li>Rule-breaking </li></ul><ul><li>Inability to make sound judgments when confronted by complex situations </li></ul><ul><li>Key areas of adolescent brain, especially prefrontal cortex that controls higher order skills like responsible decision-making are not fully formed </li></ul><ul><li>Source: Giedd, Weinberger, Elvevag. The Adolescent Brain: A Work in Progress . National Campaign to Prevent Teen Pregnancy. June 2005 </li></ul>
    • 48. Perceptions Within Educational Profession Regarding HIV/STD Programs… <ul><li>Learning objectives not tied to evaluation to determine outcome </li></ul><ul><li>Not evidenced-based </li></ul><ul><li>Not medically accurate </li></ul><ul><li>Uneasy about who is teaching class and their credentials to teach </li></ul><ul><li>Inaccurate information being given in classrooms </li></ul><ul><li> Promotes sex, rather than builds self-esteem </li></ul><ul><li>Fear of legal ramifications </li></ul><ul><li>Parents/guardians failing to talk to their teens </li></ul><ul><li>Teachers; however, desperate for students to receive this life-saving information </li></ul>
    • 49. Focus Groups (2002)… <ul><li>Asked youths, from all walks of life, in their opinion, “What do you want to know and what information do you need to stay safe?” </li></ul><ul><li>Asked parents, “What do you want your teen to know about sexual health?” </li></ul><ul><li>Asked educators, ” What tools and materials do you need in the classroom?” </li></ul>
    • 50. Bandura’s Social Learning Theory Determines Human Behavior Cognitive Factors Knowledge Expectations Attitudes Environmental Factors Social Norms Access in Community Influence on Others Behavioral Factors Skills Practice Self-efficacy
    • 51. The C ou rage to Say KNOW… <ul><li>Based on Social Learning Theory </li></ul><ul><li>“ Hands-on” experiential, evidence-based learning </li></ul><ul><li>Objectives specific to each lesson plan tied directly to program evaluation tools – Helps to answer the question: </li></ul><ul><ul><li>Do students believe they can perform a specific behavior, even in the face of challenge? </li></ul></ul><ul><ul><li>Do students value the expected outcome of certain behavior? </li></ul></ul>
    • 52. Medically Accurate, Evidence-Based, Asset-Building Programs for Youth Are Essential… <ul><li>The C ou rage to Say KNOW: </li></ul><ul><li>In compliance with State Statute 70 O.S. 11-103.3 (OSCN 2001), School Code 1971 (Sept., 2005) </li></ul><ul><ul><li>OK State Dept. of Health </li></ul></ul><ul><ul><li>OK State Board of Education </li></ul></ul><ul><li>12 Lesson Plans: </li></ul><ul><ul><li>Delivered in a logical sequence </li></ul></ul><ul><ul><li>Building in-depth knowledge/skills </li></ul></ul><ul><li>Understanding Adolescence </li></ul><ul><li>Amazing Immune System </li></ul><ul><li>HIV/AIDS: Risk or Responsibility </li></ul><ul><li>Real Talk About STDs </li></ul><ul><li>Abstinence: Just Chill' in for Now </li></ul><ul><li>Protection Check: Condoms (Optional) </li></ul><ul><li>Substance Abuse: A Real “Downer” </li></ul><ul><li>Dating Game-Balancing Power for Healthy Relationships </li></ul><ul><li>Effective Communication </li></ul><ul><li>The Power to Choose: Decision-Making/Refusal Skills </li></ul><ul><li>Setting Healthy Boundaries </li></ul><ul><li>Self Esteem:Love the Skin I’m In </li></ul>
    • 53. The C ou rage to Say KNOW… <ul><li>Links sexual and reproductive health and HIV </li></ul><ul><li>Linkage is now widely recognized. </li></ul><ul><li>Ill-health shares root causes, including: </li></ul><ul><ul><li>poverty </li></ul></ul><ul><ul><li>intolerance </li></ul></ul><ul><ul><li>gender inequality </li></ul></ul><ul><ul><li>social marginalization of vulnerable populations </li></ul></ul><ul><li>Sources: UNAIDS policy position paper, “Intensifying HIV prevention.” June 2005 </li></ul><ul><li>New York Call to Commitment: Linking HIV/AIDS and Sexual and Reproductive Health 1 </li></ul><ul><li>Glion Call to Action on Family Planning and HIV/AIDS in Women and Children2. </li></ul><ul><li>Millennium Development Goals. </li></ul>
