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The scope and nature of sexuality education in Florida public high schools

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The scope and nature of sexuality education in Florida public high schools
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vi, 168 leaves : ill. ; 29 cm.

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Birth control ( jstor )
Condoms ( jstor )
Education ( jstor )
Human sexual behavior ( jstor )
Schools ( jstor )
Sex education ( jstor )
Sexual abstinence ( jstor )
Sexually transmitted diseases ( jstor )
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Dissertations, Academic -- Health and Human Performance -- UF ( lcsh )
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Thesis (Ph. D.)--University of Florida, 1997.
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Includes bibliographical references (leaves 162-167).
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Typescript.
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Vita.
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by Michele Johnson Moore.

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THE SCOPE AND NATURE OF SEXUALITY EDUCATION
IN FLORIDA PUBLIC HIGH SCHOOLS

















BY
MICHELE JOHNSON MOORE

















A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


1997














ACKNOWLEDGMENTS

I would like to sincerely thank all those who were instrumental in helping me

achieve a lifelong goal-- receiving my doctor of philosophy degree. My committee chair, Barbara Rienzo, has been a true mentor. She willingly offered her professional guidance and was committed to ensuring my education was a valuable learning experience. My committee members, David Miller, Morgan Pigg, and Sandra Seymour, provided professional guidance, encouragement, and a supportive environment for this learning experience.

My parents, Lawrence and Veronica Johnson, provided me with a life full of love and support, always believing that I could accomplish anything.

Foremost, I would like to thank my husband, Paul Moore, who provided with me everything he could throughout this experience--his unconditional love, support, patience, and understanding--even assistance with stamping, coding, and proofing! I am truly fortunate to have married this wonderful human being, my best friend.














TABLE OF CONTENTS

pge

ACKNOW LEDGM ENTS ................................................ ii

A B ST R A C T ............................................................ v

CHAPTERS

I IN TRODU CTION ........................................... 1

Statement of Research Problem ................................. 3
Purpose of the Study ......................................... 4
N eed for the Study ........................................... 5
D elim itations .............................................. 14
L im itations ................................................ 15
A ssum ptions ............................................... 15
Research Questions ......................................... 16
D efinition of Term s ......................................... 17

2 REVIEW OF LITERATURE ................................. 21

Comprehensive School-based Sexuality Education ................. 23
The Status of School-based Sexuality Education in the U.S ......... 30
Other Factors in the Implementation of School-based Sexuality
E ducation ........................................... 50
C onclusion ................................................ 63

3 MATERIALS AND METHODS ............................... 66

Introduction ............................................... 66
Subjects .................................................. 66
Instrum entation ............................................ 68
Data Collection Procedures ................................... 72
A nalysis of D ata ............................................ 73








4 R E SU LT S ................................................ 76

The Context of Sexuality Education in Florida Schools ............. 76
The Scope and Nature of Sexuality Education in Florida Schools ..... 81 Factors Effecting the Implementation of Sexuality Education ........ 91

5 CONCLUSIONS AND IMPLICATIONS ....................... 119

The Context of Sexuality Education in Florida Schools ............ 119
The Scope and Nature of Sexuality Education in Florida Schools .... 125 The Effects of District Variables on Sexuality Education ........... 135
Conclusions and Recommendations ........................... 138

APPENDIX

SURVEY AND CORRESPONDENCE ........................ 143

R EFER EN CES ....................................................... 162

BIOGRAPHICAL SKETCH ............................................. 168














Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

THE SCOPE AND NATURE OF SEXUALITY EDUCATION IN FLORIDA PUBLIC HIGH SCHOOLS By

Michele Johnson Moore

May 1997

Chairperson: Barbara A. Rienzo
Major Department: Health and Human Performance (Health Science Education)

The status of comprehensive school-based sexuality education in the U.S. was examined in a review of the literature. Although research demonstrates these programs are needed, have proven effective and are supported at local and state levels, there is relatively little known about classroom implementation of sexuality education. This study was undertaken to provide a comprehensive and current assessment of the status of sexuality education in Florida public high schools. The components assessed included the scope of sexuality education topics; the nature of STD/HIV and pregnancy prevention information; the teaching methods and skills-building activities utilized; time spent on the whole unit, as well as individual topics within it; and teacher, school, and district variables that may have effected implementation. Also, as sexuality education is mandated in Florida, results were used to help determine compliance. The survey was








developed using three established instruments. It was sent to 500 health and family and consumer science teachers, yielding a 56% response rate. Results found that the majority of respondents were teaching sexuality education and thought it was the appropriate role of the school to do so. Most teachers covered a variety of important sexuality education topics. However, there were problems apparent with both the content and context of the sexuality education provided. There appeared to be a focus on the negative consequences of sexual activity and not enough emphasis on skills-building activities to help enable students make responsible decisions and avoid STDs/HIV and unwanted pregnancy. There are many factors that effect the implementation of sexuality education, some of which are beyond the classroom teacher's control. The factors that appeared to have the biggest impact on what was taught included teacher attitudes and status of the class as required or elective. In order to improve sexuality education in Florida schools, teacher training, provision of adequate teaching materials, increased time in the curricula, and increased support from the state, district and schools are needed. These issues and recommendations are addressed.














CHAPTER 1
INTRODUCTION

The negative consequences of risky sexual behavior among adolescents are well known in the United States today. Over half (53%) of all high school students have had intercourse in their lifetime (Kann et al., 1996), with the average age at first intercourse just under 15 years (Teens Talk, 1994). There are one million adolescent female pregnancies each year in the U.S. (Henshaw &Van Vort, 1989), one of the highest rates of any western industrialized country (Kirby et al., 1994). Teenagers have the highest rate of sexually transmitted disease (STD) among sexually active people of any age group (U.S. Department of Health and Human Services (DHHS), 1990). Of the individuals diagnosed with AIDS, approximately one in five are in their twenties. This is significant as the incubation period is about 10 years, meaning most were probably infected as adolescents (Centers for Disease Control and Prevention (CDC), 1995).

The impact of these negative consequences of risky adolescent sexual behavior is far reaching. The social and economic attainment of teen parents, as well as the health of their infants, are compromised (Nord, Moore, Morrison, Brown, & Myers, 1992). HIV and other STDs can affect the physical health, child bearing abilities, and even the lifespan of young adults. AIDS has become one of the leading causes of death among men and women ages 25 to 44 in the U.S. (Kirby et al., 1994).











One way to help decrease the prevalence of negative consequences associated with risky sexual behavior and to promote healthy sexuality is by providing effective sexuality education. Professionals agree that sexuality education is best offered through a comprehensive, skill-based approach, and linked with community resources (Sexuality Information and Education Council of the U.S. (SIECUS), 1992). This approach includes components that target cognitive, affective and skill domains at all school grade levels, and are included as part of a comprehensive school health education program. A broad range of topics should be included as well (Yarber, 1994). Many see sexuality education as a solution to the high incidence of adolescent pregnancy and HIV/STDs. Moreover, promoting a positive view of sexuality is also important (Yarber, 1994).

There is strong support for school-based sexuality education among parents,

national organizations, government, and educators. Ninety percent of parents want their children to receive sexuality education. Over 80% of them want their child to be taught about "safer sex" as a means of preventing HIV/AIDS (Louis Harris & Associates, 1985, 1988; Gallup and Clark, 1987). Over 60 national organizations concur that all children and youth should receive comprehensive school-based sexuality education (SIECUS, 1992). The number of states supporting sexuality education through the development of suggested or mandated guidelines has increased to 47 (Gambrell & Haffner, 1993). Sixty-eight percent of large districts require sexuality education and 80% require AIDS education (Kenney, Guardado, & Brown, 1989).

Government support of school health education, and more specifically sexuality education, is evident in that these programs are essential to achieving the Healthy People










2000 objectives (DHHS, 1990). These objectives serve as a challenge for the level of health that the American society should seek to achieve. Several of the 21 priority areas directly address adolescent sexuality issues, such as Family Planning, HIV Infection, and STDs. Support for school-based sexuality education is also apparent from a practical perspective. Most students attend school before they initiate sexual risk-taking behaviors and a majority are enrolled when they initiate sexual activity. Hence, many see schools as public institutions with great opportunity and responsibility in addressing and reducing sexual risk-taking behaviors (Kirby et al., 1994).

School-based sexuality education programs have proven effective. They have been shown to go beyond increasing knowledge about sexual issues, to actually delay initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, or increase the use of condoms or other contraceptives. These programs have the potential to reduce unintended pregnancies, and rates of sexually transmitted diseases and HIV (Kirby et al., 1994).

Hence, it is evident school-based sexuality education programs can prove effective, and that there is both a need for and support for them. Research needs to document the current status of these programs. Then, that data can be used to help improve sexuality education for our nation's adolescents.



Statement of Research Problem

It is evident school-based sexuality education programs can prove effective, and that there is both a need for and support for them. However, little is known about what is










taught at the classroom level. Research needs to document the current status of these programs. Then, that data can be used to help improve sexuality education for adolescents. This study assessed the scope and nature of sexuality education in Florida public high schools. Information was collected on the scope of sexuality concepts; the nature of the pregnancy and HIV/STD prevention information; the teaching methods and skills-building activities utilized; the time spent on the whole unit as well as individual concepts; and teacher, school, and district factors that may have effected implementation of school-based sexuality education.



Purpose of the Study

The purpose of this study was to assess the scope and nature of sexuality

education in Florida public high schools. It provided baseline data on the scope of sexuality education topics; the nature of STD/HIV and pregnancy prevention information; the teaching methods and skills-building activities utilized; time spent on the whole unit as well as individual topics within it; and teacher, school, and district variables that effected implementation. Also, as Florida mandates sexuality education, results were used to help determine compliance. In addition to providing valuable baseline data, this information could be used to help improve school-based sexuality education and support for those teaching it.








5

Need for the Study

Although research has shown that much support exists for school-based sexuality education at the state, district, and local levels--by teachers, parents, and students themselves--little is known about actual classroom implementation, the extent to which instruction complies with state and district policies (Donovan, 1989). Policy adoption does not always result in effective programming. Few studies have directly surveyed teachers responsible for sexuality education. These studies have been conducted at both the state and national level; however, the components of school-based sexuality education assessed, the extensiveness of the studies, and the individuals surveyed varies. This section reviews classroom implementation of school-based sexuality education, the status of sexuality education in Florida, and other factors important to the implementation of school-based sexuality education.



Classroom Implementation of Sexuality Education

Over the past fifteen years, several studies have been conducted at the national and state level to assess classroom implementation of sexuality education. The national studies were reported by Orr (1982), Sonenstein and Pittman (1984), Louis Harris and Associates (1986), Forrest and Silverman (1989), and Collins et al. (1995). The state studies include Koblinsky and Weeks (1984), Muraskin (1986), Calamidas (1990), Firestone (1994), and Yarber, Torabi and Haffner (in press). There were a variety of research methodologies used, as well as criteria for assessing the sexuality education.










This criteria has evolved over the years, as have sexuality education programs, to encompass a more comprehensive curricula.

The research methodology used included secondary analysis of data, surveys, and case studies. The respondents included random samples of students (Louis Harris, 1986) or teachers (Collins et al., 1995; Firestone, 1994; Forrest & Silverman, 1989; Yarber, Torabi, & Haffner, in press), one teacher from each school (Orr, 1982), lead teachers (Calamidas, 1990), principals, superintendents, or a combination of these (Koblinsky & Weeks, 1984; Muraskin, 1986; Sonenstein & Pittman, 1984). Obviously, data collected from those not actually teaching, as well as from lead teachers who were more involved, might have resulted in an inaccurate portrayal of what was actually being taught.

The sexuality concepts assessed also varied. Most studies included a variety of general sexuality education topics (Firestone, 1994; Koblinsky & Weeks, 1984; Louis Harris, 1986; Muraskin, 1986; Orr, 1982; Sonenstein & Pittman, 1984). One primarily assessed information related to the prevention of STDs/HIV and pregnancy (Forrest & Silverman, 1989). Another looked at educational objectives emphasized by the curricula (Calamidas, 1990). More specific messages related to some sexuality concepts were the main focus of another study (Collins et al., 1995). The most recent of these studies used the SIECUS Guidelines for Comprehensive Sexuality Education to assess the scope of concepts taught (Yarber, Torabi, & Haffner, in press).

With the variation in these studies, it is hard to provide a concrete assessment of the status of sexuality education. However, based on these studies it appears that the most basic sexuality education topics have been the ones most commonly and










consistently taught. These topics include those such as STDs/HIV, sexual anatomy and physiology, sexual development, pregnancy and birth, responsible behaviors, and decision-making. Topics generally considered controversial have consistently been those least often taught. These topics include masturbation, homosexuality, and sexual behavior. Other topics such as abortion, birth control, rape and abuse, and condoms, seem to fluctuate how commonly they are taught. This may be due in part to the variety of approaches that have been used to assess similar concepts. For example, a survey might have asked whether teachers suggested condoms for STD/HIV protection, explained how to use them, actually demonstrated correct use, or told students where to get them.

Results from these studies seem to draw similar conclusions--a base-level of sexuality education is provided, but it is not at a level where it could or should be. Sonenstein and Pittman (1984) found extensive variation in school districts' provision of sexuality education. They reported that many provided sexuality education, but far fewer offered in-depth and timely coverage of important topics. Louis Harris (1986) concluded that only 35% of teens received what they considered to be comprehensive sexuality education. Forrest and Silverman (1989) indicated that teachers focused more on helping adolescents avoid pregnancy and STDs/HIV than on the full range of sexuality education. Firestone (1994) reported that although almost all students were exposed to sexuality education, the actual instruction provided did not correspond with profiles of sexuality education programs that have been most successful. Most recently, Collins et al. (1995) reported that although many teachers included sexuality education topics, increased











coverage of priority health issues for youth--including pregnancy prevention and STD prevention--was necessary to strengthen school health education in the future.

Overall, it appears a base-level of sexuality education concepts have been

provided in classes, although it does not seem consistent with that found in programs proven effective. Further assessment using updated and comprehensive measures of sexuality education are necessary to better determine the status of school-based sexuality education and the impact of state and district guidelines/mandates. Minimally, improvements in both the scope and nature of sexuality education concepts taught are necessary to have an impact on students' knowledge, attitudes, and behaviors.



The Status of School-based Sexuality Education in Florida

Since 1973, Florida has required comprehensive health education for students in kindergarten through twelfth grade. In 1987, the Florida legislature mandated AIDS education in middle and high schools. In 1990, age-appropriate human sexuality education for grades kindergarten through twelve was added as a component of Florida's comprehensive health education law. In 1991, the School Improvement and Accountability Act passed by the Florida legislature returned education decision-making to its districts (Report, 1994).

The Red Ribbon Panel on AIDS was convened by governor Chiles in 1992 to develop specific recommendations on ways to improve the state's HIV/AIDS education and prevention programs. This panel reported that health education, including AIDS education, was inconsistent and of varying quality around the state, as well as subject to











local politics (Report, 1994). Hence, in 1994, Florida's Department of Education (DOE) and Health and Rehabilitative Services (HRS) issued the Report of the HIV/STD Prevention and Human Sexuality Education Task Force: Components of Quality HIV/STD Prevention and Human Sexuality Education (Components). This report was to assist Florida school districts in implementing quality comprehensive sexuality/HIV education (Report, 1994).

A 1995 study by SIECUS reviewed state education agency (SEA) HIV/AIDS prevention and sexuality education programs. They reported that the Florida SEA indicated all school districts implemented sexuality education, even though no state regulations monitored its implementation. Although Florida did not require training or certification of sexuality education teachers, it did encourage and provide training opportunities. There was no state committee to develop, review, or recommend materials to be taught at various grade levels; however, according to SIECUS, localities had such committees in place. SIECUS recommended requiring training and certification of sexuality education teachers and the development of a state level agency (Gambrell & Patierno, 1995).



Other Factors in the Implementation of School-based Sexuality Education

State and district support of school-based sexuality education, through

guidelines/mandates and the comprehensiveness of sexuality related concepts taught are important factors in the provision of sexuality education. However, there are other factors that effect the delivery of these concepts. Appropriate teaching materials need to










be available and current. Teaching methods and skills-building activities need to target all learning domains so that students are able to process and actually use the information learned. The time spent on teaching sexuality education needs to be sufficient enough to allow coverage of all topics, as well as time for synthesizing and practicing related skills. Training and certification of teachers are necessary not only to increase knowledge, but also comfort levels with subject matter, and hence likelihood of teaching it. Finally, positive attitudes toward teaching sexuality education are also important in determining how and whether sexuality related concepts are covered.

Materials. Teachers have reported that identification, use, and accessibility of resource materials are major sources of their feelings of inadequate preparation (Gingiss & Hamilton, 1989). Many states and districts have developed guidelines and/or curricula (Gambrell & Haffner, 1993/94); however, individual districts and schools have much discretion in terms of implementing them. Many teachers reported they developed their own materials, and 8 in 10 reported they needed more assistance (Donovan, 1989).

Teaching methods and skills-building activities. Sexuality education needs to target the cognitive, affective, and behavioral domains in order to be effective (National Guidelines Task Force, 1993). However, this is rarely the case at the state or classroom level. Only four states provided adequate coverage of these three learning domains in their sexuality education guidelines (Gambrell & Patierno, 1995). Personal skills most commonly presented in state curricula and guidelines were too simplistic and did not include instruction on skills (Gambrell & Haffner, 1993/4). At the classroom level,








11

instruction is often reported to be teacher oriented and lacking in skills-building activities (Calamidas, 1990; Firestone, 1994; Haignere, Culhane, Blasley, & Legos, 1996).

Time. Ideally, comprehensive sexuality education takes place within health

education prekindergarten through twelfth grade (Guidelines, 1991). The state of Florida asserts that quality comprehensive health education programs, which include HIV/AIDS prevention as a component, are at least 50 hours in length at each grade level and taught by trained health educators (Report, 1994). Even though the majority of teachers feel sexuality education should be given high priority, it is generally agreed that not enough time is devoted to it (Hill, Piper, & King, 1993). Insufficient time in the curriculum was reported as the major weakness in one STD/HIV curricula (Calamidas, 1990). Almost one-fifth (18%) of teachers in a national study reported lack of time was one of the three greatest problems they faced in teaching sexuality education (Forrest & Silverman, 1989), and it was ranked second of eight items that made it difficult to teach sexuality education in another (Haignere et al., 1996).

Training/certification. If sexuality education programs are to prove effective, teachers need professional training on how to teach these subjects (Rodriguez, Young, Renfro, Asencio, & Haffner, 1995/96). Such training has been shown to increase knowledge, perceptions of importance of teaching the curriculum, intent to teach, and level of comfort with the course content (Levenson-Gingiss & Hamilton, 1989). Higher levels of teacher cognitive and affective comfort, perceptions of adequate preparation, and knowledge level have been significantly associated with student perceptions of course impact on their knowledge, attitudes, and anticipated personal behaviors








12

(Hamilton & Gingiss, 1993). However, teachers often do not have the skills, knowledge, or inclination to teach sexuality education courses (Rodriguez et al., 1995/6). A national study found 80% of teachers needed factual information, teaching materials, or teaching strategies regarding pregnancy and STD/HIV prevention (Forrest & Silverman, 1989). The preparation of those teaching health, including sexuality, education is a significant concern (Collins et al., 1995).

State level requirements for teacher training and certification in sexuality

education are rare based on several assessments of guidelines conducted during the past decade (Kenney, Guardado, & Brown, 1989; Gambrell & Haffner, 1993; Gambrell & Haffner, 1993/94; and Gambrell & Patierno, 1995). According to the latest state survey (SIECUS, 1995) twelve states, D.C., and Puerto Rico required teacher certification for teachers of sexuality education. Only six states and Puerto Rico required teacher training in order to teach sexuality education (SIECUS, 1995). These requirements are more common at the district level. Over half (56%) of districts required sexuality or AIDS education teachers to be certified. Sixty-one percent of districts required training for teachers of sexuality education (Kenney, Guardado, & Brown, 1989). As noted previously, an assessment by SIECUS (1995) found that Florida did not require training or certification of teachers.

Attitudes. A national study found that the majority of teachers are teaching

sexuality education and think it is important to do so. They even felt some topics-- birth control, AIDS, STDs, sexual decision making, abstinence and homosexuality-- should be taught earlier than they are (Donovan, 1989). Few studies have been conducted on the










effect of teacher attitudes and concerns on use of a curriculum (Gingiss & Hamilton, 1989), but research does indicate that the attitudes and concerns are significantly related to the nature of the instruction provided (Forrest & Silverman, 1989; Levenson-Gingiss & Hamilton, 1989; Yarber & McCabe, 1981; Yarber, Torabi, & Haffner, in press).

Important teacher attitudes and concerns have been identified such as comfort presenting cognitive information and leading value-laden discussions, and perceived adequacy of preparation, which are modifiable by training and experience. These attitudes and concerns are directly reflected in students' sexual knowledge, attitudes, and perceptions of the effects of a sexuality education course on their future behavior, and their assessment of teacher performance and classroom environment (Hamilton & Gingiss, 1993). Teacher attitudes regarding whether a sexualtiy topic should be included in the curriculum (Orr, 1982) and regarding the importance of the topic (Yarber, Torabi, & Haffner, in press) have been found to be significantly related to the inclusion of the topic.



Conclusion

Although the nature and depth of studies assessing sexuality education have

varied greatly, it appears the majority of schools are providing a base-level of sexuality education for students. However, much work remains. Controversial topics and those pertinent to the avoidance of STDs/HIV and unwanted pregnancy are often neglected and not presented in a manner conducive to affecting behavior. Also, there is more of an










emphasis on avoiding the negative consequences of risky sexual activity rather than on promoting healthy sexuality.

In addition to the content, other factors related to implementation need to be

addressed. Current and appropriate teaching materials need to be made available. More time needs to be allotted in the curriculum to ensure thorough coverage of topics and time for skills-building activities. Finally, teacher training can help improve knowledge levels, feelings of comfort, teacher effectiveness, and attitudes toward teaching sexuality education.

This study helped provide a more comprehensive and current assessment of the scope and nature of sexuality education in Florida, a state that mandates it. Results were also used to help determine compliance with the state guidelines for sexuality education. The teacher, school, and district variables assessed provided an overview of areas requiring improvement if the status of sexuality education is to progress. Although it is difficult to provide an exact assessment of what is being taught at the classroom level, the goal of the study was to present a more comprehensive view of, and ultimately to help improve the status of school-based sexuality education.



Delimitations

1. Participants were selected from a Florida DOE list of public school teachers by

primary teaching responsibility. Teachers with health as a primary teaching code

(N=199) and a random sample of 35% (N=301) of teachers with family and










consumer science (formerly called home economics) as a primary teaching code

(N=873) were chosen.

2. Data were collected in Spring 1996.

3. Components of "Sex Education in the United States" by The Alan Guttmacher

Institute (1988), "Survey of School Sexuality Education" by Drs. William Yarber

and Mohammad Torabi (1995), and the Sexuality Education Curricula: The

Consumer's Guide by Ogletree, Fetro, Drolet, and Rienzo (1994) were modified

and combined to asses the scope and nature of sexuality education in Florida

public high schools.



Limitations

1. Subjects may not have represented the population of Florida sexuality education

teachers adequately.

2. The time frame for data collection may have influenced responses.

3. Findings depended on the ability of a combination of modified components of

"Sex Education in the United States," "Survey of School Sexuality Education,"

and Sexuality Education Curricula: The Consumer's Guide to accurately assess

the scope and nature of sexuality education in Florida public high schools.



Assumptions

I. The sample adequately represented the population of Florida public high school

sexuality education teachers.










2. The data collected in Spring 1996 was adequate for the purpose of the study.

3. The modified surveys by The Alan Guttmacher Institute, Yarber and Torabi, and

Ogletree et al. were adequate to obtain data necessary for the study.

4. Subject motivation and candor were adequate for the purpose of this study.



Research Questions

1. What was the scope of sexuality education offered in Florida public schools in the

9 - 12 grade?

2. Was the scope consistent with the Florida DOE's Guidelines, Components of

Quality HIV/STD Prevention and Human Sexuality Education?

3. What was the nature of information provided in sexuality education that was

intended to prevent unwanted pregnancy and STDs/HIV?

4. How was sexuality education being implemented in individual schools and school

districts?

5. Were teacher attitudes related to the implementation of comprehensive sexuality

education?

6. Were any school district variables related to the implementation of comprehensive

sexuality education?










Definition of Terms

Alan Guttmacher Institute - This is an independent corporation for research, policy analysis, and public education in the field of reproductive health. They gather, analyze, and report statistical data relating to family planning and fertility control.



Components of Quality HIV/STD Prevention and Human Sexuality Education (Components) - This report was developed by the Florida HIV/STD prevention and human sexuality task force. It was a joint project by the Department of Health and Rehabilitative Services and the Florida Department of Education, sponsored by the Centers for Disease Control and Prevention Division of Adolescent and School Health. The purpose of it was to provide instructional guidelines for Florida school districts on HIV/AIDS prevention and sexuality education within the context of the DOE's initiative to stress local decision-making and accountability.



Florida Department of Education (DOE) - The Florida DOE is an organization committed to the delivery of quality services to the state's education system. The mission of Florida's public education system is to provide the opportunity for all Floridians to attain the knowledge and skills necessary for lifelong learning and to become self-sufficient, contributing citizens of society.



Guidelines for Comprehensive Sexuality Education (Guidelines) - These guidelines were developed by a task force of leading health, education, and sexuality professionals in










1990. They formulated the broad concepts and sub-concepts necessary for comprehensive sexuality education. Each concept includes life behaviors and developmental messages as well. The Guidelines provide an organizational framework for human sexuality and family living within four developmental levels, grades kindergarten through twelve. There are six main concepts, human development, relationships, personal skills, sexual behavior, sexual health, and society and culture, encompassing 36 topics.



Sex Education in the United States - This instrument was developed by the Alan Guttmacher Institute and used in a 1988 survey.

"The survey questionnaire was developed through personal consultation with sex educators, researchers and education specialists. Preliminary work also included four focus groups discussions with sex educators from public secondary schools
in the Northeast and a pilot survey of 200 randomly sampled public school
teachers, 40 from each of the five specialties covered in the survey. All survey recipients were asked questions about themselves and their schools, and about
their views as to whether or not sex education should be taught and what topics
should be covered at what grade levels. Respondents currently providing sex education were asked more detailed questions" (Forrest & Silverman, 1989, p.
66).


Sexuality Education - For purposes of this study, sexuality education is defined as any instruction that includes some discussion about human sexual development, the process of reproduction, and/or the exploration of interpersonal relationships and sexual behavior. Examples of topics that might be covered are: male and female reproductive systems, dating relationships, abstinence, contraception, sexually transmitted diseases (STDs), HIV/AIDS, changes at puberty, pregnancy and childbirth, and sexual decision-making.








19

Sexuality Information and Education Council of the United States (SIECUS) - SIECUS is a professional organization that promotes and affirms the concept of human sexuality as natural and healthy part of living. They develop, collect, and disseminate information, promote comprehensive sexuality education, and advocate the right of individuals to make responsible sexual choices.



Survey of School Sexuality Education - This self-report questionnaire was developed by Drs. William Yarber and Mohammad Torabi and administered to teachers in a 1995 survey. The survey contained three sections: 1) a list of 36 sexuality education topics about which the respondent was asked to indicate whether the topic was included in the sexuality education unit in his/her class and to indicate his/her view about the degree of importance of each topic as part of comprehensive sexuality education; 2) two instruments designed to measure sex-related attitudes of the respondents; and 3) questions dealing with demographic characteristics of the respondent, the respondent's view of support for sexuality education in his/her classes, and selected characteristics of the health classes and sexuality education taught by the respondent. Only the component assessing whether the 36 topics were taught and teacher ratings of importance were used in the current research. These 36 topics were based on SIECUS's Guidelines for Comprehensive Sexuality Education (1993) described above.



Sexuality Education Curricula: The Consumer's Guide - This guide was written by Ogletree, Fetro, Drolet, and Rienzo in 1994. It was developed in an effort to assist










teachers, program planners, and administrators in determining whether published sexuality education curricula meet the school district's needs. The guide identifies key attributes of curricula including content, philosophy, skills-building strategies, and teaching methods. The skills-building and teaching strategies sub-sets were used for this research. The skills-building strategies sub-set was created based on specific personal and interpersonal skills deemed necessary for healthy sexuality. These have been identified by the SIECUS Guidelines for Comprehensive Sexuality and through evaluation of prevention programs over the past twenty years. The teaching strategies sub-set compiled a variety of teaching methods necessary to meet individual learning styles and to provide opportunities for personal and social skill-building.















CHAPTER 2
REVIEW OF THE LITERATURE

Introduction

The negative consequences of risky sexual behavior among adolescents are well known in the United States today. Over half (53%) of all high school students have had intercourse in their lifetime. with more than one-third (38%) having had intercourse in the three months preceding the survey (Kann et al., 1996). The average age at first intercourse is just inder 15 years. The average number of sexual partners is 2.7, with one-fifth of those having four or more partners (Teens Talk, 1994). The pregnancy rate for women aged 15-19 is about 110 per 1,000 per year (Henshaw & Van Vort, 1989), most of them being unintentional (Donovan. 1989). This results in one million adolescent female pregnancies each year (Henshaw &Van Vort, 1989), one of the highest rates of any western industrialized country (Kirby et al.. 1994). Approximately 478.000 of these result in birth. 416.000 in abortion, and the rest in miscarriage or stillbirth (Henshaw &Van Vort. 1989). In 1995, seven percent of students reported they had been pregnant or gotten someone pregnant (Kann et al., 1996).

Teenagers haN e the highest rate of sexually transmitted disease (STD) among

sexually active people of any age group (DHHS, 1990). Three million teens are infected with STDs every year (McGinnis, 1993). Of the individuals diagnosed with AIDS, approximately one in five are in their twenties. This is significant as the incubation 21











period is about 10 years. meaning most were probably infected as adolescents (CDC, 1995).

The impact of these negative consequences of risky adolescent sexual behavior is far reaching. Teenage parenthood can reduce social and economic attainment and marital stability. and increase dependence on welfare. The children of these young parents are at increased risk for poorer health, reduced cognitive development, behavior problems. and poorer school performance (Nord et al.. 1992). HIV and other STDs can affect the physical health, child bearing abilities, and even the lifespan of young adults. AIDS has become one of the leading causes of death among men and women agtes 25 to 44 in the U.S. (Kirby et al., 1994).

This study was undertaken to provide a more comprehensive and updated assessment of the status of school-based sexuality education in Florida. a state that mandates comprehensive sexuality education for grades K-12. The components assessed included the scope of sexuality education topics; the nature of STD/HIV and pregnancy prevention information: the teaching methods and skills-building activities utilized; time spent on the whole unit as well as individual topics within it; and teacher. school, and district variables that may effect implementation. Also, as Florida mandates sexuality education, results were used to help determine compliance.

This chapter begins by emphasizing the importance of comprehensive sexuality education as a means of helping to decrease the prevalence of negative consequences associated with risky sexual behavior. The recommended scope and nature of sexuality education, support for sexuality education, and factors of effective programs are outlined.











The current status of sexualitv education. including state and district guidelines, and classroom implementation are reviewed. Guidelines, mandates and implementation of sexuality education in Florida are addressed. Lastly. other important components involved in sexuality education such as the materials and teaching methods utilized, the time spent teaching it. teacher training and certification. and teacher attitudes toward teaching sexuality education are explored. The chapter concludes with the need for additional research on the implementation of sexuality education at the classroom level and the factors that may be related to the implementation.



Comprehensive School-based Sexuality Education

One way to help decrease the prevalence of negative consequences associated with risky sexual behavior and to promote healthy sexuality is by providing effective sexuality education. Professionals agree that sexuality education is best offered through a comprehensive, skill-based approach, and linked with community resources (SIECUS, 1992). This approach includes targeting cognitive, affective and skill domains at all school grade levels, and being included as part of a comprehensive school health education program. A broad range of topics should be included as well (Yarber, 1994). Many see sexuality education as a solution to the high incidence of adolescent pregnancy and HIV/STDs. However, promoting a positive view of sexuality is also important (Yarber. 1994).











The Scope and Nature of Comprehensive School-based Sexuality Education

In 1990. the Sexuality Information and Education Council of the United States (SIECUS) convened a task force of leading educators, health professionals. and national organ ization representatives to formulate the broad concepts and sub-concepts necessary for comprehensive sexuality education. Each concept includes life behaviors and developmental messages as well. The Guidelines for Comprehensive Sexuality Education (Guidelines). issued in 1991, provide an organizational framexork for human sexuality and family li\ ing, within four developmental levels, encompassing grades kindergarten through txelve. There are six main concepts--human development. relationships, personal skills, sexual behavior, sexual health, and society and culture-encompassing 36 topics (See Table 2-1 at the end of this chapter).

Further. the Guidelines conceptualize sexuality education as a lifelong process

affecting attitudes. beliefs, and values with its primary goal being the promotion of sexual health (National Guidelines Task Force, 1993). Thus, programs should ideally strive to help individuals develop a positive view of sexuality, rather than merely stressing abstinence and the possible negative consequences associated with being sexually active. This concurs with the World Health Organization (WHO) definition of sexual health: "the integration of the physical, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching, and that enhance personality, communication, and love every person has a right to receive sexual information and to consider accepting sexual relationships for pleasure as well as for procreation" (WHO, 1975).








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Several studies indicate that youth with negative feelings about their sexuality do not practice pregnancy and STD prevention as consistently as those with more positive attitudes (Fisher. 1990). Negative feelings about sexuality have been found to interfere with acknowledging forthcoming sexual activity. learning sexual information, and communication with others about sexuality (Yarber, 1994).

The Guidelines outline four primary goals for sexuality education: 1) to provide accurate information: 2) to provide an opportunity for young people to question. explore. and assess their sexual attitudes, 3) to help young people develop interpersonal skills; and 4) to help young people exercise responsibility regarding sexual relationships. There are also five assumptions underlying the Guidelines. They state sexuality education should be offered as part of an overall comprehensive health education program: it should only be taught by specially trained teachers; the community must be involved in the development and implementation of the program; all children and youth will benefit from it; and all three learning domains-- cognitive, affective, and behavioral-- should be addressed (National Guidelines Task Force, 1993).

The Guidelines" emphasis on the affective and behavioral domains, in addition to the cognitive, emerged from research results on knowledge based programs. Although knowledge about sexual topics may be an important precedent to behavior change, it appears to be very weakly related to adolescent sexual behavior. Other outcomes of educational programs. such as changes in attitude, norms, skills, and intentions, are also precursors to behavior. However, even these do not adequately predict change in actual sexual behavior (Kirby et al., 1994).










Results of an analysis of school-based programs to reduce sexual risk-behaviors indicated several tentative commonalities among programs with a positive impact on sexual behaviors (Kirby et al., 1994). These factors include: a) a narrow focus on reducing specific sexual risk-taking behavior: b) the use of social learning theories as a foundation for program development: c) providing basic accurate information about the risks of unprotected intercourse and methods of avoiding unprotected intercourse through experiential activities designed to personalize this information; d) actixities that address social influences or pressures on sexual behaviors; e) reinforcing clear and appropriate values to strengthen individual values and group norms against unprotected sex: and t) providing modeling and practice in communication and negotiation skills. While these components are representative of more effective programs. they are clearly not typical in school-based programs. Only four states provide adequate coverage of the three learning domains, cognitive, affective, and skills, in their sexuality education guidelines (Gambrell & Patierno, 1995).



Support for School-based Sexuality Education

Public support for the involvement of schools in implementing comprehensive sexuality education is higher than ever before. Ninety percent of parents want their children to receive sexuality education. Over 80% of them want their child to be taught about "safer sex" as a means of preventing HIV/AIDS (Louis Harris & Associates, 1985, 1988; Gallup & Clark. 1987). Over 60 national organizations concur that all children and youth should receive comprehensive sexuality education (SIECUS, 1992). State and









district administrators also show support through the development of suggested or mandated guidelines for school sexualitx education. An assessment by SIECUS (1993) found that 47 states have laws or policies requiring or recommending sexuality education. Thirty-eight states plus the District of Columbia (D.C.) and Puerto Rico have developed curricula or guidelines to proxide program assistance to local school districts.

Government support of school health education. and more specifically sexuality education. is evident in that these programs are essential to achieving the Healthy People 2000 objectives (DHHS. 1990). These objectives, developed by public health officials, private practitioners. health scientists, and academicians. serve as a challenge for the level of health that both public and private sectors of the American society should seek to achieve. Several of the 2 1 priority areas directly address adolescent sexuality issues, such as family plaming. HIV infection, and STDs. Also, the Centers for Disease Control and Prevention has identified six areas of behavior that contribute to the leading causes of mortality and morbidity in the United States. One of these is sexual behaviors that contribute to STDs!HIV and unintended pregnancies (Kann et al., 1996).

Support for school-based sexuality education is also apparent from a practical

perspective. Schools provide a unique setting for reaching large numbers of students with important prevention and early intervention strategies. Nearly 95% of all school-aged adolescents and children are in elementary or secondary schools (Iverson & Kolbe, 1983). Most students attend school before they initiate sexual risk-taking behaviors and a majority are enrolled xhen they initiate sexual activity. Hence, many see schools as










public institutions -with great opportunity and responsibility in addressing and reducing sexual risk-taking behaviors (Kirby et al.., 1994).



Effectiveness of School-based Sexuality Education

..The most effective sexuality education programs are comprehensive, skill-based, and linked with community efforts" (SIECUS, 1992. p. 14). These programs should be tailored to meet the needs of the students served by the programs. They should include effective. theory-based classroom education. confidential health services, and health counseling (Majer. Santelli, & Coyle. 1992). Educators in the public schools play a major role in shaping and influencing the behavior of adolescents (Calamidas, 1990).

School-based sexuality education programs have been shown to go beyond increasing knowledge about sexual issues, to actually delay initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners. or increase the use of condoms or other contraceptives. These programs have the potential to reduce unintended pregnancies. exposure to sexually transmitted diseases and HIV (Kirby et al., 1994). Previous research found that adolescents who had taken sexuality courses were no more likely to engage in sexual intercourse than those who had not had a course (Marsiglio & Mott, 1986: Zelnik & Kim. 1982). If they had been sexually active, those who had taken sexuality education classes were significantly more likely to use contraception (Dawson. 1986; Marsiglio & Mott, 1986; Zelnik & Kim, 1982).

Zabin et al. (1986) reported an increased use of contraception by males and females, a delay in first intercourse, and an increased use of family planning clinics










amon, students enrolled in a school-based education and clinic program. Vincent. Clearie. and Schluchter (1987) reported a reduced teen pregnancy rate for a communitybased sexuality education program with a strong school-based component. The Postponing Sexual Involvement program helped decrease the number of adolescents initiating sexual intercourse and the number of pregnancies among those in the program compared to those who were not (Howard and McCabe. 1990). The Reducing the Risk program helped increase participant knowledge and parent-child communication about abstinence and contraception. Among those who had not initiated intercourse prior to the program. it significantly reduced the likelihood that they would engage intercourse in the next year and a half. as well as reduced unprotected intercourse either by delaying the onset of sexual intercourse or by increasing the use of contraceptives (Kirby et al.. 1991). The Preventing Adolescent Pregnancy program reported older teen girls who completed the program were half as likely to get pregnant as those who participated less or not at all, and younger teen girls were twice as likely to postpone sexual intercourse (Girls Inc., 1996).

This section reviewed the nature and scope of, support for, and effectiveness of comprehensive sexuality education. The basic components necessary for effective comprehensive sexuality education programs. as agreed upon by professionals in the field, were outlined. Support for sexuality education by parents, school personnel, and other officials was established. Evaluation of effective sexuality education programs demonstrated the potential of these programs to significantly affect the sexual related








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knowledge. attitudes and behaviors of school children. Next, the prevalence and quality of school-based sexuality education throughout the nation are examined.



The Status of School-based Sexuality Education in the U.S.

Although research has shown that much support exists for school-based sexuality education at the state, district, and local levels--by teachers, parents. and students themselves--little is known about actual classroom implementation. the extent to which instruction complies with state and district policies (Donovan. 1989). Policy adoption does not always result in effective programming. A Planned Parenthood poll found that 40% of students had not had sexuality education at school and that only 35% had a comprehensive sexuality course (Louis Harris, 1986). SIECUS estimates that less than 10% of American students receive comprehensive sexuality education. kindergarten through twelfth grade (SIECUS. 1992). Few studies have directly surveyed teachers responsible for sexuality education.

This section begins with a review of state and district sexuality education

guidelines. Then, research on actual classroom implementation of sexuality education is reviewed. Studies have been conducted at both the national and state level, although the components of school-based sexuality education assessed and the extensiveness of the studies vary. Lastly, Florida sexuality education guidelines/mandates and implementation are examined.










State and District Guidelines

The number of states requiring sexuality education through state law has

increased to 22. plus the District of Columbia (D.C.) and Puerto Rico (National Abortion and Reproductive Rights Action League (NARAL). 1995). In 1993, 30 recommended it and 17 required it according to Gambrell & Haffner, consistent with a report by Kenney, Guardado. & Brow\n in 1989. and somewhat less than the 23 reported by de Mauro (1989 90) . This is a tremendous increase from the three states that mandated sexuality education prior to 1986 (Gambrell & Haffner. 1993). However. only twelve states mandate sexuality education in grades kindergarten through twelfth (Haffner. 1992).

Thirty-six states. plus D.C. and Puerto Rico. have developed curricula or

guidelines to provide program assistance to local school districts: twelve states have not (Gambrell & Patierno. 1995). They more commonly developed guidelines (N=35) than curriculum (N= 17). This suggests a preference to defer to local discretion for the specifics of programs (Gambrell & Haffner. 1993/94). Only 15 states. the D.C.. and Puerto Rico have regulations that monitor the implementation of sexuality education at the local level (Gambrell & Patierno, 1995).

Almost all of the guidelines/curricula include abstinence messages as well as positive and affirming statements about human sexuality. However, many state guidelines omit sexual behavior topics, exclude topics considered to be controversial, lack a balanced coverage of abstinence and safer sex, and lack thorough coverage of topics throughout kindergarten to twelfth grade (Gambrell & Haffner, 1993/94). Most do not include age-appropriate developmental messages. The topics most commonly










covered in state guidelines include: human development (i.e.. anatomy. puberty, body image): relationships i.e., family parenting. friendship): personal skills (decision-making and communication): and sexually transmitted diseases and HIV infection. Less than one-third include an% sexual behavior topic besides abstinence. Fewer than ten states cover shared sexual behavior, human sexual response, fantasy, and sexual dysfunction. When they do discuss sexual behavior. they tend to focus on the negative aspects of sexual activity instead of promoting sexual health and responsible decision-making. Few states include sexual identity and orientation (N= 13). abortion (N=I 1 ). and sexuality and religion (N-4). When sexual identity and orientation are discussed, it is largely limited to definitions. only four states actually affirn sexual identity as an essential quality of personality. Only 2 1 states cover contraception, mostly as a general overview (Gambrell & Haffner, 1993/94).

