Purpose

This study is part of a larger evaluation of a multilevel, multistrategy federal program to reduce high school students' risk for HIV/sexually transmitted infection and unintended pregnancy. Local education agencies supported schools in implementing three strategies: delivering exemplary sexual health education, increasing student access to quality sexual health services, and enhancing safe and supportive school environments (SSE). We examined how levels of school implementation of these strategies moderated program effects on targeted student outcomes.

Methods

The Youth Risk Behavior Survey was implemented in participating local education agencies in 2015 and 2017 to assess student behaviors and experiences, whereas the School Health Profiles surveys assessed school policies and practices in 2014 and 2016. We used these surveys to measure student-level outcomes and school-level program delivery, respectively, which were analyzed using multilevel modeling in a difference-in-differences framework.

Results

Levels of SSE implementation significantly moderated program effects on multiple student outcomes, including ever having sex, having four or more lifetime sexual partners, being sexually active, using hormonal birth control, dual use of a condom and hormonal birth control, ever being forced to have sex, missing school because of safety concerns, and lifetime and current marijuana use. However, we found few moderating effects of exemplary sexual health education and sexual health services dosage.

Discussion

We found a significant relationship between incremental increases in implementation of activities to increase the safety and supportiveness of school environments and enhanced program effects in improving multiple student health outcomes. These findings suggest that school implementation of SSE activities contributed to intended program effects.

中文翻译：

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实施有效的校本健康计划的剂量会影响青少年的健康风险行为和经历

目的

这项研究是一项多层次、多策略联邦计划的更大规模评估的一部分，该计划旨在降低高中生感染艾滋病毒/性传播感染和意外怀孕的风险。当地教育机构支持学校实施三项战略：提供模范性健康教育、增加学生获得优质性健康服务的机会以及改善安全和支持性的学校环境（SSE）。我们研究了学校实施这些策略的水平如何调节项目对目标学生成绩的影响。

方法

青年风险行为调查于 2015 年和 2017 年在参与的当地教育机构中实施，以评估学生的行为和经历，而学校健康概况调查则评估 2014 年和 2016 年的学校政策和实践。我们使用这些调查来衡量学生水平的结果和分别是学校层面的项目交付，并在双重差异框架中使用多层次建模进行分析。

结果

SSE 实施水平显着调节了项目对多种学生结果的影响，包括曾经发生过性行为、有四个或更多终生性伴侣、性活跃、使用激素避孕、双重使用避孕套和激素避孕、曾经被迫过性行为性行为、因安全问题而缺课以及终生和当前吸食大麻。然而，我们发现模范性健康教育和性健康服务剂量几乎没有调节作用。

讨论

我们发现，为提高学校环境的安全性和支持性而开展的活动的逐步增加与改善多种学生健康结果的计划效果的增强之间存在显着关系。这些结果表明，学校实施 SSE 活动有助于达到预期的计划效果。