    • 54. C ou rage to Say KNOW is an asset-building, medically accurate curriculum… <ul><li>Quantitative Data: </li></ul><ul><li>Pre-Test: See What You Know </li></ul><ul><li>Post-Test: See What You Learned </li></ul><ul><li>Program Evaluation: </li></ul><ul><ul><li>Do you value what you have learned </li></ul></ul><ul><ul><li>Do you feel you can apply what you have learned </li></ul></ul><ul><li>Qualitative Data: </li></ul><ul><li>Behavior Modification via KABB </li></ul><ul><li>Do students believe they can implement what they have learned, even in the face of challenge? (self-efficacy) </li></ul><ul><li>Do students value what they have learned? </li></ul><ul><li>Baseline; 3-6-month F/U; 1-year F/U (pending IRB approval to capture longitudinal data) </li></ul>
    • 55. The C ou rage to Say KNOW Facilitator’s Guide (10/2002) <ul><li>415-page full-color guide makes implementation easy, accurate, affordable: </li></ul><ul><ul><li>Student handout materials/worksheets </li></ul></ul><ul><ul><li>Pre-Test: “See What You Know: </li></ul></ul><ul><ul><li>Post-Test: “See What You Learned” </li></ul></ul><ul><ul><li>Program Evaluation </li></ul></ul><ul><ul><li>KABB Assessment </li></ul></ul><ul><ul><li>Power Point Overhead Transparency Templates </li></ul></ul><ul><ul><li>Baseline; 3-and 6-mo. F/U; 1 year F/U </li></ul></ul>
    • 56. The Courage to Say KNOW: Peer Educator Training Manual… <ul><li> Parallels Curriculum and Facilitator’s Guide, plus: </li></ul><ul><ul><ul><li>Health Advocacy for Other Youth </li></ul></ul></ul><ul><ul><ul><li>Professionalism in the Classroom </li></ul></ul></ul><ul><ul><ul><li>Teaching Strategies </li></ul></ul></ul><ul><ul><ul><li>Cultural Competency </li></ul></ul></ul>
    • 57. Unlocking the Doors… <ul><li>Four Key Building Blocks </li></ul>
    • 58. Program Credibility… <ul><li>Backed by the full support of OU HSC for medical accuracy, sound design </li></ul><ul><ul><li>Infectious Diseases Specialists </li></ul></ul><ul><ul><li>Adolescent Medicine Specialists </li></ul></ul><ul><ul><li>Licensed Clinical Social Workers and Licensed Counselors </li></ul></ul><ul><ul><li>Psychiatrists/Psychologists </li></ul></ul><ul><ul><li>Master’s Level Health Educators </li></ul></ul><ul><ul><li>Biostatisticians & Epidemiologists </li></ul></ul><ul><ul><li>Information/Computer Technologists </li></ul></ul><ul><ul><li>Global Medical Expertise from West Africa </li></ul></ul>
    • 59. Professional Development via Collaboration and Cooperation… <ul><li>Training of Trainers </li></ul><ul><li>15-week intensive trainings for ASOs & CBOs, schools, faith-based initiatives to learn content and implementation </li></ul><ul><li>“ How-To” session on Peer Educator Training </li></ul><ul><li>Fall 2006 will launch in collaboration with OK State Board of Education statewide trainings for public school educators, mainstreaming curriculum into public schools </li></ul><ul><li>Data collection set up through MOA’s with OU HSC </li></ul>
    • 60. Training Effectiveness <ul><li>36 ASOs/CBOs </li></ul><ul><li>Data analyzed using SAS to produce mean scores. </li></ul><ul><li>Any mean score above 3.5 as excellent/strongly agree; 2.5-3.5 as good/agree; 1.5-2.5 as fair/disagree; and below 1.5 poor/strongly disagree. </li></ul><ul><li>Four questions (#1-4) reflect evaluation of instructor and the implementation of the training. </li></ul><ul><li>Second set of five questions (#5-9) asked participants to assess their knowledge, attitudes, behaviors, and beliefs about the training </li></ul><ul><li>A final question (#10) was asked to determine the extent to which participants would recommend training to colleagues </li></ul><ul><li>Responses possible for the first 4 questions were: excellent, good, fair, poor. </li></ul><ul><li>Responses possible for the second set of questions were: strongly agree, agree, disagree, strongly disagree. </li></ul><ul><li>Responses possible for #10 was yes, no, then open-ended to allow for personal comment. </li></ul>