Unfortunately. some states restrict sexuality education and permit or encourage

the use of biased or fear-based curricula. For example. 19 prohibit making contraceptives available, five prohibit or restrict abortion discussion, and eight require or recommend teaching homosexuality is not an acceptable lifestyle and/or that it is a criminal offense under state law (NARAL, 1995). Fear-based programs are problematic because they instill fear and shame in adolescents in order to discourage sexual behavior. They also exaggerate the negative consequences of premarital sexual behavior and portray sexual activity as harmful and dangerous. These programs are in opposition to the goals of the comprehensive curricula recommended by professionals. which seek to assist adolescents










in developing a healthy understanding of their sexuality and enables them to make responsible decisions (Kantor, 1992/93).

Few studies have assessed sexuality education in terms of district level guidelines. A 1988 study by Kenney. Guardado. and Brown of the Alan Guttmacher Institute (AGI) surveyed 162 of the largest school districts, each havinu more than 22.500 students, on their sexuality education policies. The sample represented 29% of students in U.S. public schools. The researchers found that 87% of districts required or encouraged sexuality education and 96% AIDS education. The majority (87%) also had a curriculum on sexuality or AIDS education, and many of the others were in the process of developing one. Most of the districts developed their own curriculum (87%). 17% used the state education agency's curriculum, and five percent used commercially available documents (Kenney, Guardado. & Brown, 1989). Over 80% of the districts with a sexuality education curriculum reported it was mandatory for schools in that district. Those that did not said it was nevertheless used by the majority (60%).

More than 900o of these districts covered the negative consequences of sexual activity and emphasized abstinence as the best alternative for preventing pregnancy and STDs. About three-fourths (74%) included an explanation of how each contraceptive method is used. Many discussed condoms as a means of preventing AIDS (86%) and other STDs (80%). The districts tended to place an emphasis on abstinence and the possible negative outcomes of sexual activity, yet recognized that millions of teens are sexually experienced and need risk-reduction messages (Kenney, Guardado, & Brown, 1989).







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While it appears to be taken for granted that mandates will increase the amount of instruction in school. analyses show no relationship between state and district sexuality education policies. Districts were neither more nor less likely to adopt a specific sexuality education policy based on the state's policy (Kenney, Guardado. & Brown, 1989). Schools' policies also differed little regardless of the state policy requirements. However, it appeared more likely that state policies were followed when they encouraged the inclusion of certain topics rather than when they discouraged the inclusion of topics (Orr. 1982). "Although the policies and programs of states and school districts are important guides. the% provide little precise information about what is taught in the


classroom. Without such information, however, the design. implementation and evaluation of sex education initiatives are seriously hampered" (Forrest & Silverman. 1989. p. 65). Findings from the NARAL state review (1995) also concluded that legal mandates not only fail to ensure comprehensive sexuality education, but even limit these programs or encourage the use of biased/fear-based curriculums.

Muraskin (1986) asserts there is little interest in whether the state guidelines

actually change or improve the quality of sexuality education. Although several states have developed guidelines for school sexuality and HIV/AIDS education programs, most do not provide the foundation for truly comprehensive programs, as demonstrated above. "In fact. fewer than one in six of the state curricula provide young people with a comprehensive base of information and education" (National Guidelines Task Force, 1993, p. 1). This being the case, much responsibility is left at the local level and with the individual classroom teachers.









Classroom Implementation of Sexuality Education

Over the past fifteen years. several research studies and secondary analyses have been conducted at the national and state level to assess classroom implementation of sexuality education. The national studies were conducted by Orr (1982). Sonenstein and Pittman (1984). Louis Harris and Associates (1986). Alan Guttmacher Institute (1988). and the Centers for Disease Control and Prevention (1995). The state studies include Koblinsky and WVeeks (1984). Muraskin ( 1986). Calamidas (1990). Firestone (1994). and Yarber. Torabi and Haffner (in press). All have used different criteria. This criteria has evolved over the years. as have sexuality education programs, to encompass a more comprehensive curricula.

In 1982, Orr performed secondary analysis on two national studies--a 1977

National Institute of Education survey, and a 1978 follow-up by the same organization-to determine the status of sexuality and contraceptive education in U.S. public high schools. The first study was sent to principals of 2,000 U.S. public high schools to gather information on school characteristics, organizational and institutional practices, general innovativeness, community relations and parental involvement. Thirty-six percent of the principals reported their school offered a separate family life or sexuality education course. A follow-up study of one instructor in each of those schools (N=524) was then conducted to assess whether a sexuality education course was offered, along with a series of questions about course structure and content. A response rate of 43% (N=227) was obtained.











Teachers reported including an average of 18 of the 26 topics. The most

commonly covered topic was "venereal disease." followed by pregnancy and childbirth. At least 90% of instructors included puberty changes; anatomy and physiology; drugs, alcohol and sex: dating: and teenage pregnancy. Contraception and abortion were included in 78% of classes. Other controversial topics, such as homosexuality and masturbation were discussed by more than half of instructors. When the topics were grouped into five areas. 80% of schools reported covering all of the topics within social development (i.e. dating, relationships). 77% all of the human-reproduction topics, and 67% all of the contraception-related topics. Less than 20�o reported teaching all of the topics related to sexual values or contro, :rsial subjects. only about half of the topics were commonly taught in these two areas (Orr. 1982).

There were some obvious limitations to this study. It was a secondary analysis of information that was collected for a different purpose. No evidence was found to indicate any particular set of school or community characteristics analyzed was more likely to predict whether a school would offer a separate sexuality education course or what was included in it. Other variables that were not analyzed may have better explained this. The results were based on the response of the school principal, then on one instructor of sexuality education from each school. Other instructors may have given different responses. The context of the sexuality education information provided was not assessed, and could have varied from school to school. Finally, the information gathered was from schools that offered sexuality education as a separate course, suggesting more time and











emphasis on topics. However, other school districts may have included the information within other courses (Orr. 1982).

Sonenstein and Pittman (1984) conducted a study of school districts in cities with a population greater than 100.000 (N= 198) to assess the extent to which sexuality education was taught in public schools. The respondents were comprised of associate superintendents, directors of instructional services, curriculum specialists, directors of homemaking,. and coordinators of family life education (FLE). A 90% response rate (N-179) was obtained. Of districts with junior and senior high schools. 75% and 76%. respectively, provided sexuality education. Over 55% of school districts reported that more than 90% of students at all levels received sexuality education, while one-third reported 100% student participation.

The physiological aspect of sexuality was the most commonly covered topic.

included by more than 90% of districts. Personal and interpersonal aspects of sexuality were included bv 80-850 o. and contraceptives and sources of family planning services by 75%. Those topics considered controversial--rape and sexual abuse, masturbation, abortion, and homosexuality--were covered much less frequently, by an average of half of the districts. To measure the comprehensiveness of the sexuality education offered, four increasingly rigorous criteria were included. They included discussing the topic, as part of the curriculum or if student initiated questions could be discussed in class; reporting at least 75% of students enrolled in sexuality education; discussing the topic in depth, considered to be at least one class period: and topics introduced in junior high school or earlier. As the parameter became more stringent, it became clear that sexuality education








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efforts in large districts were not as extensive as first indicated. For example, while STDs were covered by 71%. only 44% also had 75% enrollment, only 37% also had an in-depth conversation on the topic. and finally. 27% also introduced it before grade nine.

There were some limitations with this study. Only large school districts were

surveyed. so findings were only generalizable to similar districts. Also. the respondents were at the administrative level, so it is not known how accurately they described the actual implementation of sexuality education. The findings demonstrated extensive variation in school districts" provision of sexuality education. Many provided some sexuality education. but far fewer offered in-depth and timely coverage of important topics (Sonenstein & Pittman. 1984).

Koblinsky and Weeks (1984) surveyed superintendents, principals, and FLE teachers in California school districts with a ninth and/or tenth grade about their FLE efforts. The topics covered by more than nine out often included STDs. human reproduction, pregnancy and birth, human anatomy and physiology, and consequences of teen pregnancy. The topics least often covered in the curriculum included value-laden topics such as premarital intercourse, adoption, sexual behavior, rape and sexual abuse, and sexual orientation. More than 75% of teachers reported including at least 20 different topics. However, it was noted that data may have over represented longer courses since the survey was given to teachers who were most involved with FLE in their schools. It was estimated that 24% of ninth graders and 32% of tenth graders received some FLE in the 1981-82 school year (Koblinsky & Weeks, 1984).










In 1986. Louis Harris and Associates conducted a national poll for Planned

Parenthood Federation of America, Inc. of 1.000 teens age 12 to 17. The poll asked, in part. about sexuality education in school. Fifty-nine percent of the teens surveyed reported they had a formal course on sexuality education in school. However, the education described \\as less than ideal. Only 35% of all the teens had received what was considered comprehensive sexuality education. Comprehensive was defined as courses that included four of the six survey topic areas--biological facts about reproduction. talk about coping with sexual development, information about the different methods of birth control. information about preventing sexual abuse, facts about abortion. and facts about where to get contraceptives (Louis Harris. 1986).

In 1988, the Alan Guttmacher Institute (AGI) conducted a national study to help identify strengths and weaknesses of existing sexuality education programs. This information was to be used in their development of recommendations for sound policies and programs at all levels (Rosoff, 1989). They surveyed 4.200 secondary public school teachers nationally in disciplines from which sexuality education teachers are usually drawn. The five disciplines were health, physical education, family and consumer sciences. biology. and school nursing. for grades 7-12. The teachers were asked what they taught in their sexuality education classes regarding pregnancy and STD/HIV prevention and what they regarded as obstacles (Donovan, 1989). Ninety-three percent of the public school teachers surveyed reported their schools offered sexuality or AIDS education in some form. Forty-five percent of the teachers actually provided sexuality education in some










manner. -oxxever. problems were apparent with the nature of the sexuality/AIDS education (Forrest & Silverman, 1989).

Among the teachers who provided sexuality education 90-96% covered AIDS, STDs. and sexual decision-making; 83-890 covered abstinence, birth control methods and factual aspects of abortion: 64-77% dealt with homosexuality. "safer sex" practices and ethical issues surrounding abortion: and 52% provided information about sources of birth control (Forrest & Silverman. 1989). Almost 90% taught abstinence as the best way to prevent pregnancies and STDs. Two-thirds presented condom use as a possible way to prevent HIV, other STDs. and pregnancy. Another 200 encouraged condom use only for the prev ention of STDs and HIV. Three-quarters discussed about how to use condoms (Donovan, 1989).

One-fourth of teachers covered birth control methods only .,,hen asked specific questions (Donovan. 1989). The vast majority (97%) of teachers felt that sexuality education classes should address where students could go to obtain a method, but only 48% were in schools where this was done (Forrest & Silverman, 1989). Nine out often covered HIV and STDs. but not always the most common STDs (Donovan, 1989). Most teachers thought a wide range of sexuality education topics related to the prevention of pregnancy and STDs!HIV should be taught and that these topics should be taught by grades 7-8 at the latest. In practice, it did not occur until the 9th or 10th grade (Forrest & Silverman, 1989). Results indicated that teachers focused more on helping adolescents avoid pregnancy and STDs/HIV than on the full range of family life and sexuality education (Donovan, 1989).










Several studies in the past decade have examined FLE in New Jersey, where a mandate was passed in 1983. Unfortunately, at the time of last assessment. 1993, administrative support and monitoring of the mandate were reported lacking. Muraskin (1986) studied the first year implementation of New Jersey's kindergarten through twelfth grade FLE mandate in a case study on six of 600 school districts. The state mandate provided the broad goals of instruction, but required that districts write an outline for the curriculum. Teachers. administrators, and school board ai;d community members involved in implementing the FLE program were interviewed. In the fixe initial districts. they all included such topics as families, social problems. social and personal interaction, the life cy-cle. family formation, the body, and sexuality (physical and psychological development. reproduction, contraception. STDs. sexual abuse. and sexual relations). However. that did not mean the topics were all covered in one class. Rather, they were addressed in different courses at different grade levels, and the information was then designated as FLE. In grades 9-12. FLE was usually a unit within health education that, according to most districts, included sexuality, family formation. and social problems (Muraskin. 1986).

In 1990, Calamidas sent surveys on STDs and HIV education to supervisors of

high school health education classes in 50 New Jersey school districts. Thirty-two (64%) were completed and returned. AIDS and STD education units were taught in two grades in 38% of the high schools, in three grades in 22%, and in four grades in 25% of high schools. Respondents were asked to list the educational objectives their curriculum emphasized with regard to STDs and HIV. The only two listed by at least half were to







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dispel myths and disseminate accurate information (56%) and to discuss prevention and transmission of pathogens (50%).

Firestone (1994) most recently explored the content and context of sexuality

education in New Jersey. The survey was completed by 506 FLE teachers. Ninety-six percent of respondents said FLE was required in their schools. It was estimated that 96% of students. in the grades sexuality education was offered. took these courses. All eleven districts stressed abstinence, with some prohibiting the discussion of any option except abstinence. Strong attention was given to HIIV!AIDS education. State mandates required teaching AIDS at every grade level, while FLE was only taught in three or four.

Key information was organized into 17 topics the researcher considered to be part of the FLE curriculum. Most teachers chose to address the "easier" topics such as sexual development, pregnancy, and reproduction. Most also dealt with general issues. such as responsible behavior and skills. Although many discussed the risks of premature sexual activity. the discussions were rarely linked to concrete coping mechanisms for reducing those risks. Almost none of the teachers said condoms were available in their schools, but 5 1% discussed condom use with their classes. Only 20% demonstrated how to put one on and 25% referred students to agencies that distributed condoms.

Results showed that although almost all students were exposed to sexuality

education, the actual instruction provided did not correspond with profiles of sexuality education programs that have been most successful in helping teens avoid pregnancy, STDs. or HIV. In addition, little time was actually spent on sexuality education and many topics were introduced late in students' schooling. Few teachers covered











prevention oriented topics, and difficult topics received limited time. Results also suggested teachers were most likely to provide facts, rather than dealing with emotions or guiding behavior. Txwo-thirds or more provided facts for all 17 topic areas. two-thirds or more dealt with feelings for all but contraception and condoms (57%) and STDs (59%); and two-thirds or more guided behavior for all but five topics, sexual orientation (41%) and masturbation (47%) ranking lowest (Firestone. 1994).

The Center for Disease Control and Prevention Division of Adolescent and

School Health (CDC - DASH) conducted the School Health Policies and Programs Study (SHPPS) in 1994 (Collins et al., 1995). This study looked at multiple components of school health at the state. district, and school levels. At the school level, interviews with classroom health education teachers included components on sexuality and HIV/AIDS education. Specifically, at least half or more of health education teachers taught about abstinence (76%), preventing STDs (75%). signs and symptoms of STDs (79%), dating and relationships (69%), social influences on sexual behavior (68%), the reproductive systems (67%), social norms toward risk behaviors related to sex (64%). perception of risk for STD and pregnancy (61%), access to STD screening programs (59%). statistics on STD and unintended pregnancy rates (56%), contraceptives (54%). marriage (50%), and prevalence of sexual risk behaviors among adolescents (50%). Although Collins et al. (1995) found that many teachers included sexuality education topics, conclusions suggested the need for increasing coverage of priority health issues for youth--including pregnancy prevention and STD prevention--to strengthen school health education in the future.







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Yarber. Torabi. & Haffner (in press) assessed the scope of sexuality education in Indiana high schools using the SIECUS Guidelines for Comprehensive Sexuality Education (Guidelines). They surveyed 187 health education teachers in grades 7-10. They found that seven of the 36 topics xwere included by 90% or more, 27 by 50% or more. and only three by less than 250' of teachers. Nine in ten or more included STDs and HIV. decision-making. abstinence, puberty. reproduction. values, and communication. Eight in ten or more included friendship, love, reproductive anatomy and physiology. dating, finding help, contraception, sexual identity and orientation. families, and bodv image. Seven in ten or more included assertiveness. marriage and lifetime commitments. parenting. sexuality throughout the lifespan, and reproductive health. Sexual abuse. sexuality and society, and sexuality and the media were included by at least six out often teachers. Less than half of teachers included human sexual response, masturbation. shared sexual behavior, diversity, sexuality and religion. sexuality and the laxx. sexual dysfunction. fantasy, and sexuality and the arts. When the six key concepts were examined, human development was found to be included most frequently, and sexuality and culture least often (See Table 2-1).

Teacher ratings of the degree of importance of the topics as part of comprehensive sexuality education found that 22 topics received a mean score of at least 4 (5=extremely important, 3=moderately important). Only three topics had average ratings less than moderately important. The key concept of personal skills was considered the most important and culture was considered the least important (See Table 2-1). When the importance and inclusion of topics were analyzed, they were found to be positively









correlated. Hence. those topics listed above as most often taught. were also those rated most important. and those least often taught were rated as least important (Yarber, Torabi, & Haffner. in press).

Recent evaluation of state level guidelines found that sexuality education is usually taught within health education (44 states). It is also commonly placed under family and consumer sciences (30 states). AIDS (29 states). and science (1 9 states). It is less commonly placed in physical education (13 states) and "other" (13 states) (Gambrell & Haffner, 1993). Local level administration are responsible for the decision as to who actually teaches sexuality education. As this varies among jurisdictions. most states reported that teachers in several disciplines handle instruction. Health education teachers were most commonly named. Other disciplines responsible included family and consumer sciences (36 states); classroom teachers, especially in the elementary grades, (32 states): and physical education (32 states). Instruction responsibilities were also carried out by public health instructors (20 states); community agency instructors (17 states): professional sexuality educators (17 states); and school nurses (15 states) (Gambrell & Haffner. 1993).

There is a great deal of variation in the studies that assessed the status of schoolbased sexuality education over the past decade and a half. They used different assessment methods--surveys, secondary analysis, case studies. The samples ranged from national to state, and the respondents from superintendent, principal, lead teacher, classroom teacher, to student. No two surveys assessed the exact same sexuality concepts or factors influencing implementation. So, with this variation, it hard to say how much, if







46

at all. sexuality education has improved over time and with the increase in the number of state and district guidelines/mandates.

loxwever. it appears that the most basic sexuality education topics have been the ones most commonly and consistently taught. These topics include those such as STDs, HIIV. sexual anatomy and physiology, sexual development, pregnancy and birth. responsible behaviors, and decision-making. Topics generally considered controversial have been consistently those least often taught. These topics include masturbation. homosexuality, and sexual behavior. Other topics such as abortion, birth control, rape and abuse, and condoms. seem to fluctuate in how commonly they are taught. This is probably due in part to the nature of the information asked about each concept. For example, does a teacher suggest condoms for STD/HIV protection, explain how to use them. actually demonstrate correct use, or tell students where to get them? Overall, it appears a base-level of sexuality education concepts are being provided in classes, although it does not seem consistent with the nature of concepts found in effective programs. Further assessment using updated and comprehensive measures of sexuality education are necessary to determine the status of school-based sexuality education. Minimally, improvements in both the scope and nature of sexuality education concepts taught are necessary to have an impact on students' knowledge, attitudes. and behaviors.



The Status of School-based Sexuality Education in Florida

Since 1973, Florida has legally required Comprehensive Health Education for students in kindergarten through twelfth grade. In 1987, the Florida Legislature








47

mandated AIDS education in middle and high schools. In 1990. age-appropriate Human Sexuality Education %\as added as a component of the Comprehensive Health Education law in kindergarten through twelfth grade in an effort to prevent teenage pregnancy and the spread of sexuall\ transmitted diseases. In 1991. the School Improvement and Accountability Act %\as adopted by the Florida Legislature in an effort to return education decision-making to the community (Report, 1994).

In 1994. Florida issued the Report of the HIV/STD Prevention and Human Sexuality Education Task Force: Components of Qualit' HIV/STD Prevention and Human Sexuality Education (Components). It was a joint project by the Department of Health and Rehabilitative Services and Florida Department of Education (DOE), sponsored by the Centers for Disease Control and Prevention Division of Adolescent and School Health. The purpose of this project was to serve as a form of assistance to Florida school districts (Report. 1994).

The development of the Components stemmed from a report by Governor Chiles' Red Ribbon Panel on AIDS. This panel was convened in 1992 to "develop specific recommendations on wavs to bolster the state's HIV/AIDS education and prevention programs" (Report. 1994). The panel indicated the following in a 1993 statement:

Our hearings revealed that Comprehensive Health Education, including AIDS
Education required by Florida law, is inconsistent and of varying quality around
the state. Local politics often interfere with providing our youth with the
information. guidance, and skills that they need to live healthy productive lives.
(p.2)

To address the in-school prevention issues addressed above, the Panel called for the development of instructional guidelines for HIV/STD prevention education. In the










first of more than 35 recommendations. the panel stated the following. Comprehensive health and HIV/AIDS education in grades kindergarten through twelve should be a joint priority of the DOE and the local school boards. Education efforts in this area should be full\ funded and taught by certified health educators. The state should set instructional guidelines, specific goals, and outcomes for which the local school districts are accountable with minimum standards for the school boards. Based upon this recommendation, a task force was charged with addressing the governor's recommendation for establishing instructional guidelines for HIV/AIDS education within the context of the DOE's Blueprint 2000 initiative which stresses local decision-making and accountability (Report. 1994). Hence, the Components were developed.

A 1995 study by SIECUS reviewed state education agency (SEA) HIV/AIDS prevention and sexuality education programs. They reported that the Florida SEA indicated all school districts implemented sexuality education, even though no state regulations monitored its implementation. Although Florida did not require training or certification of sexuality education teachers. it did encourage and provide training opportunities. There was no state committee to develop, review, or recommend materials to be taught at various grade levels. however, according to SIECUS localities had such committees in place. SIECUS recommended requiring training and certification of sexuality education teachers and the development of a state level agency (Gambrell & Patierno, 1995).

The SIECUS report also reviewed one of Florida's curriculum guidelines, Hot

Topics: Comprehensive Health and Sexuality Education (1993). However. this is not the








49

most current guideline provided by Florida. The Components. described earlier, are more recent. and the contents are discussed in the results section. Hot Topics was found to cover all six key concepts from the Guidelines and 16 of the 36 topic areas. No key concept was covered extensively, and human development and relationships were covered most thoroughly (See Table 2-1). Hot Topics gave specific topic coverage for grades six through twelve. Overview language included an explanation of topic coverage for grades kindergarten through six, but did not provide clear guidance to districts on how to co\ er topics for elementary grades in an age-appropriate manner. SIECUS recommended expanding the guidelines to ensure specific and thorough discussion of various topics grades kindergarten through twelfth, especially those not currently covered (SIECUS. 1995).

In summary. the status of school-based sexuality education is not what it needs to be to improve the sexual health of adolescents. It does appear that a base-level of sexuality education is provided for most students. State and district mandates/guidelines throughout the nation. including Florida. are in place for the most part, however they are not indicative of quality school-based sexuality education. Overall, they do not cover the full realn of sexuality related concepts, nor do they cover all important aspects of a given concept. Instruction at the classroom level is comparative. It appears there is still a need for improvement in and research assessing the quality and depth of sexuality education at the classroom level.

The topics covered are only part of the picture of comprehensive sexuality

education. The materials used, teaching methods and skills-building activities utilized,










time spent. training certification of teachers, and teacher attitudes toward teaching sexuality education are all also important factors that impact the quality of the education provided for students.



Other Factors in the Implementation of School-based Sexuality Education

The comprehensiveness of sexuality related concepts taught is important to sexuality education. How.xever. there are other factors that effect the deliverv of these concepts. Appropriate teaching materials need to be available and up to date. Teaching methods and skills-building activities need to target all learning domains so that students are able to process and actually use the information learned. The time spent on teaching sexuality education needs to be sufficient enough to allow coverage of all topics, as well as time for synthesizing and practicing related skills. Training and certification of teachers is necessarx not only to increase knowledge. but also comfort levels with subject matter. and hence likelihood of teaching it. Finally, positive attitudes toward teaching sexuality education are also an important factor in how and whether sexuality related topics are covered.



Materials Used in Implementing Sexuality Education

Teachers have reported that identification, use, and accessibility of resource materials are major sources of their feelings of inadequate preparation (Gingiss & Hamilton, 1989). In fact, one survey found teachers ranked lack of materials their greatest barrier to teaching sexuality education (Haignere et al., 1996). Even though










many states and districts are supplying districts and schools with guidelines and/or curricula (Gambrell & Haffner, 1993/94), individual districts and schools have much discretion in terms of implementing them. Eight in ten teachers reported they need more assistance (Donox an. 1989). One-third (29%) of teachers had problems with materials or information. They felt the materials were inadequate, una% ailable. or dated. had problems getting them approved for use, or that students found them uninteresting or difficult to read. Almost one-fifth ( 17%) reported this lack of adequate materials and information as the biggest problem they faced (Forrest & Silverman. 1989).

A lack of readily available materials led many instructors to develop their own materials. Forty percent developed some of the materials they used to teach abstinence. 45% birth control. 390'0 AIDS. and 39% other STDs. Twenty-three percent developed all of their own materials for abstinence instruction. 14% for birth control. 10% for AIDS, and 13% for other STDs. Fewer than half of sexuality education teachers used any , materials that had been prepared outside the school or school district, commercially or by organizations, to teach about abstinence and birth control. About half (55%) used outside materials for STD instruction and 66% used such materials for AIDS instruction (Forrest & Silverman, 1989).

Earlier research found that teachers depended most commonly (86%) on

commercially developed materials, and 59% used it as their primary source (Orr, 1982). Many (68%) also used materials they created themselves, 67% used government/nonprofit agency created materials, and 36% school created materials. Instructors used an average of 2.6 of the five possible sources (Orr, 1982).










Teaching Methods and Skills-Buildinu Activities Used in Sexuality Education

As noted before. sexuality education needs to target the cognitive, affective, and behavioral domains in order to be effective (National Guidelines Task Force. 1993). However. it is rare that all three domains are addressed at the state or classroom level. Only four states provided adequate coverage of these three learning domains in their sexuality education guidelines (Gambrell & Patierno. 1995). Personal skills most commonly presented in state curricula and guidelines were too simplistic and did not include instruction on refusal skills or assertiveness messages (Gambrell & Haffier. 1993/94).

At the classroom level, few sexuality education studies have included teaching

techniques. Haignere et al. (1996) reported teacher lecture was the most common method used by sexuality education teachers, and more interactive methods such as roleplay, small-group activities, problem solving, and decision-making activities the least likely to be utilized. Firestone (1994) found that of the five most commonly reported teaching techniques, three were teacher directed--teacher directed questioning, lectures, and work sheets. However. the most commonly used method was class discussion. Many teachers discussed the risks of premature sexual activity, but rarely linked them to concrete coping mechanisms to help reduce those risks (Firestone, 1994). Calamidas (1990) concluded that students were taught facts regarding STDs/HIV, but not how avoid them or how get help if they suspected they had been infected. Forrest & Silverman (1989) reported that two-thirds (68%) of teachers who covered sexual decision-making needed teaching strategies. Orr (1982) found teachers utilized an average of 3.9 of six teaching strategies,










with the use of only one method being rare. Eight in ten or more used lectures, group discussions, and question-and-answer sessions. Seventy-two percent used media and 46% used small group discussions (Orr, 1982). It appears that although a variety of teaching techniques may be utilized by teachers. minimally, there is not enough emphasis on the behavioral domain and skills-building.



Time Spent on Sexuality Education

Ideally. comprehensive sexuality education takes place within health education prekindergarten through twvelfth grade (Guidelines. 1991). The State of Florida asserts that quality comprehensive health education programs. which include HIV AIDS prevention as a component. are minimally 50 hours in length at each grade level and taught by trained health educators (Repo , 1994). Even though the majority of teachers feel sexuality education should be given high priority, it is generally agreed that not enough time is devoted to it (Hill, Piper. & King, 1993). Insufficient time in the curriculum has been reported as the major weakness in one STD/HIV curriculum (Calamidas. 1990). Almost one-fifth (18%) of teachers in a national study reported lack of time was one of the three greatest problems they faced in teaching sexuality education (Forrest & Silverman. 1989), and it was ranked second of eight items that made it difficult to teach sexuality education in another (Haignere et al., 1996).

In 1982, a national study found 64% of schools offering a separate sexuality

education course reported it lasted five to 20 hours, 27% more than 20 hours, and nine percent less than five hours (Orr, 1982). In 1984, over 50% of high school sexuality










education programs in a study of large school districts (over 100,000) 'were six to 20 hours long. 29o were more than 20 hours, and 11% were less than six hours (Sonenstein & Pittman. 1984). Half a decade later, the amount of time spent on sexuality education averaged 11.7 hours in grade seven and increased to 18.3 in the twelfth grade. The total number of hours spent from grade seven through twelfth averaged 38.7 (Donovan, 1989: Forrest & Silverman. 1989). In SIECUS" national study. while 72% of teens reported the\ received sexualit\ education, only 58% of teens indicated it was at the junior high level and 560o at the senior high level. Only 5% of all teens reported receiving instruction in sexuality education every year while in school (Teens Talk. 1994).

At the state lexel. Koblinsky and Weeks (1984) reported that almost half (43%) of FLE programs were quarter or semester programs, and 31% were units of 15 hours or less within another course. The greater the number of class hours, the more likely it was that more controversial topics were covered. The findings may have overestimated the actual incidence of full semester/quarter sexuality courses because surveys were given to those most involved in FLE. Calamidas (1990) reported 34% of districts provided six to ten hours of instruction. 25%o 11 to 15 hours, and 18% one to five hours. Firestone (1994) found that students received an average of 30 days of instruction per year in the years they took FLE courses. One-third of teachers in that study reported that students received 10 or fewer days and one-fourth of teachers said more than 40 days. Sexuality education within FLE lasted an average of 24 hours with one-quarter (23%) of teachers reporting five or less hours, and one-fifth (19%) reporting more than 30 hours. Half of teachers wanted students to devote more class time to FLE (Firestone, 1994).










A review of the effectiveness of school-based sexuality education programs

tentatively concluded that the amount of time spent in programs may not be as important as previously thought (Kirby et al.. 1994). Effectiveness was defined as having an impact on reported sexual or contraceptive behaviors or their outcomes. such as pregnancy. birth. or STD rates. One of the longest programs reviewed, 15 sessions, was one of the most effective. However. other long programs. 10, 18, and up to 45 sessions each, %\ere not effective. Furthermore. some of the shorter programs. 10 and 6 sessions each. \%ere effective Kirby et al.. 1994).



Training 'Certification for Sexuality Education Teachers

If sexuality education programs are to prove effective, teachers need professional training on how to teach these subjects (SIECUS. 1995/96). With regards to sexuality education. teacher training has been shown to increase knowledge, perceptions of importance of teaching the curriculum, intent to teach, and level of comfort with the course content (Levenson-Gingiss & Hamilton, 1989). Higher levels of teacher cognitive and affective comfort. and perceptions of adequate preparation have been significantly associated with student perceptions of course impact on their sexual knowledge, attitudes, and anticipated personal behaviors (Hamilton & Gingiss. 1993). Teachers rated as more influential by their students have also been found to be more knowledgeable than less influential teachers, indicating that not only is comfort important, but also a high knowledge level (Hamilton & Gingiss, 1993).








56

Yarber. Torabi and Haffner (in press) found that academic preparation in human sexuality and in teachinu sexuality education were the teacher variables most commonly related to inclusion of sexuality education topics. Teachers with this preparation were more likely to teach topics in the sexual behavior and sexual health key concepts. from the SIECUS Guidelines. than those without it (Yarber. Torabi. & Haffner. in press). Finally. teachers actively using knowledge acquired in sexuality education inservice training were better able to maintain that knoxvledge than those not teaching (Smith. Flaherty. Webb. & Mnumford, 1984).

Evaluation of health education programs has also found a positive e relationship between teacher inservice training and curriculum implementation (Connell & Turner, 1985). Inservice training has been shown to enhance teacher feelings of preparedness which in turn was significantly related to teaching more sensitive subjects and more health lessons overall (Hausman & Ruzek. 1995). Students of teachers with health education preparation recalled more specific health content, with a greater elaboration of the content, than did students of teachers without training. The trained teachers implemented a wide range of health topics delivered in an experiential and integrated manner (Oganowski. Detert. Bradley, &Schindler, 1996). Participants of health teaching workshops have also been found to believe more strongly than those not attending that they could do a good job teaching a variety of health topics, knew how to teach health education effectively, and understood health education concepts well enough to be effective in teaching it to their students. They also believed that if they did a good job teaching health education, their students would be knowledgeable about health issues,










would significantly change health related behaviors, and .vould be healthier adults. Finally, they reported spending more time per week teaching health education and expending a greater eftort on a variety of specific health content areas than those not attending (Telljohann. Everett. Durgin. & Price, 1996).

Unfortunately. teachers often do not have the skills. knowledge. or inclination to teach sexuality education classes (Rodriguez et al., 1995/96). Teachers and school personnel have reported a need for more knowledge about general HIV AIDS school related issues (Ballard. White. & Glascoff. 1990) and subjects such as sexual orientation. STDs. risk behaviors for HIV transmission, safer sex. and communication with a sexual partner about HIV (Kerr. Allensworth, & Gayle, 1989). A national stud- found 80% of teachers reported needing factual information, teaching materials, or teaching strategies regarding pregnancy and STD/HIV prevention. Almost half (45%) of those needed all three types of help for each topic they covered (Forrest & Silverman, 1989). The preparation of teachers who teach health--including sexuality--education is a significant concern (Collins et al.. 1995).

State level requirements for teacher training and certification in sexuality

education are rare based on several assessments of guidelines conducted during the past decade (Gambrell & Haffner, 1993/94; Gambrell & Haffner, 1993; and Gambrell & Patierno, 1995; Kenney. Guardado, & Brown, 1989). According to the latest state survey (Gambrell & Patierno. 1995) twelve states, D.C. and Puerto Rico required teacher certification for teachers of sexuality education. Only six states and Puerto Rico required teacher training in order to teach sexuality education. However, 17 states and D.C. did











provide some training in sexuality education, and nine updated their training annually (SIECUS. 1995).

Training and certification requirements are more common at the district level.

Over half (56%) of districts required sexuality or AIDS education teachers to be certified. most often in health education (86%). but also in science (41%). physical education (26%). family and consumer science (21%). biology (12%). or school nursing (11%). Sixty-one percent of districts required training for teachers of sexuality education. It averaged txwo days or six workshops or sessions, and was usually provided by the health department or district itself. Training usually concentrated on information on the subject rather than curriculum, materials, or teaching techniques (Kenney, Guardado, & Brown, 1989).

In contrast. when teachers were surveyed in a national study about their training a majority of them reported training in sexuality education. It was found that 89% of the sexuality educators had undergone training that specifically prepared them for teaching the topic. Seventy-eight percent had undergraduate training, 53% had graduate training, and 86% had attended workshops or seminars outside their formal academic course work. Their primary identities were not as sexuality education teachers however. As indicated above, most had other teaching priorities. Within the past year, 72% had attended a workshop, conference. or seminar designed to help them in their teaching of sexuality education (Forrest & Silverman, 1989).

A state survey also found that FLE teachers tend to be experienced. Teachers in Firestone's (1994) study had an average often years experience teaching FLE and 75%










reported feeling very prepared for teaching. This probably being because over threequarters had training in FLE, HIV, and/or human sexuality. More than half had taken undergraduate courses in FLE (53%) and human sexuality (59%), and more than onefourth had graduate training in each area. 27% and 26% respectively. Half had received district training on FLE (50%) and HIV/AIDS (52%). and more than half had received out-of-district training on FLE (65%), HIV/AIDS (72%). and human sexuality (52%) (Firestone, 1994).

The number of teachers reporting they need help teaching and those reporting they received training seems incongruent. This may be explained in that the training is not recent or frequent enough to keep them updated in all the areas of sexuality education. State and district level training sessions tend to focus on content and not curricula. materials, or teaching methods (Kenney, Guardado, & Brown, 1989). Also. research on undergraduate teacher preparation programs found the sexuality education content to be lacking, as described below.

Although over 89% of those teaching sexuality education reported some training in sexuality education (Forrest & Silverman, 1989), only recently has the content of that training been investigated. Rodriguez et al. (1995/96) reviewed the course catalogs of a sample of 169 institutes offering undergraduate preparation of teachers to assess the amount and type of sexuality education provided. They found no schools required a sexuality education course for all pre-service teachers, almost no secondary (1%) or physical education (6%) certification programs required any courses on sexuality education, and only 61% of programs required students in health education certification











programs to take sexuality education courses. Only nine percent of health education certification programs and three percent of phy sical education certification programs required a sexuality course in methodology. No schools required health education certification students to take a course on HIV/AIDS and only twelve percent offered any courses that mentioned HIV/AIDS (Rodriguez et al. 1995'96).



Teacher Characteristics and Attitudes Toward Sexuality Education

A national study found that the majority of teachers teaching sexuality education think it is important to do so. They even feel some topics--birth control. AIDS, STDs, sexual decision-making. abstinence and homosexuality--should be taught earlier than they are (Donovan, 1989). Previous research has shown that characteristics such as age, gender. marital status. and religious preference were not strongly related to the inclusion of topics in sexuality education courses (Yarber & McCabe. 1981). Few studies have been conducted on the effect of teacher attitudes and concerns on use of a curriculum (Gingiss & Hamilton. 1989). but research does indicate that the attitudes and concerns are significantly related to the nature of the instruction provided (Forrest & Silverman. 1989; Levenson-Gingiss & Hamilton. 1989; Yarber & McCabe. 1981; Yarber. Torabi, & Haffner. in press).

Important teacher attitudes and concerns have been identified such as comfort presenting cognitive information and leading value-laden discussions, and perceived adequacy of preparation, which are modifiable by training and experience. These attitudes and concerns are directly reflected in students' sexual knowledge, attitudes, and











perceptions of the effects of a sexuality education course on their future behavior, and their assessment of teacher performance and classroom environment (Hamilton & Gingiss. 1993). Teachers' own philosophy and commitment to program objectives have also proven to significantly influence outcomes of an abstinence program (De Gaston, Jensen. Weed, & Tanas. 1994).

Past research found teacher attitudes toward their own sexuality %\ere related to the inclusion of topics. Those with positive attitudes toxard sexuality tended to include more topics in their sexuality education courses. especially topics related to sexual behaviors (Yarber & McCabe, 1981). However. that finding was not replicated in a more recent study. The teacher characteristics :' st commonly related to inclusion of topics included academic preparation in human sexuality, age. and academic preparation in teaching sexuality education (Yarber, Torabi. & Haffner. in press). Instructor attitudes regarding whether or not a topic should be included in the curriculum have been found to influence their inclusion of the topic. Teachers that did not think some topics should be included, such as homosexuality, masturbation, sexual dysfunction, exploitation, and sexual techniques, did not include them in their curriculum (Orr, 1982). More recently, high importance ratings of topics was correlated with the inclusion of those topics in the curriculum (Yarber. Torabi. & Haffner. in press).

Most teachers xxho responded in one study placed high value on importance,

responsibility, and comfort scales on some central issues addressed, such as self-esteem, interactional skills, and STDs. However, diminished importance was placed on birth control and student sexual behavior. These subjects are critical to address in trying to












decrease possible negative consequences of sexual activity (Gingiss & Hamilton, 1989). Although this study did not assess what was actually taught. conclusions from studies cited above reported the decreased likelihood of teaching subjects that xvere not rated important. Hence, it is important to increase teacher comfort and feelings of importance related to these topics to increase the likelihood they are included in sexuality education curricula.

It appears there are several factors that are important to the implementation of school-based sexuality education. A lack of readily available and current materials has left many teachers feeling inadequate and unprepared. and led many to create their own materials. Teaching methods and skills-building activities are not addressed in state or district guidelines. Also, at the classroom level teaching methods are reported to be more teacher-oriented rather than emphasizing the important skills-building domain. Although there is not a specific time amount given for effective programs, it is generally agreed upon by teachers that there is not enough time in the curriculum for sexuality education. It also appears that sexuality education courses are only being offered in one or two grades in high school. rather than being incorporated in all grade consistent with the comprehensive approach recommended by professionals. Training of sexuality education teachers, when provided, has a significant positive impact on teachers and their students. Research indicates most teachers would like more training. State and district certification and training requirements are not sufficient. Training offered at this level and that provided in professional degree programs does not adequately prepare teachers for teaching sexuality education. Finally, teacher attitudes are significantly related to the











nature of instruction provided. Although most seem to have positive attitudes toward teaching sexuality education, training could help to improve attitudes overall and perhaps toward specific topics. hence enhancing the quality of sexuality education. Addressing these issues--providing current. appropriate materials. increasing the time allotment in the curriculum, and training teachers so they feel more comfortable with teaching methods. content. and sexuality education in general--could help to improve the status of schoolbased sexuality education.



Conclusion

There is both a need for and the support for comprehensive school-based sexuality education. Professionals agree that programs need to cover the scope of human sexuality issues: address the cognitive, affective, and behavioral learning domains: work with parents and community resources: and not only aim to prevent STDs/HIV and unwanted pregnancy, but promote sexual health. Evaluation of sexuality programs has proven that they can be effective in increasing knowledge and promoting behaviors that reduce the likelihood of negative consequences associated with risky sexual behavior.

State and district recommendations and mandates for school-based sexuality

education have increased tremendously in recent years. Although the depth and nature of studies assessing sexuality education have varied greatly, it appears the majority of schools are providing a base-level of sexuality education for students. However, much work remains. Controversial topics and those pertinent to the prevention of STDs/HIV and unwanted pregnancies are often avoided and not presented in a manner conducive to











effecting behavior. Also. there is still more of an emphasis on avoiding the negative consequences of risky sexual activity rather than promoting healthy sexualitv.

In addition to the content, other factors related to implementation need to be addressed. Teacher training is necessary to improve the status of sexuality education. Training can help improve knowledge levels. feelings of comfort. teacher effectiveness, and attitudes toward teaching sexuality. More time needs to be allotted in the curriculum to ensure thorough coverage of topics and time for skills-building activities. Finally. current and appropriate teaching materials need to be made available.

These conclusions are based on several studies intended to assess different aspects of sexuality education. The four conducted in this decade do not provide an adequate assessment of the current status of sexuality education. Two were in the state of New Jersey and assessed Family Life Education. Another. in Indiana, assessed the scope of sexuality education and teacher attitudes. The fourth. a national level study. was intended to assess health education as a whole and only briefly examined sexuality education. A general picture of the status of sexuality education was provided, however. none of the research reviewed in this chapter provided a total picture of sexuality education at the classroom level. Although it is difficult to provide an exact assessment of what is being taught at the classroom level, the goal of this study was to present a more comprehensive view of, and to ultimately help improve the status of, school-based sexuality education.











