Original Article
Effects of an Interprofessional Student-Led Sexual Education Program on Self-Efficacy and Attitudes About Sexual Violence in Youths in Juvenile Detention

https://doi.org/10.1016/j.jpag.2019.12.005Get rights and content

Abstract

Study Objective

We aim to explore the impact of an interprofessional graduate student−led sexual education curriculum on sexual self-efficacy, perceived importance of sexual consent, and willingness to intervene against sexual violence in the high-risk population of detained youths.

Design, Setting, and Participants

Medical, nursing, social work, and physician assistant students implemented a 3-session, comprehensive sexual health curriculum for detained youths (n = 253).

Interventions and Main Outcome Measures

The curriculum from Son et al (2017) was adapted to include a more targeted curriculum on consent and safe relationships. Youths completed pre- and postintervention assessments that evaluated their sexual self-efficacy and violence-related beliefs and behaviors.

Results

Detained youths completing the curriculum showed statistically significant increases in the sexual self-efficacy (P < .001), view of the importance of consent (P < .001), and willingness to intervene (P = .0027). The subset of male individuals and adolescents aged 17-19 years achieved statistically significant improvement in each category; adolescents aged 12-14 years did not. Female participants showed statistically significant improvement in sexual self-efficacy scores only.

Conclusions

The curriculum addressing topics of consent and sexual violence was effective in improving detained youths’ belief in their ability to safely navigate a sexual encounter and their attitudes toward sexual assault. Additional research on gender- and age-specific programming and the long-term impact on sexual health risk behaviors is needed.

Introduction

Youths incarcerated in the juvenile justice system represent a group of adolescents at particularly high risk for engaging in risky sexual behaviors. Compared to their nonincarcerated peers, detained youths initiate sexual activity at earlier ages, have more sexual partners, use contraception less reliably, use drugs or alcohol during sex more frequently, and experience higher rates of sexually transmitted infections.1, 2, 3, 4, 5, 6 These individuals face the added limitations of decreased access to a standardized sexual health curriculum during periods of incarceration. Detainees often miss school-based interventions and have limited access to health care, resulting in a lack of exposure to sexual health information and limited knowledge of reproductive health services.5, 6, 7 In addition, great overlap exists between the risk factors for youth violence and sexual violence. Notably, adolescent delinquency has been linked to sexual violence perpetration later in life in many studies.8, 9, 10, 11 A study looking specifically at adolescent girls involved in the justice system demonstrated a high prevalence of dating violence in this population, with the strongest predictors of victimization being early age of sexual debut, unwillingness of initial sexual experience, drug use, and low self-efficacy about preventing dating violence.12 The population of detained youths represents a unique group at a high risk for sexual assault. Therefore, periods of incarceration represent an important opportunity to provide health interventions to this population.

Sexual education programs targeting youths in juvenile detention have proved to be efficacious, consistently reporting improvement in sexual health knowledge, condom use skills, perceptions of risk-reducing behaviors, and risky sexual behavior change.13, 14, 15, 16 In 2017, Son et al reported on an innovative sexual health program for detained youths in Cleveland, Ohio, that demonstrated improvement in knowledge regarding sexually transmitted infections and condom use self-efficacy.17 In this program, interprofessional teams of graduate students from nursing, medical, and social work schools taught sexual health education to groups of youths and showed a benefit to both youths and student teachers.17

This study also uses interprofessional teams of students and explores whether a comprehensive sexual education program, including education on consent and safe relationships delivered at the Cuyahoga County Juvenile Detention Center (CCJDC) in Cleveland, Ohio, has an impact on perspectives regarding sexual violence. In this study, we explore sexual self-efficacy, which we define as the belief in one's ability to make decisions and to have control over one's sexual encounters. Our objectives are to determine whether this sexual health education program can lead to a significant improvement in detained youths' (a) sexual self-efficacy, (b) perceived importance of sexual consent, and (c) willingness to intervene against sexual violence.

Section snippets

Study Design and Participants

Between September 2017 and December 2018, interprofessional student teams conducted 9 sexual health education interventions, lasting 3 days each. A total of 253 youths residing at the CCJDC in Cleveland, Ohio, were enrolled, with ages ranging from 12 to 19 years. All youths were required to attend the education sessions as part of their mandatory in-house curriculum; however, participation in the group activities, discussions, and surveys was voluntary. Organization of the youths into teaching

Results

In total, 253 youths at the CCJDC completed the demographics and sexual risk characteristic portion of the surveys. Of those, 149 (59%) completed both pre and post surveys.

Discussion

The results of this study demonstrate that adolescent detainees may benefit from sexual health education interventions that include content on consent and safe relationships. Although many studies have independently focused on sexual education programs for detained youths14,17 and sexual violence prevention programs in adolescents and college populations,21, 22, 23, 24 none have reported specifically on the impact of educational interventions on attitudes on consent and sexual violence in the

Acknowledgments

We would like to thank the many caring individuals who offered their help, expertise, and resources to support our project. Without the establishment of this program by Dr. Jessica Son and Willa Miller, this project would not have been possible. We thank our parent organization, the Student Run Health Clinic of CWRU, who provided support and advising on our project development and the Key Bank Foundation for its support of the Student Run Health Clinic of CWRU. We would like to thank Ms.

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    • The authors report no conflicts of interest.

    No funding was provided for this work.

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    © 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.