    • 61. Training Effectiveness… <ul><li>Instructor’s knowledge of training content was: 4.0 Excellent </li></ul><ul><li>Instructor’s ability to present content in a well-organized, understandable, and engaging fashion: 4.0 Excellent </li></ul><ul><li>Curriculum, Facilitator’s Guide and other training materials used were: 3.90 Excellent </li></ul><ul><li>Overall, the training was: 3.94 (Excellent) </li></ul>
    • 62. Training Effectiveness… <ul><li>5. As a result of this training I feel prepared to implement The Courage to Say KNOW: 3.74 Strongly Agree </li></ul><ul><li>The training goals and objectives were obtained: 3.77 Strongly Agree </li></ul><ul><li>The time and effort I spent for this training was worthwhile: 3.87 Strongly Agree </li></ul><ul><li>8. This training afforded me an opportunity to collaborate and bond with other ASOs/CBOs: 3.71 Strongly Agree </li></ul><ul><li>A supportive environment was maintained throughout the training: 3.87 Strongly Agree </li></ul><ul><li>10. Would you recommend this training to a colleague: 100% said Yes </li></ul>
    • 63. Volunteer Development…All Working Together … <ul><li>Other trainings: </li></ul><ul><li>Peer educators </li></ul><ul><li>Youth organizations </li></ul><ul><li>Parents and PTAs (How to Talk to Your Teens About HIV/STDs) </li></ul><ul><li>Parent Universities </li></ul><ul><li>Group homes/shelters </li></ul><ul><li>After School Programs </li></ul><ul><li>Juvenile Justice </li></ul><ul><li>Faith-based youth initiatives </li></ul><ul><li>Other advocates for youth </li></ul>
    • 64. Comprehensive Marketing Orientation – Social Marketing Theory <ul><li>Combining education with services and products to effectively communicate and encourage adoption of appropriate health practices </li></ul><ul><li>Target-specific advertising, education campaigns, interpersonal communication </li></ul><ul><li>IDI – Titles II, III, IV </li></ul><ul><li>Youth-friendly care -- Adolescent Medicine Clinic </li></ul><ul><li>Relationships built on trust that are nurtured through on-going support </li></ul><ul><li>Considers the “whole” adolescent, not just in terms of HIV/AIDS/STDs </li></ul>
    • 65. Preliminary Data… <ul><li>1,182 participants of 130 courses </li></ul><ul><li>Data analyzed using SAS to produce mean scores. </li></ul><ul><li>Any mean score above 3.5 as excellent; 2.5-3.5 as good; 1.5-2.5 as fair; and below 1.5 poor. </li></ul><ul><li>Four questions (#1-4) reflect evaluation of instructors and the conduct of the course. </li></ul><ul><li>Second set of four questions (#5-8) asks participants to assess their knowledge, attitudes, behaviors, and beliefs obtained from the course. </li></ul><ul><li>A final question (#9) was asked to determine the extent to which participants would share vital information with peers and encourage others to participate. </li></ul><ul><li>Responses possible for the first 4 questions were: excellent, good, fair, poor. </li></ul><ul><li>Responses possible for the second set of questions were: strongly agree, agree, disagree, strongly disagree. </li></ul><ul><li>Responses possible for #9 was yes, no, then open-ended to allow for personal comment. </li></ul>
    • 66. Preliminary Data… <ul><li>Questions: </li></ul><ul><li>1. Instructor’s ability to answer questions was: </li></ul><ul><li>2. Instructor’s knowledge of subject was: </li></ul><ul><li>3. Materials used were: </li></ul><ul><li>4. Overall, the class was: </li></ul><ul><li>All mean scores on the first four questions (1-4) were above 3.8, regardless of the target population or time of year presented. </li></ul><ul><li>The courses were extremely well received by the participants who thought the courses were presented well and that they learned something from the courses </li></ul>