Table 2-1 Key Concepts and Topics in a Comprehensive Sexuality Education Program (National Guidelines Task Force, 1993).


Key Concept 1: Human Development
Reproductive Anatomy & Physiology
Reproduction
Puberty
Body Image
Sexual Identity & Orientation


Key Concept 2: Relationships
Families
Friendship
Love
Dating
Marriage & Lifetime Commitments
Parenting


Key Concept 3: Personal Skills
Values
Decision-making Communication
Assertiveness
Negotiation
Finding Help


Key Concept 4: Sexual Behavior
Sexuality Throughout Life
Masturbation
Shared Sexual Behavior
Abstinence
Human Sexual Response
Fantasy
Sexual Dysfunction

Key Concept 5: Sexual Health
Contraception
Abortion
STDs & HIV Infection
Sexual Abuse
Reproductive Health


Key Concept 6: Society & Culture
Sexuality & Society
Gender Roles
Sexuality & the Law Sexuality & Religion
Diversity
Sexuality & the Arts















CHAPTER 3
MATERIALS AND METHODS

Introduction

This study assessed the scope and nature of sexuality education in Florida public high schools. It provided information on the scope and nature of information that was covered in sexuality education courses. and teacher. school. and district variables that were related to implementation of sexuality education. As sexuality education is mandated in Florida. data was used to determine compliance with the Components. In addition to providing valuable baseline data. this information will help improve schoolbased sexuality education and support for those teaching it. Chapter 3 includes the following sections: (1) subjects, (2) instrumentation. (3) procedures. and (4) analysis.



Subjects

A 1982 study (Orr, 1982) found that five specialty areas were most likely to

include sexuality education teachers-- biology, health education, family and consumer science (FCS). school nursing, and physical education. A 1989 study used a national sample from the same five specialty areas (Forrest & Silverman, 1989). They found that teachers of health education were most likely to provide sexuality education, with FCS being second most likely. They comprised 25% and 23%, respectively, of the sexuality education teachers. However, there were more than twice as many physical education 66










67

teachers as teachers of health education or any other specialty, so they accounted for the largest proportion, 3! 00. Based on the results of these two previous studies. it was decided to survey health education and FCS teachers. In Florida, FCS teachers are also reported to be most likely to teach Life Management Skills (LMS) (Darci Lolley, HIV STD Prevention Specialist, Comprehensive School Health Program. Florida Department of Education. personal communication, November 3. 1995). LMS is a required class for graduation, usually taught in the ninth or tenth grade. and likely covers health and sexuality education topics. Physical education teachers were not chosen based on prior findings that they were least likely to teach sexuality education (Forrest & Silverman. 1989).

The subjects for this study were public school teachers teaching sexuality education within grades 9 - 12. Originally, only required classes were going to be assessed so that baseline information could be established on minimal sexuality education Florida students were provided. However, only 176 teachers reported their class was required, so all completed surveys were used. A list of all teachers with primary teaching codes "health" and "consumer and family sciences" for the 1995-1996 school year was obtained from the Florida Department of Education (DOE). Teachers were listed by school and district. Thus, this list did not include all possible teachers responsible for sexuality education. As found in the previous studies cited above, some probably had primary teaching codes biology/science, physical education, school nursing, and other subjects. This list also contained some teachers that did not teach sexuality education.











Of the sample. 76 respondents returned the survey indicating they were not currently teaching sexuality education.

There were a total of 204 health teachers in 37 of the 67 school districts in Florida and 880 FCS teachers in 64 of the 67 districts. It was assumed that the 27 districts with no listed health educators did not have any since information was turned in for FCS teachers in those districts. One district (Charlotte) did not turn in a full report, so information was missing for five health and eight FCS teachers, bringing the numbers to 199 and 872 respectively. There wvas no information, and hence no participants. for three other districts (Bradford. Lafayette. Union). All health teachers listed (N= 199) and a random sample of FCS teachers were selected. Using a random number assignment, a 35% sample (N=301) of FCS teachers was selected. A pilot-test of 18 was selected, nine student teachers and nine teachers. The University of Florida Department of Health Science Education had nine student teacher interns each working with a supervising teaching who either taught health or LMS in a Florida hiuh school. Information on school districts was obtained from the Florida DOE's Statistical Report, Profiles of Florida School Districts 1993-94, the most recent edition available. Information on individual schools was not available from the Florida DOE.



Instrumentation

Two survey instruments and one assessment instrument were used for this

research. The instruments chosen were "Sex Education in the United States," from a national survey by the Alan Guttmacher Institute (AGI) (1988), and "Survey of School













Sexuality Education." from a state survey by Drs. William Yarber and Mohammad Torabi (1995). These instruments were chosen after reviewing research on school-based sexuality education in the United States. Few similar studies were found in the literature search. Within the past decade, these were the only two instruments developed that were found to be suitable for the objectives of this study. The only other national survey used an interviews questionnaire and was too broad in scope. including numerous health topics (CDC. 1995). The other recent state level studv did not have the survey instrument available for use (Firestone. 1994). A sub-section was replicated from the assessment instrument, Sexuality education curricula: The consumer's guide by Ogletree et al. (1994). The three instruments were modified and combined using Dillman's Total Design Method (1978). The researcher's dissertation committee--two experts in sexuality education. one in school health programs, and one in research design and statistical analysis--reviewed the instrument for validation purposes. In addition. survey questions were taken directly from the above mentioned studies which had already been extensively reviewed by expert panels, as described below.



Sex Education in the United States

This instrument was used in a 1988 AGI national survey of school teachers that taught sexuality education. The study reported the frequency of sexuality education in grades 7-12, some topics covered in sexuality education, and institutional and other obstacles that may have impeded instruction. Special emphasis was placed on prevention of pregnancy, sexually transmitted diseases (STDs), and HIV/AIDS to obtain a clear













picture of schools' coverage. The study provided primarily the first national-level statistics on these issues.

Survey development, methodology, and results were reported by Forrest and Silverman ( 1989). The survey was developed through personal consultation with sexuality educators. researchers. and education specialists. Four focus group discussions with sexuality educators from public secondary schools in the Northeast. and a pilot survey ol200 randomly sampled public school teachers. 40 from each of the five specialties covered in the survey. were also used to gather preliminary information. Survey recipients were asked questions about themselves, their schools. and their views as to whether sexuality education should be taught and what topics should be covered at what grade levels. More detailed questions were asked of those currently providing sexuality education (Forrest & Silverman. 1989). No measures of reliability or validity were reported. Portions of this instrument were used in the current study to measure coverage of abstinence. pregnancy prevention, birth control methods, condoms, and STDs HIV: determine how sexuality education was taught (classes, materials. time); and assess teacher training and demographics.



Survey of School Sexuality Education

This self-report questionnaire was developed by Drs. William Yarber and

Mohammad Torabi and administered to Indiana high school teachers in a 1995 survey. The survey contained three sections: 1) a list of 36 sexuality education topics about which the respondent was asked to indicate whether the topic was included in the sexuality










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education unit in his her class and to indicate his/her vie\ about the degree of importance of each topic as part of comprehensive sexuality education: 2) two instruments designed to measure sex-related attitudes of the respondents, and 3) questions dealing with demographic characteristics of the respondent. the respondent's view of support for sexuality education in his/her classes, and selected characteristics of the health classes and sexuality education taught by the respondent. Only the component assessing whether each of the 36 topics were taught and teacher ratings of importance were used in the current research. These 36 topics were based on SIECUS's Guidelines for Comprehensive Sexuality Education (1993) described in Chapters 1 and 2. Survey development. methodology and results were reported by Yarber, Torabi. and Haffner (in press). The survey was deemed valid because the items were directly from the Guidelines ,which were developed and reviewed by a national panel of experts. No measures of reliability were reported.



Sexualit\ Education Curricula: The Consumer's Guide

This guide was developed in an effort to assist teachers, program planners, and administrators in determining whether published sexuality education curricula meet the school district's needs (Ogletree et al., 1994). The guide identifies key attributes of curricula including content, philosophy, skills-building strategies, and teaching methods. The skills-building and teaching strategies sub-sets were used for this research. The skills-building strategies sub-set was created based on specific personal and interpersonal skills deemed necessary for healthy sexuality. These have been identified by the











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SIECL S Guidelines for Comprehensive Sexuality and through evaluation of prevention programs over the past twenty years. This sub-set was used in two ways--to assess whether teachers included the strategy while teaching sexuality education and whether they actually had students practice the skills. The teaching strategies sub-set compiled a variety of teaching methods necessary to meet individual learning styles and to provide opportunities for personal and social skills-building (Ogletree et al., 1994).



Data Collection Procedures

The survey and data collection procedures were approved by the University of Florida Institutional Review Board on February 22, 1996. The survey methodology followed Dillman's recommendations in The Total Design Method (1978). Contents included a cover letter. the survey booklet, and a pre-addressed, postage-paid return envelope. On February 27, 1996 a pilot survey was sent to the Department of Health Science Education student teacher interns and their supervising teachers (N- 18). Those not responding within one week were followed-up by post-card on March 5. Ten surveys were returned. After reviewing comments, a few minor revisions were made. Some words or phrases within questions were underlined and bolded to emphasize the major elements of some questions.

On March 26. surveys were sent to the 500 sample subjects. On April 2, a followup post-card was mailed to all subjects. On April 23, a follow-up letter including a new survey and pre-addressed, postage-paid envelope was sent to subjects who had not yet













responded (N=278). There was a three week lapse of time following the post-card reminder rather than the usual two weeks due to spring break in some districts.

For respondents that indicated they were not teaching sexuality or HIV/AIDS education in grades 9-12. replacements were chosen based on random number assignment. Replacement surveys were sent for approximately the first half of the ineligible surveys that wvere returned. Those received back after April 16 were not replaced. The replacement surveys were mailed April 9 (N= 17) and April 16 (N=20). with follow-up post-cards on April 16 and April 23 respectively. A letter of appreciation and a summary of study results were forwarded to each participant who requested them following completion of the study.



Analysis of Data

A total of 555 surveys were mailed. There were 18 in the pilot sample. 500 in the original sample, and 37 in the replacement sample. Of the 18 in the pilot sample, seven of the nine surveys were returned by the teachers. and three of the nine were returned by the student interns. Since the students and teachers answered the survey based on the same class, the students' surveys were not used in data analysis. The seven pilot teacher surveys were used in data analysis, since no major revisions were made in the survey.

Seventy-six of the sample of 500 respondents indicated they were not teaching sexuality education in grades 9-12. Replacement surveys were sent on a weekly basis until April 16, for a total of 37 replacement surveys. In addition, two respondents completed the survey twice, so the two duplicates were omitted by the researcher. Of the













555 surveys sent. 87--nine pilot. 76 not teaching. and two duplicates--were not useable, leaving 468 eligible. Of these, 261 completed surveys were received and used for data analysis--seven pilot. 105 health. and 149 FCS teachers--yielding a 56% response rate.

Quantitative results were calculated for all information gathered. These results were used to answ er research questions 1. 3. and 4. An analysis of variance (ANOVA) was used to assess relations between the number of concepts taught for each of the survey sub-scales and teacher and school/district characteristics. The sub-scales included the scope of sexuality education concepts. abstinence concepts. types of birth control methods, birth control concepts. condom concepts. types of STDs, STD concepts, HIV concepts. skills-building strategies taught. skills-building strategies practiced by students, teaching methods utilized, time spent on abstinence, birth control, condoms. STDs, HIV. and total time. For the ANOVAs, five characteristics were used as covariates--age. race, sex. years teaching. and years teaching sexuality education--and two teacher variables were tested for main effects--degree of liking teaching sexuality education, and certification in health or FCS. Two school/district variables were also tested for main effects--the status of the curricula mandate and the class as required or elective. Post hoc analyses on significant findings were performed using Tukey's Honestly Significant Difference test. These results were used to answer research questions 5 and 6. A regression was used to assess the relation between the above listed sub-scales and continuous district demographics--total number of students, percent minority students, percent students on free/reduced lunch, as an indicator of socioeconomic status. These results were used to answer research question 6.













In 1991. SIECUS issued the Guidelines for Comprehensive Sexuality Education (Guidelines). an idealized model of comprehensive sexuality education. as described previously in Chapter 1 and 2. In 1994. Florida issued the Report of the HIV'STD Prevention and Human Sexuality Education Task Force: Components of Quality HIVSiSTD Prevention and Human Sexuality Education (Components). The purpose of this project was to serN e as a form of assistance to Florida school districts in implementing the mandated kindergarten through twelfih grade comprehensive sexuality education, as described in Chapter 1 and 2 (Report. 1994).

The Components were compared to the Guidelines by the researcher. The

Guidelines were utilized in the development of the Components. Hence. most of the Components' objectives were identical to those in the Guidelines. It was found that the Components included learning objectives for all six key concepts and the majority of the 36 subconcepts. Thus. the assessment of the scope of sexuality education at the classroom level using the Guidelines' 36 concepts was used to help determine compliance with the Components as most concepts .vere included in both. These results were used to answer research question 2.
















CHAPTER 4
RESULTS

The Context of Sexuality Education in Florida Schools

This study assessed the scope and nature of sexuality education in Florida public high schools. The results of the study are discussed in three sections in this chapter. The first section, the context of sexuality education in Florida schools, addresses the subjects surveyed. the types of courses sexuality education is taught in. district mandates for sexuality education. and the time spent on sexuality education. The second and third sections are the scope and nature of. and the factors effecting implementation of sexuality education in Florida schools.



Teachers

The subjects for this study were health and family and consumer science (FCS) public school teachers teaching sexuality education within grades 9 - 12. The sample for the pilot-test was comprised of the University of Florida Department of Health Science student teacher interns and their supervising teachers. There was a total of 18 in the pilot sample, nine student teachers and nine supervising teachers. After their surveys were returned and necessary changes made, a sample of 500 was sent. Their names were obtained from a Florida Department of Education (DOE) list. There were a total of 199 health teachers in 36 of the 67 school districts in Florida and 872 FCS teachers in 63 of 76











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the 67 districts. All health teachers listed (N= 199) and a random sample of FCS teachers were selected. Using a random number assignment. a 350" sample (N=301) of FCS teachers was selected. Seventy-six of these respondents indicated they were not teaching sexuality or HIV!AIDS education in grades 9-12 during the 1995-96 school ,ear. Replacement survey s xere sent on a weekly basis in place of these until April 16, for a total of 37.

A total of 555 surveys were sent--18 pilot. 500 in the sample. and 37 as

replacements. Eighty-seven of these were not eligible. The nine student teachers in the pilot were taken out to avoid duplication as they based surveys on the same class as their supervising teachers. Two respondents completed the survey twice, so these duplicates were omitted. In addition 76 were not teaching sexuality/HIV education. so 468 respondents remained eligible. Of these. 261 surveys were completed yielding a response rate of 56%.

Demographics. The majority of the teachers were Caucasian females (68%). Overall. 80% of respondents were female and 84% Caucasian. African Americans accounted for 11%. Hispanics 2%, and Asian. Pacific Islander, and bi-racial 1%. The ages ranged from 20-24 (2%) to 60-64 (2-%). The majority (75%) were between 35 and 54 years of age, 16% were 35-39 years, 18% 40-44 years, and 26% 45-49 years. The teachers had been teaching for an average of 16 years and sexuality education specifically for ten years.

College preparation. The most common bachelor level degree was FCS (48%), followed by a combined degree in health/physical education (18%), health education













(9%). and physical education (60). A range of other majors comprised the rest of the sample. Almost halfl41%) of the teachers also completed a master's degree. Again, of these the most common major was FCS (33%). Health education and school administration comprised 9�0 and 10%. respectively. of the majors. with a variety of other majors completing the group. O111-\ four teachers (1.5%) reported having a doctorate degree and 3% having various other certifications, such as Certified Health Educator (CHE) and Professional Diploma. Teacher certification was also most commonly in FCS (510). followed by health/physical education (26%/). and health (80).

Teachers (N=173) had an average of 7.16 (s= 10.38) undergraduate semester hours of training that specifically prepared them for teaching sexuality education. with a range of zero to 60. Seventeen percent (N=44) had no undergraduate training. 32% (N=84) did not respond. Teachers (N=132) had an average of 2.68 (s=5.79) graduate semester hours for the same purpose. with a range of zero to 40. Thirty-one percent (N82) had no' graduate training in this area. and 49% (N=128) did not respond. As the range was great in these semester hours estimates. it was assumed that some respondents misinterpreted the question. It does not seem likely that one could receive 40 or 60 semester hours specific to sexuality education. Respondents may have estimated total class hours during the semester, rather than semester hours where one class is generally three. However, since there was not a clear cut off point in the results, it was not possible to make a definitive determination.

Continuing education. Teachers (N= 176) had a mean of 19.48 (s= 17.72) hours of workshops, in-service training, and seminars to date that specifically prepared them for












teaching sexuality education. with a range of zero to 75. The majority of teachers had some training within the last school year. Twenty-seven percent reported they had attended one session in the past school year. 330% attended several times. and less than 2% attended monthly or weekly. Thirty-six percent reported they had not attended a workshop designed to help with teaching sexuality education since the end of the last school year.

Attitudes. Teacher attitudes toward sexuality education were positive overall. The majority of teachers reported they 'very much" (64%) or 'somewhat'" (22%) liked teaching sexuality education. Only 10% were neutral ("neither like nor dislike") and less than 2% reported they did not like teaching sexuality education "too much" or "at all." Almost all (94%) teachers thought it was the appropriate role ,' he school to teach sexuality education.



Types of Courses

The majority of eligible teachers (82%) indicated they were teaching sexuality education that included HIViAIDS education. Only four percent said their class did not cover HIV/AIDS. About twelve percent indicated they were teaching an HIV/AIDS class. Life management skills, a required class in Florida high schools, was the class most commonly used as the basis for answering the survey (58%). FCS was the next most prevalent (25%) class, followed by health education (11%). FCS had several classes within it rubric, most commonly "Child Development" and "Family









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LivingDynamics." Four percent (N= 11) of the respondents did not indicate what class they based the survey on.

Two-thirds (67%) of respondents reported their class was required for students. One-ti fth (210) reported it was an elective course. The remaining 11% did not respond. Students receiving sexuality education were most likely in the ninth grade (39%). follo\\ed by a mixed grade level class (34%). tenth grade (15%). eleventh (2%). and twelfth (1%).



Mandates for Courses

Just over one-third (37%) of teachers reported that it was mandated for them to use a specific sexuality education curriculum and almost one-fourth (230o) reported that one was suggested. Another one-fifth (22%) said it was neither mandated nor suggested. Fifteen percent either did not know whether their district mandated or suggested a curriculum or did not respond. Almost all (93%) of those with a mandate suggestion reported it was established by the district. Numerous responses were given for the name and publisher of the mandated/suggested curriculum. The most common answers were not specific names, but rather that the district produced/provided it (3 1%) or that they did not know the name or publisher (22%).



Time Spent on Sexuality Education

HIV and STDs received the most coverage in classes. An average of 134 minutes (s= 106), with a range of zero to 720 minutes, was spent on HIV and 122 minutes (s=92),












with a range of zero to 500. on STDs. Abstinence received more coverage than either birth control options or condoms, with averages of 77 (s=88), 65 (s=70). and 34 (s=50) minutes being spent on each topic respectively. The ranges for these topics were zero to 750. 480. and 400 respectively. However, for each of these topics, less than 15% of the respondents reported greater than 200 minutes for HIV (13.8%) or STDs (10.4%), greater than 120 minutes on abstinence (12.3%) or birth control (10.4%). and greater than 50 minutes on condoms ( 11.5%). About 20% of teachers did not respond to the number of minutes spent on abstinence, birth control, or condoms. and 15% to HIV or STDs. Total time spent on sexuality education averaged 11 hours (sd=8) with a range of one to 60 hours. Twentv-three percent of respondents spent between 1 and 5 hours on the unit. 28% between 6 and 10 hours, 17% between 11 and 15 hours, 10% between 16 and 20 hours, for a total of 78% spending between 1 and 20 hours. Only 9% spent 20 to 60 hours on the unit. with 13% not responding.



The Scope and Nature of Sexuality Education in Florida Schools

This section addresses the scope of concepts taught, teacher ratings of importance toward the concepts. and compliance with Florida's Guidelines. The nature of concepts taught and use of referrals and guest speakers are also reviewed. Finally, the skillsbuilding activities, teaching methods, and materials utilized by the teachers are summarized.











Scope of Concepts Taught

The scope was measured using the 36 concepts outlined in the SIECUS

Guidelines for Comprehensive Sexuality Education Grades K-12. Teachers were asked to indicate whether or not they were teaching each concept. An average of 25 concepts (s=6.75) wxere tauuht \\ith a minimum of seven and a maximum of 36. The topics most comninly reported taught were abstinence (99%). decision making (99 0). sexually transmitted diseases IIIV (97%). communication (95%). values (93%). finding help (92%). love (89%). friendships (88%). assertiveness (88%). reproduction (87%). reproductive health (85%). dating (84%). body image (83%). puberty (82%). families (820/0. sexual identity and orientation (810%). marriage and lifetime commitments (81%). sexual abuse (810%), and negotiation (80%). Topics tauLI . by about three-fourths of teachers included reproductive anatomy and physiology so). parenting (76)%. sexuality and society (730%), sexuality and the media (73%). contraception (72%). sexuality' throughout the lifespan (70%). Gender roh, (67%) and human sexual response (55%) were taught by more than half of teachers. he most neglected topics were those often considered to be controversial topics such as abortion (40%). sexuality and religion (39%). sexuality and the law (38%), shared sexual behavior (36%),. diversity (32%), masturbation (28%), fantasy (25%), sexual dysfunction (24%), and sexuality and the arts

(8%). (See Table 4-1.)

Although 810% of teachers reported they taught sexual identity and orientation, their comments and the Florida definition of this topic lead to the questionable nature of this finding. The Guidelines' description of the sexual identity and orientation concept,











used in this survey, %%as general (As young people grow and develop, they begin to feel romantically and sexually attracted to other people.) and not technically accurate, even though it contained some specific objectives that correctly address the topic. Thus, some of the teachers completing the survey may have misinterpreted the meaning of this concept. Further discussion follows in Chapter 5.



Rated Importance of Concepts

Teachers were also asked to rate each concept in terms of importance on a scale of "'not at all important'* 1) to *'extremely important" (5). Tw'o thirds (N=24) of the items were rated toward the extremely important end of the scale. having an average score of at least 4.0. Abstinence and STDs/HIV were rated highest. averaging 4.97 and 4.96 respectively. Those rated toward the "extremely important- end of the scale (4 to 5) included decision making (4.86), values (4.73), communication (4.72). sexual abuse (4.61), finding help (4.59), reproductive health (4.57). contraception (4.52). parenting (4.50). assertiveness(4.45), marriage and lifetime commitments (4.44). love (4.44), reproduction (4.43). negotiation (4.34). friendship (4.29). dating (4.18), body image (4.12). families (4.11 ). puberty (4.09), sexuality and society (4.07), sexuality throughout the lifespan (4.05), sexual anatomy and physiology (4.02). and sexual identity and orientation (4.02). Those averaging in the higher end of"moderately important" (between 3 and 4) included sexuality and the media (3.98). gender roles (3.82), human sexual response (3.71). sexuality and religion (3.42), sexuality and the law (3.40), abortion (3.34), diversity (3.12), shared sexual behavior (3.02). Those concepts that were













rated. on average, as less than "moderately important" (between 2 and 3) included masturbation (2.82). fantasy (2.73). sexual dysfunction (2.78), and sexuality and the arts (2.13). (See Table 4-1.)



Compliance with Florida Sexuality Education Guidelines

The guidelines for sexuality education published by the Florida DOE.

Components of Quality HIV/STD Prevention and Human Sexuality, were compared to the 36 concepts of the SIECUS Guidelines for Comprehensive Sexuality Education. which were used to assess the scope of sexuality education in this survey. The Components covered 25 of the 36 Guidelines' concepts. Teachers also covered an average of 25 of the Guidelines' concepts. however, they were not necessarily the same as those covered in the Components.

Of the concepts covered in the Components, those most likely to be taught by teachers included abstinence (99%). decision making (99%). STDs/HIV (97%), communication (95%). and finding help (92%). Those least likely to be taught included abortion (40%). sexuality and the law (3 8%), shared sexual behavior (36� ) fantasy (25%). and sexual dysfunction (24%). There were seven concepts that were not covered in the Components, but were covered by over half of teachers. These included values (93%). friendship (88%). puberty (82%), sexual identity and orientation (81%), negotiation (80%), sexuality and society (73%), and human sexual response (55%). There were four concepts not covered by the Components, nor by the majority of teachers. These included sexuality and religion (39%), diversity (32%), masturbation












(28%). and sexuality and the arts (8%). The remaining topics included in the Components were taught by between 66% and 89% of teachers, as noted in the previous section. (See Table 4-2.)

The eleven Guidelines' topics not covered in the Florida Components included puberty. sexual identity and orientation, friendship. values. negotiation. masturbation, human sexual response. sexuality and society, sexuality and religion. diversity. and sexuality and the arts. However, in examining the Guidelines' coverage of four of these topics. it becomes more understandable why the Components do not include them. The Guidelines break down each concept into developmental messages for four levels. Level 1 is middle childhood and early elementary; Level 2 is preadolescence. upper elementary, Level 3 is early adolescence, middle school/junior high school; and Level 4 adolescence, high school. This study covered grades 9 - 12, or the upper end of Level 3 and Level 4.

Puberty, diversity, and sexuality and the media are only briefly/moderately

touched on at Level 3 (through age 15) and not at all covered in Level 4 (15-18 years, high school) in the Guidelines. Friendship only has two objectives at Level 3 and one at Level 4 in the Guidelines. In addition, the non-specific wording of the sexual identity and orientation subconcept. described previously, helps explain the high percentage (81%) that reported teaching a concept not only omitted in the Components, but one that is considered very controversial in our society. Finally, some objectives related to the relationships key concept were difficult to classify into the subconcepts of love, dating, or marriage and lifetime commitments. Most of the Components' objectives were identical to those in the Guidelines, however several were not. Therefore, whether or not the










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Components addressed a subconcept was dependent upon how it was classified within the Guidelines.



The Nature of Sexuality Education

Abstinence. Thirty-six percent of teachers taught abstinence as the only way to

prevent unwanted pregnancy and STDsiHIV. while 95% taught that it wvas the best way to prevent them. Ninety percent taught students how to resist peer pressure to have sexual intercourse and 910 how to say no to a partner. The negative consequences of sexual intercourse were taught by 95%. An average of 4.08 (82%) of the 5 abstinence related concepts were taught by teachers.

Pregnancy Prevention. Ninety-seven taught abstinence as a method of preventing unwanted pregnancy. Birth control methods were taught as an option by 64% of teachers and 33% reported birth control methods were covered in other courses in the same grade(s) they taught. Twenty-eight percent said they would answer questions about birth control only if a student initiated a question, 61% on a one-on-one basis after class. 53% had students submit questions anonymously on a slip of paper, and 85% answered questions in class.

Birth Control Methods. An average of 5.30 of the 10 birth control methods were taught by teachers. At least half of respondents included the birth control pill (63%), diaphragm (61%). spermicide (59%), intrauterine device (56%), norplant (53%), fertility awareness/rhythm (52%) and the female condom (50%). A little less than half taught withdrawal (49%), cervical cap (46%), and depo-provera (42%).












Fifty-nine percent of respondents taught how birth control methods worked and 54% how to use them. Specific resources for birth control were provided by 39% of teachers. Only twenty-nine percent actually showed the devices to their classes. Half (510%) of teachers taught students how to discuss contraceptive options with a partner. Of the five birth control concepts. only half (46%) were taught on average by teachers.

Condoms. Almost half (48%) of teachers described the proper way to use a

condom and 40% showed the proper wax to use one through printed material, film or demonstration. Sixty-four percent taught condoms should be put on before any vaginal contact by the penis. Fifty-seven percent encouraged condoms as a means of preventing pregnancy and 77% as prevention for STDs'HIV. Concerns about the condom. such as decreased sexual pleasure and/or lack of spontaneity were addressed by 430O of teachers and 64% taught that condoms should always be used with a spermicide. On average, just over half (56%) of the seven condom items were taught by teachers.

STDs/HIV. An average of 8.11 of the 10 types of STIDs were covered in sexuality education classes. At least nine out often teachers taught HIV (94%). chlamydia (90%). genital herpes (90%). gonorrhea (90%), and syphilis (90%). Over half taught genital warts (85%). pelvic inflammatory disease (77%), crab lice (74%), and hepatitis B (71%). Forty-nine percent taught "other STDs," however, few indicated specifically which these were. Only 3% of those teaching human sexuality courses reported not teaching anything about STDs/HIV.

Ninety-four percent of teachers taught how HIV is transmitted, 93% the signs of HIV, and 93% the effects of HIV. Abstinence was taught as a method of HIV prevention










by 96%. monogamy by 88%. and condoms by 85%. Clinic names for testing and help with HIV were provided by 70/0 of teachers, and issues about confidentiality were discussed by 84%. Regarding other STDs, 88% of teachers taught about transmission routes. 87% about siens of STDs. and 85% about the effects of them. Abstinence was taught as a method of prevention by 89%o. monogamy by 82% and condoms by 80%. The names of clinics for testing and treatment of STDs were provided by 64% of teachers and 78% discussed confidentiality issues. Averages of 7.02 of the 8 concepts (88%) related to HIV and 6.52 of the eight (82%) concepts related to STDs were taught by teachers.



Student Referrals

For help with birth control. teachers were most likely to refer students to parents (63%). local family planning clinic/health department (62%), or a family doctor (60%). They were less likely to send them to a school nurse (35%) or guidance counselor (22%). Students who needed help xith HIV/AIDS were most likely to be referred to a family doctor (58%), local family planning clinic/health department (57%), or parents (5 1%). They were less likely referred to a school nurse (37%) or guidance counselor (20%). For help with other STDs. teachers were most likely to refer students to a local family planning clinic/health department (57%). family doctor (56%), or parents (49%). They were, again, less likely to refer to school nurses (37%) or guidance counselors (20%).










Guest Speakers

The use of guest speakers from an outside organization was much more common than use of speakers from within the school. especially for HIV/AIDS. 53% versus 20%, and STDs. 43% versus 17%. About one-third of teachers brought in guest speakers for abstinence (330 0). birth control (27%), and condoms (27%). Guest speakers from within the school were utilized by less than one-fifth of teachers for the topics of abstinence (18%). birth control (14%), and condoms (12%).



Skills-Building Activities

A wide variety of skills-building activities were taught by the majority of

teachers. Half of the 14 items were incorporated by an average of nine out of ten, or more. teachers. These included identifying consequences of decisions (95%). increasing self-awareness/building self-esteem (93%). examining influences on decisions (93%), building decision-making skills (93%). examining perceived STD\HIV risks (92%), building planning/goal-setting skills (91%), and examining personal values (90%). Between eight and nine out often identified community resources (86%). examined perceived pregnancy risks (83%). and taught general communication (89%), refusal (85%). and assertiveness (81%) skills. Slightly less than three-quarters built conflictmanagement skills (72%) and addressed peer norms (71%).

Actually having students practice these skills in class was reported less often by teachers. Teachers taught an average of 12.14 (87%) of the 14 different skills activities, but only had students practice 9.04 (65%) of the 14 skills. At least seven out often











teachers had students engage in activities to identify consequences of decisions (77%), examine influences on decisions (74%), increase self-awareness/build self-esteem (73%), and practice decision-making (79%). planning/goal-setting (76%), and general communication skills (72%). Slightly less had students examine personal values (68%) and perceived STD/HIV risks (55%). and practice refusal (66%), assertiveness (63%). and conflict-management skills (58%). Less than half of teachers had students address peer norms (481,,o). identify community resources (48%). and examine perceived pregnancy' risks (47%o).



Teaching Methods

The teaching methods most commonly employed were teacher lecture (95%), audiovisual materials (95%). student worksheets (91%). and large group discussions (90%). Case studies (74%), cooperative learning/small groups (74%). and ground rules (69%) were also used by many instructors. Far less used an anonymous question box (49%). journals/story writing (30%). a peer helper component (26%), or parent/guardian involvement (19%). Sixty-five percent of the 11 methods were used on average by teachers.



Course Materials

Teachers were asked what curriculum/materials they used in their classrooms, a commercially available curriculum, created materials, and/or other sources. Teachers' most common response was that they created their own materials (29%). One-fifth (21%)










reported using a published curriculum and 14% use a variety of other sources. Another 11% reported using a combination of created materials and other sources. Using a combination of a published curriculum and created materials; a published curriculum and other sources: or a combination of all three sources were each reported by 5% of respondents. A wide range of publishers was reported. all answers being given by less than 500 of the respondents. The "'other sources" specified also covered a range of responses. The most common was materials provided by the school district (11%). The rest of the responses were each reported by less than 2%0 of the respondents. These responses included materials such as community resources/speakers. news articles, videos, excerpts from texts. and pamphlets/ information from local/national organizations.

There were a variety of textbooks used by the teachers. Most commonly they

used a general health. life management skills, or making choices text book (46%). Some reported using more specific human sexuality/marriage and family (7%) or child development (9%) texts. Almost one-third of teachers (28%) did not respond to this question.



Factors Effecting the Implementation of Sexuality Education

In order to examine the relation between the scope and nature of sexuality

education, and teacher attitudes/demographics and district demographics, several subscales were created from the survey to be used as dependent variables. The number of items teachers reported teaching in each of the sub-scales were totaled to provide a measure of the depth of information covered in each area. Totals were calculated for each










respondent on the following sub-scales: the scope of sexuality education taught (Q3-38, N=36. Scope Taught). abstinence (Q39, N=5, Abstinence), methods of birth control (Q41, N= 10. Birth Control Methods), howx birth control methods were taught (Q42, N=5, Birth Control Concepts). howv condoms were taught (Q43, N=7. Condom Concepts), types of STDs HIV (Q44. N=10. Types of STDs). how HIV was taught (Q45, N=8. HIV Concepts). how other STDs were taught (Q45, N=8. STD Concepts). skills-building activities taught (Q48. N=14, Skills Taught). skills-building activities practiced by students (Q48. N=14. Skills Practiced). and teaching methods utilized (Q49. N=12. Teaching Methods). (See Table 4-3.) There was no weighting given to topics that might be considered more or less important. Estimated time in minutes spent teaching each of abstinence, birth control. condoms. STDs. and HIV, and total amount of time in hours spent on the sexuality education unit were also used as dependent variables for comparisons. This series of 17 dependent variables was used for all analysis of variance and multiple regressions.

Analysis of variance was conducted for all of the dependent sub-scales and time estimates listed above. Age, race, gender, total years teaching, and years teaching sexuality education wNere used as covariates, and degree of liking teaching sexuality education, required or elective course, certification in health or FCS, and the status of the curriculum as mandated, suggested, neither or not sure were tested as main effects. Tukey's Honestly Significant Difference test was used for post hoc analysis. The district variables--total number of students, percent minority students, and percent of students on free or reduced lunch--were tested using multiple regressions with the dependent sub-










scales and time estimates listed above. Additionally, a t-test was used to assess the relation between teacher ratings of importance and whether or not a concept was taught.



Teacher Attitudes

Teacher attitudes toward the concepts presented in the scope of sexuality

education were positive in general as reported earlier. Most concepts were rated toward the extremely important end of the scale. Items rated lower tended to be those considered controversial. Using a t-test. a positive relation was found between rated importance and whether or not a concept was taught in class. The average rating for a concept's importance was significantly higher (PR>.O 1) for those teaching the concept than for those not teaching the concept for all items except one. For decision making, only one person reported not teaching it and they rated it extremely important (5). hence no significant difference was found in rated importance. (See Table 4-1.)

Teacher attitude toward how much they liked teaching sexuality education was the factor most commonly related to its implementation at the classroom level. An analysis of variance found a significant difference in the average number of items taught in eight of the sub-scales, as well as two of the average time estimates, in relation to the teachers' ratings of how much they liked teaching sexuality education. The sub-scales included the scope of concepts taught (PR>.O1, F=4.87), birth control methods (PR>.00, F=8.22). birth control concepts (PR>.00, F= 10. 33), condom concepts (PR>.00, F=24.69), types of STDs (PR>.00, F=6.59), HIV concepts (PR>.O1, F=4.45), STD concepts (PR>.Ol, F=5.07), and teaching methods utilized (PR>.Ol, F=5.21). Differences in the










estimated time spent teaching included birth control (PR>.02. F=4.12) and condoms (PR>.02, F=4.31). (See Table 4-4.)

Folloxvx-up. using Tukey's Honestly Significant Difference Test. found that those ,vho reported they "very much" liked teaching sexuality education taught significantly more items on average than both those who **somewhat"' and "neither liked nor disliked" teaching for the scope. birth control methods. birth control concepts, condom concepts, types of STDs. teaching methods utilized, and time spent on condoms. For the HIV and STD concepts. those who reported they "very much" liked teaching taught more on average than those who only "somewhat" liked teaching. For time spent on birth control methods. those who reported they "very much" liked teaching reported significantly more time on average than those who "neither liked nor disliked" teaching sexuality education. (See Tables 4-5 and 4-6.)



Teacher Certification

Teacher certification in health or FCS was significantly related to the number of concepts taught in two sub-scales and the time spent on two topics. FCS teachers taught significantly more birth control methods (PR>.02, F=5.24). an average of 5.9, while health teachers taught an average of 4.3. FCS teachers also taught significantly more of the birth control concepts on average (PR>.03, F=4.93), 2.6 versus 1.9. (See Table 4-4.)

Of the teachers certified in FCS, 39% (N=46) taught elective courses, and 61% (N=72) taught required classes. Of those certified in health, less than 3% (N=2) taught elective courses, and 97% (N=75) taught required classes. The distribution was




Full Text

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THE SCOPE AND NATURE OF SEXUALITY EDUCATION IN FLORIDA PUBLIC HIGH SCHOOLS BY MICHELE JOHNSON MOORE A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1997

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ACKNOWLEDGMENTS I would like to sincerely thank all those who were instrumental in helping me achieve a lifelong goal— receiving my doctor of philosophy degree. My committee chair, Barbara Rienzo, has been a true mentor. She willingly offered her professional guidance and was committed to ensuring my education was a valuable learning experience. My committee members, David Miller, Morgan Pigg, and Sandra Seymour, provided professional guidance, encouragement, and a supportive environment for this learning experience. My parents, Lawrence and Veronica Johnson, provided me with a life full of love and support, always believing that I could accomplish anything. Foremost, I would like to thank my husband, Paul Moore, who provided with me everything he could throughout this experience— his unconditional love, support, patience, and understanding— even assistance with stamping, coding, and proofing! 1 am truly fortunate to have married this wonderful human being, my best friend. n

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TABLE OF CONTENTS page ACKNOWLEDGMENTS ii ABSTRACT v CHAPTERS 1 INTRODUCTION 1 Statement of Research Problem 3 Purpose of the Study 4 Need for the Study 5 Delimitations 14 Limitations 15 Assumptions 15 Research Questions 16 Definition of Terms 17 2 REVIEW OF LITERATURE 21 Comprehensive School-based Sexuality Education 23 The Status of School-based Sexuality Education in the U.S 30 Other Factors in the Implementation of School-based Sexuality Education 50 Conclusion 63 3 MATERIALS AND METHODS 66 Introduction 66 Subjects 66 Instrumentation 68 Data Collection Procedures 72 Analysis of Data 73

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4 RESULTS 76 The Context of Sexuality Education in Florida Schools 76 The Scope and Nature of Sexuality Education in Florida Schools 81 Factors Effecting the Implementation of Sexuality Education 91 5 CONCLUSIONS AND IMPLICATIONS 119 The Context of Sexuality Education in Florida Schools 119 The Scope and Nature of Sexuality Education in Florida Schools .... 125 The Effects of District Variables on Sexuality Education 135 Conclusions and Recommendations 138 APPENDIX SURVEY AND CORRESPONDENCE 143 REFERENCES 162 BIOGRAPHICAL SKETCH 168 IV

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Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy THE SCOPE AND NATURE OF SEXUALITY EDUCATION IN FLORIDA PUBLIC HIGH SCHOOLS By Michele Johnson Moore May 1997 Chairperson: Barbara A. Rienzo Major Department: Health and Human Performance (Health Science Education) The status of comprehensive school-based sexuality education in the U.S. was examined in a review of the literature. Although research demonstrates these programs are needed, have proven effective and are supported at local and state levels, there is relatively little known about classroom implementation of sexuality education. This study was undertaken to provide a comprehensive and current assessment of the status of sexuality education in Florida public high schools. The components assessed included the scope of sexuality education topics; the nature of STD/HIV and pregnancy prevention information; the teaching methods and skills-building activities utilized; time spent on the whole unit, as well as individual topics within it; and teacher, school, and district variables that may have effected implementation. Also, as sexuality education is mandated in Florida, results were used to help determine compliance. The survey was v

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developed using three established instruments. It was sent to 500 health and family and consumer science teachers, yielding a 56% response rate. Results found that the majority of respondents were teaching sexuality education and thought it was the appropriate role of the school to do so. Most teachers covered a variety of important sexuality education topics. However, there were problems apparent with both the content and context of the sexuality education provided. There appeared to be a focus on the negative consequences of sexual activity and not enough emphasis on skills-building activities to help enable students make responsible decisions and avoid STDs/HIV and unwanted pregnancy. There are many factors that effect the implementation of sexuality education, some of which are beyond the classroom teacherÂ’s control. The factors that appeared to have the biggest impact on what was taught included teacher attitudes and status of the class as required or elective. In order to improve sexuality education in Florida schools, teacher training, provision of adequate teaching materials, increased time in the curricula, and increased support from the state, district and schools are needed. These issues and recommendations are addressed. vi

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CHAPTER 1 INTRODUCTION The negative consequences of risky sexual behavior among adolescents are well known in the United States today. Over half (53%) of all high school students have had intercourse in their lifetime (Kann et ah, 1996), with the average age at first intercourse just under 15 years (Teens Talk. 1994). There are one million adolescent female pregnancies each year in the U.S. (Henshaw &Van Vort, 1989), one of the highest rates of any western industrialized country (Kirby et ah, 1994). Teenagers have the highest rate of sexually transmitted disease (STD) among sexually active people of any age group (U.S. Department of Health and Human Services (DHHS), 1990). Of the individuals diagnosed with AIDS, approximately one in five are in their twenties. This is significant as the incubation period is about 10 years, meaning most were probably infected as adolescents (Centers for Disease Control and Prevention (CDC), 1995). The impact of these negative consequences of risky adolescent sexual behavior is far reaching. The social and economic attainment of teen parents, as well as the health of their infants, are compromised (Nord, Moore, Morrison, Brown, & Myers, 1 992). HIV and other STDs can affect the physical health, child bearing abilities, and even the lifespan of young adults. AIDS has become one of the leading causes of death among men and women ages 25 to 44 in the U.S. (Kirby et ah, 1994). 1

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2 One way to help decrease the prevalence of negative consequences associated with risky sexual behavior and to promote healthy sexuality is by providing effective sexuality education. Professionals agree that sexuality education is best offered through a comprehensive, skill-based approach, and linked with community resources (Sexuality Information and Education Council of the U.S. (SIECUS), 1992). This approach includes components that target cognitive, affective and skill domains at all school grade levels, and are included as part of a comprehensive school health education program. A broad range of topics should be included as well (Yarber, 1994). Many see sexuality education as a solution to the high incidence of adolescent pregnancy and HIV/STDs. Moreover, promoting a positive view of sexuality is also important (Yarber, 1994). There is strong support for school-based sexuality education among parents, national organizations, government, and educators. Ninety percent of parents want their children to receive sexuality education. Over 80% of them want their child to be taught about "safer sex" as a means of preventing 1IIV/A1DS (Louis Harris & Associates, 1985, 1988; Gallup and Clark, 1987). Over 60 national organizations concur that all children and youth should receive comprehensive school-based sexuality education (SIECUS, 1992). The number of states supporting sexuality education through the development of suggested or mandated guidelines has increased to 47 (Gambrell & Haffner, 1993). Sixty-eight percent of large districts require sexuality education and 80% require AIDS education (Kenney, Guardado, & Brown, 1989). Government support of school health education, and more specifically sexuality education, is evident in that these programs are essential to achieving the Healthy People

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3 2000 objectives (DHHS, 1990). These objectives serve as a challenge for the level of health that the American society should seek to achieve. Several of the 2 1 priority areas directly address adolescent sexuality issues, such as Family Planning, HIV Infection, and STDs. Support for school-based sexuality education is also apparent from a practical perspective. Most students attend school before they initiate sexual risk-taking behaviors and a majority are enrolled when they initiate sexual activity. Hence, many see schools as public institutions with great opportunity and responsibility in addressing and reducing sexual risk-taking behaviors (Kirby et al., 1994). School-based sexuality education programs have proven effective. They have been shown to go beyond increasing knowledge about sexual issues, to actually delay initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, or increase the use of condoms or other contraceptives. These programs have the potential to reduce unintended pregnancies, and rates of sexually transmitted diseases and HIV (Kirby et al., 1994). Hence, it is evident school-based sexuality education programs can prove effective, and that there is both a need for and support for them. Research needs to document the current status of these programs. Then, that data can be used to help improve sexuality education for our nationÂ’s adolescents. Statement of Research Problem It is evident school-based sexuality education programs can prove effective, and that there is both a need for and support for them. However, little is known about what is

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4 taught at the classroom level. Research needs to document the current status of these programs. Then, that data can be used to help improve sexuality education for adolescents. This study assessed the scope and nature of sexuality education in Florida public high schools. Information was collected on the scope of sexuality concepts; the nature of the pregnancy and HIV/STD prevention information; the teaching methods and skills-building activities utilized; the time spent on the whole unit as well as individual concepts; and teacher, school, and district factors that may have effected implementation of school-based sexuality education. Purpose of the Study The purpose of this study was to assess the scope and nature of sexuality education in Florida public high schools. It provided baseline data on the scope of sexuality education topics; the nature of STD/HIV and pregnancy prevention information; the teaching methods and skills-building activities utilized; time spent on the whole unit as well as individual topics within it; and teacher, school, and district variables that effected implementation. Also, as Florida mandates sexuality education, results were used to help determine compliance. In addition to providing valuable baseline data, this information could be used to help improve school-based sexuality education and support for those teaching it.

