Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial,The Lancet Public Health

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Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial
The Lancet Public Health ( IF 25.4 ) Pub Date : 2022-06-29 , DOI: 10.1016/s2468-2667(22)00117-7
Maria Lohan ₁ , Aoibheann Brennan-Wilson ₁ , Rachael Hunter ₂ , Andrea Gabrio ₃ , Lisa McDaid ₄ , Honor Young ₅ , Rebecca French ₆ , Áine Aventin ₁ , Mike Clarke ₇ , Clíona McDowell ₈ , Danielle Logan ₈ , Sorcha Toase ₈ , Liam O'Hare ₉ , Chris Bonell ₆ , Katie Gillespie ₉ , Aisling Gough ₁ , Susan Lagdon ₁₀ , Emily Warren ₆ , Kelly Buckley ₁₁ , Ruth Lewis ₁₂ , Linda Adara ₁₃ , Theresa McShane ₁₄ , Julia Bailey ₁₅ , James White ₁₆

Affiliation

School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
Health Economics Analysis and Research Methods Team, University College London, London, England, UK.
Department of Methodology and Statistics (FHML), Maastricht University, Maastricht, Netherlands.
MRC-CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK; Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia.
Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, Wales, UK.
Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, England, UK.
School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK; Northern Ireland Clinical Trials Unit, Belfast, Northern Ireland, UK.
Northern Ireland Clinical Trials Unit, Belfast, Northern Ireland, UK.
School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK.
School of Psychology, Ulster University, Coleraine, Northern Ireland, UK.
Y Lab, School of Social Sciences, Cardiff University, Cardiff, Wales, UK.
MRC-CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK.
Centre for Trials Research, Cardiff University, Cardiff, Wales, UK.
School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK.
E-Health Unit, University College London, London, England, UK.
Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, Wales, UK; Centre for Trials Research, Cardiff University, Cardiff, Wales, UK.

Background

The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex.

Methods

This cluster-randomised trial with process and economic evaluations tested a school-based intervention entitled If I Were Jack versus standard RSE (control) for students (aged 14–15 years) in UK schools. Schools were randomly allocated (1:1) and masked to allocation at baseline. The primary outcome was self-reported avoidance of unprotected sex (sexual abstinence or use of reliable contraception at last sex) after 12–14-months. We analysed the data using intention-to-treat mixed effects regression models.

Findings

Of 803 schools assessed for eligibility, 263 schools were invited by letter, of which 66 schools agreed to be randomly assigned, of which 62 schools completed follow-up. The trial was done between Feb 1, 2018, and March 6, 2020. 8216 students participated at baseline in 2018; 6561 (79·85%) provided 12–14 months follow-up. There was no significant difference in the primary outcome of avoidance of unprotected sex: 2648 (86·62) of 3057 in the intervention group avoided unprotected sex versus 2768 (86·41%) of 3203 in the control group (adjusted odds ratio [aOR] 0·85 [95% CI 0·58–1·26], p=0·42). Exploratory post-hoc analysis of the two components of the primary outcome showed that significantly more intervention students used reliable contraception at last sex compared with control students and there was no significant difference between the groups for sexual abstinence. No adverse events were reported.

Interpretation

The intervention had a null effect on the primary outcome of preventing unprotected sex (increasing sexual abstinence or use of reliable contraception) in the whole student population. However, the results showed significant increases in use of reliable contraceptives for sexually active students. Engaging all young people early through RSE is important so that as they become sexually active, rates of unprotected sex are reduced.

Funding

National Institute for Health Research.

中文翻译：

改变性别的关系和性教育对减少青少年怀孕的影响（JACK 试验）：一项整群随机试验

背景

世卫组织支持让男孩参与改变性别的关系和性教育（RSE）以减少青少年怀孕的必要性。我们的目的是测试一种干预措施，该干预措施使用一种改变性别的方法让青少年参与 RSE，以防止无保护的性行为。

方法

这项包含过程和经济评估的整群随机试验测试了一项名为 If I Were Jack 的学校干预与英国学校学生（14-15 岁）的标准 RSE（对照）。学校被随机分配 (1:1) 并在基线时隐藏分配。主要结果是 12-14 个月后自我报告避免无保护性行为（性禁欲或在最后一次性行为时使用可靠的避孕措施）。我们使用意向治疗混合效应回归模型分析了数据。

发现

803所学校进行资格评估，263所学校通过信函邀请，其中66所学校同意随机分配，其中62所学校完成随访。该试验于 2018 年 2 月 1 日至 2020 年 3 月 6 日期间进行。2018 年有 8216 名学生参加了基线；6561 (79·85%) 人提供了 12-14 个月的随访。避免无保护性行为的主要结果没有显着差异：干预组 3057 人中有 2648 人 (86·62) 避免了无保护性行为，而对照组 3203 人中有 2768 人 (86·41%) 避免了无保护性行为（调整优势比 [aOR ] 0·85 [95% CI 0·58–1·26]，p=0·42)。对主要结果的两个组成部分的探索性事后分析表明，与对照组学生相比，干预学生在末次性行为中使用可靠避孕措施的人数显着增加，并且在性禁欲方面两组之间没有显着差异。未报告任何不良事件。