    • 67. Preliminary Data… <ul><li>5. As a result of this class I know how and where a person can get tested/ treated for STDs/HIV: </li></ul><ul><li>6. As a result of this class I know the most common STDs, signs and symptoms: </li></ul><ul><li>7. As a result of this class I know what behaviors put me at risk of getting HIV/STDs: </li></ul><ul><li>8. As a result of this class I am confident that I can carry out a personal plan of action to protect myself from HIV/STDs: </li></ul><ul><li>9. Would you recommend this class to your peers? Why or why not? </li></ul><ul><li>All mean scores of the second four questions (5-8) produced results from 3.81 to 3.85, indicating the participants “strongly agree” concerning their knowledge gained from participation in the courses and their ability to carry out a personal plan of action for protection. </li></ul><ul><li>At least 90% of the participants said the course helped and that they would share the information and recommend the program to their peers. </li></ul>
    • 68. Where do we go from here…
    • 69. OU HSC/CH  RTS is Ready to Help…Coordinated School Health Programs (8 Component Model) <ul><li>Health Education </li></ul><ul><li>Physical Education </li></ul><ul><li>Health Services </li></ul><ul><li>Nutrition Services </li></ul><ul><li>Counseling, Psychological, Social Services </li></ul><ul><li>Healthy School Environment </li></ul><ul><li>Health Promotion Staff </li></ul><ul><li>Family/Community Involvement </li></ul>
    • 70. Young People Deserve a Voice… <ul><li>Youth-Friendly Clinics, Youth Councils, Youth Advisory Boards. Young people deserve – </li></ul><ul><ul><li>the right to speak for their needs, and their quality of health care </li></ul></ul><ul><li>7 Principals of Best Practices in Youth Health include: </li></ul><ul><li>Accessibility </li></ul><ul><li>Youth Participation </li></ul><ul><li>Medically Accurate, Evidenced-Based Approach </li></ul><ul><li>Professional Development </li></ul><ul><li>Sustainability </li></ul><ul><li>Evaluation </li></ul>
    • 71. Unlocking the Doors to Quality HIV/STD Education for Youth: Recommendations: <ul><li>Make certain curriculum is medically accurate, evidenced-based </li></ul><ul><li>Include asset-building skills </li></ul><ul><li>Do not ignore the linkage between sexual and reproductive health and HIV </li></ul><ul><li>Start a “youth council” </li></ul><ul><li>Get parents involved </li></ul><ul><li>Open forum discussions so everyone can be part of the solution </li></ul><ul><li>Collaborate to support changes in sexual health education, including options that are respectful of all youths </li></ul>
    • 72. Partnerships Built on Credibility and Trust… Education Built on Accuracy and Evidence… <ul><li>When these key components are intact, everyone becomes a shareholder in the fight against HIV/AIDS/STDs and teen pregnancy </li></ul><ul><li>Efforts of cooperation and collaboration greatly improving overall health for young people. </li></ul>
    • 73. Talk to Youths… <ul><li>#1 thing all youths say they want is to hear from parent(s) or guardian(s): </li></ul><ul><ul><li>“ I love you” </li></ul></ul><ul><li>To have their parent(s), guardian(s), undivided attention some of the time, without feeling that their parent(s) or guardian(s) are obligated. </li></ul><ul><li>Validates that: </li></ul><ul><ul><li>“ I am important.” </li></ul></ul><ul><li>Remember: There is a direct correlation between risk behavior and low self-esteem </li></ul>
    • 74. “ All I ever wanted was to know I mattered.” --17-year-old male
    • 75. This presentation was developed by: University of Oklahoma Health Sciences Center Dept. of Medicine, Section of Infectious Diseases Dept. of Pediatrics, Section of Adolescent Medicine with support from a Ryan White Title IV Grant For More Information or to Schedule a Training Please Call: Jana B. Knol, M.Ed Robert Settles, LCSW (405) 271-6235