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5 Need for the Study Although research has shown that much support exists for school-based sexuality education at the state, district, and local levels— by teachers, parents, and students themselves— little is known about actual classroom implementation, the extent to which instruction complies with state and district policies (Donovan, 1989). Policy adoption does not always result in effective programming. Few studies have directly surveyed teachers responsible for sexuality education. These studies have been conducted at both the state and national level; however, the components of school-based sexuality education assessed, the extensiveness of the studies, and the individuals surveyed varies. This section reviews classroom implementation of school-based sexuality education, the status of sexuality education in Florida, and other factors important to the implementation of school-based sexuality education. Classroom Implementation of Sexuality Education Over the past fifteen years, several studies have been conducted at the national and state level to assess classroom implementation of sexuality education. The national studies were reported by Orr (1982), Sonenstein and Pittman (1984), Louis Harris and Associates (1986), Forrest and Silverman (1989), and Collins et al. (1995). The state studies include Koblinsky and Weeks (1984), Muraskin (1986), Calamidas (1990), Firestone (1994), and Yarber, Torabi and Haffner (in press). There were a variety of research methodologies used, as well as criteria for assessing the sexuality education.

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6 This criteria has evolved over the years, as have sexuality education programs, to encompass a more comprehensive curricula. The research methodology used included secondary analysis of data, surveys, and case studies. The respondents included random samples of students (Louis Harris, 1986) or teachers (Collins et al., 1995; Firestone, 1994; Forrest & Silverman, 1989; Yarber, Torabi, & Haffner, in press), one teacher from each school (Orr, 1982), lead teachers (Calamidas, 1990), principals, superintendents, or a combination of these (Koblinsky & Weeks, 1984; Muraskin, 1986; Sonenstein & Pittman, 1984). Obviously, data collected from those not actually teaching, as well as from lead teachers who were more involved, might have resulted in an inaccurate portrayal of what was actually being taught. The sexuality concepts assessed also varied. Most studies included a variety of general sexuality education topics (Firestone, 1994; Koblinsky & Weeks, 1984; Louis Harris, 1986; Muraskin, 1986; Orr, 1982; Sonenstein & Pittman, 1984). One primarily assessed information related to the prevention of STDs/HIV and pregnancy (Forrest & Silverman, 1989). Another looked at educational objectives emphasized by the curricula (Calamidas, 1990). More specific messages related to some sexuality concepts were the main focus of another study (Collins et al., 1995). The most recent of these studies used the SIECUS Guidelines for Comprehensive Sexuality Education to assess the scope of concepts taught (Yarber, Torabi. & Haffner, in press). With the variation in these studies, it is hard to provide a concrete assessment of the status of sexuality education. However, based on these studies it appears that the most basic sexuality education topics have been the ones most commonly and

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7 consistently taught. These topics include those such as STDs/HIV, sexual anatomy and physiology, sexual development, pregnancy and birth, responsible behaviors, and decision-making. Topics generally considered controversial have consistently been those least often taught. These topics include masturbation, homosexuality, and sexual behavior. Other topics such as abortion, birth control, rape and abuse, and condoms, seem to fluctuate how commonly they are taught. This may be due in part to the variety of approaches that have been used to assess similar concepts. For example, a survey might have asked whether teachers suggested condoms for STD/HIV protection, explained how to use them, actually demonstrated correct use, or told students where to get them. Results from these studies seem to draw similar conclusions— a base-level of sexuality education is provided, but it is not at a level where it could or should be. Sonenstein and Pittman (1984) found extensive variation in school districts’ provision of sexuality education. They reported that many provided sexuality education, but far fewer offered in-depth and timely coverage of important topics. Louis Harris (1986) concluded that only 35% of teens received what they considered to be comprehensive sexuality education. Forrest and Silverman (1989) indicated that teachers focused more on helping adolescents avoid pregnancy and STDs/HIV than on the full range of sexuality education. Firestone (1994) reported that although almost all students were exposed to sexuality education, the actual instruction provided did not correspond with profiles of sexuality education programs that have been most successful. Most recently, Collins et al. (1995) reported that although many teachers included sexuality education topics, increased

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8 coverage of priority health issues for youth— including pregnancy prevention and STD prevention— was necessary to strengthen school health education in the future. Overall, it appears a base-level of sexuality education concepts have been provided in classes, although it does not seem consistent with that found in programs proven effective. Further assessment using updated and comprehensive measures of sexuality education are necessary to better determine the status of school-based sexuality education and the impact of state and district guidelines/mandates. Minimally, improvements in both the scope and nature of sexuality education concepts taught are necessary to have an impact on students’ knowledge, attitudes, and behaviors. The Status of School-based Sexuality Education in Florida Since 1973, Florida has required comprehensive health education for students in kindergarten through twelfth grade. In 1987, the Florida legislature mandated AIDS education in middle and high schools. In 1 990. age-appropriate human sexuality education for grades kindergarten through twelve was added as a component of Florida's comprehensive health education law. In 1991, the School Improvement and Accountability Act passed by the Florida legislature returned education decision-making to its districts ( Report . 1994). The Red Ribbon Panel on AIDS was convened by governor Chiles in 1992 to develop specific recommendations on ways to improve the state's HIV/AIDS education and prevention programs. This panel reported that health education, including AIDS education, was inconsistent and of varying quality around the state, as well as subject to

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local politics ( Report . 1994). Hence, in 1994. Florida's Department of Education (DOE) and Health and Rehabilitative Services (HRS) issued the Report of the HIV/STD Prevention and Human Sexuality Education Task Force: Components of Quality HIV/STD Prevention and Human Sexuality Education ( Components ). This report was to assist Florida school districts in implementing quality comprehensive sexuality/HIV education ( Report . 1994). A 1995 study by SIECUS reviewed state education agency (SEA) HIV/AIDS prevention and sexuality education programs. They reported that the Florida SEA indicated all school districts implemented sexuality education, even though no state regulations monitored its implementation. Although Florida did not require training or certification of sexuality education teachers, it did encourage and provide training opportunities. There was no state committee to develop, review, or recommend materials to be taught at various grade levels; however, according to SIECUS, localities had such committees in place. SIECUS recommended requiring training and certification of sexuality education teachers and the development of a state level agency (Gambrell & Patierno, 1995). Other Factors in the Implementation of School-based Sexuality Education State and district support of school-based sexuality education, through guidelines/mandates and the comprehensiveness of sexuality related concepts taught are important factors in the provision of sexuality education. However, there are other factors that effect the delivery of these concepts. Appropriate teaching materials need to

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10 be available and current. Teaching methods and skills-building activities need to target all learning domains so that students are able to process and actually use the information learned. The time spent on teaching sexuality education needs to be sufficient enough to allow coverage of all topics, as well as time for synthesizing and practicing related skills. Training and certification of teachers are necessary not only to increase knowledge, but also comfort levels with subject matter, and hence likelihood of teaching it. Finally, positive attitudes toward teaching sexuality education are also important in determining how and whether sexuality related concepts are covered. Materials. Teachers have reported that identification, use, and accessibility of resource materials are major sources of their feelings of inadequate preparation (Gingiss & Hamilton. 1 989). Many states and districts have developed guidelines and/or curricula (Gambrell & Haffner, 1 993/94); however, individual districts and schools have much discretion in terms of implementing them. Many teachers reported they developed their own materials, and 8 in 10 reported they needed more assistance (Donovan, 1989). Teaching methods and skills-building activities. Sexuality education needs to target the cognitive, affective, and behavioral domains in order to be effective (National Guidelines Task Force, 1993). However, this is rarely the case at the state or classroom level. Only four states provided adequate coverage of these three learning domains in their sexuality education guidelines (Gambrell & Patierno, 1995). Personal skills most commonly presented in state curricula and guidelines were too simplistic and did not include instruction on skills (Gambrell & Haffner, 1993/4). At the classroom level.

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11 instruction is often reported to be teacher oriented and lacking in skills-building activities (Calamidas, 1990; Firestone, 1994; Haignere, Culhane, Blasley, & Legos, 1996). Time. Ideally, comprehensive sexuality education takes place within health education prekindergarten through twelfth grade ( Guidelines . 1991). The state of Florida asserts that quality comprehensive health education programs, which include HIV/AIDS prevention as a component, are at least 50 hours in length at each grade level and taught by trained health educators ( Report . 1994). Even though the majority of teachers feel sexuality education should be given high priority, it is generally agreed that not enough time is devoted to it (Hill, Piper, & King, 1993). Insufficient time in the curriculum was reported as the major weakness in one STD/HIV curricula (Calamidas, 1990). Almost one-fifth (18%) of teachers in a national study reported lack of time was one of the three greatest problems they faced in teaching sexuality education (Forrest & Silverman, 1989), and it was ranked second of eight items that made it difficult to teach sexuality education in another (Haignere et ah, 1 996). T raining/certification. If sexuality education programs are to prove effective, teachers need professional training on how to teach these subjects (Rodriguez, Young, Renfro, Asencio, & Haffner, 1995/96). Such training has been shown to increase knowledge, perceptions of importance of teaching the curriculum, intent to teach, and level of comfort with the course content (Levenson-Gingiss & Hamilton. 1989). Higher levels of teacher cognitive and affective comfort, perceptions of adequate preparation, and knowledge level have been significantly associated with student perceptions of course impact on their knowledge, attitudes, and anticipated personal behaviors

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12 (Hamilton & Gingiss, 1993). However, teachers often do not have the skills, knowledge, or inclination to teach sexuality education courses (Rodriguez et ah, 1995/6). A national study found 80% of teachers needed factual information, teaching materials, or teaching strategies regarding pregnancy and STD/HIV prevention (Forrest & Silverman, 1989). The preparation of those teaching health, including sexuality, education is a significant concern (Collins et al.. 1995). State level requirements for teacher training and certification in sexuality education are rare based on several assessments of guidelines conducted during the past decade (Kenney, Guardado, & Brown, 1989; Gambrell & Haffner, 1993; Gambrell & Haffner, 1993/94; and Gambrell & Patierno, 1995). According to the latest state survey (SIECUS, 1995) twelve states, D.C., and Puerto Rico required teacher certification for teachers of sexuality education. Only six states and Puerto Rico required teacher training in order to teach sexuality education (SIECUS, 1995). These requirements are more common at the district level. Over half (56%) of districts required sexuality or AIDS education teachers to be certified. Sixty-one percent of districts required training for teachers of sexuality education (Kenney, Guardado, & Brown, 1989). As noted previously, an assessment by SIECUS (1995) found that Florida did not require training or certification of teachers. Attitudes. A national study found that the majority of teachers are teaching sexuality education and think it is important to do so. They even felt some topics— birth control, AIDS, STDs, sexual decision making, abstinence and homosexuality— should be taught earlier than they are (Donovan, 1989). Few studies have been conducted on the

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13 effect of teacher attitudes and concerns on use of a curriculum (Gingiss & Hamilton, 1989). but research does indicate that the attitudes and concerns are significantly related to the nature of the instruction provided ( Forrest & Silverman, 1989; Levenson-Gingiss & Hamilton, 1989; Yarber & McCabe. 1981; Yarber, Torabi, & Haffner, in press). important teacher attitudes and concerns have been identified such as comfort presenting cognitive information and leading value-laden discussions, and perceived adequacy of preparation, which are modifiable by training and experience. These attitudes and concerns are directly reflected in students' sexual knowledge, attitudes, and perceptions of the effects of a sexuality education course on their future behavior, and their assessment of teacher performance and classroom environment (Hamilton & Gingiss. 1 993). Teacher attitudes regarding whether a sexualtiy topic should be included in the curriculum (Orr. 1982) and regarding the importance of the topic (Yarber, Torabi, & Haffner. in press) have been found to be significantly related to the inclusion of the topic. Conclusion Although the nature and depth of studies assessing sexuality education have varied greatly, it appears the majority of schools are providing a base-level of sexuality education for students. However, much work remains. Controversial topics and those pertinent to the avoidance of STDs/HIV and unwanted pregnancy are often neglected and not presented in a manner conducive to affecting behavior. Also, there is more of an

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14 emphasis on avoiding the negative consequences of risky sexual activity rather than on promoting healthy sexuality. In addition to the content, other factors related to implementation need to be addressed. Current and appropriate teaching materials need to be made available. More time needs to be allotted in the curriculum to ensure thorough coverage of topics and time for skills-building activities. Finally, teacher training can help improve knowledge levels, feelings of comfort, teacher effectiveness, and attitudes toward teaching sexuality education. This study helped provide a more comprehensive and current assessment of the scope and nature of sexuality education in Florida, a state that mandates it. Results were also used to help determine compliance with the state guidelines for sexuality education. The teacher, school, and district variables assessed provided an overview of areas requiring improvement if the status of sexuality education is to progress. Although it is difficult to provide an exact assessment of what is being taught at the classroom level, the goal of the study was to present a more comprehensive view of, and ultimately to help improve the status of school-based sexuality education. Delimitations 1 . Participants were selected from a Florida DOE list of public school teachers by primary teaching responsibility. Teachers with health as a primary teaching code (N=199) and a random sample of 35% (N=301) of teachers with family and

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15 consumer science (formerly called home economics) as a primary teaching code (N=873) were chosen. 2. Data were collected in Spring 1996. 3. Components of "Sex Education in the United States" by The Alan Guttmacher Institute (1988), "Survey of School Sexuality Education" by Drs. William Yarber and Mohammad Torabi (1995), and the Sexuality Education Curricula: The Consumer's Guide by Ogletree, Fetro, Drolet, and Rienzo (1994) were modified and combined to asses the scope and nature of sexuality education in Florida public high schools. Limitations 1 . Subjects may not have represented the population of Florida sexuality education teachers adequately. 2. The time frame for data collection may have influenced responses. 3. Findings depended on the ability of a combination of modified components of "Sex Education in the United States," "Survey of School Sexuality Education." and Sexuality Education Curricula: The Consumer's Guide to accurately assess the scope and nature of sexuality education in Florida public high schools. Assumptions 1 . The sample adequately represented the population of Florida public high school sexuality education teachers.

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16 2. The data collected in Spring 1996 was adequate for the purpose of the study. 3. The modified surveys by The Alan Guttmacher Institute, Yarber and Torabi, and Ogletree et al. were adequate to obtain data necessary for the study. 4. Subject motivation and candor were adequate for the purpose of this study. Research Questions 1 . What was the scope of sexuality education offered in Florida public schools in the 9-12 grade? 2. Was the scope consistent with the Florida DOE's Guidelines, Components of Quality HIV/STD Prevention and Human Sexuality Education ? 3. What was the nature of information provided in sexuality education that was intended to prevent unwanted pregnancy and STDs/HIV? 4. Flow was sexuality education being implemented in individual schools and school districts? 5. Were teacher attitudes related to the implementation of comprehensive sexuality education? 6. Were any school district variables related to the implementation of comprehensive sexuality education?

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17 Definition of Terms Alan Guttmacher Institute This is an independent corporation for research, policy analysis, and public education in the field of reproductive health. They gather, analyze, and report statistical data relating to family planning and fertility control. Components of Quality HIV/STD Prevention and Human Sexuality Education (Components) This report was developed by the Florida HIV/STD prevention and human sexuality task force. It was a joint project by the Department of Health and Rehabilitative Services and the Florida Department of Education, sponsored by the Centers for Disease Control and Prevention Division of Adolescent and School Health. The purpose of it was to provide instructional guidelines for Florida school districts on HIV/AIDS prevention and sexuality education within the context of the DOEÂ’s initiative to stress local decision-making and accountability. Florida Department of Education (DOE) The Florida DOE is an organization committed to the delivery of quality services to the stateÂ’s education system. The mission of Florida's public education system is to provide the opportunity for all Floridians to attain the knowledge and skills necessary for lifelong learning and to become self-sufficient, contributing citizens of society. Guidelines for Comprehensive Sexuality Education (Guidelines) These guidelines were developed by a task force of leading health, education, and sexuality professionals in

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18 1990. They formulated the broad concepts and sub-concepts necessary for comprehensive sexuality education. Each concept includes life behaviors and developmental messages as well. The Guidelines provide an organizational framework for human sexuality and family living within four developmental levels, grades kindergarten through twelve. There are six main concepts, human development, relationships, personal skills, sexual behavior, sexual health, and society and culture, encompassing 36 topics. Sex Education in the United States This instrument was developed by the Alan Guttmacher Institute and used in a 1988 survey. "The survey questionnaire was developed through personal consultation with sex educators, researchers and education specialists. Preliminary work also included four focus groups discussions with sex educators from public secondary schools in the Northeast and a pilot survey of 200 randomly sampled public school teachers, 40 from each of the five specialties covered in the survey. All survey recipients were asked questions about themselves and their schools, and about their views as to whether or not sex education should be taught and what topics should be covered at what grade levels. Respondents currently providing sex education were asked more detailed questions" (Forrest & Silverman, 1989, p. 66 ). Sexuality Education For purposes of this study, sexuality education is defined as any instruction that includes some discussion about human sexual development, the process of reproduction, and/or the exploration of interpersonal relationships and sexual behavior. Examples of topics that might be covered are: male and female reproductive systems, dating relationships, abstinence, contraception, sexually transmitted diseases (STDs), F1IV/AIDS, changes at puberty, pregnancy and childbirth, and sexual decision-making.

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19 Sexuality Information and Education Council of the United States (SIECUS) SIECUS is a professional organization that promotes and affirms the concept of human sexuality as natural and healthy part of living. They develop, collect, and disseminate information, promote comprehensive sexuality education, and advocate the right of individuals to make responsible sexual choices. Survey of School Sexuality Education This self-report questionnaire was developed by Drs. William Yarber and Mohammad Torabi and administered to teachers in a 1995 survey. The survey contained three sections: 1) a list of 36 sexuality education topics about which the respondent was asked to indicate whether the topic was included in the sexuality education unit in his/her class and to indicate his/her view about the degree of importance of each topic as part of comprehensive sexuality education; 2) two instruments designed to measure sex-related attitudes of the respondents; and 3) questions dealing with demographic characteristics of the respondent, the respondentÂ’s view of support for sexuality education in his/her classes, and selected characteristics of the health classes and sexuality education taught by the respondent. Only the component assessing whether the 36 topics were taught and teacher ratings of importance were used in the current research. These 36 topics were based on SIECUSÂ’s Guidelines for Comprehensive Sexuality Education (1993) described above. Sexuality Education Curricula: The Consumer's Guide This guide was written by Ogletree. Fetro, Drolet, and Rienzo in 1994. It was developed in an effort to assist

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20 teachers, program planners, and administrators in determining whether published sexuality education curricula meet the school districtÂ’s needs. The guide identifies key attributes of curricula including content, philosophy, skills-building strategies, and teaching methods. The skills-building and teaching strategies sub-sets were used for this research. The skills-building strategies sub-set was created based on specific personal and interpersonal skills deemed necessary for healthy sexuality. These have been identified by the SIECUS Guidelines for Comprehensive Sexuality and through evaluation of prevention programs over the past twenty years. The teaching strategies sub-set compiled a variety of teaching methods necessary to meet individual learning styles and to provide opportunities for personal and social skill-building.

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CHAPTER 2 REVIEW OF THE LITERATURE Introduction The negative consequences of risky sexual behavior among adolescents are well known in the United States today. Over half (53%) of all high school students have had intercourse in their lifetime, with more than one-third (38%) having had intercourse in the three months preceding the survey (Kann et ah. 19%). The average age a, first intercourse is just under 15 years. The average number of sexual partners is 2.7. with one-fifth of those hav ing four or more partners (Teens Talk. 1994). The pregnancy rate for women aged 1 51 9 is about 1 1 0 per 1 .000 per year (Henshaw & Van Vort. 1 989). most of them being unintentional (Donovan. 1989). Tins results in one million adolescent female pregnancies each year (Henshaw &Van Vort, 1989). one of the highest rates of any western industrialized country (Kirby et ah. 1994). Approximately 478.000 of these result in birth. 416.000 in abortion, and the rest in miscarriage or stillbirth (Henshaw &Van Von. 1989). In 1995. seven percent of students reported they had been pregnant or gotten someone pregnant (Kann et al., 1 996). Teenagers have the highest rate of sexually transmitted disease (STD) among sexually active people of any age group (DHHS, 1990). Three million teens are infected with STDs every year (McGinnis, 1993). Of the individuals diagnosed with AIDS, approximately one in fiv e are in their twenties. This is significant as the incubation 21

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22 period is about 10 years, meaning most were probably infected as adolescents (CDC, 1995). The impact of these negative consequences of risky adolescent sexual behavior is far reaching. Teenage parenthood can reduce social and economic attainment and marital stability, and increase dependence on welfare. The children of these young parents are at increased risk for poorer health, reduced cognitive development, behavior problems, and poorer school performance (Nord et ah. 1992). HIV and other STDs can affect the physical health, child bearing abilities, and even the lifespan of young adults. AIDS has become one of the leading causes of death among men and women ages 25 to 44 in the U.S. (Kirby et al., 1994). This study was undertaken to provide a more comprehensive and updated assessment of the status of school-based sexuality education in Florida, a state that mandates comprehensive sexuality education for grades K-12. The components assessed included the scope of sexuality education topics; the nature of STD/HIV and pregnancy prevention information; the teaching methods and skills-building activities utilized; time spent on the whole unit as well as individual topics within it; and teacher, school, and district variables that may effect implementation. Also, as Florida mandates sexuality education, results were used to help determine compliance. This chapter begins by emphasizing the importance of comprehensive sexuality education as a means of helping to decrease the prevalence of negative consequences associated with risky sexual behavior. The recommended scope and nature of sexuality education, support for sexuality education, and factors of effective programs are outlined

PAGE 29

The current status of sexuality education, including state and district guidelines, and classroom implementation are reviewed. Guidelines, mandates and implementation of sexuality education in Florida are addressed. Lastly, other important components involved in sexuality education such as the materials and teaching methods utilized, the time spent teaching it. teacher training and certification, and teacher attitudes toward teaching sexuality education are explored. The chapter concludes with the need for additional research on the implementation of sexuality education a, the classroom level and the factors that may be related to the implementation. rnmpivhensive Sc h ool-based Sexuality Educati on One way to help decrease the prevalence of negative consequences associated with risky sexual behavior and to promote healthy sexuality is by providing effective sexuality education. Professionals agree that sexuality education is best offered through a comprehensive, skill-based approach, and linked with community resources (SIECUS, 1992). This approach includes targeting cognitive, affective and skill domains at all school grade levels, and being included as part of a comprehensive school health education program. A broad range of topics should be included as well (Yarber, 1994). Many see sexuality education as a solution to the high incidence of adolescent pregnancy and HIV/STDs. However, promoting a positive view of sexuality is also important (Yarber. 1994).

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24 The Scope and Nature of Comprehensi v e School-based Sexuality Educatio n In 1990. the Sexuality Information and Education Council ot the Lnited States (SIECUS) convened a task force of leading educators, health professionals, and national organization representatives to formulate the broad concepts and sub-concepts necessary for comprehensive sexuality education. Each concept includes life behaviors and developmental messages as well. The Guidelines for Comprehensive Sexual ity Education ( Guidelines ), issued in 1991. provide an organizational framework for human sexuality and family living within four developmental levels, encompassing grades kindergarten through twelve. There are six main concepts-human development, relationships, personal skills, sexual behavior, sexual health, and society and cultureencompassing 36 topics (See Table 2-1 at the end ot this chapter). Further, the Guidelines conceptualize sexuality education as a lifelong process affecting attitudes, beliefs, and values with its primary goal being the promotion of sexual health (National Guidelines Task Force. 1993). Thus, programs should ideally strive to help individuals develop a positive view of sexuality, rather than merely stressing abstinence and the possible negative consequences associated with being sexually active. This concurs with the World Health Organization (WHO) definition of sexual health: "the integration of the physical, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching, and that enhance personality, communication, and love . . . every person has a right to receive sexual information and to consider accepting sexual relationships for pleasure as well as for procreation" (WHO, 1975).

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Several studies indicate that youth with negative feelings about their sexuality do not practice pregnancy and STD prevention as consistently as those with more positive attitudes (Fisher. 1990). Negative feelings about sexuality have been found to interfere with acknowledging forthcoming sexual activity, learning sexual information, and communication with others about sexuality (Yarber. 1994). The Guidelines outline four primary goals for sexuality education: 1 ) to pio\ ide accurate information: 2) to provide an opportunity for young people to question, explore, and assess their sexual attitudes; 3) to help young people develop interpersonal skills; and 4) to help young people exercise responsibility regarding sexual relationships. There are also five assumptions underlying the Guidelin es. They state sexuality education should be offered as part of an overall comprehensive health education program: it should only be taught by specially trained teachers; the community must be involved in the development and implementation of the program; all children and youth will benefit from it; and all three learning domainscognitive, affective, and behavioralshould be addressed (National Guidelines Task Force, 199 j). The Guidelinesemphasis on the affective and behavioral domains, in addition to the cognitive, emerged from research results on knowledge based programs. Although knowledge about sexual topics may be an important precedent to behavior change, it appears to be very weakly related to adolescent sexual behavior. Other outcomes of educational programs, such as changes in attitude, norms, skills, and intentions, are also precursors to behavior. However, even these do not adequately predict change in actual sexual behavior (Kirby et ah, 1994).

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26 Results of an analysis of school-based programs to reduce sexual risk-beha\ iors indicated several tentative commonalities among programs with a positive impact on sexual behaviors (Kirby et ah, 1994). These factors include: a) a narrow focus on reducing specific sexual risk-taking behavior; b) the use of social learning theories as a foundation for program development; c) providing basic accurate information about the risks of unprotected intercourse and methods of avoiding unprotected intercourse through experiential activities designed to personalize this information; d) activities that address social influences or pressures on sexual behaviors; e) reinforcing clear and appropriate values to strengthen individual values and group norms against unprotected sex; and f) providing modeling and practice in communication and negotiation skills. While these components are representative of more effective programs, they are clearly not typical in school-based programs. Only four states provide adequate coverage of the three learning domains, cognitive, affective, and skills, in their sexuality education guidelines (Gambrell & Patierno, 1995). Support for School-based Sexuality Education Public support for the involvement of schools in implementing comprehensive sexuality education is higher than ever before. Ninety percent of parents want their children to receive sexuality education. Over 80% of them want their child to be taught about "safer sex" as a means of preventing HIV/AIDS (Louis Harris & Associates, 1985, 1988; Gallup & Clark. 1987). Over 60 national organizations concur that all children and youth should receive comprehensive sexuality education (SIECUS. 1992). State and

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27 district administrators also show support through the development of suggested or mandated guidelines for school sexuality education. An assessment by SIECUS (199o) found that 47 states have laws or policies requiring or recommending sexuality education. Thirtv-eight states plus the District of Columbia (D.C.) and Puerto Rico have developed curricula or guidelines to provide program assistance to local school districts. Government support of school health education, and more specifically sexuality education, is evident in that these programs are essential to achieving the Healthy People , 20Q0 objectives (DHHS. 1990). These objectives, developed by public health officials, private practitioners, health scientists, and academicians, serve as a challenge for the level of health that both public and private sectors of the American society should seek to achieve. Several of the 21 priority areas directly address adolescent sexuality issues, such as family planning. HIV infection, and STDs. Also, the Centers for Disease Control and Prevention has identified six areas of behavior that contribute to the leading causes of mortality and morbidity in the United States. One of these is sexual behaviors that contribute to STDs/HlY and unintended pregnancies (Kann et al„ 1996). Support for school-based sexuality education is also apparent from a practical perspective. Schools provide a unique setting for reaching large numbers of students with important prevention and early intervention strategies. Nearly 95% of all school-aged adolescents and children are in elementary or secondary schools (Iverson & Kolbe, 198o). Most students attend school before they initiate sexual risk-taking behaviors and a majority are enrolled when they initiate sexual activity. Hence, many see schools as

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28 public institutions with great opportunity and responsibility in addressing and reducing sexual risk-taking behaviors (Kirby et ah, 1994). Et'fectiveness of School-based Sexuality Education “The most effective sexuality education programs are comprehensive, skill-based, and linked with community efforts" (SIECUS. 1992. p. 14). These programs should be tailored to meet the needs of the students served by the programs. They should include effective, theorv-based classroom education, confidential health services, and health counseling (Majer. Santelli, & Coyle. 1992). Educators in the public schools play a major role in shaping and influencing the behavior of adolescents (Calamidas, 1990). School-based sexuality education programs have been shown to go beyond increasing knowledge about sexual issues, to actually delay initiation of intercourse, reduce the frequence’ of intercourse, reduce the number of sexual partners, or inciease the use of condoms or other contraceptives. These programs have the potential to reduce unintended pregnancies, exposure to sexually transmitted diseases and HI\ (Kirby et al., 1994). Previous research found that adolescents who had taken sexualitc courses were no more likely to engage in sexual intercourse than those who had not had a course (Marsiglio & Mott. 1986: Zelnik & Kim. 1982). If they had been sexually active, those who had taken sexuality education classes were significantly more likely to use contraception (Dawson. 1986; Marsiglio & Mott, 1986; Zelnik & Kim, 1982). Zabin et al. (1986) reported an increased use of contraception by males and females, a delay in first intercourse, and an increased use of family planning clinics

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29 among students enrolled in a school-based education and clinic program. Vincent. Clearie. and Schluchter (1987) reported a reduced teen pregnancy rate for a communitybased sexuality education program with a strong school-based component. The Postponing Sexual Involvement program helped decrease the number of adolescents initiating sexual intercourse and the number of pregnancies among those in the program compared to those who were not (Howard and McCabe. 1990). The Reducing the Risk program helped increase participant knowledge and parent-child communication about abstinence and contraception. Among those who had not initiated intercourse prior to the program, it significantly reduced the likelihood that they would engage intercourse in the next year and a half, as well as reduced unprotected intercourse either by delaying the onset of sexual intercourse or by increasing the use ot contraceptives (Kirby et ah. 1991). The Preventing Adolescent Pregnancy program reported older teen girls who completed the program were half as likely to get pregnant as those who participated less or not at all, and younger teen girls were twice as likely to postpone sexual intercourse (Girls Inc., 1996). This section reviewed the nature and scope of, support for, and effectiveness of comprehensive sexuality education. The basic components necessary for effective comprehensive sexuality education programs, as agreed upon by professionals in the field, were outlined. Support for sexuality education by parents, school personnel, and other officials was established. Evaluation of effective sexuality education programs demonstrated the potential of these programs to significantly affect the sexual related

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30 knowledge, attitudes and behaviors of school children. Next, the prevalence and quality of school-based sexuality education throughout the nation are examined. The Status of School-based Sexuality Education in the U.S. Although research has shown that much support exists for school-based sexuality education at the state, district, and local levels-by teachers, parents, and students themseh'es— little is known about actual classroom implementation, the extent to which instruction complies with state and district policies (Donovan. 1989). Policy adoption does not always result in effective programming. A Planned Parenthood poll found that 40% of students had not had sexuality education at school and that only 35% had a comprehensive sexuality course (Louis Harris, 1986). SIECUS estimates that less than 10% of American students receive comprehensive sexuality education, kindergarten through twelfth grade (SIECUS, 1992). Few studies have directly surveyed teachers responsible for sexuality education. This section begins with a review of state and district sexuality education guidelines. Then, research on actual classroom implementation of sexuality education is reviewed. Studies have been conducted at both the national and state level, although the components of school-based sexuality education assessed and the extensiveness of the studies vary. Lastly, Florida sexuality education guidelines/mandates and implementation are examined.

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31 State and District Guidelines The number of states requiring sexuality education through state law has increased to 22. plus the District of Columbia (D.C.) and Puerto Rico (National Abortion and Reproductive Rights Action League (NARAL), 1995). In 1993, 30 recommended it and 17 required it according to Gambrell & Haffner, consistent with a report by Kenney. Guardado. & Brown in 1989. and somewhat less than the 23 reported by de Mauro (1989/90) . This is a tremendous increase from the three states that mandated sexuality education prior to 1986 (Gambrell & Haffner. 1993). However, only twehe states mandate sexuality education in grades kindergarten through twelfth (Haffner. 1992). Thirty-six states, plus D.C. and Puerto Rico, have developed curricula or guidelines to provide program assistance to local school districts; twelve states have not (Gambrell & Patierno. 1995). They more commonly developed guidelines (N=35) than curriculum (N=17). This suggests a preference to defer to local discretion for the specifics of programs (Gambrell & Haffner. 1993/94). Only 15 states, the D.C.. and Puerto Rico have regulations that monitor the implementation of sexuality education at the local level (Gambrell & Patierno, 1995). Almost all of the guidelines/curricula include abstinence messages as well as positive and affirming statements about human sexuality. However, many state guidelines omit sexual behavior topics, exclude topics considered to be controversial, lack a balanced coverage of abstinence and safer sex, and lack thorough coverage of topics throughout kindergarten to twelfth grade (Gambrell & Haffner, 1993/94). Most do not include age-appropriate developmental messages. The topics most commonly

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covered in state guidelines include: human development (i.e.. anatomy, puberty, body image): relationships (i.e.. family parenting, friendship): personal skills (decision-making and communication): and sexually transmitted diseases and HIV infection. Less than one-third include any sexual behavior topic besides abstinence. Fewer than ten states cover shared sexual behavior, human sexual response, fantasy, and sexual dysfunction. When they do discuss sexual behavior, they tend to focus on the negative aspects of sexual activity instead of promoting sexual health and responsible decision-making. Few states include sexual identity and orientation (N=13). abortion (N=l 1 ). and sexuality and religion (N=4). When sexual identity and orientation are discussed, it is largely limited to definitions, only four states actually affirm sexual identity as an essential quality of personality. Only 21 states cover contraception, mostly as a general overview (Gambrell & Haffner, 1993/94). Unfortunately, some states restrict sexuality education and permit or encourage the use of biased or fear-based curricula. For example. 19 prohibit making contraceptives available, five prohibit or restrict abortion discussion, and eight require or recommend teaching homosexuality is not an acceptable lifestyle and/or that it is a criminal offense under state law (NARAL, 1995). Fear-based programs are problematic because they instill fear and shame in adolescents in order to discourage sexual behavior. They also exaggerate the negative consequences ot premarital sexual behavior and portray sexual activity as harmful and dangerous. These programs are in opposition to the goals of the comprehensive curricula recommended by professionals, which seek to assist adolescents

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in developing a healthy understanding of their sexuality and enables them to make responsible decisions (Kantor, 1992/93). Few studies have assessed sexuality education in terms of district level guidelines. A 1988 study by Kenney. Guardado, and Brown of the Alan Guttmacher Institute (AGI) surveyed 162 of the largest school districts, each having more than 22.500 students, on their sexuality education policies. The sample represented 29% ot students in U.S. public schools. The researchers found that 87% of districts required or encouraged sexuality education and 96% AIDS education. The majority (87%) also had a curriculum on sexuality or AIDS education, and many of the others were in the process of developing one. Most of the districts developed their own curriculum (87%). 1 7% used the state education agencv's curriculum, and five percent used commercially available documents (Kenney, Guardado. & Brown, 1989). Over 80% of the districts with a sexuality education curriculum reported it was mandatory tor schools in that district. Those that did not said it was nevertheless used by the majority (60%). More than 90% of these districts covered the negative consequences of sexual activity and emphasized abstinence as the best alternative for preventing pregnancy and STDs. About three-fourths (74%) included an explanation of how each contraceptive method is used. Many discussed condoms as a means of preventing AIDS (86%) and other STDs (80%). The districts tended to place an emphasis on abstinence and the possible negative outcomes of sexual activity, yet recognized that millions of teens are sexually experienced and need risk-reduction messages (Kenney, Guardado. & Brown, 1989).

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While it appears to be taken for granted that mandates will increase the amount of instruction in school, analyses show no relationship between state and district sexuality education policies. Districts were neither more nor less likely to adopt a specific sexuality education policy based on the state's policy (Kenney. Guardado. & Brown, 1989). Schools' policies also differed little regardless of the state policy requirements. However, it appeared more likely that state policies were followed when they encouraged the inclusion of certain topics rather than when they discouraged the inclusion of topics (Orr. 1982). "Although the policies and programs of states and school districts are important guides, thev provide little precise information about what is taught in the classroom. Without such information, however, the design, implementation and evaluation of sex education initiatives are seriously hampered" (Forrest & Silverman. 1989. p. 65). Findings from the NARAL state review (1995) also concluded that legal mandates not only fail to ensure comprehensive sexuality education, but even limit these programs or encourage the use ot biased/fear-based curriculums. Muraskin (1986) asserts there is little interest in whether the state guidelines actuallv change or improve the quality of sexuality education. Although several states have developed guidelines for school sexuality and HIV/AIDS education programs, most do not provide the foundation for truly comprehensive programs, as demonstrated above. “In fact, fewer than one in six of the state curricula provide young people with a comprehensive base of information and education” (National Guidelines Fask Force, 1993, p.l). This being the case, much responsibility is left at the local level and with the individual classroom teachers.

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35 rin^rnnm Implantation of Sexiia litv^ducatjon Over the pest fifteen years, several research studies and secondary analyses have been conducted at the national and state level to assess classroom implementation of sexuality educatton. The national studies were conducted by Orr (1982). Sonenstem and Pittman (1984). Louis Harris and Associates (1986), Alan Guttmacher Institute (1988), and the Centers for Disease Control and Prevention (1995). The state studies include Koblinsky and Weeks (1984). Muraskin 11986). Calamidas (1990). Firestone (1994). and Yarber. Torabi and Haffner (in press). All have used different criteria. This criteria has evolved over the years, as have sexuality education programs, to encompass a more comprehensive curricula. In 1982. Orr performed secondary analysis on two national studies a 1977 National Institute of Education survey, and a 1978 follow-up by the same organization,0 determine the status of sexuality and contraceptive education in U.S. public high schools. The first study was sent ,0 principals of 2.000 U.S. public high schools to gather information on school characteristics, organizational and institutional practices, general innovativeness, community relations and parental involvement. Thirty-six percent of the principals reported their school offered a separate family life or sexuality education course. A follow-up study of one instructor in each of those schools (N=524) was then conducted to assess whether a sexuality education course was offered, along with a senes of questions about course structure and content. A response rate of 43% (N=227) was obtained.

