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Girls delayed first intercourse, but safe-sex practices didn't improve

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By
HealthDay Reporter

THURSDAY, July 22, 2004 (HealthDayNews) -- A school-based sex education program taught by older students helped girls delay their first intercourse.

But the program didn't have a similar impact on boys, and it didn't increase the likelihood the teens would use protection, reports a study in the July 24 issue of The Lancet.

The study by the British researchers was prompted by concern that the United Kingdom has the highest under-18 pregnancy rates in western Europe. The researchers evaluated sex education programs taught to 13- and 14-year-olds by 16- and 17-year-olds, and compared them to the more traditional programs led by teachers. They assigned 8,000 students in 27 schools to either a peer-led group or a teacher-led group.

By age 16, fewer girls from the peer-led group reported intercourse than girls in the teacher-led group; 35 percent of the peer-taught girls said they were having sex, compared to 41 percent of the teacher-led students.

No differences were found among the boys in either group. Thirty-three percent of the boys in the peer-led programs and 31 percent in the teacher-led sessions had sex for the first time before age 16.

And the proportion of students reporting unprotected first sex didn't differ for girls or boys, regardless of whether they were taught by peers or teachers.

Judith Stephenson, senior lecturer in epidemiology at University College London and the study's lead author, said that although the peer-led groups didn't boost the numbers of teens practicing safer sex, "we were encouraged to find high levels of contraception use irrespective of the type of sex education received. Four out of five girls and four out of five boys used contraception the first time they had sex."

Girls in the peer-led groups had fewer unintended pregnancies, with 2.3 percent of them becoming pregnant, compared to 3.3 percent of the girls in the traditional programs.

The peer-led groups consisted of three one-hour sessions during which the teens discussed birth control, information about sexually transmitted infections, and relationships. The older teens received special training before leading the groups. And they could go to teachers for help, although teachers weren't in the classrooms during the sessions.

Stephenson said her next plan is to explore the concept of single-gender sessions rather than mixed gender sessions.

The teacher-led groups, she said, included information traditionally taught in sex-education classes.

The peer-led groups focused more on practical skills, such as how to use a condom. They also featured role-playing, including ways to decline sexual advances.

Stephenson said the role-playing may have been key. "The peer-led program improved knowledge about preventing sexually transmitted infection and included role play about resisting pressure to have sex, which may have led to fewer girls having sex," she said.

Asked why the peer-led groups didn't have the same effect on the boys, Stephenson said, "We can't be sure why this is. It will be useful to look more closely at single-sex sessions (which a third of the boys and more than half the girls said they would have preferred) to try to improve school sex education for boys."

In a commentary accompanying the study, Roger V. Short, a professorial fellow at the University of Melbourne in Australia, noted the severity of the pregnancy problem in England. Every year about 90,000 teen girls become pregnant, he said.

In an interview, Short suggested that England and other countries with teen-pregnancy problems should look to success stories of other nations. The Netherlands, for instance, has one of the world's lowest teen birth and abortion rates, five times lower than Britain's.

Health officials in Holland promote the "Double Dutch" approach, which advocates the simultaneous use of condoms by boys and birth-control pills by girls, he said.

In China, Short added, peer group sex education led by medical students has become very popular and successful. He took part in some of those sessions. "I guess the reason for the success is that it allows Chinese youth to speak out openly to knowledgeable peers about the very sensitive issue of sex," he said.

The snag with the British study, Short added, is that "we do not know how well-informed the peer educators were. That is what makes medical students the ideal educators, since they are well informed, and are instantly respected by their peers."

Peer-led sex education has been tried in the United States with varying results, Stephenson said.

More information

To learn more about sex education, visit Avert.org.

SOURCES: Judith Stephenson, senior lecturer in epidemiology, University College London, England; Roger Short, Wexler Professorial Fellow, University of Melbourne, Australia; July 24, 2004, The Lancet

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