    • 76. Major Sources <ul><li>This presentation uses information from a variety of nationally representative surveys from federal and private agencies. The data sources include surveys of school superintendents, teachers, students and the general public. Other data and sources include international statistics from a range of sources. Evaluation research results on the effectiveness of sex education programs and policy analysis conducted by the University of Oklahoma Health Sciences Center, the National Campaign to Prevent Teen Pregnancy, the Centers for Disease Control and Prevention, the Alan Guttmacher Institute, ETR Associates, SIECUS, Family Health International, Advocates for Youth, The Kaiser Family Foundation, Cicatelli Assoc., World Health Organization, UNAIDS </li></ul>
    • 77. Major Sources <ul><li>Other Sources </li></ul><ul><li>Teenage pregnancy statistics </li></ul><ul><li>Adolescent Focus Groups </li></ul><ul><li>Evaluation research–National Campaign to Prevent Teen Pregnancy, ETR Associates, SIECUS, Alan Guttmacher Institute, Kaiser Family Foundation, Advoactes for Youth </li></ul><ul><li>Federal law and policy </li></ul><ul><li>Statements on sex education from national organizations </li></ul><ul><li>Policy analysis from CDC, WHO, UNAIDS </li></ul>
    • 78. Scientific Literature <ul><li>Bearman, P., Bruckner, H. “Promising the future: Virginity pledges and the transition to first intercourse .” Amer J of Sociology Vol. 106, No. 4(2001), pp 859-912. </li></ul><ul><li>Bearman, P, Bruckner, H. “The Relationship Between Virginity Pledges in Adolescence and STD Acquisition in Young Adulthood. After the Promise: The Long-Term Consequences of Adolescent Virginity Pledges .” National STD Prevention Conference, Philadelphia, PA, March 9, 2004. </li></ul><ul><li>Professional Data Analysts, Inc. & Professional Evaluation Services. “Minnesota Education Now and Babies Later Evaluation Report 1998-2002.” Prepared for the MN Dept. of Health, January 2004. </li></ul><ul><li>LeCroy & Milligan Assoc., Inc. “Final Report Arizona Abstinence Only Education Program 1998-2003.” Prepared for the AZ Dept of Health, June 2003. </li></ul><ul><li>Brenen, N, Lowry, R, et al. “Trends in sexual risk behaviors among high school students in the U.S. 1991-2001.” Morbidity & Mortality Weekly Report , 51(38): 856-859, Sept. 27, 2002. </li></ul><ul><li>Devaney, B., Johnson, A., et al. “The evaluation of abstinence education programming funded under Title V Section 510: Interim Report.” Princeton, NJ: Mathematica Policy Research, Inc., 2002. </li></ul>
    • 79. Scientific Literature <ul><li> Global Implications of US Domestic and International Policies on Sexuality </li></ul><ul><li>“ Toward a Sexually Healthy America: Roadblocks Imposed by the Federal Government’s Abstinence-Only-Until-Marriage Education Program.” Advocates for Youth and SIECUS, 2001. </li></ul><ul><li>CDC. “Youth risk behavior surveillance-US, 2003.” In: Surveillance summaries . MMWR 2004:53 (No. SS-2), May 21, 2004. </li></ul><ul><li>CDC. “Surveillance summaries.” MMWR 2006:55/SS-5, June 9, 2006. </li></ul><ul><li>Cates, JR, Herndon, NL, Schulz, SL, & Darroch, JE. “Our Voices, Our Lives, Our Futures: Youth and Sexually Transmitted Diseases.” School of Journalism & Mass Communication, University of North Carolina, Chapel Hill, NC 2004. </li></ul><ul><li>Kirby, Douglas, Laris, B.A., Rolleri, Lori. “The Impact of Sex and HIV Education Programs in Schools and Communities on Sexual Behaviors among Young Adults.” Family Health International, Research Triangle Park, NC, 2006. </li></ul><ul><li>U.S. Dept. of Health & Human Services. “Healthy People 2010: Objectives for Improving Health” (Objective No. 25 STDs). </li></ul><ul><li>“ Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made?” Occasional Report, New York: AGI, 2001, No. 3. </li></ul>