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36 Teachers reported including an average of 18 of the 26 topics. The most commonly covered topic was “venereal disease.” followed by pregnancy and childbirth. At least 90% of instructors included puberty changes; anatomy and physiology; drugs, alcohol and sex; dating; and teenage pregnancy. Contraception and abortion were included in 78% of classes. Other controversial topics, such as homosexuality and masturbation were discussed by more than half of instructors. When the topics w ere grouped into five areas. 80% of schools reported covering all of the topics w ithin social development (i.e. dating, relationships). 77% all of the human-reproduction topics, and 67% all of the contraception-related topics. Less than 20% reported teaching all of the topics related to sexual values or control ersial subjects, only about half of the topics were commonly taught in these two areas (On'. 1982). There were some obvious limitations to this study. It was a secondary analysis of information that was collected for a different purpose. No evidence was found to indicate any particular set of school or community characteristics analyzed was more likely to predict whether a school would offer a separate sexuality education course or what was included in it. Other variables that were not analyzed may have better explained this. The results were based on the response of the school principal then on one instructor of sexuality education from each school. Other instructors may have given different responses. The context of the sexuality education information provided was not assessed, and could have varied from school to school. Finally, the information gathered was from schools that offered sexuality education as a separate course, suggesting more time and

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37 emphasis on topics. However, other school districts may have included the information within other courses (Orr. 1982). Sonenstein and Pittman (1984) conducted a study of school districts in cutes with a population greater than 100.000 (N= 198) to assess the extent to which sexuahty education was taught in public schools. The respondents were comprised of associate superintendents, d, rectors of instructional services, curriculum specialists, directors of homemaking, and coordinators of family life education (FLE). A 90% response rate (N=179) was obtained. Of districts with junior and senior high schools. 75% and 76%. respectively, provided sexuality education. Over 55% of school districts reported that more than 90% of students at all levels received sexuality education, while one-third reported 100% student participation. The physiological aspect of sexuality was the most commonly cov ered topic, included by more than 90% of districts. Personal and interpersonal aspects of sexuality were included by 80-S5" ». and contraceptives and sources of family planning serv ices by 75%. Those topics considered controversial-rape and sexual abuse, masturbation, abortion, and homosexuality-were covered much less frequently, by an average of half ol the districts. To measure the comprehensiveness of the sexuality education otfered. fou increasingly rigorous criteria were included. They included discussing the top.c, as part of the curriculum or if student initiated questions could be discussed in class; reporting at least 75% of students enrolled in sexuality education; discussing the topic in depth, considered to be at least one class period; and topics introduced in junior high school or earlier. As the parameter became more stringent, it became clear that sexuality education

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38 efforts in large districts were not as extensive as first indicated. For example, while STDs were covered by 71%. only 44% also had 75% enrollment, only 37% also had an in-depth conversation on the topic, and finally, 27% also introduced it before grade nine. There were some limitations with this study. Only large school districts were surveyed, so findings were only generalizable to similar districts. Also, the respondents were at the administrative level, so it is not known how accurately they described the actual implementation of sexuality education. The findings demonstrated extensive variation in school districts' provision ot sexuality education. Many provided some sexuality education, but tar fewer ottered in-depth and timely coverage ot important topics (Sonenstein & Pittman. 1984). Koblinsky and Weeks (1984) surveyed superintendents, principals, and FLE teachers in California school districts with a ninth and/or tenth grade about their FLE efforts. The topics covered by more than nine out of ten included STDs, human reproduction, pregnancy and birth, human anatomy and physiology, and consequences ot teen pregnancy. The topics least often covered in the curriculum included value-laden topics such as premarital intercourse, adoption, sexual behavior, rape and sexual abuse, and sexual orientation. More than 75% of teachers reported including at least 20 different topics. However, it was noted that data may have over represented longer courses since the survey was given to teachers who were most involved with FLE in their schools. It was estimated that 24% of ninth graders and 32% of tenth graders received some FLE in the 1981-82 school year (Koblinsky & Weeks, 1984).

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39 In 1986. Louis Harris and Associates conducted a national poll for Planned Parenthood Federation of America. Inc. of 1.000 teens age 12 to 17. The poll asked, in part, about sexuality education in school. Fifty-nine percent ot the teens surveyed reported they had a formal course on sexuality education in school. However, the education described was less than ideal. Only 35% of all the teens had received what was considered comprehensive sexuality education. Comprehensive was detined as couises that included four of the six survey topic areas— biological tacts about reproduction, talk about coping with sexual development, information about the different methods of birth control, information about preventing sexual abuse, tacts about aboition. and facts about where to get contraceptives (Louis Harris. 1986). In 1988. the Alan Guttmacher Institute (AGI) conducted a national study to help identifv strengths and weaknesses ot existing sexuality education programs. This information was to be used in their development of recommendations tor sound policies and programs at all levels (Rosoff, 1989). They surveyed 4,200 secondary public school teachers nationally in disciplines from which sexuality education teachers are usually drawn. The five disciplines were health, physical education, family and consumer sciences, biology, and school nursing, for grades 7-12. The teachers were asked what they taught in their sexuality education classes regarding pregnancy and STD/HIV prevention and what they regarded as obstacles (Donovan, 1989). Ninety -thiee percent of the public school teachers surveyed reported their schools offered sexuality or AIDS education in some form. Forty-five percent of the teachers actually pro\ ided sexuality education in some

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40 manner. However, problems were apparent with the nature of the sexualitv/AIDS education (Forrest & Silverman. 1989). Among the teachers who provided sexuality education 90-96% covered AIDS, STDs, and sexual decision-making: 83-89% covered abstinence, birth control methods and factual aspects of abortion; 64-77% dealt with homosexuality, "safer sex" practices and ethical issues surrounding abortion: and 52% provided information about sources of birth control (Forrest & Silverman. 1989). Almost 90% taught abstinence as the best way to prevent pregnancies and STDs. Two-thirds presented condom use as a possible way to prevent HIV, other STDs, and pregnancy. Another 20% encouraged condom use only for the prevention of STDs and HIV. Three-quarters discussed about how to use condoms (Donovan. 1989). One-fourth of teachers covered birth control methods only when asked specific questions (Donovan. 1989). The vast majority (97%) of teachers felt that sexualityeducation classes should address where students could go to obtain a method, but only 48% were in schools where this was done (Forrest & Silverman. 1989). Nine out ol ten covered HIV and STDs, but not always the most common STDs (Donovan, 1989). Most teachers thought a wide range of sexuality education topics related to the prevention of pregnancy and STDs/HIV should be taught and that these topics should be taught by grades 7-8 at the latest. In practice, it did not occur until the 9th or 10th grade (Forrest & Silverman, 1989). Results indicated that teachers focused more on helping adolescents avoid pregnancy and STDs/HIV than on the full range of family life and sexuality education (Donovan. 1989).

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41 Several studies in the pas, decade have examined FLE in New Jersey, where a mandate was passed in 1983. Unfortunately, at the time oflast assessment, 1993, administrative support and monitortng of the mandate were reported lacking. Muraskin (1986) studied the first year implementation of New Jersey’s kindergarten through twelfth grade FLE mandate in a case study on six of 600 school districts. The state mandate provided the broad goals of instruction, but required that districts write an outline for the curriculum. Teachers, administrators, and school board a, yd commumty members involved in tmplemen.ing the FLE program were interviewed. In the five initial districts, they all included such topics as families, social problems, social and personal interaction, the life cy cle, family formation, the body, and sexuality (physical and psychological development, reproduction, contraception. STDs, sexual abuse, and sexual relations). However, tha, did not mean the topics were all covered in one class. Rather, they were addressed in dtfferent courses a. different grade levels, and the information was then designated as FLE. In grades 9-12. FLE was usually a unit within health education that, according to most districts, included sexuality, family formation, and social problems (Muraskin. 1986). „„ cttic nnrl T4TV education, to supervisors ot In 1990, Calamidas sent surveys on STDs and Hi v euucai htgh school health education classes in 30 New Jersey school districts. Thirty-two (64%) were completed and returned. AIDS and STD education units were taught in two grades in 38% of the high schools, in three grades in 22%, and in four grades in 25% of high schools. Respondents were asked to list the educational objectives their curriculum emphasized with regard ,0 STDs and HIV. The only two listed by a, least half were to

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42 dispel myths and disseminate accurate information (56%) and to discuss prevention and transmission of pathogens (50%). Firestone (1994) most recently explored the content and context of sexuality education in New Jersev. The survey was completed b} 506 FLE teachers. Ninety-six percent of respondents said FLE was required in their schools. It was estimated that 96 /o of students, in the grades sexuality education was offered, took these courses. All eleven districts stressed abstinence, with some prohibiting the discussion ot an} option except abstinence. Strong attention was given to HIV/AIDS education. State mandates required teaching AIDS at every grade level, while FLE was only taught in tluee or lour. Key information was organized into 1 7 topics the researcher considered to be part of the FLE curriculum. Most teachers chose to address the "easier" topics such as sexual development, pregnancy, and reproduction. Most also dealt with general issues, such as responsible behavior and skills. Although many discussed the risks ol premature sexual activity, the discussions were rarely linked to concrete coping mechanisms loi reducing those risks. Almost none of the teachers said condoms were available in their schools, but 51% discussed condom use with their classes. Only 20% demonstrated how to put one on and 25% referred students to agencies that distributed condoms. Results showed that although almost all students were exposed to sexuality education, the actual instruction provided did not correspond with pioltles of sexuality education programs that have been most successful in helping teens avoid pregnancy, STDs, or HIV. In addition, little time was actually spent on sexuality education and many topics were introduced late in students' schooling. Few teachers co\ered

PAGE 49

43 prevention oriented topics, and difficult topics received limited time. Results also suggested teachers were most likely to provide facts, rather than dealing with emotions or guiding behavior. Two-thirds or more provided facts for all 17 topic areas; two-thirds or more dealt with feelings for all but contraception and condoms (57%) and STDs (59%); and two-thirds or more guided behavior for all but five topics, sexual orientation (41%) and masturbation (47%) ranking lowest (Firestone. 1994). The Center for Disease Control and Prevention Division of Adolescent and School Health (CDC DASH) conducted the School Health Policies and Programs Study (SHPPS) in 1994 (Collins et ah. 1995). This study looked at multiple components of school health at the state, district, and school levels. At the school level, interviews with classroom health education teachers included components on sexuality and HIV/AIDS education. Specifically, at least half or more of health education teachers taught about abstinence (76%), preventing STDs (75%). signs and symptoms of STDs (79%), dating and relationships (69%), social influences on sexual behavior (68%), the reproductive systems (67%), social norms toward risk behaviors related to sex (64%), perception of risk for STD and pregnancy (61%), access to STD screening programs (59%). statistics on STD and unintended pregnancy rates (56%), contraceptives (54%), marriage (50%), and prevalence of sexual risk behaviors among adolescents (50%). Although Collins et al. (1995) found that many teachers included sexuality education topics, conclusions suggested the need for increasing coverage of priority health issues for youth— including pregnancy prevention and STD prevention— to strengthen school health education in the future.

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44 Yarber. Torabi. & Haffner (in press) assessed the scope ot sexuality education in Indiana high schools using the SIECUS Guidelines for Comprehensive Sexual ity Education ^ Guidelines ). They surveyed 187 health education teachers in grades 7-10. They found that seven of the 36 topics were included by 90% or more. 27 by 50% or more, and only three by less than 25% of teachers. Nine in ten or more included STDs and HIV. decision-making, abstinence, puberty, reproduction, values, and communication. Eight in ten or more included friendship, love, reproductive anatomy and physiology, dating, finding help, contraception, sexual identity and orientation, families, and body image. Seven in ten or more included assertiveness, marriage and lifetime commitments, parenting, sexuality throughout the lifespan, and reproductive health. Sexual abuse, sexuality and society, and sexuality and the media were included by at least six out often teachers. Less than half of teachers included human sexual response, masturbation, shared sexual behavior, diversity, sexuality and religion, sexuality and the law. sexual dysfunction, fantasy, and sexuality and the arts. W hen the six key concepts were examined, human development was found to be included most frequently, and sexuality and culture least often (See Table 2-1). Teacher ratings of the degree of importance of the topics as part of comprehensive sexuality education found that 22 topics received a mean score of at least 4 (5=extremely important, 3=moderately important). Only three topics had average ratings less than moderately important. The key concept of personal skills was considered the most important and culture was considered the least important (See Table 2-1). W hen the importance and inclusion of topics were analyzed, they were found to be positively

PAGE 51

45 correlated. Hence, those topics listed above as most often taught, were also those rated most important, and those least often taught were rated as least important (Yarber, Torabi, & Haffner, in press). Recent evaluation ot state level guidelines lound that sexuality education is usually taught within health education (44 states). It is also commonly placed under familv and consumer sciences (30 states). AIDS (29 states), and science ( 19 states). It is less commonly placed in physical education (13 states) and other (1 j states) (Gambiell & Haffner, 1993). Local level administration are responsible for the decision as to who actually teaches sexuality education. As this varies among jurisdictions, most states reported that teachers in several disciplines handle instruction. Health education teachers were most commonly named. Other disciplines responsible included family and consumer sciences (36 states); classroom teachers, especially in the elementary grades, (32 states); and physical education (32 states). Instruction responsibilities were also carried out by public health instructors (20 states); community agency instructors (17 states): professional sexuality educators (17 states); and school nurses (15 states) (Gambrell & Haffner. 1993). There is a great deal of variation in the studies that assessed the status of schoolbased sexuality education over the past decade and a halt. They used ditterent assessment methods— surveys, secondary analysis, case studies. The samples ranged Irom national to state, and the respondents from superintendent, principal, lead teacher, classroom teacher, to student. No two surveys assessed the exact same sexuality concepts or factors influencing implementation. So. with this variation, it hard to say how much, it

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46 at all. sexualitv education has improved over time and with the increase in the number of state and district guidelines/mandates. However, it appears that the most basic sexuality education topics have been the ones most commonly and consistently taught. These topics include those such as STDs/HIV, sexual anatomy and physiology, sexual development, pregnancy and birth, responsible behaviors, and decision-making. Topics generally considered controversial have been consistently those least often taught. These topics include masturbation, homosexuality, and sexual behavior. Other topics such as abortion, birth control, rape and abuse, and condoms, seem to fluctuate in how commonly they are taught. This is probably due in part to the nature of the information asked about each concept. For example, does a teacher suggest condoms for STD/HIV protection, explain how to use them, actually demonstrate correct use. or tell students where to get them? Overall, it appears a base-level of sexuality education concepts are being provided in classes, although it does not seem consistent with the nature of concepts found in etfecti\e programs. Further assessment using updated and comprehensive measures of sexuality education are necessary to determine the status of school-based sexuality education. Minimally, improvements in both the scope and nature of sexuality education concepts taught are necessary to have an impact on studentsÂ’ knowledge, attitudes, and behaviors. The Status of School-based Sexualitv Education in Florida Since 1973, Florida has legally required Comprehensive Health Education for students in kindergarten through twelfth grade. In 1987, the Florida Legislatuie

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47 mandated AIDS education in middle and high schools. In 1990. age-appropriate Human Sexuality Education w as added as a component of the Comprehensive Health Education law in kindergarten through twelfth grade in an effort to prevent teenage pregnancy and the spread of sexually transmitted diseases. In 1991. the School Improvement and Accountability Act was adopted by the Florida Legislature in an effort to return education decision-making to the community ( Report . 1994). In 1994. Florida issued the Report of the HIV/STD Prevention and H uman Sexuality Education Task Force: Components of Qu a lity HIV /STD Prevention and Human Sexuality Education ( Components ). It was a joint project by the Department of Health and Rehabilitative Services and Florida Department of Education (DOE), sponsored by the Centers for Disease Control and Prevention Division of Adolescent and School Health. The purpose of this project was to serve as a form of assistance to Florida school districts ( Report . 1994). The development of the Components stemmed from a report by Governor Chiles' Red Ribbon Panel on AIDS. This panel was convened in 1992 to "develop specific recommendations on ways to bolster the state's HIV /AIDS education and prevention programs" ( Report . 1994). The panel indicated the following in a 1993 statement: Our hearings revealed that Comprehensive Health Education, including AIDS Education required by Florida law, is inconsistent and of varying quality around the state. Local politics often interfere with providing our youth with the information, guidance, and skills that they need to live healthy productive lives. (P-2) To address the in-school prevention issues addressed above, the Panel called for the development of instructional guidelines for HIV/S fD prevention education. In the

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48 first of more than 35 recommendations, the panel stated the following. Comprehensive health and HIV/AIDS education in grades kindergarten through twelve should be a joint prioritv of the DOE and the local school boards. Education efforts in this area should be fully funded and taught by certified health educators. The state should set instructional guidelines, specific goals, and outcomes tor which the local school districts are accountable with minimum standards for the school boards. Based upon this recommendation, a task torce was charged with addressing the governor s recommendation for establishing instructional guidelines for HIV/AIDS education within the context of the DOE's Blueprint 2000 initiative which stresses local decision-making and accountability ( Report . 1994). Hence, the Components were developed. A 1995 studv by SIECUS reviewed state education agency (SEA) HIV/AIDS prevention and sexuality education programs. They reported that the Florida SEA indicated all school districts implemented sexuality education, even though no state regulations monitored its implementation. Although Florida did not require training or certification of sexuality education teachers, it did encourage and provide training opportunities. There was no state committee to develop, review, or recommend materials to be taught at various grade levels, however, according to SIECUS localities had such committees in place. SIECUS recommended requiring training and certitication ol sexuality education teachers and the development of a state level agency (Gambrell & Patierno, 1995). The SIECUS report also reviewed one of Florida's curriculum guidelines. Hot Topics: Comprehensive Health and Sexuality Education ( 1 99 j). Howev er. this is not the

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49 most current guideline provided by Florida. The Components , described earlier, ate more recent, and the contents are discussed in the results section. Hot Topics, was lound to cover all six key concepts from the Guidelines and 16 of the j 6 topic areas. No key concept was covered extensively, and human development and relationships were covered most thoroughly (See Table 2-1 ). Hot Topics gave specilic topic coverage tor grades six through twelve. Overview language included an explanation of topic coverage for grades kindergarten through six. but did not provide clear guidance to districts on how to cover topics for elementary grades in an age-appropriate manner. SIF.CL S recommended expanding the guidelines to ensure specitic and thorough discussion ot various topics grades kindergarten through twelfth, especially those not currently covered (S1ECUS, 1995). In summary, the status of school-based sexuality education is not what it needs to be to improve the sexual health of adolescents. It does appear that a base-level of sexuality education is provided for most students. State and district mandates/guidelines throughout the nation, including Florida, are in place tor the most part, howevei they aie not indicative of quality school-based sexuality education. Overall, they do not cover the full realm of sexuality related concepts, nor do they cover all important aspects ot a given concept. Instruction at the classroom level is comparative. It appears there is still a need for improvement in and research assessing the quality and depth of sexuality education at the classroom level. The topics covered are only part of the picture of comprehensive sexuality education. The materials used, teaching methods and skills-building activities utilized.

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50 time spent, training certification of teachers, and teacher attitudes toward teaching sexuality education are all also important factors that impact the quality of the education provided for students. Other Factors in the Implementation of School-based Sexua lity Education The comprehensiveness of sexuality related concepts taught is important to sexuality education. However, there are other factors that effect the deli\er\ of these concepts. Appropriate teaching materials need to be available and up to date. Teaching methods and skills-building activities need to target all learning domains so that students are able to process and actually use the information learned. The time spent on teaching sexuality education needs to be sufficient enough to allow coverage of all topics, as well as time for synthesizing and practicing related skills. Training and certification of teachers is necessary not only to increase knowledge, but also comfort le\els with subject matter, and hence likelihood of teaching it. Finally, positive attitudes toward teaching sexuality education are also an important factor in how and whether sexuality related topics are covered. Materials Used in Implementing Sexuality Education Teachers have reported that identification, use, and accessibility of lesource materials are major sources of their feelings of inadequate preparation (Gingiss & Hamilton, 1989). In fact, one survey found teachers ranked lack of materials their greatest barrier to teaching sexuality education (Haignere et al., 1996). E\en though

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51 many states and districts are supplying districts and schools with guidelines and/or curricula (Gambrell & Haffner, 1993/94), individual districts and schools have much discretion in terms of implementing them. Eight in ten teachers reported they need more assistance (Donovan. 1989). One-third (29%) of teachers had problems with materials or information. They felt the materials were inadequate, unavailable, or dated, had problems getting them approved for use, or that students found them uninteresting or difficult to read. Almost one-fifth ( 1 7%) reported this lack of adequate materials and information as the biggest problem they faced (Forrest & Silverman. 1989). A lack of readily available materials led many instructors to develop their own materials. Fortv percent developed some of the materials they used to teach abstinence, 45% birth control. 39% AIDS, and 39% other STDs. Twenty-three percent developed all of their own materials for abstinence instruction. 14% for birth control. 10% for AIDS, and 13% for other STDs. Fewer than half of sexuality education teachers used any materials that had been prepared outside the school or school district, commercially or by organizations, to teach about abstinence and birth control. About half (55%) used outside materials for STD instruction and 66% used such materials tor AIDS instruction (Forrest & Silverman. 1989). Earlier research found that teachers depended most commonly (86%) on commercially developed materials, and 59% used it as their primary source (Orr, 1982). Many (68%) also used materials they created themselves, 67% used govemment/nonprofit agency created materials, and 36% school created materials. Instructors used an average of 2.6 of the five possible sources (Orr. 1982).

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52 Teaching Methods and Skills-Building Activities Us e d in Sexuality Education As noted before, sexuality education needs to target the cognitive, affective, and behavioral domains in order to be effective (National Guidelines Task Force, 199 j). However, it is rare that all three domains are addressed at the state or classroom level. Only four states provided adequate coverage of these three learning domains in their sexualitv education guidelines (Gambrell & Patierno. 1995). Personal skills most commonly presented in state curricula and guidelines were too simplistic and did not include instruction on refusal skills or assertiveness messages (Gambrell & Hattner. 1993/94). At the classroom level, few sexuality education studies have included teaching techniques. Haignere et al. (1996) reported teacher lecture was the most common method used by sexuality education teachers, and more interactive methods such as roleplav, small-group activities, problem solving, and decision-making activities the least likely to be utilized. Firestone (1994) found that of the five most commonly reported teaching techniques, three were teacher directed-teacher directed questioning, lectures, and work sheets. However, the most commonly used method was class discussion. Many teacheis discussed the risks of premature sexual activity, but rarely linked them to concrete coping mechanisms to help reduce those risks (Firestone, 1994). Calamidas (1990) concluded that students were taught facts regarding STDs/HIV, but not how avoid them or how get help if they suspected they had been infected. Forrest & Silverman (1989) reported that two-thirds (68%) of teachers who covered sexual decision-making needed teaching strategies. Orr (1982) found teachers utilized an average of 3.9 of six teaching strategies.

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53 with the use of only one method being rare. Eight in ten or more used lectures, group discussions, and question-and-answer sessions. Seventy-two percent used media and 46% used small group discussions (Orr, 1982). It appears that although a variety of teaching techniques ma\' be utilized by teachers, minimally, there is not enough emphasis on the behavioral domain and skills-building. Time Spent on Sexuality Education Ideally, comprehensive sexuality education takes place within health education prekindergarten through twelfth grade ( Guidelines . 1991 ). The State ol Florida asseits that quality comprehensive health education programs, which include HI\ AIDS prevention as a component, are minimally 50 hours in length at each grade level and taught by trained health educators ( Report . 1994). Even though the majority of teachers feel sexuality education should be given high priority, it is generally agreed that not enough time is devoted to it (Hill. Piper. & King. 1993). Insufficient time in the curriculum has been reported as the major weakness in one S TD/HIV curriculum (Calamidas. 1990). Almost one-fifth (18%) of teachers in a national study reported lack of time was one of the three greatest problems they faced in teaching sexuality education (Forrest & Silverman. 1989). and it was ranked second of eight items that made it difficult to teach sexuality education in another (Haignere et al., 1996). In 1982, a national study found 64% of schools offering a separate sexuality education course reported it lasted five to 20 hours, 27% more than 20 hours, and nine percent less than five hours (Orr, 1982). In 1984, over 50% of high school sexuality

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54 education programs in a study of large school districts (over 100,000) were six to 20 hours long. 29% were more than 20 hours, and 1 1% were less than six hours (Sonenstein & Pittman. 1984). Half a decade later, the amount of time spent on sexuality education averaged 11.7 hours in grade seven and increased to 1 8.3 in the twelfth grade. 1 he total number of hours spent from grade seven through twelfth averaged 38.7 (Donovan. 1989; Forrest & Silverman. 1989). In SIECUS' national study, while 72% of teens reported thev received sexuality education, only 58% of teens indicated it was at the junior high level and 56% at the senior high level. Only 5% of all teens reported receiving instruction in sexuality education every year while in school (Teens Talk. 1994). At the state level. Koblinsky and Weeks (1984) reported that almost halt (43%) of FLE programs were quarter or semester programs, and 31% were units of 15 hours or less within another course. The greater the number of class hours, the more likely it was that more controversial topics were covered. The findings may have overestimated the actual incidence of full semester/quarter sexuality courses because surveys were given to those most involved in FLE. Calamidas (1990) reported 34% of districts provided six to ten hours of instruction. 25% 1 1 to 15 hours, and 18% one to five hours. Firestone (1994) found that students received an average of 30 days of instruction per year in the years they took FLE courses. One-third of teachers in that study reported that students received 10 or fewer days and one-fourth of teachers said more than 40 days. Sexuality education within FLE lasted an average of 24 hours with one-quarter (2 j%) of teachers repotting five or less hours, and one-fifth (19%) reporting more than 30 hours. Half of teachers wanted students to devote more class time to FLE (Firestone, 1994).

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55 A review of the effectiveness of school-based sexuality education programs tentatively concluded that the amount of time spent in programs may not be as important as previously thought (Kirby et ah. 1994). Effectiveness was defined as having an impact on reported sexual or contraceptive behaviors or their outcomes, such as pregnancv, birth, or STD rates. One ot the longest programs re\iewed. 15 sessions, was one of the most effective. However, other long programs. 10, 18, and up to 45 sessions each, w ere not effective. Furthermore, some of the shorter programs, 10 and 6 sessions each, were effective (Kirbv et ah. 1994). Training ''Certification for Sexuality Education Teachers If sexuality education programs are to prove effective, teachers need protessional training on how to teach these subjects (SIECUS, 1995/96). With regards to sexuality education, teacher training has been shown to increase knowledge, perceptions ol importance of teaching the curriculum, intent to teach, and level of comfort with the course content (Levenson-Gingiss & Hamilton. 1989). Higher levels ot teacher cognitive and affective comfort, and perceptions of adequate preparation have been significantly associated with student perceptions of course impact on their sexual knowledge, attitudes, and anticipated personal behaviors (Hamilton & Gingiss. 1993). Teachers rated as more influential by their students have also been found to be more knowledgeable than less influential teachers, indicating that not only is comfort important, but also a high knowledge level (Hamilton & Gingiss, 1993).

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56 Yarber. Torabi and Haffner (in press) found that academic pieparation in human sexuality and in teaching sexuality education were the teacher variables most commonly related to inclusion of sexuality education topics. Teachers with this preparation were more likelv to teach topics in the sexual behavior and sexual health ke\ concepts, from the SIECUS Guidelines , than those without it (Yarber. Torabi. & Haffner. in press). Finally, teachers actively using knowledge acquired in sexuality education inservice training were better able to maintain that knowledge than those not teaching (Smith. Flaherty. Webb. & Mumford, 1984). Evaluation of health education programs has also found a positive relationship between teacher inservice training and curriculum implementation (Connell & Turner, 1985). Inservice training has been shown to enhance teacher teelings ol prepaiedness which in turn was significantly related to teaching more sensitive subjects and mote health lessons overall (Hausman & Ruzek. 1995). Students of teachers with health education preparation recalled more specific health content, with a greater elaboration of the content, than did students of teachers without training. The trained teacheis implemented a wide range of health topics delivered in an experiential and integrated manner (Oganowski. Detert. Bradley. &Schindler, 1996). Participants of health teaching workshops have also been found to believe more strongly than those not attending that they could do a good job teaching a variety of health topics, knew how' to teach health education effectively, and understood health education concepts well enough to be effective in teaching it to their students. They also believed that it they did a good job teaching health education, their students would be knowledgeable about health issues.

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57 would significantly change health related behaviors, and would be healthier adults. Finallv. they reported spending more time per week teaching health education and expending a greater effort on a variety of specific health content areas than those not attending (Telljohann. Everett, Durgin. & Price. 1996). Unfortunately, teachers often do not have the skills, knowledge, or inclination to teach sexuality education classes (Rodriguez et ah, 1995/96). Teachers and school personnel have reported a need for more knowledge about general HIV AIDS school related issues (Ballard. White. & Glascoff. 1990) and subjects such as sexual orientation. STDs, risk behaviors for HIV transmission, safer sex. and communicating with a sexual partner about HIV (Kerr. Allensworth, & Gayle, 19S9). A national stud) found 80% of teachers reported needing factual information, teaching materials, oi teaching stiategies regarding pregnancv and STD/HIV prevention. Almost half (45%) of those needed all three types of help for each topic they covered (Forrest & Silverman, 1989). The preparation of teachers who teach health— including sexuality— education is a significant concern (Collins et ah. 1995). State level requirements for teacher training and certification in sexualityeducation are rare based on several assessments of guidelines conducted during the past decade (Gambrell & Haffner, 1993/94; Gambrell & Haffner, 1993; and Gambrell & Patiemo, 1995; Kenney. Guardado, & Brown, 1989). According to the latest state survey (Gambrell & Patierno, 1995) twelve states, D.C. and Puerto Rico required teacher certification for teachers of sexuality education. Only six states and Puerto Rico required teacher training in order to teach sexuality education. However, 17 states and D.C. did

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5 prov ide some training in sexuality education, and nine updated their training annually (S1ECUS. 1995). Training and certification requirements are more common at the district level. Over half (56%) of districts required sexuality or AIDS education teachers to be certified, most often in health education (86%). but also in science (41%). physical education (26%). family and consumer science (21%). biology (12%). or school nursing (11%). Sixty-one percent of districts required training for teachers of sexuality education. It averaued two davs or six workshops or sessions, and was usually pto\ ided b\ the health department or district itself. Training usually concentrated on information on the subject rather than curriculum, materials, or teaching techniques (Kenney. Guardado. & Brown, 1989). In contrast, when teachers were surveyed in a national study about their training a majority of them reported training in sexuality education. It was tound that 89 /o ol the sexuality educators had undergone training that specifically prepared them tor teaching the topic. Seventy-eight percent had undergraduate training, 53% had graduate training, and 86% had attended workshops or seminars outside their formal academic course work. Their primary identities were not as sexuality education teachers however. As indicated above, most had other teaching priorities. Within the past year, 72% had attended a workshop, conference, or seminar designed to help them in their teaching of sexuality education (Forrest & Silverman, 1989). A state survey also found that FLE teachers tend to be experienced. Teachers in Firestone's (1994) study had an average of ten years experience teaching FEE and 75%

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59 reported feeling very prepared for teaching. This probably being because over threequarters had training in FLE, HIV, and/or human sexuality. More than half had taken undergraduate courses in FLE (53%) and human sexuality (59%). and more than onefourth had graduate training in each area. 27% and 26% respectively. Halt had received district training on FLE (50%) and HIV/AIDS (52%). and more than half had received out-of-district training on FLE (65%). HIV/AIDS (72%). and human sexuality (52%) (Firestone. 1994). The number of teachers reporting they need help teaching and those reporting they received training seems incongruent. This may be explained in that the training is not recent or frequent enough to keep them updated in all the areas ot sexuality education. State and district level training sessions tend to focus on content and not curricula, materials, or teaching methods (Kenney. Guardado, & Brown, 1989). Also, research on undergraduate teacher preparation programs found the sexuality education content to be lacking, as described below. Although over 89% of those teaching sexuality education reported some training in sexuality education (Forrest & Silverman. 1989), only recently has the content of that training been investigated. Rodriguez et al. (1995/96) reviewed the course catalogs of a sample of 169 institutes offering undergraduate preparation of teachers to assess the amount and type of sexuality education provided. They found no schools required a sexuality education course for all pre-service teachers, almost no secondary' (1%) or physical education (6%) certification programs required any courses on sexuality education, and only 61% of programs required students in health education certification

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60 programs to take sexuality education courses. Only nine percent ot health education certification programs and three percent of physical education certification programs required a sexuality course in methodology. No schools required health education certification students to take a course on HIV 'AIDS and only twelve percent offered any courses that mentioned HIV/AIDS (Rodriguez et al. 1995/96). Teacher Characteristics and Attitudes Toward Sex uality Education A national study found that the majority of teachers teaching sexuality education think it is important to do so. They even teel some topics— birth control. AIDS, STDs, sexual decision-making, abstinence and homosexuality— should be taught earlier than they are (Donovan, 1989). Previous research has shown that characteristics such as age, gender, marital status, and religious preference were not strongly related to the inclusion of topics in sexuality education courses (V arber & McCabe. 1981). Few studies haxe been conducted on the effect of teacher attitudes and concerns on use of a curriculum (Gingiss & Hamilton. 1989), but research does indicate that the attitudes and concerns are significantly related to the nature of the instruction provided (Forrest & Silverman, 1989; Levenson-Gingiss & Hamilton, 1989; Yarber & McCabe. 1981; Yarber. Torabi, & Haffner. in press). Important teacher attitudes and concerns have been identified such as comfort presenting cognitive information and leading value-laden discussions, and perceixed adequacy of preparation, which are modifiable by training and experience. These attitudes and concerns are directly reflected in students sexual knowledge, attitudes, and

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61 perceptions of the effects of a sexuality education course on their future behavior, and their assessment of teacher performance and classroom environment (Hamilton & Gingiss. 1993). Teachers' own philosophy and commitment to program objectives have also proven to significantly influence outcomes of an abstinence program (De Gaston, Jensen. Weed, & Tanas. 1994). Past research found teacher attitudes toward their own sexuality were related to the inclusion of topics. Those with positive attitudes tow ard sexuality tended to include more topics in their sexuality education courses, especially topics related to sexual behaviors (Yarber & McCabe. 1981 ). However, that finding was not replicated in a more recent study. The teacher characteristics most commonly related to inclusion of topics included academic preparation in human sexuality, age. and academic preparation in teaching sexuality education (Yarber, Torabi. & Halfner. in press). Instructor attitudes regarding whether or not a topic should be included in the curriculum have been found to influence their inclusion of the topic. Teachers that did not think some topics should be included, such as homosexuality, masturbation, sexual dysfunction, exploitation, and sexual techniques, did not include them in their curriculum (Orr, 1982). More recently, high importance ratings of topics w r as correlated with the inclusion of those topics in the curriculum (Yarber. Torabi. & Hatlner, in press). Most teachers who responded in one study placed high value on importance, responsibility, and comfort scales on some central issues addressed, such as self-esteem, interactional skills, and STDs. However, diminished importance was placed on birth control and student sexual behavior. Ihese subjects are critical to address in trying to

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62 decrease possible negative consequences of sexual activity (Gingiss & Hamilton, 1989 ). Although this study did not assess what was actually taught, conclusions from studies cited above reported the decreased likelihood of teaching subjects that w ere not rated important. Hence, it is important to increase teacher comfort and feelings of importance related to these topics to increase the likelihood they are included in sexuality education curricula. It appears there are several factors that are important to the implementation of school-based sexuality education. A lack of readily available and current materials has left many teachers feeling inadequate and unprepared, and led many to create their own materials. Teaching methods and skills-building activities are not addressed in state or district guidelines. Also, at the classroom level teaching methods are reported to be more teacher-oriented rather than emphasizing the important skills-building domain. Although there is not a specific time amount given for effective programs, it is generally agreed upon by teachers that there is not enough time in the curriculum for sexuality education. It also appears that sexuality education courses are only being offered in one or two grades in high school, rather than being incorporated in all grade consistent with the comprehensive approach recommended by professionals. Training of sexuality education teachers, when provided, has a significant positive impact on teachers and their students. Research indicates most teachers would like more training. State and district certification and training requirements are not sufficient. Training offered at this level and that provided in professional degree programs does not adequately prepare teachers for teaching sexuality education. Finally, teacher attitudes are significantly related to the

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63 nature of instruction provided. Although most seem to have positive attitudes toward teaching sexuality education, training could help to improve attitudes overall and perhaps toward specific topics, hence enhancing the quality of sexuality education. Addressing these issues-providing current, appropriate materials, increasing the time allotment in the curriculum, and training teachers so they feel more comfortable with teaching methods, content, and sexualitv education in general— could help to improve the status ot schoolbased sexuality education. Conclusion There is both a need for and the support for comprehensive school-based sexuality education. Professionals agree that programs need to cover the scope ot human sexuality issues; address the cognitive, affective, and behavioral learning domains; work with parents and community resources; and not only aim to prevent STDs/HIV and unwanted pregnancy, but promote sexual health. Evaluation of sexuality programs has proven that they can be effective in increasing knowledge and promoting behaviors that reduce the likelihood of negative consequences associated with risky sexual behavior. State and district recommendations and mandates for school-based sexuality education have increased tremendously in recent years. Although the depth and nature ol studies assessing sexuality education have varied greatly, it appears the majority of schools are providing a base-level of sexuality education for students. However, much work remains. Controversial topics and those pertinent to the prevention of STDs/HIV and unwanted pregnancies are often avoided and not presented in a manner conducive to

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64 effecting behavior. Also, there is still more of an emphasis on avoiding the negative consequences of risky sexual activity rather than promoting healthy sexuality. In addition to the content, other factors related to implementation need to be addressed. Teacher training is necessary to improve the status of sexuality education. Training can help improve knowledge levels, feelings ot comfort, teacher effectiveness, and attitudes toward teaching sexuality. More time needs to be allotted in the curriculum to ensure thorough coverage of topics and time for skills-bui lding acti\ itics. Finally . current and appropriate teaching materials need to be made available. These conclusions are based on several studies intended to assess different aspects of sexuality education. The four conducted in this decade do not provide an adequate assessment of the current status of sexuality education. Two were in the state ot New Jersey and assessed Family Life Education. Another, in Indiana, assessed the scope of sexuality education and teacher attitudes. The fourth, a national level study, was intended to assess health education as a whole and only briefly examined sexualitv education. A general picture of the status of sexuality education was provided, however, none of the research reviewed in this chapter provided a total picture of sexuality education at the classroom level. Although it is difficult to provide an exact assessment of what is being taught at the classroom level, the goal of this study was to present a more comprehensive view of, and to ultimately help improve the status of, school-based sexuality education.

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65 Table 2-1 Key Concepts and Topics in a Comprehensive Sexuality Education Program (National Guidelines Task Force, 1993). Kev Concept 1 : Human Development Kev Concept 4: Sexual Behavior Reproductive Anatomy & Physiology Sexuality Throughout Life Reproduction Masturbation Puberty Shared Sexual Behavior Bodv Image Abstinence Sexual Identity & Orientation Human Sexual Response Fantasy Sexual Dysfunction Kev Concept T Relationships Kev Concept 5: Sexual Health Families Contraception Friendship Abortion Love STDs & HIV Infection Dating Sexual Abuse Marriage & Lifetime Commitments Parenting Reproductive Health Kev Concept 5: Personal Skills Kev Concept 6: Societv & Culture Values Sexuality & Society Decision-making Gender Roles Communication Sexuality & the Law Assertiveness Sexuality & Religion Negotiation Diversity Finding Help Sexuality & the Arts

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CHAPTER 3 MATERIALS AND METHODS Introduction This study assessed the scope and nature of sexuality education in Florida public high schools. It provided information on the scope and nature of information that was covered in sexuality education courses, and teacher, school, and district variables that were related to implementation of sexuality education. As sexuality education is mandated in Florida, data was used to determine compliance with the Components. In addition to providing valuable baseline data, this information will help improve schoolbased sexuality education and support for those teaching it. Chapter 3 includes the following sections: (1) subjects, (2) instrumentation. (3) procedures, and (4) analysis. Subjects A 1982 study (Orr, 1982) found that five specialty areas were most likely to include sexuality education teachers— biology, health education, family and consumer science (FCS). school nursing, and physical education. A 1989 study used a national sample from the same five specialty areas (Forrest & Silverman, 1989). They found that teachers of health education were most likely to provide sexuality education, with FCS beinsz second most likely. They comprised 25% and 2 j%, respectively, ot the sexuality education teachers. However, there were more than twice as many physical education 66

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67 teachers as teachers of health education or any other specialty, so they accounted for the largest proportion, 31%. Based on the results of these two previous studies, it was decided to survey health education and FCS teachers. In Florida. FCS teachers are also reported to be most likely to teach Life Management Skills (LMS) (Darci Lolley, HIV STD Prevention Specialist. Comprehensive School Health Program. Florida Department of Education, personal communication. November 3. 1995). LMS is a required class for graduation, usually taught in the ninth or tenth grade, and likely covers health and sexuality education topics. Physical education teachers were not chosen based on prior findings that they were least likely to teach sexuality education (Forrest & Silverman. 1989). The subjects for this study were public school teachers teaching sexuality education within grades 9-12. Originally, only required classes were going to be assessed so that baseline information could be established on minimal sexuality education Florida students were provided. However, only 1 76 teachers reported their class was required, so all completed surveys were used. A list of all teachers with primary teaching codes "health" and "consumer and family sciences” for the 1995-1996 school year was obtained from the Florida Department of Education (DOE). Teachers were listed by school and district. Thus, this list did not include all possible teachers responsible for sexuality education. As found in the previous studies cited above, some probably had primary teaching codes biology/science, physical education, school nursing, and other subjects. This list also contained some teachers that did not teach sexuality education.

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68 Of the sample. 76 respondents returned the survey indicating they were not currently teaching sexuality education. There were a total of 204 health teachers in 37 of the 67 school districts in Florida and 880 FCS teachers in 64 of the 67 districts. It was assumed that the 27 districts with no listed health educators did not have any since information was turned in for FCS teachers in those districts. One district (Charlotte) did not turn in a full report, so information was missing for five health and eight FCS teachers, bringing the numbers to 199 and 872 respectively. There was no information, and hence no participants, for three other districts (Bradford. Lafayette, Union). All health teachers listed (N=199) and a random sample of FCS teachers were selected. Using a random number assignment, a 35% sample (N=301 ) of FCS teachers was selected. A pilot-test of 1 8 was selected, nine student teachers and nine teachers. The University of Florida Department of Health Science Education had nine student teacher interns each working with a supervising teaching who either taught health or LMS in a Florida high school. Information on school districts was obtained from the Florida DOE's Statistical Report. Profiles of Florida School Districts 1993-94 . the most recent edition available. Information on individual schools was not available from the Florida DOE. Instrumentation Two survey instruments and one assessment instrument were used for this research. The instruments chosen were "Sex Education in the United States," from a national survey by the Alan Guttmacher Institute (AGI) (1988), and "Survey of School

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69 Sexuality Education." from a state survey by Drs. William Yarber and Mohammad Torabi ( 1 995). These instruments were chosen after reviewing research on school-based sexuality education in the United States. Few similar studies were found in the literature search. Within the past decade, these were the only two instruments developed that were found to be suitable for the objectives of this study. The only other national survey used an interview questionnaire and was too broad in scope, including numerous health topics (CDC. 1995). The other recent state level study did not have the survey instrument available for use (Firestone. 1994). A sub-section was replicated from the assessment instrument. Sexuality education curricula: The consumer's guide by Ogletree et al. (1994). The three instruments were modified and combined using Dillman's Total Design Method ( 1978). The researcher's dissertation committee— two experts in sexuality education, one in school health programs, and one in research design and statistical analysis— reviewed the instrument for validation purposes. In addition, survey questions were taken directly from the above mentioned studies which had already been extensively reviewed by expert panels, as described below. Sex Education in the United States This instrument was used in a 1988 AGI national survey of school teachers that taught sexuality education. The study reported the frequency of sexuality education in grades 7-12, some topics covered in sexuality education, and institutional and other obstacles that may have impeded instruction. Special emphasis was placed on prevention of pregnancy, sexually transmitted diseases (STDs), and HIV/AIDS to obtain a clear

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70 picture of schools' coverage. The study provided primarily the first national-level statistics on these issues. Survey development, methodology, and results were reported by Forrest and Silverman ( 1989). The survey was developed through personal consultation with sexuality educators, researchers, and education specialists. Four focus group discussions with sexuality educators from public secondary schools in the Northeast, and a pilot survey of 200 randomly sampled public school teachers. 40 from each of the five specialties covered in the survey, were also used to gather preliminary information. Survey recipients were asked questions about themselves, their schools, and their views as to whether sexuality education should be taught and what topics should be covered at what grade levels. More detailed questions were asked of those currently providing sexuality education (Forrest & Silverman. 1989). No measures of reliability or validity w'ere reported. Portions of this instrument were used in the current study to measure coverage of abstinence, pregnancy prevention, birth control methods, condoms, and STDs/HIV: determine how sexuality education was taught (classes, materials, time); and assess teacher training and demographics. Survey of School Sexuality Education This self-report questionnaire was developed by Drs. William Yarber and Mohammad Torabi and administered to Indiana high school teachers in a 1995 survey. The survey contained three sections: 1) a list of 36 sexuality education topics about which the respondent was asked to indicate w'hether the topic was included in the sexuality

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71 education unit in his/her class and to indicate his/her view about the degree of importance of each topic as part of comprehensive sexuality education: 2) two instruments designed to measure sex-related attitudes of the respondents: and 3) questions dealing with demographic characteristics of the respondent, the respondent's view of support for sexuality education in his/her classes, and selected characteristics of the health classes and sexuality education taught by the respondent. Only the component assessing whether each of the 36 topics were taught and teacher ratings of importance were used in the current research. These 36 topics were based on SIECUS's Guidelines for Comprehensive Sexuality Education (1993) described in Chapters 1 and 2. Survey development, methodology and results were reported by Yarber, Torabi. and Haffner (in press). The survey was deemed valid because the items were directly from the Guidelines which were developed and reviewed by a national panel of experts. No measures of reliability were reported. Sexuality Education Curricula: The Consumer's Guide This guide was developed in an effort to assist teachers, program planners, and administrators in determining whether published sexuality education curricula meet the school district's needs (Ogletree et ah, 1994). The guide identifies key attributes of curricula including content, philosophy, skills-building strategies, and teaching methods. The skills-building and teaching strategies sub-sets were used for this research. The skills-building strategies sub-set was created based on specific personal and interpersonal skills deemed necessary for healthy sexuality. These have been identified by the

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72 SIECUS Guidelines for Comprehensive Sexuality and through evaluation of prevention programs over the past twenty years. This sub-set was used in two ways— to assess whether teachers included the strategy while teaching sexuality education and whether they actually had students practice the skills. The teaching strategies sub-set compiled a variety of teaching methods necessary to meet individual learning styles and to provide opportunities for personal and social skills-building (Ogletree et al.. 1994). Data Collection Procedures The survey and data collection procedures were approved by the University of Florida Institutional Review Board on February 22, 1996. The survey methodology followed Dillman's recommendations in The Total Design Method (1978). Contents included a cover letter, the survey booklet, and a pre-addressed. postage-paid return envelope. On February 27. 1996 a pilot survey was sent to the Department of Health Science Education student teacher interns and their superv ising teachers (N=18). Those not responding within one week were followed-up by post-card on March 5. Ten surveys were returned. After reviewing comments, a few minor revisions were made. Some words or phrases within questions were underlined and bolded to emphasize the major elements of some questions. On March 26. surveys were sent to the 500 sample subjects. On April 2, a followup post-card was mailed to all subjects. On April 23, a follow-up letter including a new survey and pre-addressed, postage-paid envelope was sent to subjects who had not yet

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73 responded (N=278). There was a three week lapse of time following the post-card reminder rather than the usual two weeks due to spring break in some districts. For respondents that indicated they were not teaching sexuality or HIV/AIDS education in grades 9-12. replacements were chosen based on random number assignment. Replacement surveys were sent for approximately the first half of the ineligible surveys that were returned. Those received back after April 16 were not replaced. The replacement surveys were mailed April 9 (N=17) and April 16 (N=20). with follow-up post-cards on April 16 and April 23 respectively. A letter of appreciation and a summary of study results were forwarded to each participant who requested them following completion of the study. Analysis of Data A total of 555 surveys were mailed. There were 18 in the pilot sample. 500 in the original sample, and 37 in the replacement sample. Of the 18 in the pilot sample, seven of the nine surveys w ere returned by the teachers, and three of the nine were returned by the student interns. Since the students and teachers answered the survey based on the same class, the students' surveys were not used in data analysis. The seven pilot teacher surveys were used in data analysis, since no major revisions were made in the survey. Seventy-six of the sample of 500 respondents indicated they were not teaching sexuality education in grades 9-12. Replacement surveys were sent on a weekly basis until April 16, for a total of 37 replacement surveys. In addition, two respondents completed the survey twice, so the two duplicates were omitted by the researcher. Of the

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74 555 sui\c\s sent. 8/ nine pilot, 76 not teaching, and two duplicates — were not useable leaving 468 eligible. Of these, 261 completed surveys were received and used for data anal\ sis se\en pilot. 105 health, and 149 FCS teachers — yielding a 56% response rate Quantitative results were calculated tor all information gathered. These results were used to answer research questions 1.3. and 4. An analysis of variance (ANOVA) was used to assess relations between the number of concepts taught for each of the survey sub-scales and teacher and school/district characteristics. The sub-scales included the scope of sexuality education concepts, abstinence concepts, types of birth control methods, birth control concepts, condom concepts, types of STDs, STD concepts. HIV concepts, skills-building strategies taught, skills-building strategies practiced by students, teaching methods utilized, time spent on abstinence, birth control, condoms. STDs, HIV, and total time. For the ANOVAs, five characteristics were used as co variates— age, race, sex. years teaching, and years teaching sexuality education-and two teacher variables were tested for main effects-degree of liking teaching sexuality education, and certification in health or FCS. Two school/district variables were also tested for main effects-the status of the curricula mandate and the class as required or elective. Post hoc analyses on significant findings were performed using Tukey’s Honestlv Significant Difference test. These results were used to answer research questions 5 and 6. A regression was used to assess the relation between the above listed sub-scales and continuous district demographics— total number of students, percent minority students, percent students on free/reduced lunch, as an indicator of socioeconomic status. These results were used to answer research question 6.

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75 In 1991. SIECUS issued the Guidelines for Comprehensive Sexuality Education ( Guidelines ), an idealized model of comprehensive sexuality education, as described previously in Chapter 1 and 2. In 1994. Florida issued the Report of the HIV 'STD Prevention and Human Sexuality Education Task Force: Components of Quality HIV/STD Prevention and Human Sexuality Education ( Components ). The purpose of this project was to serve as a form of assistance to Florida school districts in implementing the mandated kindergarten through twelfth grade comprehensive sexualityeducation. as described in Chapter 1 and 2 ( Report . 1994). The Components were compared to the Guidelines by the researcher. The Guidelines were utilized in the development of the Components . Hence, most of the Components ' objectives were identical to those in the Guidelines . It was found that the Components included learning objectives for all six key concepts and the majority of the 36 subconcepts. Thus, the assessment of the scope of sexuality education at the classroom level using the Guidelines ' 36 concepts was used to help determine compliance with the Components as most concepts were included in both. These results were used to answer research question 2.

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CHAPTER 4 RESULTS The Context of Sexuality Education in Florida Schools This study assessed the scope and nature of sexuality education in Florida public high schools. The results of the study are discussed in three sections in this chapter. The first section, the context of sexuality education in Florida schools, addresses the subjects surveyed, the types of courses sexuality education is taught in. district mandates for sexuality education, and the time spent on sexuality education. The second and third sections are the scope and nature of. and the factors effecting implementation of sexuality education in Florida schools. Teachers The subjects for this study were health and family and consumer science (FCS) public school teachers teaching sexuality education within grades 9-12. The sample for the pilot-test was comprised of the University of Florida Department of Health Science student teacher interns and their supervising teachers. There was a total of 1 8 in the pilot sample, nine student teachers and nine supervising teachers. After their surveys were returned and necessary changes made, a sample of 500 was sent. Their names were obtained from a Florida Department of Education (DOE) list. There were a total of 199 health teachers in 36 of the 67 school districts in Florida and 872 FCS teachers in 63 of 76

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77 the 67 districts. All health teachers listed (N=199) and a random sample of FCS teachers were selected. Using a random number assignment, a 35% sample (N=301 ) of FCS teachers was selected. Seventy-six of these respondents indicated they were not teaching sexuality or FIIV/AIDS education in grades 9-12 during the 1995-96 school vear. Replacement surveys were sent on a weekly basis in place of these until April 16, for a total of 37. A total of 555 surveys were sent-18 pilot. 500 in the sample, and 37 as replacements. Eighty-seven of these were not eligible. The nine student teachers in the pilot were taken out to avoid duplication as they based surveys on the same class as their supervising teachers. Two respondents completed the survey twice, so these duplicates were omitted. In addition 76 were not teaching sexuality/FIIV education, so 468 respondents remained eligible. Of these. 261 surveys were completed yielding a response rate of 56%. Demographics. The majority of the teachers were Caucasian females (68%). Overall. 80% of respondents were female and 84% Caucasian. African Americans accounted for 1 1%. Hispanics 2%, and Asian. Pacific Islander, and bi-racial 1%. The ages ranged from 20-24 (2%) to 60-64 (2%). The majority (75%) were between 35 and 54 years of age, 16% were 35-39 years. 18% 40-44 years, and 26% 45-49 years. The teachers had been teaching for an average of 16 years and sexuality education specifically for ten years. College preparation. The most common bachelor level degree was FCS (48%), followed by a combined degree in health/physical education (18%), health education

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78 (9%). and physical education (6%). A range of other majors comprised the rest of the sample. Almost half (41%) of the teachers also completed a master's degree. Again, of these the most common major was FCS (33%). Health education and school administration comprised 9% and 10%. respectively, of the majors, with a variety of other majors completing the group. Only four teachers (1.5%) reported having a doctorate degree and 3% having various other certifications, such as Certified Health Educator (CHE) and Professional Diploma. Teacher certification was also most commonly in FCS (51%). followed by health/physical education (26%). and health (8%). Teachers (N=173) had an average of 7.16 (s= 10.38) undergraduate semester hours of training that specifically prepared them for teaching sexuality education, with a range of zero to 60. Seventeen percent (N=44) had no undergraduate training. 32% (N=84) did not respond. Teachers (N=132) had an average of 2.68 (s=5.79) graduate semester hours for the same purpose, with a range of zero to 40. Thirty-one percent (N=82) had no' graduate training in this area, and 49% (N=128) did not respond. As the range was great in these semester hours estimates, it was assumed that some respondents misinterpreted the question. It does not seem likely that one could receive 40 or 60 semester hours specific to sexuality education. Respondents may have estimated total class hours during the semester, rather than semester hours where one class is generally three. However, since there was not a clear cut off point in the results, it was not possible to make a definitive determination. Continuing education. Teachers (N=176) had a mean of 19.48 (s=l 7.72) hours of workshops, in-service training, and seminars to date that specifically prepared them for

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79 teaching sexuality education, with a range of 2 ero to 75. The majority of teachers had some training within the last school year. Twenty-seven percent reported they had attended one session in the past school year. 33% attended several times, and less than 7% attended monthly or weekly. Thirty-six percent reported they had no, attended a workshop designed to help with teaching sexuality education since the end of the last school year. AtthutteL Teacher attitudes toward sexuality education were positive overall. The majority of teachers reported they -very much" (64%) or "somewhat" (22%) liked teaching sexuality education. Only 1 0% were neutral ("neither like nor dislike") and less than 2% reported they did not like teaching sexuality education “too much" or “at all.” Almost all ,94%) teachers though, i, was the appropriate role of the school to teach sexuality education. J\ pes of Courses The majority of eligible teachers (82%) indicated they were teaching sexuality education that included HIV/AIDS education. Only four percent said their class did no. cover HIV/AIDS. About twelve percent indicated they were teaching an HIV/AIDS class. Life management skills, a required class in Florida high schools, was the class most commonly used as the basis for answering the survey (58%). FCS was the next most prevalent (25%) class, followed by health education (11%), FCS had several classes within it rubric, most commonly “Child Development” and “Family

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80 Living/Dynamics." Four percent (N= 11) of the respondents did not indicate what class they based the survey on. Two-thirds (67%) of respondents reported their class was required for students. One-fifth (21%) reported it was an elective course. The remaining 1 1% did not respond. Students receiving sexuality education were most likely in the ninth grade (39%) followed by a mixed grade level class (34%). tenth grade (15%). eleventh (2%). and twelfth ( 1 %). Mandates lor Courses Just over one-third (37%) of teachers reported that it was mandated for them to use a specific sexuality education curriculum and almost one-fourth (23%) reported that one was suggested. Another one-fifth (22%) said it was neither mandated nor suggested. Fifteen percent either did not know whether their district mandated or suggested a curriculum or did not respond. Almost all (93%) of those with a mandate/suggestion reported it was established by the district. Numerous responses were given for the name and publisher of the mandated/suggested curriculum. The most common answers were not specific names, but rather that the district produced/provided it (31%) or that they did not know the name or publisher (22%). 1 ime Spe nt on Sexuality F.dncatinn HIV and STDs received the most coverage in classes. An average of 134 minutes (s=106), with a range of zero to 720 minutes, was spent on HIV and 122 minutes (s=92),

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81 with a range ot zero to 500. on STDs. Abstinence received more coverage than either birth control options or condoms, with averages of 77 (s=88), 65 (s=70). and 34 (s=50) minutes being spent on each topic lespectivelv. The ranges for these topics were zero to 750. 480. and 400 respectively. However, for each of these topics, less than 15% of the respondents reported greater than 200 minutes for HIV (13.8%) or STDs (10.4%), greater than 120 minutes on abstinence ( 12.3%) or birth control (10.4%), and greater than 50 minutes on condoms ( 1 1 .5%). About 20% ot teachers did not respond to the number of minutes spent on abstinence, birth control, or condoms, and 15% to HIV or STDs. Total time spent on sexuality education averaged 1 1 hours (sd=8) with a range of one to 60 hours. Twenty-three percent of respondents spent between 1 and 5 hours on the unit, 28% between 6 and 10 hours, 17% between 1 1 and 15 hours. 10% between 16 and 20 hours, for a total of 78% spending between 1 and 20 hours. Only 9% spent 20 to 60 hours on the unit, with 13% not responding. The Scope and Nature of Sexuality Education in Florida Schools This section addresses the scope of concepts taught, teacher ratings of importance toward the concepts, and compliance with Florida's Guidelines . The nature of concepts taught and use of referrals and guest speakers are also reviewed. Finally, the skillsbuilding activities, teaching methods, and materials utilized by the teachers are summarized.

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Scope of Concepts Tmioht 82 The scope was measured using the 36 concepts outlined in the SIECUS Gui delines for Comprehensive Sexuality Education r.n Teachers were asked to indicate whether or not they were teaching each concept. An average of 25 concepts (s-6.7:') were taught with a minimum of seven and a maximum of 36. The topics most commonly reported taught were abstinence (99%). decision making (99%). sexually transmitted diseases/HIV (97%). communication (95%). values (93%). finding help (92%). love (89%). friendships (88%). assertiveness (88%), reproduction (87%). reproductive health (85%). dating (84%). body image (83%). puberty (82%). families (82 /o). sexual identity and orientation (81%). marriage and lifetime commitments (81%). sexual abuse (81%), and negotiation (80%). Topics taught by about three-fourths of teachers included reproductive anatomy and physiology (77%), parenting (76)%, sexuality and society (73%). sexuality and the media (73%). contraception (72%). sexuality throughout the lifespan (70%). Gender roles (67%) and human sexual response (55%) were taught by more than half of teachers. 1 he most neglected topics were those often considered to be controversial topics such as abortion (40%), sexuality and religion (j 9%). sexuality and the law (38%), shared sexual behavior (36%), diversity (32%), masturbation (28%), fantasy (25%), sexual dysfunction (24%), and sexuality and the arts (8%). (See Table 4-1.) Although 81% of teachers reported they taught sexual identity and orientation, .heir comments and the Florida definition of this topic lead to the questionable nature of this finding. The G uidelines Â’ description of the sexual identity and orientation concept.

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83 used in this survey, was general (As young people grow and develop, they begin to feel romantically and sexually attracted to other people.) and not technically accurate, even though it contained some specific objectives that correctly address the topic. Thus, some ot the teachers completing the survey may have misinterpreted the meaning of this concept. Further discussion follows in Chapter 5. Rated Importance of Concepts Teachers were also asked to rate each concept in terms of importance on a scale of "not at all important" ( 1 ) to "extremely important” (5). Two thirds (N=24) of the items were rated toward the extremely important end of the scale, having an av erage score of at least 4.0. Abstinence and STDs/HIV were rated highest, averaging 4.97 and 4.96 respectively. Those rated toward the “extremely important" end of the scale (4 to 5) included decision making (4.86), values (4.73), communication (4.72). sexual abuse (4.61). finding help (4.59), reproductive health (4.57). contraception (4.52). parenting (4-50). assertiveness (4.45), marriage and lifetime commitments (4.44). love (4.44). reproduction (4.43). negotiation (4.34). friendship (4.29). dating (4.18). body image (4.12), families (4.1 1 ). puberty (4.09), sexuality and society (4.07), sexuality throughout the lifespan (4.05), sexual anatomy and physiology (4.02). and sexual identity and orientation (4.02). Those averaging in the higher end of "moderately important’' (between 3 and 4) included sexuality and the media (3.98). gender roles (3.82). human sexual response (3.71). sexuality and religion (3.42), sexuality and the law (3.40), abortion (3.34), diversity (3.12), shared sexual behavior (3.02). Those concepts that were

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84 rated, on average, as less than "moderately important” (between 2 and 3) included masturbation (2.82). fantasy (2.73). sexual dysfunction (2.78), and sexuality and the arts (2.13). (See Table 4-1.) Compliance with Florida Sexuality Education Guidelines The guidelines for sexuality education published by the Florida DOE. Components of Quality HIV/STD Prevention and Human Sexuality , were compared to the 36 concepts of the SIECUS Guidelines for Comprehensive Sexuality Education , which were used to assess the scope of sexuality education in this survey. The Components covered 25 of the 36 Guidelines ' concepts. Teachers also covered an average of 25 of the Guidelines ' concepts, however, they were not necessarily the same as those covered in the Components . Of the concepts covered in the Components , those most likely to be taught by teachers included abstinence (99%). decision making (99%). STDs/HIV (97%). communication (95%). and finding help (92%). Those least likely to be taught included abortion (40%). sexuality and the law (38%), shared sexual behavior (36%), fantasy (25%). and sexual dysfunction (24%). There were seven concepts that were not covered in the Components , but were covered by over half of teachers. These included values (93%). friendship (88%), puberty (82%), sexual identity and orientation (81%), negotiation (80%), sexuality and society (73%), and human sexual response (55%). There were four concepts not covered by the Components , nor by the majority of teachers. These included sexuality and religion (39%), diversity (32%), masturbation

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85 (28%). and sexuality and the arts (8%). The remaining topics included in the Co mponents were taught by between 66% and 89% of teachers, as noted in the previous section. (See Table 4-2.) The eleven Guidelines ' topics not covered in the Florida Components included puberty, sexual identity and orientation, friendship, values, negotiation, masturbation, human sexual response, sexuality and society, sexuality and religion, diversity, and sexuality and the arts. However, in examining the Guidelines ' coverage of four of these topics, it becomes more understandable why the Components do not include them. The Guidelines break down each concept into developmental messages for four levels. Level 1 is middle childhood and early elementary; Level 2 is preadolescence, upper elementary; Level 3 is early adolescence, middle school/junior high school; and Level 4 adolescence, high school. This study covered grades 9 12, or the upper end of Level 3 and Level 4. Puberty, diversity, and sexuality and the media are only briefly/moderately touched on at Level 3 (through age 15) and not at all covered in Level 4(15-18 years, high school) in the Guidelines . Friendship only has two objectives at Level 3 and one at Level 4 in the Guidelines . In addition, the non-specific wording of the sexual identity and orientation subconcept, described previously, helps explain the high percentage (81%) that reported teaching a concept not only omitted in the Components , but one that is considered very controversial in our society. Finally, some objectives related to the relationships key concept were difficult to classify into the subconcepts of love, dating, or marriage and lifetime commitments. Most of the Components Â’ objectives were identical to those in the Guidelines , however several were not. Therefore, whether or not the

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86 Components addressed a subconcept was dependent upon how it was classified within the Guidelines . The Nature of Sexuality Education Abstinence. Thirty-six percent of teachers taught abstinence as the only way to prevent unwanted pregnancy and STDs/HIV, while 95% taught that it was the best way to prevent them. Ninety percent taught students how to resist peer pressure to have sexual intercourse and 9 1 % how to say no to a partner. The negative consequences of sexual intercourse were taught by 95%. An average of 4.08 (82%) of the 5 abstinence related concepts were taught by teachers. Pr egnancy Prevention. Ninety-seven taught abstinence as a method of preventing unwanted pregnancy. Birth control methods were taught as an option by 64% of teachers and 33% reported birth control methods were covered in other courses in the same grade) s) they taught. Twenty-eight percent said they would answer questions about birth control only if a student initiated a question, 61% on a one-on-one basis after class. 53% had students submit questions anonymously on a slip of paper, and 85% answered questions in class. Birth Control Methods. An average of 5.30 of the 10 birth control methods were taught by teachers. At least half of respondents included the birth control pill (63%), diaphragm (61%), spermicide (59%), intrauterine device (56%), norplant (53%), fertility awareness/rhythm (52%) and the female condom (50%). A little less than half taught withdrawal (49%), cervical cap (46%), and depo-provera (42%).

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87 Fifty-nine percent of respondents taught how birth control methods worked and 54% how to use them. Specific resources for birth control were provided by 39% of teachers. Only twenty-nine percent actually showed the devices to their classes. Half (51%) of teachers taught students how to discuss contraceptive options with a partner. Of the five birth control concepts, only half (46%) were taught on average by teachers. Condoms. Almost half (48%) of teachers described the proper way to use a condom and 40% showed the proper way to use one through printed material, film or demonstration. Sixty-four percent taught condoms should be put on before any vaginal contact by the penis. Fifty-seven percent encouraged condoms as a means of preventing pregnancy and 77% as prevention for STDs/HIV. Concerns about the condom, such as decreased sexual pleasure and/or lack of spontaneity were addressed by 43% of teachers and 64% taught that condoms should always be used with a spermicide. On average, just over half (56%) of the seven condom items were taught by teachers. STDs/HIV. An average of 8. 1 1 of the 1 0 types of STDs were covered in sexuality education classes. At least nine out of ten teachers taught HIV (94%). chlamydia (90%), genital herpes (90%). gonorrhea (90%). and syphilis (90%). Over half taught genital warts (85%). pelvic inflammatory disease (77%), crab lice (74%), and hepatitis B (71%). Forty-nine percent taught “other STDs," however, few indicated specifically which these were. Only 3% of those teaching human sexuality courses reported not teaching anything about STDs/HIV. Ninety-four percent of teachers taught how HIV is transmitted, 93% the signs of HIV, and 93% the effects of HIV. Abstinence was taught as a method of HIV prevention

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88 by 96%. monogamy by 88%. and condoms by 85%. Clinic names for testing and help with HIV were provided by 70% of teachers, and issues about confidentiality were discussed by 84%. Regarding other STDs, 88% of teachers taught about transmission routes. 87% about signs of STDs, and 85% about the effects of them. Abstinence was taught as a method of prevention by 89%. monogamy by 82% and condoms by 80%. The names of clinics for testing and treatment of STDs were provided by 64% of teachers and 78% discussed confidentiality issues. Averages of 7.02 of the 8 concepts (88%) related to HIV and 6.52 of the eight (82%) concepts related to STDs were taught by teachers. Student Referrals For help with birth control, teachers were most likely to refer students to parents (63%). local family planning clinic/health department (62%). or a family doctor (60%). They were less likely to send them to a school nurse (35%) or guidance counselor (22%). Students who needed help with HIV/AIDS were most likely to be referred to a family doctor (58%), local family planning clinic/health department (57%), or parents (51%). They were less likely referred to a school nurse (37%) or guidance counselor (20%). For help with other STDs, teachers were most likely to refer students to a local family planning clinic/health department (57%), family doctor (56%), or parents (49%). They were, again, less likely to refer to school nurses (37%) or guidance counselors (20%).

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89 Guest Speakers The use of guest speakers from an outside organization was much more common than use of speakers from within the school, especially for HIV/AIDS. 53% versus 20%, and STDs, 43% versus 17%. About one-third of teachers brought in guest speakers for abstinence (33%). birth control (27%). and condoms (27%). Guest speakers from within the school w'ere utilized by less than one-fifth of teachers for the topics of abstinence (18%). birth control (14%). and condoms (12%). Skills-Building Activities A wide variety of skills-building activities were taught by the majority of teachers. Half of the 14 items were incorporated by an average of nine out of ten. or more, teachers. These included identifying consequences of decisions (95%). increasing self-awareness/building self-esteem (93%). examining influences on decisions (93%). building decision-making skills (93%), examining perceived STD\HIV risks (92%), building planning/goal-setting skills (91%). and examining personal values (90%). Between eight and nine out of ten identified community resources (86%). examined perceived pregnancy risks (83%), and taught general communication (89%). refusal (85%). and assertiveness (81%) skills. Slightly less than three-quarters built conflictmanagement skills (72%) and addressed peer norms (71%). Actually having students practice these skills in class was reported less often by teachers. Teachers taught an average of 12.14 (87%) of the 14 different skills activities, but only had students practice 9.04 (65%) of the 14 skills. At least seven out of ten

PAGE 96

90 teachers had students engage in activities to identify consequences of decisions (77%), examine influences on decisions (74%), increase self-awareness/build self-esteem (73%), and practice decision-making (79%). planning/goal-setting (76%). and general communication skills (72%). Slightly less had students examine personal values (68%) and perceived STD/HIV risks (55%). and practice refusal (66%), assertiveness (63%). and conflict-management skills (58%). Less than half of teachers had students address peer norms (48%). identify community resources (48%). and examine perceived pregnancy risks (47%). Teaching Methods The teaching methods most commonly employed were teacher lecture (95%), audiovisual materials (95%). student worksheets (91%). and large group discussions (90%). Case studies (74%), cooperative learning/small groups (74%). and ground rules (69%) were also used by many instructors. Far less used an anonymous question box (49%). journals/storv writing (30%), a peer helper component (26%), or parent/guardian involvement (19%). Sixty-five percent of the 1 1 methods were used on average by teachers. Course Materials Teachers were asked what curriculum/materials they used in their classrooms, a commercially available curriculum, created materials, and/or other sources. TeachersÂ’ most common response was that they created their own materials (29%). One-fifth (21%)

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91 reported using a published curriculum and 14% use a variety of other sources. Another 1 1% reported using a combination of created materials and other sources. Using a combination of a published curriculum and created materials; a published curriculum and other sources; or a combination of all three sources were each reported by 5% of respondents. A wide range of publishers was reported, all answers being given by less than 5% of the respondents. The "other sources" specified also covered a range of responses. The most common was materials provided by the school district (1 1%). The rest of the responses were each reported by less than 2% of the respondents. These responses included materials such as community resources/speakers, news articles, videos, excerpts from texts, and pamphlets/information from local/national organizations. There were a variety of textbooks used by the teachers. Most commonly they used a general health, life management skills, or making choices text book (46%). Some reported using more specific human sexuality/marriage and family (7%) or child development (9%) texts. Almost one-third of teachers (28%) did not respond to this question. Factors Effecting the Implementation of Sexuality Education In order to examine the relation between the scope and nature of sexuality education, and teacher attitudes/demographics and district demographics, several subscales were created from the survey to be used as dependent variables. The number of items teachers reported teaching in each of the sub-scales were totaled to provide a measure of the depth of information covered in each area. Totals were calculated for each

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92 respondent on the following sub-scales: the scope of sexuality education taught (Q3-38, N=36. Scope Taught), abstinence (Q39, N=5, Abstinence), methods of birth control (Q41, N=10. Birth Control Methods), how birth control methods were taught (Q42, N=5, Birth Control Concepts), how condoms were taught (Q43, N=7, Condom Concepts), types of STDs HIV (Q44. N=10. Types of STDs), how HIV was taught (Q45, N=8. HIV Concepts), how other STDs were taught (Q45. N=8. STD Concepts), skills-building acti\ ities taught (Q48. N=14. Skills Taught), skills-building activities practiced bystudents (Q48. N=14. Skills Practiced), and teaching methods utilized (Q49. N=12, Teaching Methods). (See Table 4-3.) There was no weighting given to topics that might be considered more or less important. Estimated time in minutes spent teaching each of abstinence, birth control, condoms. STDs, and HIV, and total amount of time in hours spent on the sexuality education unit were also used as dependent variables for comparisons. This series of 17 dependent variables was used for all analysis of variance and multiple regressions. Analysis of variance was conducted for all of the dependent sub-scales and time estimates listed above. Age, race, gender, total years teaching, and years teaching sexuality education were used as covariates, and degree of liking teaching sexuality education, required or elective course, certification in health or FCS, and the status of the curriculum as mandated, suggested, neither or not sure were tested as main effects. Tukev's Honestly Significant Difference test was used for post hoc analysis. The district variables-total number of students, percent minority students, and percent of students on free or reduced lunch-were tested using multiple regressions with the dependent sub-

PAGE 99

93 scales and time estimates listed above. Additionally, a t-test was used to assess the relation between teacher ratings of importance and whether or not a concept was taught. Teacher Attitudes Teacher attitudes toward the concepts presented in the scope of sexuality education were positive in general as reported earlier. Most concepts were rated toward the extremely important end of the scale. Items rated lower tended to be those considered controversial. Using a t-test. a positive relation was found between rated importance and whether or not a concept was taught in class. The average rating for a concept's importance was significantly higher (PR>.01 ) for those teaching the concept than tor those not teaching the concept for all items except one. For decision making, only one person reported not teaching it and they rated it extremely important (5). hence no significant difference was found in rated importance. (See Table 4-1 .) Teacher attitude toward how much they liked teaching sexuality education was the factor most commonly related to its implementation at the classroom level. An analysis of variance found a significant difference in the average number of items taught in eight of the sub-scales, as well as two of the average time estimates, in relation to the teachers' ratings of how much they liked teaching sexuality education. The sub-scales included the scope of concepts taught (PR>.01. F=4.87), birth control methods (PR>.00, F=8.22). birth control concepts (PR>.00, F= 10.33), condom concepts (PR>.00, F=24.69), types of STDs (PR>.00, F=6.59), HIV concepts (PR>.01. F=4.45), STD concepts (PR>.01, F=5.07), and teaching methods utilized (PR>.01, F=5.21). Differences in the

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94 estimated time spent teaching included birth control (PR>.02, F=4.12) and condoms (PR>.02, F=4.3 1). (See Table 4-4.) Follow-up. using Tukey’s Flonestly Significant Difference Test, found that those who reported they "very much" liked teaching sexuality education taught significantly more items on average than both those who “somewhat" and "neither liked nor disliked" teaching for the scope, birth control methods, birth control concepts, condom concepts, types of STDs, teaching methods utilized, and time spent on condoms. For the FIIV and STD concepts, those who reported they "very much" liked teaching taught more on average than those who only “somewhat" liked teaching. For time spent on birth control methods, those who reported they "very much" liked teaching reported significantly more time on average than those who "neither liked nor disliked teaching sexuality education. (See Tables 4-5 and 4-6.) Teacher Certification Teacher certification in health or FCS was significantly related to the number of concepts taught in two sub-scales and the time spent on two topics. FCS teachers taught significantly more birth control methods (PR>.02, F=5.24), an average ot 5.9, while health teachers taught an average of 4.3. FCS teachers also taught significantly more of the birth control concepts on average (PR>.03, F=4.93), 2.6 versus 1.9. (See Table 4-4.) Of the teachers certified in FCS, 39% (N=46) taught elective courses, and 61% (N=72) taught required classes. Of those certified in health, less than 3% (N=2) taught elective courses, and 97% (N=75) taught required classes. The distribution was

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95 significantly different from the expected values using a Chi-Square, Pearson (PR>.00). It is possible that the significantly greater emphasis on birth control by FCS teachers might be better explained by whether the class was required or elective rather than by teacher certification. There were similar findings, with regard to birth control methods and concepts, when required and elective course were compared. These findings are described below. District Sexuality Education Mandates Whether a curriculum was mandated, suggested, neither, or unknown, and whether or not the class was required or elective were used as independent variables to determine relations to what was taught in classes. The status of the district sexuality education curriculum mandate had a significant effect on the number of items taught in three of the sub-scales and the time spent on one topic. They were the scope of items taught (PR>.04. F=2.75). birth control methods taught (PR>.01, F=3.96). teaching methods utilized (PR>.02. F=3.46), and time spent on birth control methods (PR>.04, F=2.85). (See Table 4-4.) Follow-up tests, using TukeyÂ’s Honestly Significant Difference, found that respondents who reported the sexuality education curriculum was mandated spent significantly more time on birth control than did those who reported it was neither suggested nor mandated. 57.5 versus 31.2 minutes. Both those who reported it was mandated and suggested used more teaching methods on average than those who reported it was neither mandated nor suggested, 7.5, 7.4 and 6.3 methods respectively. In the post

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96 hoc test, no significant differences were detected between the groups and the number of birth control methods taught or the number of items taught in the scope. (See Tables 4-5 and 4-6.) Required Versus Elective Courses The status of the class as required or elective also had a significant effect on the number of items taught in several of the sub-scales and the time spent on some topics. Those teaching elective classes reported teaching more items on average for the scope of items taught (PR>.00. F=9.31), 26.6 versus 24.4, birth control methods (PR>.00, F= 1 0.43). 6.7 versus 4.9. and birth control concepts (PR>.01, F=6.58), 2.8 versus 2.2. Those in required classes taught an average of 7.3 HIV concepts versus 6.1 (PR>.00. F=1 7.28). and 6.9 STD concepts versus 5.3 in elective classes (PR>.00, F=18.01). They also reported spending an average ot 127 minutes on HIV versus 69 (PR>.01. F=6.16), and 1 12 minutes on STDs versus 70 minutes in elective classes (PR>.05. F=3.81). (See Table 4-4.) District Demographics Multiple regression analysis was used to determine the relation between the scope and nature of sexuality education and district demographics. The dependent variables used were those previously listed. (See Table 4-3.) The independent district variables used were total number of students, percent white students, and percent students on free/reduced lunch, as an indicator of economic status of the district.

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97 As the total number of students increased, there was a decrease in the number of birth control methods taught, birth control concepts taught, condom concepts taught, and teaching methods utilized. There was also a decrease in the amount of time spent teaching abstinence, birth control methods, and condoms, and total amount of time spent teaching. As the percent of white students in a district increased, so did the number of birth control methods taught, birth control concepts taught, and condom concepts taught. There was also an increase in the amount of time spent on birth control methods, condoms, and total time teaching. As the percent of students on free/reduced lunch increased, so did the number of items in the scope of concepts taught, birth control methods taught, birth control concepts taught, condom concepts taught, and teaching methods utilized. There was also an increase in the amount of time spent teaching abstinence, birth control methods, condoms, and total time teaching. (See Table 4-7.)