    • 80. <ul><li>Scientific Literature </li></ul><ul><li> Jemmott JB, Jemmott LS and Fong GT. “Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial.” JAMA , 1998, 279(19):1529-1536. </li></ul><ul><li>Dailard C. “Abstinence promotion and teen family planning: the misguided drive for equal funding.” The Guttmacher Report on Public Policy , 2002, Vol. 5, No. 1, pp. 1-3. </li></ul><ul><li>Behavioral Risk Factor Surveillance System. www.cdc.gov/brfss . </li></ul><ul><li>YRBSS: National Youth Risk Behavior Survey: 1991-2005. www.cdc.gov/yrbss . </li></ul><ul><li>Kirby, D. “What does the research say about sexuality education?” Educational Leadership , October 2000, p. 74. </li></ul><ul><li>SIECUS/Advocates for Youth . “Survey of Americans’ Views on Sexuality Education”. (Washington, DC: Sexuality Information Council of the United States, and Advocates for Youth, 1999). </li></ul><ul><li>Spencer, J.M., et al. “Self-esteem as a predictor of initiation of coitus in early adolescents.” Pediatrics , 109(4), 581-584, 2003. </li></ul><ul><li>“ Improving the Health of Adolescents and Young Adults: A Guide for States and Communities.” CDC, Division of Adolescent Health, 2004. </li></ul>
    • 81. <ul><li>Scientific Literature </li></ul><ul><li>The Henry J. Kaiser Family Foundation. “Talking with Kids about Tough Issues: A National Survey of Parents and Kids, Questionnaire and Detailed Results”. Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2001. </li></ul><ul><li>The Henry J. Kaiser Family Foundation. “Sex Education in America: A View from Inside the Nation’s Classrooms.” Chart Pack. Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2000, chart 9. </li></ul><ul><li>“ Sexual Health Education Does Lead to Safer Sexual Behaviour—UNAIDS Review” Press Release, Joint United Nations Programme on HIV/AIDS, October 22, 1997. </li></ul><ul><li>Whitaker and K. S. Miller, “Parent-adolescent discussions about sex and condoms: Impact on peer influences of sexual risk behaviors,” Journal of Adolescent Research , March 2000, vol. 15, no. 2, pp. 251-73. </li></ul><ul><li>U.S. Dept. of Health & Human Services. (2003). “Toward a blueprint for youth: Making positive youth development a national priority.” www.acf.dhhs.gov/programs/fysb/youthinfo/blueprint.htm . </li></ul><ul><li>Gallagher, J.M. “Health care for adolescents: Are we meeting developmental needs?” J. Amer. Acad. Nurse Practitioners , 11(6), 253 (2003). </li></ul><ul><li>Bandura, A. “Social Foundations of Thought & Actions.” Englewood Cliffs, NJ. Prentice-Hall, 1986. </li></ul><ul><li>Bandura, A. “Social Learning Theory.” Englewood Cliffs, NJ. Prentice-Hall, 1977. </li></ul><ul><li>Landry DJ, Kaeser L and Richards CL. “Abstinence promotion and the provision of information about contraception in public school district sexuality education policies.” Family Planning Perspectives , 1999, 31(6):280-286. </li></ul>
    • 82. Scientific Literature <ul><li>Park, Alice. “What makes teens tick.” Time . May 10, 2004. </li></ul><ul><li>Weinberger, D.R., Elvevag, B., Giedd, J.N. “The Adolescent Brain: A Work in Progress.” The National Campaign to Prevent Teen Pregnancy. June 2005. </li></ul><ul><li>Wilburn, D.A. “It’s not really sex.” Family Circle . October 19, 2004. </li></ul><ul><li>“ Hearing Their Voices: A Qualitative Research Study on HIV Testing and Higher-Risk Teens.” The Henry J. Kaiser Family Foundation. June 1999. </li></ul><ul><li>The National Campaign to Prevent Teen Pregnancy. “This is My Reality: The Price of Sex.” Motivational Educational Entertainment, Philadelphia, PA. January 2004. </li></ul><ul><li>DuRant, R.H., et al. “An evaluation of a mass media campaign to encourage parents of adolescents to talk to their children about sex.” J. Adol. Hlth . Vol. 38; No. 3: pp. 298.e1-298.e9. March 2006. </li></ul><ul><li>Whetten, K., et al. “Prevalence of childhood sexual abuse and physical trauma in an HIV-positive sample from the deep south.” Amer. J. Public Hlth. Vol. 96; No. 6: pp. 1028-1030. June 2006. </li></ul><ul><li>Ohene, Sally-Ann, et al. “Sexual abuse history, risk behavior, and sexually transmitted diseases: The impact of age at abuse.” Sexually Transmitted Diseases . Vol. 32; No. 6: pp. 358-363. June 2005. </li></ul><ul><li>Petrak, J., Byrne, A., Baker, M. “The association between abuse in childhood and STD/HIV risk behaviours in female genitourinary (GU) clinic attendees.” Sex Transm Inf 2000; 76: 457-461. </li></ul>

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