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98 Table 4-1: Scope of Sexuality Education Rated Importance in Relation to What is Taught Average Overall Tau ght Average Importance Concept Importance N % Tauaht Not Taught Abstinence 4.97 258 98.9 4.97 4.33 STDs HIV 4.96 254 97.3 4.97 4.50 Decision Making 4.86 258 98.9 4.86 5.00 Values 4.73 243 93.1 4.77 4.19 Communication 4.72 248 95.0 4.74 4.00 Sexual Abuse 4.61 211 80.8 4.72 4.05 Finding Help 4.59 241 92.3 4.63 4.00 Reproductive Health 4.57 221 84.7 4.68 3.95 Contraception 4.52 187 71.6 4.67 4.05 Parenting 4.50 199 76.2 4.63 4.07 Assertiveness 4.45 230 88.1 4.52 3.82 Marriage & Lifetime Commitments 4.44 211 80.8 4.55 3.94 Love 4.44 233 89.3 4.53 3.60 Reproduction 4.43 226 86.6 4.52 3.70 Negotiation 4.34 209 80.1 4.51 3.59 Friendship 4.29 229 87.7 4.41 •*> -> J.JJ) Dating 4.18 219 83.9 4.32 3.34 Body Image 4.12 216 82.8 4.28 3.28 Families 4.11 215 82.4 4.31 3.05 Puberty 4.09 213 81.6 4.23 3.47 Sexuality & Society 4.07 190 72.8 4.28 3.49 Sexuality Throughout the Lifespan 4.05 183 70.1 4.36 3.30 Sexual Anatomy & Physiology 4.02 202 77.4 4.20 3.29 Sexual Identity & Orientation 4.02 212 81.2 4.15 Sexuality & Media 3.98 191 73.2 4.25 3.14 Gender Roles 3.82 174 66.7 4.14 3.08 Sexual Response 3.71 144 55.2 4.17 3.06 Sexuality & Religion 3.42 101 38.7 3.99 3.00 Sexuality & Law 3.40 98 37.5 3.94 3.05 Abortion 3.34 104 39.8 3.81 2.99 Diversity 3.12 83 31.8 3.90 2.71 Shared Sexual Behav ior 3.02 93 35.6 3.70 2.57 Masturbation 2.82 73 28.0 3.68 2.43 Fantasy 2.73 65 24.9 3.62 2.40 Sexual Dysfunction 2.78 63 24.1 3.43 2.55 Sexuality & Arts 2.13 21 08.0 3.29 2.02

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Table 4-2: Objectives of FloridaÂ’s Components of Quality HIV/STD Prevention & Sexuality Education Compared to the Concepts and Objectives of SIECUSÂ’ Guidelines for Comprehensive Sexuality Education 99 SIECUS Guidelines Kev Concept 1: Human Development 1 . Reproductive Anatomy & Physiology 2. Reproduction 3. Puberty 4. Body Image 5. Sexual Identity and Orientation. Kev Concept 2: Relationships 1. Families 2. Friendship 3. Love 4. Dating 5. Marriage & Lifetime Commitments 6. Parenting Kev Concept 3: Personal Skills 1. Values 2. Decision Making 3. Communication 4. Assertiveness 5. Negotiation 6. Finding Help Key Concept 4: Sexual Behavior 1 . Sexuality Throughout the Lifespan 2. Masturbation 3. Shared Sexual Behavior 4. Abstinence 5. Human Sexual Response 6. Fantasy 7. Sexual Dysfunction Kev Concept 5: Sexual Health 1. Contraception 2. Abortion 3. Sexually Transmitted Disease/ HIV 4. Sexual Abuse 5. Reproductive Health # of GuidelinesÂ’ # of Component % Respondents Objectives Objectives Teaching Level 3 Level 4 Grades 9-12 the Concept 02 6 2 77.4 08 6 4 86.6 01 0 0 81.6 04 3 2 82.8 13 5 0 81.2 10 4 J 82.4 02 1 0 87.7 06 0 2 89.3 11 5 1 83.9 10 7 9 80.8 09 4 2 76.2 05 5 0 93.1 13 -> a 4 98.9 10 *> a 1 95.0 10 2 1 88.1 06 3 0 80.1 08 j 7 92.3 03 10 2 70.1 07 02 0 28.0 05 05 1 35.6 10 04 o 98.9 04 05 0 55.2 03 04 2 24.9 02 08 4 24.1 13 4 03 71.6 12 4 01 39.8 34 1 15 97.3 12 7 02 80.8 19 6 02 84.7

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100 Table 4-2: Continued SIECUS Guidelines Kev Concept 6: Society and Culture 1. Sexuality and Society 2. Gender Roles 3. Sexuality and the Law 4. Sexuality and Religion 5. Diversity 6. Sexuality and the Arts 7. Sexuality and the Media # of GuidelinesÂ’ # of Component % Respondents Objectives Objectives Teaching Level 3 Level 4 Grades 9-12 the Concept 5 3 0 72.8 7 4 2 66.7 6 8 1 37.5 5 3 0 38.7 0 0 31.8 1 5 0 08.0 5 0 0 73.2

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101 Table 4-3: Series of Variables Used for ANOVA and Multiple Regression Dependent Variables Question #of Key Word Used Concept Measured # in Survev Concepts in Tables Scope of sexuality education taught Q3-38 36 Scope Taught Abstinence concepts taught Q39 05 Abstinence Methods of birth control taught Q41 10 Birth Control Methods How birth control was taught Q42 05 Birth Control Concepts How condoms were taught Q43 07 Condom Concepts Types of STDs/HIV taught Q44 10 Types of STDs How HIV was taught Q45 08 HIV Concepts How other STDs were taught Q45 08 STD Concepts Skill building activities taught Q48 14 Skills Taught Skill building activities practiced Q48 14 Skills Practiced Teaching strategies utilized Q49 12 Teaching Methods Time spent teaching abstinence Q50 NA Time on Abstinence Time spent teaching birth control Q50 NA Time on Birth Control Time spent teaching condoms Q50 NA Time on Condoms Time spent teaching STDs Q50 NA Time on STDs Time spent teaching HIV Q50 NA Time on HIV Total time on sexuality education Q51 NA Total Time Independent Variables Co variates Rev Words Used in Tables Age of Respondent Age Race of Respondent Race Sex of Respondent Sex Years Teaching Sex Education Yearsx Total Years Teaching Years Main Effects Status of Curricula Mandate Curr Degree of Liking Teaching Sexuality Education Like Required or Elective Course Req Certification of Respondent Cert District Variables Percent of White Students in District % White Total Number of Students in District Total N Percent of Students in District on Free or Reduced Lunch % Free/Red

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102 Table 4-4: Analysis of Variance Dependent Variable: Scope Taught Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 87.052 5 17.410 0.437 .822 Age 08.206 1 08.206 0.206 .651 Race 41.153 1 41.153 1.033 .311 Sex 11.232 1 11.232 0.282 .596 Yearsx 06.692 1 06.692 0.168 .682 Years 00.002 1 00.002 0.000 .995 Main Effects 1078.368 7 154.053 3.866 .001 Curr 0328.499 109.500 2.748 .044* Like 0388.226 2 194.113 4.872 .009* Req 0370.938 1 370.938 9.309 .003* Cert 0014.545 1 014.545 0.365 .546 Explained 1330.097 012 110.841 2.782 .002 Residual 7252.036 182 039.846 Total 8582.133 194 044.238 Dependent Variable: Abstinence Concepts Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 4.101 5 0.820 1.214 .304 Age 1.322 1 1.322 1.958 .163 Race 0.695 1 0.695 1.028 .312 Sex 1.691 1 1.691 2.504 .115 Yearsx 0.904 1 0.904 1.338 .249 Years 0.820 1 0.820 1.214 .272 Main Effects 2.429 7 0.347 0.514 .824 Curr 0.398 3 0.133 0.196 .899 Like 0.803 2 0.401 0.594 .553 Req 1.161 1 1.161 1.718 .192 Cert 0.797 1 0.797 1.180 .279 Explained 006.200 012 .517 .765 .686 Residual 122.949 182 .676 Total 129.149 194 .666

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103 Table 4-4: Continued Dependent Variable: Birth Control Methods Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 69.734 5 13.947 0.861 .509 Age 07.809 1 07.809 0.482 .488 Race 35.107 1 35.107 2.167 .143 Sex 14.691 1 14.691 0.907 .342 Yearsx 01.581 1 01.581 0.098 .755 Years 21.966 1 21.966 1.356 .246 Main Effects 781.219 7 111.603 06.889 .000 Curr 092.599 064.200 03.963 .009* Like 266.401 2 133.201 08.222 .000* Req 168.960 1 168.960 10.429 .001* Cert 084.860 1 084.860 05.238 .023* Explained 0954.484 012 79.540 4.910 .000 Residual 2948.511 182 16.201 Total 3902.995 194 20.119 Dependent Variable: Birth Control Concepts Sunt of Mean Sig Source of Variation Squares DF Square F ofF Covariates 20.261 5 04.052 1.351 .245 Age 05.402 1 05.402 1.800 .181 Race 11.616 1 11.616 3.871 .051 Sex 00.820 1 00.820 0.273 .602 Yearsx 00.091 1 00.091 0.030 .862 Years 00.453 1 00.453 0.151 .698 Main Effects 121.278 7 17.325 05.774 .000 Curr 017.448 3 05.816 01.938 .125 Like 062.008 2 31.004 10.333 .000* Req 019.729 1 19.729 06.575 .011* Cert 014.792 1 14.792 04.930 .028* Explained 163.245 012 13.604 4.534 .000 Residual 546.088 182 03.000 Total 709.333 194 03.656

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104 Table 4-4: Continued Dependent Variable: Condom Concepts Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 6.025 5 1.205 .258 .935 Age 0.815 1 0.815 .175 .677 Race 2 277 1 o 077 .488 .486 Sex 0.916 1 0.916 .196 .658 Yearsx 1.237 1 1.237 .265 .607 Y ears 0.328 1 0.328 .070 .791 Main Effects 277.856 7 039.694 08.510 .000 Curr 031.537 010.512 02.254 .084 Like 230.323 2 115.161 24.691 . 000 * Req 005.133 1 005.133 01.100 .296 Cert 005.036 1 005.036 01.080 .300 Explained 305.076 012 25.423 5.451 .000 Residual 848.873 182 04.664 Total 1153.949 194 05.948 Dependent Variable: Types of STDs Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 51.805 5 10.361 1.489 .196 Age 05.197 1 05.197 0.747 .389 Race 42.982 1 42.982 6.176 .014 Sex 00.748 1 00.748 0.108 .743 Yearsx 00.065 1 00.065 0.009 .923 Years 05.954 1 05.954 0.855 .356 Main Effects 130.177 7 18.597 2.672 .012 Curr 005.453 "> 01.818 0.261 .853 Like 091.791 2 45.895 6.594 . 002 * Req 020.278 1 20.278 2.914 .090 Cert 001.598 1 01.598 0.230 .632 Explained 0209.113 012 17.426 2.504 .005 Residual 1266.733 182 06.960 Total 1475.846 194 07.607

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105 Table 4-4: Continued Dependent Variable : HIV Concepts Sum of Mean Sis Source of Variation Squares df Square F ofF Covariates 21.000 5 4.200 1 .440 .212 Age 04.572 1 4.572 1.568 .212 Race 01.549 1 1.549 0.531 .467 Sex 02.818 1 2.818 0.966 .327 Yearsx 08.345 1 8.345 2.861 .092 Years 04.056 1 4.056 1.391 .240 Main Effects 83.760 7 11.966 04.103 .000 Curr 03.312 a 01.104 00.379 .769 Like 25.945 2 12.973 04.448 .013* Req 50.400 1 50.400 17.281 .000* Cert 00.957 1 00.957 00.328 .568 Explained 113.165 012 9.430 -> J.ZJJ .000 Residual 530.814 182 2.917 Total 643.979 194 3.319 Dependent Variable: STD Concepts Sum of Mean Sis Source of Variation Squares DF Square F ofF Covariates 16.426 5 03.285 0.631 .676 Age 00.012 1 00.012 0.002 .961 Race 00.547 1 00.547 0.105 .746 Sex 01.516 1 01.516 0.291 .590 Yearsx 10.838 1 10.838 2.083 .151 Years 00.276 1 00.276 0.053 .818 Main Effects 166.680 7 23.811 04.577 .000 Curr 021.502 3 07.167 01.378 .251 Like 052.790 2 26.395 05.074 .007* Req 093.703 1 93.703 18.012 .000* Cert 000.805 1 00.805 00.155 .695 Explained 0193.645 012 16.137 3.102 .001 Residual 0946.817 182 05.202 Total 1140.462 194 05.879

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106 Tabic 4-4: Continued Dependent Variable: Skills Taught Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 57.863 5 11.573 1.409 .223 Age 34.923 1 34.923 4.252 .041 Race 01.965 1 01.965 0.239 .625 Sex 02.864 1 02.864 0.349 .556 Yearsx 08.584 1 08.584 1.045 .308 Years 00.622 1 00.622 0.076 .783 Main Effects 146.482 7 20.926 2.548 .016 CuiT 041.035 J 13.678 1.665 .176 Like 043.539 2 21.769 2.650 .073 Req 019.860 1 19.860 2.418 .122 Cert 004.720 1 04.720 0.575 .449 Explained 0254.570 012 21.214 2.583 .003 Residual 1494.948 182 08.214 Total 1749.518 194 09.018 Dependent Variable: Skills Practiced Sum of Mean Sig Source of Variation Squares DF Square F of F Covariates 213.464 5 42.693 2.025 .077 Age 064.461 1 64.461 3.057 .082 Race 018.828 1 18.828 0.893 .346 Sex 013.372 1 13.372 0.634 .427 Yearsx 055.842 1 55.842 2.648 .105 Years 010.405 1 10.405 0.493 .483 Main Effects 152.279 7 21.754 1.032 .410 Curr 085.153 3 28.384 1.346 .261 Like 019.894 2 09.947 0.472 .625 Req 001.446 1 01.446 0.069 .794 Cert 016.626 1 16.626 0.789 .376 Explained 0407.259 012 33.938 1.610 .092 Residual 3837.479 182 21.085 Total 4244.738 194 21.880

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107 Table 4-4: Continued Dependent Variable: Teaching Methods Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 17.004 5 3.401 0.756 .583 Age 07.548 1 7.548 1.678 .197 Race 02.122 1 9 129 0.472 .493 Sex 00.950 1 0.950 0.211 .646 Yearsx 01.671 1 1.671 0.371 .543 Years 00.000 1 0.000 0.000 .996 Main Effects 114.056 7 16.294 3.622 .001 Curr 046.635 15.545 3.455 .018 Like 046.899 2 23.449 5.212 .006 Req 001.487 1 01.487 0.330 .566 Cert 000.664 1 00.664 0.148 .701 Explained 152.206 012 12.684 2.819 .001 Residual 818.788 182 04.499 Total 970.995 194 05.005 Dependent Variable: Time on Abstinence Sum of Mean Sig Source of Variation Squares DF Square F ofF Co variates 74856.162 5 14971.232 2.365 .042 Age 28787.257 1 28787.257 4.548 .034 Years 04195.698 1 04195.698 0.663 .417 Yearsx 05011.962 1 05011.962 0.792 .375 Race 00259.289 1 00259.289 0.041 .840 Sex 21144.118 1 21144.118 3.340 .069 Main Effects 32663.361 7 4666.194 .737 .641 Curr 16270.848 o J 5423.616 .857 .465 Like 03392.041 2 1696.020 .268 .765 Req 00077.275 1 0077.275 .012 .912 Cert 04449.518 1 4449.518 .703 .403 Explained 0110117.538 012 9176.462 1.450 .149 Residual 1031779.002 163 6329.933 Total 1141896.540 175 6525.123

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108 Table 4-4: Continued Dependent Variable: Time on Birth Control Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 19501.803 5 03900.361 1.092 .367 Age 00000.061 1 00000.061 0.000 .997 Years 00589.001 1 00589.001 0.165 .685 Yearsx 00642.706 1 00642.706 0.180 .672 Race 14658.324 1 14658.324 4.105 .044 Sex 01734.732 1 01734.732 0.486 .487 Main Effects 79057.111 7 11293.873 3.163 .004 Curr 30555.577 o 10185.192 2.852 .039* Like 29427.986 2 14713.993 4.120 .018* Req 04012.496 1 04012.496 1.124 .291 Cert 06805.025 1 06805.025 1.906 .169 Explained 106174.294 012 8847.858 2.478 .005 Residual 582065.684 163 3570.955 Total 688239.977 175 3932.800 Dependent Variable: Time on Condoms Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 4370.355 5 0874.071 0.724 .606 Age 0290.781 1 0290.781 0.241 .624 Years 0053.880 1 0053.880 0.045 .833 Y earsx 0103.731 1 0103.731 0.086 .770 Race 2724.026 1 2724.026 2.257 .135 Sex 0001.216 1 0001.216 0.001 .975 Main Effects 21027.791 7 3003.970 2.489 .019 Curr 06293.485 o J 2097.828 1.738 .161 Like 10404.821 2 5202.410 4.310 .015* Req 00262.181 1 0262.181 0.217 .642 Cert 01011.129 1 1011.129 0.838 .361 Explained 26775.307 012 2231.276 1.849 .045 Residual 196747.580 163 1207.040 Total 223522.886 175 1277.274

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109 Table 4-4: Continued Dependent Variable: Time on HI J Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 74157.320 5 14831.464 1.327 .255 Age 00240.672 1 00240.672 0.022 .884 Years 11464.478 1 11464.478 1.026 .313 Yearsx 00004.025 1 00004.025 0.000 .985 Race 25650.148 1 25650.148 2.295 .132 Sex 18512.909 1 18512.909 1 .656 .200 Main Effects 165957.271 7 23708.182 2.121 .044 Curr 023899.014 -> J 07966.338 0.713 .546 Like 035066.440 2 17533.220 1.568 .212 Req 068826.109 1 68826.109 6.157 .014* Cert 010893.234 1 10893.234 0.974 .325 Explained 0364365.055 012 30363.755 2.716 .002 Residual 1822170.922 163 11178.963 Total 2186535.977 175 12494.491 Dependent Variable: Time on STDs Sum of Mean Sig Source of Variation Squares DF Square F ofF Covariates 60457.498 5 12091.500 1.813 .113 Age 07844.358 1 07844.358 1.176 .280 Years 02501.317 1 02501.317 0.375 .541 Y earsx 01081.866 1 01081.866 0.162 .688 Race 16437.526 1 16437.526 2.465 .118 Sex 09741.821 1 09741.821 1.461 .229 Main Effects 61136.951 7 08733.850 1.310 .249 Curr 05469.621 J 01823.207 0.273 .845 Like 15081.763 2 07540.882 1.131 .325 Req 25378.559 1 25378.559 3.806 .053* Cert 04417.278 1 04417.278 0.662 .417 Explained 0204956.565 012 17079.714 2.561 .004 Residual 1087019.162 163 06668.829 Total 1291975.727 175 07382.718

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110 Table 4-4: Continued Dependent Variable: Total Time Sum of Mean Sig Source of Variation Squares DF Square F ofF Co variates 345.280 5 069.056 1.050 .390 Age 137.905 1 137.905 2.097 .150 Years 083.903 1 083.903 1.276 .260 Yearsx 014.006 1 014.006 0.213 .645 Race 193.020 1 193.020 2.935 .089 Sex 000.020 1 000.020 0.000 .986 Main Effects 1320.097 7 188.585 2.868 .008 Curr 0268.840 j 089.613 1.363 .256 Like 0349.311 2 174.656 2.656 .073 Req 0115.336 1 115.336 1.754 .187 Cert 0074.536 1 074.536 1.133 .289 Explained 01918.578 012 159.882 2.431 .006 Residual 10719.416 163 065.763 Total 12637.994 175 072.217 ^Significant at level .050.

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Table 4-5: Post Hoc Analysis of Variance Variables: Scope Taught & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 00722.8033 361.4016 8.8881 .0002* Within Groups 249 10124.6689 040.6613 Total 251 10847.4722 I ariables : Birth Control Methods & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 0365.9161 182.9581 9.9831 .0001* Within Groups 249 4563.3537 018.3267 Total 251 4929.2698 l ariables: Birth Control Concepts & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 082.2488 41.1244 12.7617 .0000* Within Groups 249 802.4020 03.2225 Total 251 884.6508 Variables: Condom Concepts & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Group 002 0196.9386 98.4693 18.8903 .0000* Within Groups 249 1297.9621 05.2127 Total 251 1494.9008 Variables: Types of STDs & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 0113.6844 56.8422 8.3228 .0003* Within Groups 249 1700.5855 06.8297 Total 251 1814.2698

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112 Table 4-5: Continued Variables: HIJ Concepts & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 032.1246 16.0623 5.3212 .0055* Within Groups 249 751.6215 03.0186 Total 251 783.7460 Variables: STD Concepts & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 0056.9522 28.4761 5.0087 .0074* Within Groups 249 1415.6510 05.6853 Total 251 1472.6032 Variables: Teachin g Methods & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 0049.8675 24.9338 6.0479 .0027* Within Groups 249 1026.5611 04.1227 Total 251 1076.4286 Variables: Time on Birth Control & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 0054634.443 27317.2214 6.3442 .0021* Within Groups 249 1072155.696 04305.8462 Total 251 1126790.139 Variables: Time on Condoms & Degree of Liking Teaching Sexuality Education Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 002 025702.5079 12851.2540 6.1073 .0026* Within Groups 249 523955.4762 02104.2389 Total 251 549657.9841

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Table 4-5: Continued Variables: Scope Taught & Status of District Curricula Mandate Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 003 00229.6283 76.5428 1.7553 .1565 Within Groups 235 10247.4595 43.6062 Total 238 10477.0879 1 'ariables: Birth Control Methods & Status of District Curricula Mandate Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 003 Oil 1.8996 37.2999 1.9226 .1266 Within Groups 235 4559.1967 19.4008 Total 238 4671.0962 Variables: Teaching Methods & Status of District Curricula Mandate Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Groups 003 55.6859 18.5620 4.5153 .0042 Within Groups 235 966.0714 04.1109 Total 238 1021.7573 Variables: Time on Birth Control & Status of District Cun nculci Mandate Sum of Mean F F Source D.F. Squares Squares Ratio Prob. Between Group 003 031109.2388 10369.7463 2.8104 .0402 Within Groups 235 867097.9328 03689.7784 Total 238 898207.1715 *Significant at level .050.

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Table 4-6: Post Hoc Tests— Tukey’s Honestly Significant Test Independent Variable: Degree of Liking Teaching Sexuality Education Very Much Somewhat Neither Like Sia. Dependent Variable Like in Like (2) nor Dislike 13 ) Pairs* Scope Taught 26.40 22.72 23.04 1-2. 1-3 Birth Control Methods 06.20 03.83 03.33 1-2, 1-3 Birth Control Concepts 02.75 01.57 01.48 1-2, 1-3 Condom Concepts 04.60 02.90 02.44 1-2, 1-3 Types of STDs 08.63 07.16 07.33 1-2, 1-3 HIV Concepts 07.23 06.38 07.19 1-2 STD Concepts 06.81 05.67 06.70 1-2 Teaching Methods 07.53 06.69 06.41 1-2. 1-3 Time on Birth Control 59.88 40.71 14.81 1-3 Time on Condoms 33.62 15.07 07.59 1-2, 1-3 Independent Variable : Status of District Curricula Mandate Mandated Suggested Don't Sig. Dependent Variables Curricula Curricula Neither Know Pairs* Scope Taught None Birth Control Methods None Teaching Methods 07.47 07.44 06.34 07.52 1-3, 2-3 Time on Birth Control 57.53 58.73 31.22 44.80 1-3 *Tukey-HSD test with significance level .050.

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115 Table 4-7: Multiple Regression Dependent Variable: Scope Taught Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 24.59712 0.78836 31.20 0.00 0.04 % White 00.00003 0.00003 00.83 0.41 0.04 Total N -00.00009 0.00005 -01.83 0.07 0.04 % Free/Red 00.00018 0.00008 02.24 0.03* 0.04 Dependent Variable: Birth Control Methods Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 4.53084 0.51459 8.81 0.00 0.05 % WTiite 0.00006 0.00002 2.94 0.00* 0.05 Total N -0.00010 0.00003 -3.18 0.00* 0.05 % Free/Red 0.00018 0.00005 3.35 0.00* 0.05 Dependent Variable: Birth Control Concepts Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 2.09419 0.21457 9.76 0.00 0.08 % White 0.00002 0.00001 2.42 0.02* 0.08 Total N -0.00005 0.00001 -3.56 0.00* 0.08 %Free/Red 0.00009 0.00002 4.00 0.00* 0.08 Dependent Variable: Condom Concepts Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 3.48808 0.27931 12.49 0.00 0.08 % White 0.00003 0.00001 02.73 0.01* 0.08 Total N -0.00006 0.00002 -03.47 0.00* 0.08 % Free/Red 0.00011 0.00003 03.87 0.00* 0.08

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116 Table 4-7: Continued Dependent Variable: Types of STDs Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 8.21217 0.31922 25.73 0.00 0.01 % White 0.00002 0.00001 01.21 0.23 0.01 Total N -0.00003 0.00002 -01.34 0.18 0.01 % Free/Red 0.00004 0.00003 01.15 0.25 0.01 Dependent Variable: HU ' Concepts Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 7.18122 0.20925 34.32 0.00 0.02 % W'hite 0.00001 0.00001 00.82 0.42 0.02 Total N -0.00001 0.00001 -01.04 0.30 0.02 %Free/Red 0.00002 0.00002 00.80 0.42 0.02 Dependent Variable: STD Concepts Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T E2 Intercept 6.92110 0.28671 24.14 0.00 0.02 % White 0.00000 0.00001 00.16 0.87 0.02 Total N -0.00001 0.00002 -00.72 0.47 0.02 %Free/Red 0.00001 0.00003 00.50 0.62 0.02 Dependent Variable: Skills Taught Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 12.13078 0.34296 35.37 0.00 0.01 % White -00.00001 0.00001 -00.85 0.40 0.01 Total N 00.00001 0.00002 00.651 0.52 0.01 %Free/Red -00.00002 0.00004 -00.47 0.64 0.01

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117 Table 4-7: Continued Dependent Variable: Skills Practiced Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 9.32290 0.55634 16.76 0.00 0.01 % White -0.00004 0.00002 -01.75 0.08 0.01 Total N 0.00006 0.00003 01.66 0.10 0.01 %Free/Red -0.00009 0.00006 -01.56 0.12 0.01 Dependent Variable: Teaching Methods Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 6.91770 0.25464 27.17 0.00 0.03 % White 0.00002 0.00001 01.54 0.16 0.03 Total N -0.00003 0.00002 -01.96 0.05* 0.03 %Free/Red 0.00006 0.00003 02.18 0.03* 0.03 Dependent Variable: Time on Abstinence Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 79.51012 1 1.93980 6.66 0.00 0.03 % White 00.00061 00.00047 1.28 0.20 0.03 Total N -00.00157 00.00072 -2.17 O o OJ •X0.03 %Free/Red 00.00282 00.00124 2.28 0.02* 0.03 Dependent Variable: Time on Birth Control Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 44.91300 9.22049 4.87 0.00 0.07 % White 00.00122 0.00037 3.30 0.00* 0.07 Total N -00.00164 0.00056 -2.93 0.00* 0.07 %Free/Red 00.00290 0.00096 3.03 0.00* 0.07

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118 Table 4-7: Continued Dependent Variable: Time on Condoms Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 29.47657 5.59491 4.47 0.00 0.07 % White 00.00084 0.00028 3.03 0.00* 0.07 Total N -00.00149 0.00041 -3.63 0.00* 0.07 %Free/Red 00.00258 0.00070 3.68 0.00* 0.07 Dependent Variable: Time on STDs Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 140.56516 1 1.80731 11.91 0.00 0.03 % White 000.00018 00.00048 00.37 0.71 0.03 Total N -000.00122 00.00070 -01.74 0.08 0.03 %Free/Red 000.00211 00.00120 01.76 0.08 0.03 Dependent Variable: Time on HIV Independent Parameter Standard T for HO: Variable Estimate Error Parameter^} Prob >T R2 Intercept 156.46736 13.69687 11.42 0.00 0.03 % White 000.00031 00.00054 00.57 0.57 0.03 Total N -000.00137 00.00079 -01.74 0.08 0.03 %Free/Red 000.00216 00.00134 01.61 0.11 0.03 Dependent Variable: Total Time Independent Parameter Standard T for HO: Variable Estimate Error Parameter=0 Prob >T R2 Intercept 9.50800 1.03979 9.14 0.00 0.04 % White 0.00009 0.00004 2.14 0.03* 0.04 Total N -0.00015 0.00007 -2.24 0.03* 0.04 %Free/Red 0.00028 0.00011 2.46 0.01* 0.04 * Significant at level .050.

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CHAPTER 5 CONCLUSIONS AND IMPLICATIONS The Context of Sexuality Education in Florida Schools This study was undertaken to determine the scope and nature of sexuality education in Florida public high schools. The survey assessed the scope of sexuality education topics; the nature of STD/HIV and pregnancy prevention information; the teaching methods and skills-building activities utilized; time spent on the unit as a whole, as well as individual topics within it; and teacher, school, and district variables that may have effected implementation. Also, as Florida mandates comprehensive sexuality, results were used to help determine compliance. This chapter discusses the implications of the results. It is divided into four sections, the context of the sexuality education courses, the scope and nature of the courses, the district variables affecting implementation, and conclusions and recommendations. The first section includes the teachers, courses, and time spent on sexuality education. The second addresses the scope of concepts, compliance with state guidelines, and nature of pregnancy and STD/HIV prevention information. The third section addresses district mandates and variables related to the implementation of sexuality education. 119

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120 Subjects The respondents for this survey were 26 1 health and family and consumer science (FCS) teachers in Florida public high schools, grades 9-12. Two-thirds were Caucasian females and three-fourths between the ages of 35 and 54. Overall they were experienced teachers, as they had been teaching for an average of 1 6 years and sexuality education specifically for an average of ten years. Most commonly. Bachelors and Masters degrees, as well as teacher certification, were in FCS. followed by health/physical education or health. Reported number of undergraduate and graduate semester hours were assumed to be misinterpreted by some respondents due to the range of responses. Half either did not respond or had no undergraduate training, and 80% either did not respond or had no graduate training. So. minimally, it appears academic training in sexuality education is not a norm among those teaching it. Certification. Teacher certification was significantly related to the implementation of one aspect of sexuality education. FCS teachers taught significantly more birth control methods and concepts. However, this finding may be effected by the finding that FCS teachers were significantly more likely to teach elective courses and health teachers required classes. Less than 3% of health teachers taught elective courses. It is possible that class status as required or elective had a greater effect on what was taught in courses than did teacher certification. It seems more plausible that required courses would have restrictions on what could be taught in classes rather than teacher certification accounting for the difference.

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121 Continuing Education. Teachers had an average of 19 hours of workshops, inservice training, and seminars that specifically prepared them for teaching sexuality education. Based on the 10 year average for teaching sexuality education, that would be equivalent to slightly less than two hours per year. This seems consistent with the more than half that reported they attended at least one (27%) or more (35%) sessions in the past year. Although it is commendable that teachers are receiving a baseline of training somewhat regularly, the time is probably not sufficient to keep abreast of changing information, teaching techniques, and skills-building activities. Attitudes. Teacher attitudes toward teaching sexuality education were positive overall. Almost all (94%) felt is was the appropriate role of the school to teach sexuality education. Teacher ratings of the importance of concepts that could be included in comprehensive sexuality education, and the degree to which they reported liking teaching sexuality education, had a significant impact on what was taught in courses. Teacher ratings of the importance of topics is postulated to have had a greater impact than the state sexuality education guidelines on whether or not a concept was included in the curriculum. This is discussed in more detail below. Teacher degree of liking teaching sexuality education had the greatest impact, of the variables measured in this study, on what was included in the curriculum. Higher degrees of liking teaching sexuality education were related to including significantly more concepts on eight of the sub-scales and spending more time on three of the time estimates. These findings reinforce the important effect teacher attitudes have on curriculum implementation. It has been previously documented that teacher attitudes about whether

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122 or not a topic should be included in the curriculum (Orr, 1982) and the importance of a topic (Yarber, Torabi. & Haffner. in press) significantly influence the inclusion of the topic. There is a need for training sessions that not only strive to increase knowledge, but also improve attitudes toward the concepts within and the sexuality education unit as a whole. Teacher training for sexuality education courses has been found to increase knowledge, perceptions of importance of teaching a curriculum, intent to teach, and level of comfort with the course content (Levenson-Gingiss & Hamilton. 1989). Courses Sexuality education was most commonly taught in Life Management Skills (58%). FCS (25%). and Health Education (1 1%) courses. The majority of the students were in ninth grade (39%). followed by mixed grade levels (34%). tenth (15%). eleventh (2%). and twelfth grade (1%). This indicates that sexuality education was not comprehensive in nature, as it was not taught at all grade levels. Throughout the nation, it is also raie that sexuality education is provided in every grade level (Teens Talk 1994) This is problematic for several reasons. First, comprehensive sexuality grades kindergarten through twelve is mandated by Florida. There is also a need for sexuality education to continue through twelfth grade given the changing needs and issues for students at older ages. Finally, there is the practical matter that all topics for comprehensive sexuality education can not possibly be handled in one grade level. R equired and elective courses. The status of the course as required or elective had a significant impact on what was taught in sexuality education courses. Elective courses

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123 covered significantly more concepts in the scope of sexuality education, birth control methods and birth control concepts. Those teaching required courses taught significantly more HIV and STD concepts, and spent more time on both HIV and STDs. This implie ,ha, in required Casses there were restrictions placed on what could be taugh, and an emphasis on the negative consequences of sexual activity. STDs and HIV. Elective courses appeared to have more latitude in what could be taught, including addressing the more debated issue of contraceptives rather than taking an abstinence only approach. Although it was beneficial that some courses included birth control options, obviously not all students received this information. This survey did not assess the percent of students that enrolled in these elective courses, so it is no, known what percent of students were taugh, about birth control options and exposed to a broader scope of human sexuality education concepts. rourse Materials. Most commonly teachers reported they created their own materials for class, which is consistent with previous findings that this is a common practice (Forres, & Silverman, 1989; Orr. 1982). They also reported using published curricula and other resources such as materials provided by the district, news articles, and pamphlets. It seems that teachers were either no, satisfied with the materials they were provided with or did no, have access to adequate materials. Lack of acceptable materials has been commonly reported as a major barrier and cause of inadequate feelings in teaching sexuality education (Forres, & Silverman. 1989; Gingiss & Hamilton, 1989; Haignere et al„ 1996). The text books used were most commonly general health, life management skills, or making choices texts. A few used human sexuality, marriage and

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124 family, or child development texts. The general texts more than likely do not pro\ ide adequate coverage of many of the topics teachers reported covering such as birth control methods and sexual orientation. Often this material is produced as an addendum, completely separate from the text. Time Spent on Sexuality E ducation Over half of respondents in this study reported spending between six and 20 hours on sexuality education. Previous research has also reported that the majority ot teachers spend within this time frame on sexuality education (Calamidas, 1990; Orr. 1982; Sonenstein & Pittman. 1984). The emphasis in sexuality education courses in this study was on HIV and STDs. Over two hours were spent on average on HIV and another two hours on STDs. Abstinence followed with an average ot one and a quarter hours dedicated to it. birth control with an hour, and finally condoms with half an hour. The total time spent on these prevention related topics was approximately seven and onefourth hours. The total time spent teaching sexuality education averaged eleven hours. This means that less than four hours were spent on the other 33 topics listed in the SIECUS Guidelines . Of the 36 concepts, condoms and birth control were considered one topic, as well as STDs and HIV . Teachers reported including an average of 25 of the Guideline s 36 concepts, as well as teaching an average of 12 of the 14 skills-building activities. It does not seem possible to include all these other topics, as well as incorporate skills-building activities, in four hours. Of course, some of the skills-building activities were probably

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incorporated into the five prevention topics listed above. This implies that the focus in these classes was on the negative consequences of sexual behavior, rather than on sexual health promotion. Lack of time has often been cited as a major barrier to the implementation ot sexuality education (Calamidas, 1990; Forrest & Silverman. 1989; Haignere et ah. 1996). A review of the effectiveness of school-based sexuality education programs tentatively concluded that the amount of time spent in programs may not be as important as previously thought (Kirby et al„ 1994). More important may be the content of, theory behind, and skills-building addressed in sexuality education programs. However, it seems apparent that more time needs to be allotted for sexuality education in the curricula in order to implement the comprehensive approach that is recommended by professionals. The Scope and Nature of Sexuality Ed ucation in Florida Schools Scope of Concepts Taught An average of 25 of the Guidelines ’ 36 concepts were taught by teachers, and more than 7 in 10 taught 25 of the concepts. Prevention oriented and factual topics were most commonly included. These included abstinence, decision-making. STDs/FIIV, communication, finding help, love, friendship, etc. Those that were most often neglected included topics often considered to be controversial, such as abortion, shared sexual behavior, masturbation, and diversity. These findings were fairly consistent with previous studies of sexuality education teachers (Forrest & Silverman. 1989; Koblinsky

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& Weeks. 1984: Orr. 1982; Sonenstein & Pittman, 1984: Yarber. Torabi. & Haffner, in press). With some topics, variability in the percent of teachers that included it was evident across studies. Sexual abuse, taught by more than eight in ten in this study, has been reported to be considered controversial and taught by six in ten or less in some studies (Koblinsky & Weeks, 1984; Sonenstein & Pittman. 1984; Yarber. Torabi, & Haffner. in press). Abortion, taught by less than half of teachers in this study, has been included by more than three-fourths in previous research (Forrest & Silverman, 1989; Orr. 1982). Contraception, taught by seven in ten in this study, has been reported taught more commonly in other research-by three-fourths to more than eight in ten teachers (Forrest & Silverman. 1989; Orr. 1982; Sonenstein & Pittman, 1984; Yarber, Torabi, & Haffner, in press). Additionally, although 71% reported teaching it in this study, when further examined, just under two-thirds actually taught it. The others only discussed it if students initiated questions. The differences in what was included may be due to numerous factors. For example, as sexual abuse has become more apparent as a social problem, it may now be considered more important and socially acceptable to discuss it in classes. Some concepts may have been assessed or defined differently across studies. Abortion may have been discussed positively or negatively, factually or morally in various studies. State and district policies and politics may have brought more attention to, and/or supported or suppressed the teaching of a topic such as contraception.

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127 The one topic that seemed to produce a bogus finding was sexual identity and orientation. Eighty-one percent of teachers reported teaching it. However, written comments in some surveys questioned the meaning ol it. Some respondents indicated that if the concept referred to homosexuality, then they did not teach it. The Guidelines description of it. used in this survey, was general (As young people grow and develop, they begin to feel romantically and sexually attracted to other people.), and not technically accurate as noted previously. In comparison to findings trom previous research (Forrest & Silverman, 1989; Koblinsky & Weeks. 1984; Orr, 1982. Sonenstein & Pittman. 1984). it does not seem likely that this many teachers would include the topic. Also, in comparison to the low percent (^2%) who reported teaching the dix ex sity concept, which is similar in nature, it seems unlikely that more than 8 in 10 teachers would include sexual identity and orientation. Rated Importance of Concepts Most of the sexuality education topics (66%) were rated important to extremely important. Higher ratings of importance were significantly related to inclusion ot the topic. Therefore, topics that were rated most important were also those most commonly taught and topics rated least important were those least likely taught. Teachers taught prevention related and factual topics most often, perhaps because they felt they were the most important, as well as being the most accepted of sexuality education topics in general. The controversial topics were not only taught least olten, but considered to be least important. These findings are consistent with Yarber. Torabi, & Hatiner s (in

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128 press) research, which was used as the basis tor this portion ot the sui\e\ . This implies a need for teacher training to help increase feelings of importance as well as comfort with the whole scope of sexuality education topics, especially topics considered controversial. Teacher training, previously mentioned, has been tound to have this eltect (LevensonGingiss & Hamilton. 1989). There is also probably a need for local-school and community-support for dealing with these controversial topics. In addition, these excluded controversial topics are probably appropriate tor more comprehensiv e programs, of which there are few of in general, and programs at higher grade levels, of which there are few of in Florida. Compliance With Florida Sexuality Education Guidelines Results indicated that teachers taught an average of 25 of the SIECUS Guidelines , concepts and the Florida Components also included 25 of these concepts. However, these were not the same 25 concepts. Some concepts were covered by both the Components and teachers, others were covered by the either the Components or the majority ol teachers, and still others were not covered by either. It appears that inclusion ol a concept was more likely influenced by teacher ratings of the importance of it. rather than whether it was included in the Components . Topics included by both were similar to those most commonly taught and considered important by teachers, listed above. I opics included by the Components , but taught by less than half of teachers, may be considered controversial topics and were rated as some of the least important topics by teachers. These included sexuality and the

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129 law. abortion, shared sexual behavior, fantasy, and sexual dysfunction. Both teachers and the Components avoided some other controversial topics such as masturbation, sexuality and religion, and diversity. Three of the Guidelines' topics were probably not included by the Components because they were not age appropriate. However, some of the topics excluded from the Components were among the most often taught by teachers. These topics included values (93%), friendship (88%), negotiation (80%). and puberty (82%). Attain, these topics were considered important by teachers. In summary, it appears that teachers' personal attitudes toward sexuality education concepts had a greater influence than Florida’s Components on what was taught at the classroom level. Teachers neglected topics they did not consider important-which were generally those considered controversial— and included those they thought important, regardless ol what the Components included. The Nature of Sexuality Education Abstinence. As expected, abstinence w ? as the method most likely to be taught as a method of preventing pregnancy and STDs/HIV over both birth control methods or condoms. The majority of teachers (95%) taught abstinence as the best method of prevention. Fortunately the majority reported they supported this message by teaching students skills such as how to say no to a partner (91%) and how to resist peer pressure (90%). Accordingly, more time on average was devoted to abstinence than either birth control or condoms. Previous research has also documented abstinence is taught by the

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130 majority of teachers (Firestone, 1994; Forrest & Silverman. 1989; Yarber. Torabi. & Haffner. in press). Birth control methods. Although 72% of teachers reported teaching birth control, less than two-thirds (64%) actually included it in their curriculum. Almost one-third of teachers only addressed this topic if students initiated questions. This is somewhat less than the between eight and nine out of ten teachers that reported teaching birth control methods in prec ious research (Firestone. 1994; Forrest & Silverman, 1989; Koblinskv & Weeks. 1984; Yarber. Torabi. & Haffner. in press). However, as with this study. Forrest and Silverman (1989) also found that although 94% of teachers reported classroom discussions on birth control, only 70% actually taught it. The other 24% ol teachers only addressed the topic if students initiated questions. Additionally, a significantly greater number of birth control methods and concepts were addressed in elective courses than in required courses in this study. Only five of the 10 birth control methods were taught on average, and the methods addressed were not necessarily the most appropriate. For example, some of the methods taught less frequently, by about half or less, were newer technologies such as norplant. the female condom, and depo-provera. Of these, the hormonal methods have high user effectiveness rates and hence are probably more desirable to teens. A method not appropriate for adolescents, the intrauterine device, was taught by slightly more teachers than the previously mentioned methods. All of the related concepts on how to use the methods were covered by less than six in ten of teachers. Only halt included how to communicate with a partner about birth control, an important issue since both

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131 participants need to be involved. Additionally, the average time spent on birth control methods was just ox er an hour. This does not leave time for much more than presenting the basic facts. Even though two-thirds of teachers included birth control methods, elective courses covered significantly more methods and concepts. The peicent ol students that received this information through elective courses is questionable, and the extent of the information in the required classes was limited. The information may have been limited due to district restrictions, a lack of information on newer technologies, time constraints, or personal discomfort or negatix ? e attitude toward the topic. Some respondents wrote in that they would cover birth control methods if they were not prohibited from doing so. Regardless, efforts need to be made to provide current information on birth control methods in these courses and to ensure that all students are exposed to it. Education on birth control options and their correct use is necessary to help decrease unwanted pregnancies. Additionally, preventing teen pregnancies and STDs is the rationale behind Florida's mandate. Condoms. Coverage of condoms was similar. Three of the seven concepts were covered by less than half of teachers, and another three by less than two-thirds. The other concept encouraged condoms for S TD prevention. Although this is an important concept, it is not very useful if students do not know how to use or where to get condoms. Only half an hour was spent on average on condoms. The percent of teachers that discussed condom use in this study was substantially lower than that found in one studx —77 /> (Forrest & Silverman. 1989), and similar to another study-5 1% (Firestone. 1994).

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Again, efforts need to be made to increase the percent of teachers who address this concept and the manner in which it is addressed. STDs HIV. The emphasis in these courses was definitely on the negative consequences of sexuality, namely STDs/HIV. STDs/HIV have commonly been reported as the topic most likely to be addressed in high school sexuality education courses (Firestone. 1994: Forrest & Silverman. 1989: Koblinskv & Weeks. 1984: Yarber. Torabi, & Haffner. in press). Teachers taught an average of eight out often ot the STDs listed. However, as with contraceptives, some of the diseases that have recently become more prevalent were less likely to be taught than others. These included genital warts and pelvic inflammatory disease. The majority of concepts related to STDs/HIV were covered by most teachers, although slightly more of the HIV than the STD concepts were taught on average. This was consistent with the finding that the greatest amount of time was dedicated to HIV. followed by STDs. Condoms were least likely to be taught as a method of prevention, preceded by abstinence and monogamy. Additionally, the concept least likely to be included was where students could obtain testing and treatment. Once again, information about STDs/HIV is useful only if students know how and where to get help. Referrals. Teachers were most likely to refer students to parents tor help with birth control, but most likely to send them to a local family planning center/health department or family doctor for help with STDs/HIV. It could be speculated that this is because finding out about birth control is hopefully done before initiating sexual activity and hence the teachers felt this situation was best handled by the parents. This supports

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133 -I-. — (LeIght ,994). Seeking help for STDs/HIV is something that would usually 1 done . . . , s . xual acti vi,v The student might need medical attention regat Hess of the after initiating sexual acm ny . f the parent hence teachers might have felt it was more oproprtate influence or reaction ot the paren , It was also interesting that for all three issues, teachers were ,o refer them in this manner. It was also leas, likely to refer students to resources within the school. Less than four in ten sa, counselor for these Issues. This may have keen because some schools did no, employ^ school nurse or teachers did no, fee. it was the appropnate role o. the gu, dance conn It mav have also been because teachers and/or students were not comfortable with or aa ,S 1, seems tha, in-school resources would provide easter access not trust these individuals. seeking help and maybe increase the percent tha, did so. Most commonly, guest speakers were brought m trom outs, e organizations to talk about HIV, AID, followed by STDs. Somewhat less commonly speakers were brought in to address abstinence, birth control or condoms. It was rare t at f the tonics A»ain. this may have been because ms.de inside sources were used tor any of the topics. A* resources were not av ailable. T , 1 4 skills-building concepts included in this survey qhiic-H, nldine acti vities. The 14 skills buiiai g average of 1 2 on, of, 4 of these topics, they only had students practice an average „ mne practice refuse,, assertiveness, or conflict management ski, is. Less than one ha, f had

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134 students address peer norms, identify community resources, or examine perceived pregnane)' risks. Although teachers may have discussed the importance of these issues, students do not fully comprehend them unless they are given the opportunity to explore the issues and practice the skills themselves. For example, students can be told it is important to be assertive, but actually hav ing them role play a situation that requires being assertive or write about how they would handle a situation in an assertive manner would have more of an effect. Research shows that although necessary, information alone is not enough to effect behavior. Skills-building activities are a common component of programs proven to have a positive effect on sexual behavior (Kirby et ah, 1994). Teaching methods. The most common teaching methods employed were teacher oriented. Methods such as cooperative learning/small groups, journal/story writing, and peer helpers were used less frequently, consistent with the finding that practicing skills is less common than teaching about them, mentioned above. These are methods that could personalize information, address social influences or pressures on sexual behavior, reinforce values against unprotected sexual activity, and provide modeling and practice in communication negotiation skills. These factors have been identified as commonalities among programs with a positive impact on sexual behaviors (Kirby et ah. 1994). Previous research has also found that teacher centered methods are among the methods most commonly utilized (Firestone, 1994; Flaignere et ah, 1996; Orr, 1982). This implies that teachers need assistance with interactive teaching methods, also documented in prior

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135 research (Forrest & Silverman. 1989), if sexuality education programs are to have a positive impact on adolescent sexual behavior. The Effects of District Variables on Sexuality Education District Sexuality Education Mandates Sexuality education is mandated by Florida, however, the Components were issued only as guidelines. In addition, there are no state regulations to monitor the implementation of sexuality education ( Gambrell & Patierno. 1995). Flence. in this survey, district mandates were assessed, as well as compliance with state guidelines. Just over one-third of teachers reported a specific sexuality education curriculum was mandated for them to use and almost one-fourth reported one was suggested. Another one-fifth said it was neither mandated nor suggested, and 15% did not know or did not respond. However, when this question was broken down by district, there was an apparent lack of agreement among respondents as to the actual status of the mandate. Within most districts, inconsistent responses were given, especially among larger districts. So, findings related to how a mandate affected what was taught in sexuality education courses may be more related to respondents' perception of the mandate status or a bogus finding. Only two sub-scales were found to differ significantly according to the status of the mandate in post hoc tests performed. Those who reported a curriculum was mandated spent more time on birth control methods than did those who reported it was neither mandated nor suggested. Both those who reported it was mandated and suggested used

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136 more teaching methods on average than those who reported it was neither mandated nor suggested. The first finding could be interpreted in two ways. It could have been that the mandate, or perception of a mandate, was indicative of local support and/or justification for those teaching birth control methods, hence they spent more time on it. This explanation is less clear if the state guidelines are considered. The Components include birth control methods as an area that should be addressed, so all teachers had this support if they desired it. If mandates had this effect— supporting teachers' inclusion of various topics— significant differences between required and elective courses would not be expected. However, it is assumed that district policies and politics have more influence on what is actually taught, especially since Florida initiated the School Improvement and Accountability Act to give decision making responsibility back to the communities. The other explanation is that the finding is bogus. The reported differences between what was taught in required versus elective courses, discussed previously, is inconsistent with the reported effect of a mandate on what was taught in classes. Required classes emphasized STDs/HIV while elective classes emphasized birth control methods. If district mandates supported teaching about birth control, this finding would seem unlikely. Additionally, previous research found that only 37% of respondents in districts with a mandated curriculum said birth control was included as a topic (Forrest & Silverman, 1989).

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137 District Variables Three district variables were analyzed for effects on implementation of sexuality education-total number of students in the districts, the percent of white students, and the percent of students on free/reduced lunch ( as an indicator of economic status of the district). The number of students in the district appeared to have a negative effect on what was taught in classes. As the number of students increased, significantly fewer items were taught in four of the sub-scales and less time spent on four of the topics. The other two variables, percent of white students in the district and percent on free/reduced lunch had a positive impact on what was taught. As these increased, so did the number of items taught in three of the same sub-scales and three of the same time estimates. Additionally, another two sub-scales and one time estimate increased as the percent of students on free/reduced lunch did. Previous research found that urban districts were more likely than rural districts, and larger districts were more likely than smaller districts to provide sexuality education. There were no significant differences found based on geographic location or percent minority students (Koblinsky & Weeks, 1984). Another study analyzed social and demographic district variables related to implementation of sexuality education. Of these factors, southern schools were less likely to have sexuality education, and number and type of post-secondary schools around the schools influenced the inclusion of sexuality education. The other factors assessed-area served (urban, suburban, etc.), parental occupation, type of housing, and percent of non-white students— were not found to have a

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138 significant effect on sexuality education (Orr. 1982). Hence, an interpretation of the effect of district variables on sexuality education is difficult to establish. Conclusions and Recommendations The majority of respondents in this survey were teaching sexuality education and liked doing so. They also felt it was the appropriate role of the school to be providing this education. Most teachers covered a variety of important topics such as abstinence, HIV/STDs, decision-making, values, communication, sexual abuse, finding help, reproductive health, contraception, parenting, assertiveness, friendship, and love. In fact, an average of 25 of the 36 topics listed were taught by teachers and 21 of the topics by at least three-fourths of teachers. This demonstrates that a baseline of sexuality education is being provided for students in Florida public high schools. However. w : hen examined more closely, problems with both the content and context of this education become apparent. Although teachers covered a wide variety of important sexuality education topics, there appeared to be a focus on the negative consequences of sexual behavior, mainly HIV and STDs. The greatest amount of time, almost 40% of the total average time, was spent on these areas. Accordingly the highest percent of concepts were also covered in these areas. After these topics, the emphasis was on abstinence, birth control, and condoms-methods of preventing these negative consequences. These five topics accounted for two-thirds of the total average time spent on sexuality education. This means that an average of less than four hours were spent on the other 33 topics listed. This is not to say that the topics emphasized are not important.

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139 At least Florida is addressing some of the priority areas-pregnancy and STD preventionsuggested in conclusions from Collins et al. (1995) work. In addition, pregnancy and STD/HIV prevention are the rationale behind Florida's mandate for sexuality education. However, these findings imply that the approach taken in these sexuality education courses emphasized the negative consequences of sexual behavior and how to prevent them. In addition, the prevention aspect appeared not to be as comprehensive as it could have been. Kirby et al. ( 1994) listed several commonalities among programs that had a positive impact on sexual behavior, discussed in Chapter 2. Most of these factors are skills-building activities. Although teachers reported teaching many of the skills-building concepts, substantially fewer actually had students practice these skills. Findings related to the teaching methods utilized by respondents w r ere consistent in that they tended to be teacher oriented. The methods used least often were those that incorporated student activities. Also, the concepts assessed in the sub-scales— birth control, condoms, and STD/HIV concepts— that were related to skills-building were taught less often than other concepts within the same sub-scale. The sexuality education provided in Florida public high schools apparently is not from a sexual health promotion approach and lacks emphasis on the behavioral domain which is necessary to promote positive behavior and reduce the negative consequences associated with unprotected sexual activity. There are obviously many factors that effect the type of education that is provided in sexuality education courses, many of which are beyond the individual classroom teacher's control. In order to improve sexuality

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140 education, teacher training, provision of adequate materials, increased time in the curricula, and increased support from the state, district, and schools are needed. Teacher attitudes had a significant effect on what was taught in classes in this study. This is an area that has been researched relatively infrequently. However, other studies have reported similar findings (Orr. 1982; Yarber. Torabi, & Haffner, in press). Fortunately, research has also found that teacher training can have a significant effect on knowledge, perceptions of importance of teaching a curriculum, intent to teach, and level of comfort with the course content (Levenson-Gingiss & Hamilton. 1989). Future research needs to investigate this area further to establish the content of this training and the feasibility of making it available to, perhaps even required for, those teaching sexuality education. Florida does not currently require training or certification for sexuality education teachers (Gambrell & Patierno. 1995). However, teacher training needs should not be solely addressed as a state or district responsibility. Although academic preparation in sexuality education for FCS teachers has not been assessed, it has been shown to be lacking for health education majors (Rodriguez et al.. 1995/96). This is a problem that also needs to be addressed to help improve sexuality education at the classroom level. The Components provided by the state were developed as a guideline on the topics that should be included in sexuality education programs. They do not include the information, skills-building activities, or teaching methods necessary to teach sexuality education. Most commonly teachers reported they created the materials used in class, followed by using a published curriculum. However, all responses for the name of the

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141 publisher were given by less than 5% of respondents. It appears that teachers approached teaching sexuality education in a fragmented manner, using materials from a variety of sources that they pieced together on their own. If the sexuality education provided in schools is to be current, comprehensive and include effective skills-building strategies, teachers need appropriate materials to enable them to do so. This initiative could originate at the state level, but be tailored at the district level to allow community involvement and ensure appropriateness. Ideally, these materials should be presented in training sessions. This ensures that teachers are not only prepared to teach, but also taught how to use a specific curriculum and given the appropriate materials to take back to their classrooms. Teachers also need to be allotted more time in the curricula to ensure that they can adequately cover the full range of sexuality education. Life management skills, the course most commonly named in this study, is a required class and probably over loaded with information that has to be covered, hence limiting time for all topics. Lack of time to cover sexuality education is often cited as a barrier to implementation. However, one approach that may help to alleviate this is to use a comprehensive approach to sexuality education, addressing it in all grade levels, as mandated by the state of Florida. This way, topics could be built on at age appropriate levels, helping to decrease the amount of information that has to be addressed in one course. All of these factors require improved support from the schools, districts, and state. A cooperative effort has to be made if sexuality education is to improve in Florida. Sexuality education guidelines, curricula, and related materials need to be shared and

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consistent across these levels. This requires improving communication among these levels, as well as with teachers, to ensure that expectations are known and resources for teaching and training available. District mandates may be supporting or restricting what can be taught in classes. Regardless, it is evident that teachers need more support for teaching the full range of sexuality education, especially for a topic such as birth control that is critical to the rationale of Florida's mandate-preventing STDs/HIY and unwanted pregnancy. It is apparent that the sexuality education provided in Florida public high schools is not consistent with profiles of programs proven to have a positive effect on sexual behavior. However, they have the potential to be part of the solution to the high rates of adolescent STDs/HIV and unwanted pregnancy, as well to promote sexual health. Support from the schools, districts, and state should be pooled and coordinated to help train teachers, provide them with adequate teaching materials and sufficient time in the curricula in order to improve school-based sexuality education. In addition, further research should be done in other states that mandate sexuality education to assess compliance with guidelines and factors effecting implementation. At the national level, a comparison study at the classroom level could assess the differences in implementation among states that require, suggest, or do not take a position on— perhaps even discourage-sexuality education. Findings from these studies could help to further clarify factors important to the improvement of comprehensive school-based sexuality education, as well as demonstration of the efficacy of state versus district level mandates.

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APPENDIX SURVEY AND CORRESPONDENCE 143

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A STATEWIDE SURVEY OF HIGH SCHOOL SEXUALITY EDUCATION TEACHERS: THE NATURE AND SCOPE OF SEXUALITY EDUCATION IN FLORIDA PUBLIC HIGH SCHOOLS This survey is being conducted to assess the nature and scope of sexuality education in Florida public high schools. If you wish to comment on any questions or qualify your answers, please feel free to use the space in the margins. Your comments will be read and taken into account. Please answer all of the questions. Of course, if there are any you do not wish to answer, you need not do so. Thank you for your help. (Insert picture of Florida.) Michele Johnson Moore, M.H.S.E., C.H.E.S. Project Coordinator Department of Health Science Education University of Florida Gainesville, Florida 3261 1 144

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145 Q1 . Which one of the following statements is correct? (Circle the best response.) 1 I AM TEACHING SEX EDUCATION THAT INCLUDES AIDS EDUCATION THIS SCHOOL YEAR (1995-96) WITHIN GRADES 9-12. 2 I AM TEACHING SEX EDUCATION THAT DOES NOT INCLUDE AIDS EDUCATION THIS SCHOOL YEAR WITHIN GRADES 9-12. 3 I AM TEACHING AIDS EDUCATION. BUT NOT WITHIN COMPREHENSIVE SEXUALITY EDUCATION. THIS SCHOOL YEAR WITHIN GRADES 9-12. (Please answer all questions, substituting "AIDS education" for "sex education" where appropriate.) 4 I AM NOT TEACHING ANY SEX OR AIDS EDUCATION THIS YEAR. (Please do not fill out this survey. Please mail it back in the return envelope so we do not bother you further with follow-up letters.) Q2. In what class! es) do vou teach sex education? Indicate what grade the majority of students are in for each class and whether it is a required class. (Circle all that apply.) GRADE REQUIRED 1 AS A UNIT IN LIFE MANAGEMENT SKILLS . 9 10 11 12 YES NO 2 AS A UNIT IN HEALTH EDUCATION 9 10 11 12 YES NO 3 AS A UNIT IN HOME ECONOMICS 9 10 11 12 YES NO 4 AS A UNIT IN BIOLOGY 9 10 11 12 YES NO 5 AS A UNIT IN PHYSICAL EDUCATION 9 10 11 12 YES NO 6 AS A SEPARATE COURSE 9 10 11 12 YES NO 7 OTHER (Specify: ) 9 10 11 12 YES NO Q2a. If you teach more than one class that includes sex education, please write in the ONE class and grade , from the list above, that you will refer to in answering the remainder of this survey. Please choose this class based on these priorities : 1 ) it is required : 2) greatest amount of time spent on sex education: 3) greatest number of students reached.

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146 Part I. Directions: Questions 3-38 list the topics and concepts that could be taught in a comprehensive sexuality education program. Please react to each topic/concept in two ways: Column 1: Using the below response key, indicate vour viewpoint concerning the degree of importance of each topic/concept as part of a comprehensive approach to sexuality education. Response Kev: NOT AT ALL MODERATELY EXTREMELY IMPORTANT) L) IMPORT ANT(M) IMPORT ANT(H) 1 2 3 4 5 Column II: Indicate whether or not the topic/concept is included by yourself or a guest lecturer, even if briefly, in the sexuality education unit in vour selected class. Q3. REPRODUCTIVE ANATOMY AND IMPORTANCE TAUGHT PHYSIOLOGY. The human body has the L M H Yes No capability to reproduce as well as to give and receive pleasure 1 2 3 4 5 1 2 Q4. REPRODUCTION. People have both the capability and the ability to choose to reproduce 1 2 3 4 5 1 2 Q5. PUBERTY. Puberty is a universally experienced transition from childhood to adulthood that is characterized by physical changes 1 2 3 4 5 1 2 Q6. BODY IMAGE. People's image of their bodies affect feelings and behavior 1 2 3 4 5 1 2 Q7. SEXUAL IDENTITY AND ORIENTATION. As young people grow and develop, they begin to feel romantically and sexually attracted to other people ... 1 2 3 4 5 1 2 Q8. FAMILIES. People are raised in families and most live in families as adults 1 2 3 4 5 1 2 Q9. FRIENDSHIP. Friendships are important throughout life 1 2 3 4 5 1 2

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147 Q10. LOVE. Loving relationships of many types are important throughout life 1 2 3 4 5 1 2 Q 1 1 . DATING. Dating enables people to experience companionship and intimacy 1 2 3 4 5 1 2 Q12. MARRIAGE AND LIFETIME COMMITMENTS. Marriage is a legal commitment that two people make to share their lives and family responsibilities ..1 2 3 4 5 1 2 Q13. PARENTING. Parenting children can be one of life's most rewarding responsibilities 1 2 3 4 5 1 2 Q14. VALUES. Values guide our behavior and give purpose and direction to our lives 1 2 3 4 5 1 2 Q15. DECISIONMAKING. Making responsible decisions about sexuality is important because those decisions can affect not only ourselves but others 1 2 3 4 5 1 2 Q16. COMMUNICATION. Communication includes sharing information, feelings, and attitudes with one another 1 2 3 4 5 1 2 Q17. ASSERTIVENESS. Assertiveness is communicating feelings and needs, while respecting the rights of others 1 2 3 4 5 1 2 Q18. NEGOTIATION. Negotiation allows people to solve a problem or resolve a conflict 1 2 3 4 5 1 2 Q19. FINDING HELP. People with problems can seek help from family, friends, or a professional 12345 1 2 Q20. SEXUALITY THROUGHOUT THE LIFESPAN. Sexuality is a natural and healthy part of life 12 3 4 5 1 2 Q21. MASTURBATION. Masturbation is one way human beings express their sexuality 1 2 3 4 5 1 2 Q22. SHARED SEXUAL BEHAVIOR. Individuals express their sexuality with a partner in diverse ways 1 2 3 4 5 1 2

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Q23. ABSTINENCE. Abstinence from sexual intercourse is the most effective method of preventing pregnancies and STD/HIV 148 1 2 3 4 5 1 2 Q24. HUMAN SEXUAL RESPONSE. Male and female bodies respond both similarly and differently to sexual stimulation 1 2 3 4 5 1 2 Q25. FANTASY. Sexual fantasies are common 12 3 45 1 2 Q26. SEXUAL DYSFUNCTION. Sexual dysfunction is the inability to express or enjoy sexuality 1 2 3 4 5 1 2 Q27. CONTRACEPTION. Contraception enables people to have sexual intercourse without the fear of unintended pregnancy 1 2 3 4 5 1 2 Q28. ABORTION. When a woman becomes pregnant and chooses not to have a child, she has the option of having a legal abortion 1 2 3 4 5 1 2 Q29. SEXUALLY TRANSMITTED DISEASE AND HIV INFECTION. Sexually transmitted disease, including HIV infection, can be avoided by individual preventive behavior 1 2 3 4 5 1 2 Q30. SEXUAL ABLÂ’SE. Sexual abuse can prevented or stopped 1 2 3 4 5 1 2 Q31. REPRODUCTIVE HEALTH. Men and women must care for their reproductive health to assure their future children's health and development 12345 1 2 Q32. SEXUALITY AND SOCIETY. Society influences what people believe and how they feel about sexuality 1 2 3 4 5 1 2 Q33. GENDER ROLES. Cultures teach what it is to be a man or a woman 1 2 3 4 5 1 2 Q34. SEXUALITY AND THE LAW. Certain laws govern sexual and reproductive rights 1 2 3 4 5 1 2

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149 Q35. SEXUALITY AND RELIGION. Religious views about sexuality affect people's sexual attitudes 1 2345 1 2 Q36. DIVERSITY. Our society has a diversity of sexual attitudes and behavior; some people are unfairly discriminated against because of the way they express their sexuality 1 2 3 4 5 1 2 Q37. SEXUALITY AND THE ARTS. Erotic images are a common theme in art 1 2 3 4 5 1 2 Q38. SEXUALITY AND THE MEDIA. The media have a profound effect on sexual information, values, and behavior 1 2 3 4 5 1 2 Part II. Directions: The following questions address concepts that could be included in teaching pregnancy and STD/HIV prevention in sexuality education. To answer each question, circle the answer you choose AND/OR write in the appropriate response. Q39. The following items relate to teaching about abstinence. Please indicate whether or not each item is taught in your selected class. TAUGHT -Abstinence as the only alternative for preventing pregnancy and STDs YES NO -Abstinence as the best alternative for preventing pregnancy and STDs YES NO -How to resist peer pressure to have sexual intercourse YES NO -How to say no to boy/girlfriend YES NO -Negative consequences of sexual intercourse for teens YES NO Q40. This question refers only to teaching about pregnancy prevention. Please indicate whether or not each item is taught in your selected class. TAUGHT -I teach abstinence YES NO -Teaching about birth control methods is part of my curriculum YES NO

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-Teaching about birth control methods is done in other required classes in some of the same grades I teach 150 YES NO -I discuss birth control methods in class ONLY if a student initiates a question about them YES NO -I answer questions about birth control methods on a one-to-one basis after class YES NO -I have my students submit questions anonymously on slips of paper YES NO -If there are questions about birth control methods. I answer them in class YES NO -I do not discuss anything about birth control methods either in class or after class. (SKIP TO Q43) YES NO Q41 . If you teach about birth control methods, which of the following are included in your selected class? (Circle all that apply.) 1 BIRTH CONTROL PILL6 FERTILITY AWARENESS/RHYTHM METHOD 2 CERVICAL CAP 7 INTRAUTERINE DEVICE 3 DEPO-PROVERA 8 NORPLANT 4 DIAPHRAGM 9 SPERMICIDES (JELLY, FOAM. FILM) 5 FEMALE CONDOM 10 WITHDRAWAL Q42. Please indicate whether or not you teach each item in your selected class. DO YOU: TAUGHT -Explain how each birth control method works? YES NO -Explain how each birth control method is used? YES NO -Give information about specific clinics or doctors students can go to for birth control? YES NO -Show actual birth control devices to the class to aid in instruction? . . . YES NO -Discuss how to communicate with a partner about birth control? YES NO

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This question deals with teaching about condoms. Please indicate whether or not each item is taught in your selected class. DO you-Describe the proper way to use a condom? -Show the proper way to use a condom through printed material, him or demonstration? TAUGHT YES NO YES NO 1 each that condoms should be put on before any vaginal contact by the penis? YES NO -Encourage condom use for pregnancy prevention? YES NO -Encourage condom use for STD/HIV prevention? YES NO -Address concerns about the condom such as reduced sexual pleasure and/or lack of spontaneity? -Teach that condoms should always be used with spermicide? YES NO YES NO Which of the following sexually transmitted diseases do you include in your selected class? (Circle all that apply.) 1 CHLAMYDIA 2 CRAB LICE 3 GENITAL WARTS 4 GONORRHEA 5 HEPATITIS B 6 HERPES 7 HIV/AIDS 8 PELVIC INFLAMMATORY DISEASE 9 SYPHILIS 10 OTHER STDS 11 NONE (SKIP TO Q46) The following items relate to HIV/AIDS and STDs. Please indicate whether or not each item is taught in your selected class. -How each disease is transmitted -Signs and symptoms of each disease HIV/AIDS OTHER STDs . YES NO YES NO YES NO YES NO -Effects of each disease YES NO YES NO

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152 -Sexual abstinence as a form of prevention . . . . YES NO YES NO -Sexual monosamy as a form prevention . . . . . YES NO YES NO -Use of condoms as a form of prevention .... . . YES NO YES NO -Names ot clinics or other specific sources students can so to for help . . YES NO YES NO -Confidentialitv of medical treatment . . . . . YES NO YES NO Q46. To which of the following people do you refer students who want help with birth control. STDs or HIV/AIDS? (Circle all that apply.) BIRTH HIV/ OTHER CONTROL AIDS STDS -Parents 1 2 o -Family doctor 1 2 J -Local familv plannins clinic .... 1 2 "> J -School nurse 1 2 -> J -School euidance counselor .... 1 2 -Other (SoecitV: t . 1 2 -> a Q47. During this school year, please indicate whether you invited or plan to invite someone else from within your school or an outside organization to address any of the following topics in your selected education class/unit. (Circle all that apply.) WITHIN OUTSIDE SCHOOL ORGANIZATION NONE -Abstinence 1 2 "5 J -Birth Control Methods . . . 1 2 o J) -Condoms 1 2 3 -STDs 2 "> -HIV/AIDS 1 2 3 -Other (Specifc: ) 1 2 3 Q48. The following items relate to skill building activities that could be taught in sexuality education. Please indicate whether or not each item is tausht in your selected class and whether or not students practice the skill as a part of class. TAUGHT PRACTTCFD -Examine Personal Values YES NO YES NO

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-Increase Seif-Awareness/Build Self-Esteem . . .. YES NO YES NO -Examine Influences on Decisions .. YES NO YES NO -Identify Consequences of Decisions . . YES NO YES NO -Address Peer Norms . . YES NO YES NO -Examine Perceived Pregnancy Risks . . YES NO YES NO -Examine Perceived STD/HIV Risks .. YES NO YES NO -Identify Community Resources .. YES NO YES NO -Build General Communications Skills . . YES NO YES NO -Build Assertiveness Skills .. YES NO YES NO -Build Refusal Skills . . YES NO YES NO -Build Conflict-Management Skills . . YES NO YES NO -Build Decision-Making Skills . . YES NO YES NO -Build Planning Goal-Setting Skills . . YES NO YES NO Q49. The following items relate to teaching strategies that could be used in sexuality education. Please indicate whether or not each strategy is utilized in your selected class. UTILIZED -Ground Rules YES NO -Anonymous Question Box YES NO -Teacher Lecture YES NO -Large Group Discussion YES NO -Student Workshops YES NO -Journal/Story Writing YES NO

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154 -Cooperative Learning/Small Groups YES NO -Case Studies/Scenarios YES NO -Audiovisual Materials YES NO -Peer Helper Component YES NO -Parent/Guardian Involvement YES NO -Other: Part III. Directions: The following questions address the implementation of sexuality education in you school and your professional background related to sexuality education. To answer each question, please circle the appropriate answer AND/OR write in the appropriate response. Q50. Approximately how much time is spent teaching about each of the following topics, in your selected class? TIME IN MINUTES -Abstinence -Birth Control (other than condoms/abstinence) -Condoms -STDs -HIV/AIDS Q5 1 . How many total hours are spent on sexuality education in your selected class? HOURS Q52. How r else is sexuality education offered in your school? (Circle all that apply.) 1 UNIT IN LIFE MANAGEMENT SKILLS 9 2 UNIT IN HEALTH EDUCATION 9 3 UNIT IN HOME ECONOMICS 9 4 UNIT IN BIOLOGY 9 5 UNIT IN PHYSICAL EDUCATION 9 6 SEPARATE COURSE 9 7 OTHER (Specify: ) .... 9 GRADE REQUIRED 10 11 12 YES NO 10 11 12 YES NO 10 11 12 YES NO 10 11 12 YES NO 10 11 12 YES NO 10 11 12 YES NO 10 11 12 YES NO

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155 Q53. Is teaching about any of the following topics done in other required classes? If so, in which grades and class(es)? (Circle/write in all that apply.) TAUGHT GRADE CLASSiESt -Abstinence YES NO 9 10 11 12 -Birth Control YES NO 9 10 11 12 -Condoms YES NO 9 10 11 12 -STDs YES NO 9 10 11 12 -HIV/AIDS YES NO 9 10 11 12 Q54. Is a specific sexuality education curriculum mandated or suggested for you to use? 1 YES. MANDATED 2 YES. SUGGESTED 3 NO (SKIP TO Q55) 4 DON'T KNOW (SKIP TO Q55) Q54a. By whom is it mandated or suggested? 1 DISTRICT 2 SCHOOL 3 DON'T KNOW Q54b. What is the name and publisher of that curriculum? Q55. Do you use a commercially available curriculum for sex education in your classroom? 1 YES NAME/PUBLISHER: 2 NO — I create my own materials. 3 NO — I use other sources. Specify: Q56. What textbook(s). if any, do you use in teaching your sexuality education unit or class: (Please list title , author , and which grades you use it for.) 1 2

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156 Q57. What academic degree(s) do you hold? DEGREE: MAJOR: DEGREE: MAJOR: DEGREE: MAJOR: Q58. What subject areas are you certified to teach? Q59. How many years have you been teaching? years Q60. How/ many years have you been teaching sex education? years Q61 . Since the end of the last school year, how often have you attended workshops, conferences, or in-services designed to help you in your teaching of sexuality education? 1 WEEKLY 2 MONTHLY 3 SEVERAL TIMES 4 ONCE 5 NEVER Q62. Within each of the following settings, indicate approximately how many semester HOURS of training you have received, if any, that specifically prepared you for teaching sex education . # HOURS 1 UNDERGRADUATE DEGREE PROGRAM credit hours 2 GRADUATE DEGREE PROGRAM(S) credit hours 3 WORKSHOPS. SEMINARS, IN-SERVICES (OR OTHER SOURCES OUTSIDE YOUR FORMAL ACADEMIC COURSEWORK) hours

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157 Q63. Sex: 1 MALE 2 FEMALE Q64. Age: 1 20-24 5 40-44 9 60-64 9 25-29 6 45-49 10 65-69 -> J 30-34 7 50-54 11 70-74 4 35-39 8 55+ 12 75+ Q6d. Race/ethnicity: 1 WHITE 2 BLACK 3 HISPANIC 4 OTHER (Specify: ) Q66. To what extent do you like teaching sexuality education? 1 VERY MUCH 2 SOMEWHAT 3 NEITHER LIKE NOR DISLIKE 4 NOT TOO MUCH 5 NOT AT ALL Q67. Do you think it is the appropriate role of the school to teach sexuality education? 1 YES (Skip to Q68) 2 NO Q67a. (IF NO) Please explain why not. Q68. Is there any additional information you would like to provide that was not covered in the survey?

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Thank you for your time and help with this survey. If you would like a copy of the results, please print your name and address on the enclosed request slip and return it with the survey. Please do not write this information on the survey itself in order to maintain confidentiality. *Note: This survey was produced on a 4 1/4 by 5 !4 inch booklet and questions were fitted appropriately onto pages.

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159 Cover Letter (On University of Florida. Department of Health Science Education letter head paper.) Month. XX 1 996 Dear Colleague, The potential negative consequences related to teenage sexuality are of great concern to many Americans. The high rates of unintended pregnancy, sexually transmitted diseases, and HIV infection result in many devastating consequences in our society. One method of addressing these problems is through school-based sexuality education. Although Florida, like 21 other states, requires sexuality education, there is currently little information on what is actually being taught. Health education and home economics teachers throughout Florida have been asked to complete this form in order to find out what is being taught and what their needs are in this area. In order to find out the nature and scope of. and teacher attitudes and needs regarding sexuality education, it is important that each questionnaire be completed and returned. Your participation is completely voluntary. A copy of the results will be offered as compensation if you would like. Further instructions on this are included in the survey. The survey should take approximately 15 minutes to complete. By participating, you will be making a valuable contribution to addressing the health problems of young people in our state. You may be assured of complete confidentiality. The questionnaire has an identification number for follow-up purposes only. This is so I may check your name off ol the mailing list when your questionnaire is returned. Your name will never be placed on the questionnaire. I he results ol this study will provide much needed baseline information regarding school-based sexuality education. Information about your opinions, needs, and teaching content and methods will help to improve sexuality education in the future and adolescent health. I would be most happy to answer any questions you might have. Please write or call the address or telephone number above, or (352)335-3002. Thank you for your assistance. Sincerely, Michele Johnson Moore. M.FI.S.E., C.H.E.S. Project Director

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First Follow-up Letter (In postcard format-5 !4 X 4 1/4 inch cardstock.) Side 1 . 160 Month , 1996 Last week a questionnaire seeking information about sexuality education in Florida public high schools was mailed to you. Your name was obtained from a list of health and home economics teachers from the Department of Education. If you have already completed and returned it to me please accept my sincere thanks. If not. please do so today. Because it has been sent to only a small, but representative, sample of sexuality education teachers it is extremely important that yours also be included in the study if the results are to accurately represent the opinions of Florida sexuality education teachers. If by some chance you did not receive the questionnaire, or it got misplaced, please call me collect at (352) 335-3002 and I will get another one in the mail to you today. Sincerely, Michele Johnson Moore, M.H.S.E., C.H.E.S Project Coordinator Side 2. Michele Johnson Moore. M.H.S.E.. C.H.E.S. Project Coordinator 2826 SW 40th Place Gainesville. FL 32608 (RespondentÂ’s Address.)

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Second Follow-up Letter (On University ot Florida. Department of Health Science Education letterhead paper.) 161 Month XX. 1996 Dear Colleague. About tour weeks ago I wrote to you seeking information about sexuality education in Florida public high schools. As of today. I have not yet received your completed questionnaire. I have undertaken this study because school-based sexuality education is one method of addressing the high rates of unintended pregnancy, sexually transmitted diseases, and HIV infection among Florida adolescents. It is necessary to take into account your opinions, needs, and teaching content and methods in order to help improve sexuality education and the health of adolescents in our state. I am writing to you again because of the significance each questionnaire has to the usefulness of this study. Your name was obtained from a Florida Department of Education list consisting of health and home economics teachers in Florida public schools, grades 9-12. In order for the results of this study to be truly representative of sexuality education teachers in Florida it is essential that each person in the sample return their questionnaire. In the event that your questionnaire has been misplaced, a replacement is enclosed. Your cooperation is greatly appreciated. Sincerely, Michele Johnson Moore. M.H.S.E., C.H.E.S. Project Director

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REFERENCES Ballard. D. J.. White, D. M.. & Glascoff, M. A. (1990). AIDS/HIV education for pre-service elementary school teachers. Journal of School Health. 60 . 262-265. Calamidas. E. G. (1990). AIDS and STD education: WhatÂ’s really happening in our schools? Journal of Sex Education & Therapy. 16 (?10). 54-63. Centers for Disease Control and Prevention (CDC). (1995). HIV AIDS Surveillance Report. 7 (2). Atlanta. GA: U.S. Department of Health and Human Services. Collins. J. L.. Small, M. L.. Kann. L., Pateman, B. C., Gold. R. S.. & Kolbe, L. J. (1995). School health education. Journal of School Health. 65 . 302-31 1. Connell. D. B. & Turner. R. R. (1985). The impact of instructional experience and the effects of cumulative instruction. The Journal of School Health. 55 . 324-331. Dawson. D. A. (1986). The effects of sex education on adolescent behavior. Family Planning Perspectives. 18 . 162-170. De Gaston, J. F.. Jensen. L., Weed. S. E., & Tanas, R. (1994). Teacher philosophy and program implementation and the impact on sex education outcomes. The Journal of Research and Development in Education. 27 . 265-270. de Mauro. D. (1989/1990). Sexuality education 1990: A review of state sexuality and AIDS education curricula. SIECUS Report. 18 (2), 1-9. Department of Health and Human Services. (1990). Healthy people 2000: National health promotion and disease prevention objectives (DHHS Publication No. 9150212). Washington. D.C.: U.S. Government Printing Office. Dillman. D. (1978). Mail and telephone surveys: The total desien method . New York: John Wiley & Sons. Donovan. P. A. (1989). Risk and responsibility: Teaching sex education in America's schools todav . New York: Alan Guttmacher Institute. 162

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163 Firestone. W. A. (1994). The content and context of sexuality education: An exploratory study in one state. Family Planning Perspectives. 26 . 125-131. Fisher. \V. A. (1990). All together now: An integrated approach to preventing adolescent pregnancy and STD/HIV infection. SI ECUS Report. 18 (4). 1-11. Florida Department of Education. (1995). Profiles of Florida school districts 1993-94: Student and staff data ( Series 95-15). Tallahassee. FL: Education Information and Accountability Service Section. Division of Public Schools. Forrest, J. D. & Silverman. J. (1989). What public school teachers teach about preventing pregnancy. AIDS and sexually transmitted diseases. Family Planning Perspectives. 21 . 65-72. Gallup. A. M. & Clark. D. L. (1987). The 19th annual Gallup Poll of the publicÂ’s attitudes toward the public school. Gallup Polls. 69 (1). Gambrell. A. E. & Haffner. D. W. (1993/94). Unfinished business: The executive summary from the SIECUS assessment of state sexuality education programs in the United States. SIECUS Report. 22 (2). 27. Gambrell. A. E. & Flaffner, D. W. (1993). Unfinished business: A SIECUS assessment of state sexuality education programs (M. B. Caschetta. Ed.). New York: SIECUS. Gambrell. A. E. & Patierno. C. (1995). SIECUS review of state education agency HIV/AIDS prevention and sexuality education programs (D. Hollander. Ed.). New York: SIECUS. Gingiss, P. L. & Hamilton, R. (1989). Teacher perspectives after implementing a human sexuality education program. Journal of School Health. 59 . 427-431. Girls Inc. (1996). Preventing adolescent pregnancy . Indianapolis, IN: National Resource Center. Haffner, D. W. (1992). 1992 report card on the states: Sexual rights in America. SIECUS Report. 20 (3). 1-7. Haignere, C. S.. Culhane, J. F., Balsley, C. M., & Legos, P. (1996). TeachersÂ’ receptiveness and comfort teaching sexuality education and using non-traditional teaching strategies. Journal of School Health. 66 . 140-144.

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164 Hamilton. R. & Gingiss, P. L. (1993). The relationship of teacher attitudes to course implementation and student responses. Teaching and Teacher Education 9 (2) 193-204. Hausman. A. J. & Ruzek. S. B. (1995). Implementation of comprehensive school health education in elementary schools: Focus on teacher concerns. Journal of School Health. 65 . 81-86. Henshaw, S. K. & Van Vort. J. (1989). Teenage abortion, birth and pregnancy statistics: An update. Family Planning Perspectives. 21 . 85-88. Hill. FI., Piper. D.. & King. M. (1993). The nature of school-based prevention experiences for middle school students. Journal of Health Education. 24 (Snppld 15-23. Howard. M. & McCabe. J. B. (1990). Helping teenagers postpone sexual involvement. Family Planning Perspectives. 22 . 21-26. Iverson. D. C. & Kolbe. L. J. (1983 ). Evolution of the national disease prevention and health promotion strategy: Establishing a role for the schools. Journal of School Health. 53 . 294-302. Kann, L„ Warren. C. W.. Harris, W. A., Collins, J. L., Williams, B. I.. Ross, J. G., Kolbe. L. J.. & State and Local YRBSS Coordinators. (1996). Youth risk behavior surveillanceUnited States, 1995. Morbidity and Mortality Weekly Report 4^ (Suppl 4), 1-26. Kantor, L. M. (1992/93). Scared Chaste? Fear-based educational curricula. SIECUS Report. 21 . ( 2 T 1-15. Kenney. A. M.. Guardado, S., & Brown, L. (1989). Sex education and AIDS education in the schools: What states and large school districts are doing. Family Planning Perspectiyes. U . 56-64. Kerr. D., Allensworth, D„ & Gayle, J. (1989). The ASHA national HIV education needs assessment of health and education professionals. Journal of School Health. 59 301-307. Kirby, D., Barth, R. P., Leland, N., & Fetro, J. V. (1991). Reducing the risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives 23 253263.

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165 Knby. D„ Short. L.. Collins. J., Rugg, D., Kolbe, L., Howard. M., Miller, B„ onenstein, F.. & Zabin. L. S. (1994). School-based programs to reduce sexual risk 5 behaviors: A review ol effectiveness. Public Health Reports 1 DQ 339-360. Koblinsky. S. A. & Weeks. J. R. (1984). Family life education in California ninth and tenth grades. Journal of School Health. 54 . 181-184. height. L. (1994). Parents and caregivers as educators, partners, and advocates in sexuality education. In J. C. Drolet & K. Clark (Eds.). The sexuality education challenge: Promoting healthv sexuality i n voting people (pp. 3-28). Santa Cruz. CA: ETR Associates. Levenson-Gingiss. P. & Hamilton. R. (1989). Evaluation of training effects on teacher attitudes and concerns prior to implementing a human sexuality education program. Journal of School Health S9 156-160. Louis Harris & Associates. (1985). Public Attitudes about sex education, family p la nning and abortion in the United States . New York: Planned Parenthood Federation of America. Louis Harris & Associates (1986). American teens speak: Sex, mvths. TV. and birth control . New York: Planned Parenthood Federation of American. Louis Harris & Associates. (1988). Public attitudes toward teen pregnancy sex e ducation and birth control . New York: Planned Parenthood Federation of America. Majer. L. S.. Santelli. J. S.. & Coyle. K. (1992). Adolescent reproductive health: Roles tor school personnel in prevention and early intervention. Journa l of School Health. 62 . 294-297. ~ 1 Marsigho. W. & Mott. F. (1986). The impact of sex education on sexual activity, contraceptive use and premarital pregnancy among American teenagers. Family Planning Perspectives. 18 . 151-162. ~ McGinnis, J. M. (1993). The year 2000 initiative: Implications for comprehensive school health. Preventive Medicine 79 493.493 Muraskin. L. D. (1986). Sex education mandates: Are thev the answer 9 Familv Planning Perspectives. 18 171-174. " National Guidelines Task Force. (1991). Guidelines for comprehensive sexuality gdu cation: Kindergarten12th prnde New York: SIECUS.

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166 Nord, C. W.. Moore. K. A.. Morrison. D. R., Brown. B., & Myers. D. E.. (1992). Consequences of teen-age parenting. Journal of School Health. 62 . 310-31 8. Oganowski. J. L„ Detert. R. A., Bradley, C.. & Schindler, J. (1996). The Wisconsin elementary health education pilot project: On-site interviews of student learning and curricular integration. Journal of Health Education. 27 . 235-241. Ogletree. R. J.. Fetro. J. V.. Drolet. J. C, & Rienzo. B. A. (1994). Sexuality Education Curricula: The Consumer's Guide . Santa Cruz. CA: ETR Associates. Orr. M. T. (1982). Sex education and contraceptive education in U.S. public high schools. Family Planning Perspectives. 14 . 304-313. Report of the HIV/STD prevention and human sexuality education task force: Components of quality HIV/STD prevention and human sexuality education . (1994). The Department of Health and Rehabilitative Services and The Florida Department of Education Comprehensive School Health Program. Rodriguez, M.. Young, R.. Renfro. S.. Asencio, M.. & Haffner, D. W. (1995/96). Teaching our teachers to teach: A SIECUS study on training and preparation for HIV/AIDS prevention and sexuality education. SIECUS Report. 24 (2). 15-23. Rosoff, J. I. (1989). Sex education in the schools: Policies and practice. Family Planning Perspectives. 21 . 52. 64. Sexuality education in America: A state-bv-state review . (1995). Washington, DC: The NARAL Foundation. SIECUS fact sheet #3: On comprehensive sexuality education: Sexuality education and the schools: Issues and answers. (1992). SIECUS Report. 20 (6), 13-14. Smith. P. B.. Flaherty, C., Webb. L. J., & Mumford. D. M. (1984). The long-term effects of human sexuality training programs for public school teachers. Journal of School Health. 54 . 157-159. Sonenstein F. L. & Pittman, K. J. (1984). The availability of sex education in large city school districts. Family Planning Perspectives. 16 . 19-25. Teens talk about sex: Adolescent sexuality in the 1990's. (1994). SIECUS Report. 22(5). 16-17.

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167 Telljohann, S. K., Everett, S. A., Durgin. J.. & Price, J. H. (1996). Effects of an inservice workshop on the health teaching self-efficacy of elementary school teachers. Journal of School Health. 66 . 261-265. Vincent, M. L., Clearie, A. F.. & Schluchter, M. D. (1987). Reducing adolescent pregnancy through school and community-based education. Journal of the American Medical Association. 257 . 3382-3386. World Health Organization: Education and Treatment in Human Sexuality: The Training of Health Professionals (Report of a WHO Meeting, Technical Report Series, No. 572), 1975. Yarber. W. L. (1994). Past, present and future perspectives on sexuality education. In J. C. Drolet & K. Clark (Eds.), The sexuality education challenge: Promoting healthv sexuality in young people (pp. 3-28). Santa Cruz, CA: ETR Associates. Yarber. W. L. & McCabe. G. P. (1981). Teacher characteristics and the inclusion of sex education topics in grades 6-8 and 9-11. Journal of School Health. 5 1 . 288-291. Yarber, W. L.. Torabi, M. R.. & Haffner, D. W. (in press). Comprehensive sexuality education in Indiana secondary schools: Instructional topics, importance ratings, and correlates with teacher traits. American Journal of Health Studies . Zabin, L. S., Hirsch, M. B.. Smith. E. A. Streett, R.. & Hardy, J. B.. (1986). ' Evaluation of a pregnancy prevention program for urban teenagers. Family Planning Perspectives. 18 . 119-126. Zelnik, M. & Kim. Y. J. (1982). Sex education and its association with teenage sexual activity, pregnancy, and contraceptive use. Family Planning Perspectives. 14 . 1 1 7126.

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BIOGRAPHICAL SKETCH I started my undergraduate degree at the University of Florida in the Fall of 1987. 1 received a Bachelor of Science degree in psychology in May 1991. In the Spring of 1992. I entered graduate school at the University of Florida. I received a Master of Health Science Education degree with a specialization in health promotion in December 1993. I will be granted a Doctor of Philosophy in health and human performance with an emphasis in health behavior and a minor in human sexuality through the College of Health and Human Performance, Department of Health Science Education in May 1997. I started as a professor at Western Kentucky University in the Department of Public Health in August of 1996. 168

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I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, Philosophy. as a dissertation for the degree of Doctor W/l . Barbara A. Rien/o. CKa Professor of Health Science E cation I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Docto^of Philosophy. 4s'-'m R. Morgan Pij Professor of Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. M. David Miller Professor of Foundations of Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy.