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Running head: PILOT PROGRAM OF SEXUAL HEALTH CURRICULUM 1

Research Proposal: Pilot Program of Sexual Health Curriculum for Youth in Hattiesburg Public

School District, Forest County, Mississippi

Maria Lira Marquez: 003409509

Alejandra Sanchez: 004685537

HSCI 608: Health Research Methods

Dr. Yen
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Abstract: The purpose of this research study is to prospectively determine the knowledge of

students based on current sexual health curriculum that is already being implemented but is not

inclusive of information of prevention of sexually transmitted infections and also if they are

knowledgeable of alternative birth control methods in the Hattiesburg Public School District in

Forrest County, Mississippi. A thorough literature review was conducted and created the gap that

equivalent mandatory nationwide sexual health curriculums have not been implemented and

hence up brought the need for an implementation of a pilot program to address this issue. A

correlational research design through survey administration by health education staff to students

in the Hattiesburg Public School District was chosen to ensure results are a generalizable

representation of youth in Forrest County, Mississippi. This research design allows for the

responses to provide both quantitative and qualitative data. Due to the lack of mandatory

nationwide policy implementation and equivalent curriculum on school campuses that is

evidenced-based sexual health curriculum amongst youth aged 12-19 years of age in the United

States, it is hypothesized that there is a lack of knowledge on alternative sexual practice methods

amongst this population. This mandatory equivalent sexual health curriculum implemented

nationwide can decrease the gap of misinformation or lack of knowledge among youth to reduce

the rates of teen birth and sexually transmitted infections that are currently at alarming high rates.

Introduction: In the United States, the rates of teenage pregnancy and sexually transmitted

infections among youth of 12-19 years of age has consistently maintained itself at a marginally

high rate. In the year 2017, there were a total of 194,377 babies born to female youth within 15-

19 years of age making a rate of 18.8 per 1,000 hence making this an alarming rate among this

youth population.1 Geographic differences in teen birth rates and sexually transmitted infections

persist, both nationwide and within states. Among some states with low overall teen birth rates
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and sexually transmitted infection rates, some counties have higher rates in these topics than

those of the nation as a whole.1 Nationwide high birth rates are not the only public health issue in

regards to the lack of sexual health education, as previously mentioned, sexually transmitted

infections are also at alarming rates within the same youth age groups. Young people aged 15-24

account for nearly half of all newly diagnosed sexually transmitted infections.2 Based on

extensive literature review there is a gap due to lack of mandatory sexual health education

curriculum equivalent across all states. Due to the lack of mandatory nationwide policy

implementation and equivalent curriculum on school campuses that is evidenced-based sexual

health curriculum amongst youth aged 12-19 years of age in the United States, it is hypothesized

that there is a lack of knowledge on alternative sexual practice methods amongst this population.

Based on this hypothesis, there is an increase of misinformation for youth who within this age

range are now placed at a higher prevalence of unhealthy sexual activity.

Most states have approved a form of policy that allows for implementation of sexual health

curriculums to be taught at public schools. Not all states have passed a bill to implement this

policy, and legislator stakeholders are also allowed to tailor how they chose to implement such

policy. Currently, 24 states and the District of Columbia require public schools teach sex

education; 21 of which mandate sex education and HIV education.3 33 states and the District of

Columbia require students receive instruction about HIV/AIDS. 20 states require that if provide,

sex and/or HIV education must be medically, factually or technically accurate. State definitions

of “medically accurate” vary, from requiring that the department of health review curriculum for

accuracy, to mandating that curriculum be based on information from “published authorities

upon which medical professionals rely.3 In the state of California, as of January 1, 2016 the

Healthy California Youth Act was enacted which requires school districts to provide students
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with integrated, accurate, and inclusive comprehensive sexual health education and HIV

prevention education, to be taught at least once in high school and once in middle school. Prior

to the Healthy California Youth Act, AB 517: The California Comprehensive Sexual Health and

HIV/AIDS Prevention Education Act: did not pass in 2015 in the state of California.4 The AB

517 similar to the Healthy California Youth Act which was enacted in 2016 proposed that school

districts provide sexual health education that also include HIV/AIDS prevention education.5, 6

The California Department of Public Health announced that there is a record low of 15.7

births per 1,000 females between the ages of 15 and 19. Therefore, reflecting an 11% decline

within one year implementation of the Healthy California Youth Act.4 More information would

be necessary to determine the full impact of the Healthy California Youth Act but based on this

information the need arises for a nationwide equivalent curriculum across all public schools. The

research proposal goal is to focus on implementation of a pilot program of sexual health

curriculum amongst public schools within the State of Mississippi. Selection of this state was

made after continuous research demonstrates that the State of Mississippi is within the top 5

states with the highest sexually transmitted infection rates in comparison to the nation. Further

research then lead to the discovery of no current sexual health curriculum implemented in this

state. Mississippi currently considers any individual under the age of 21 to be a minor.7 This is

important to mention as each state defines different legal ages for minors. The state of

Mississippi ranks third among the nation in teen birth rates, and second in the most common

sexually transmitted infections such as chlamydia and gonorrhea, Forrest County has even more

alarming rates in both of these categories. The teen birth rate for Forrest County is 34.9 per 1,000

in comparison to the state with the rate of 34.8 3. In sexually transmitted infections in Forrest
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County the rate for chlamydia per 100,000 is 825.6 and gonorrhea 421.4 in comparison to the

state having the rates of 580.6 for chlamydia and for gonorrhea 193.0.7

To prevent these public health issue outcomes, sexually experienced adolescents require

sexual and reproductive health care that includes preventative counseling, risk assessment,

provision of contraceptives, and sexually transmitted disease (STD) testing and treatment.

Implementation of a pilot program for sexual health curriculum would decrease teen pregnancy

and childbearing which currently bring substantial social and economic costs through immediate

and long-term impacts on teen parents and their children.8-10 In addition, a pilot program for

sexual education might reduce the $9.4 billion cost to taxpayers for teen childbearing as well as

the $6.5 billion spent annually in medical costs for treating young people with sexually

transmitted infections.11

Methods: Sample population: The sample population for this research would be youth under the

age of 21 (as defined as the legal minority age in the state of Mississippi) who are currently

enrolled Hattiesburg Public School District in Forest County in the state of Mississippi.12 The

sample was chosen due to this school district providing the most generalized population among

all school districts within this county. Hattiesburg school district has the most schools in

comparison to the other school districts in Forrest County. This is the only school district who

has two middle schools and two high schools while the rest of the districts have only one school

for each category.7 Inclusion of all participants for this pilot program fall within the age group at

risk of teen births and sexually transmitted infections. For the purpose of this study students over

the age of 19 or no longer enrolled in a public school would be excluded from the study in efforts

to obtain the most relevant information that can be addressed towards the proposed goal.
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Sampling method: The sampling method chosen for the purpose of this study was a stratified

sampling. A stratified sampling was deemed most appropriate for this study due to our sample

population being a subpopulation of the entire county. The subpopulation is representative for

the purpose of this study because it focuses on a county in which teen birth rates and sexually

transmitted infections are at alarming rates and because the sexual health education material

excludes the use of any alternative methods besides abstinence.13 In conducting a stratified

sampling it allows for reduction of selection bias to ensure the most accurate results are obtained.

Variables: The independent variables of this study consist of gender, age, and ethnicity.14 The

dependent variables would be the awareness of sexual health curriculum within the participants’

school, their awareness and knowledge on alternative methods apart from abstinence for birth

control and prevention of sexually transmitted infections.15, 16 These variables were chosen as

they can be defining factors that help best understand the results obtained through this pilot

program. Confounding variables for this study can be the students choice of participation, their

personal views and beliefs on the topics addressed as well as the influence they obtain through

their family, and or politically conservative community.17 Declined parent consent would also be

a confounding variable that can decrease the participation of some of the students in this study.

To control confounding variables it is possible to notify parents of the intention of the research

proposals ahead of time via email, automated phone call to the home, and a letter that would be

sent via postal mail. Another suggestion to help reduce or control confounding variables could be

to have school staff administration discuss with parents the purpose of the research during parent

meetings or extracurricular activities outside of normal school hours.18

Measurements/tools: The tools used for the purpose of this study would be the administration

of surveys during current health education courses. Choosing this way of distribution would
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allow for relevance of the curriculum implemented to that specific course and bring willingness

from students to participate in this study. This correlational quantitative research design was

chosen because it allows for understanding of the awareness and knowledge of the participants to

the topics presented (see appendix).

Participants were informed that all information obtained would be anonymous and would

only be disclosed for study purposes. Participants were asked to provide written informed

consent and had an opportunity to ask questions for ethical consideration. Any personal

information would not be connected to data files, therefore ensuring autonomy, confidentiality,

and anonymity. Parental consent would be sent prior to initiation of the study to comply with

laws within the state.

IRB application would be submitted and required to be approved due to information

obtained by this study involves human subjects and needs to provide ethical and regulatory

oversight of the research. IRB application would ensure that all rights, welfare and well-being of

all human research participants recruited to participate in this research are enforced to the highest

ethical standards. By establishing compliance it would ensure relevant local, state, and federal

laws and regulations are also not bypassed. Upon approval of IRB application, implementation

of research program proposed would be conducted.

Public Health Implications: After conducting a thorough literature review to address the

current gap of a lack of mandatory sexual health education curriculum equivalent across all states

would benefit for the betterment of public health policies. The research proposal of this pilot

program for Forrest County would then lead to the betterment of services and programs already

in place in the state of Mississippi. The results from this pilot program can be used to initiate a

statewide understanding of why such programs are necessary to reduce sexual transmitted
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infections as well as decrease high teen birth rates. Further studies can also use the results of this

research as a reference for future public health research amongst other states who also have

currently high sexual transmitted infection rates and high teen birth rates.19 The significance of

the research from this pilot program could close the gap that current literature reviews are

missing. Most literature reviews mention the barriers to care seeking among adolescents such as;

confidentiality concerns, stigma, insufficient knowledge about available services, poor

accessibility, and adolescents’ perceptions.20 While other literature reviews focus on parenteral

aspects, religion, minorities such as specific ethnicities, and policies covering this topic yet none

of the literature reviewed mention the importance of a sexual health education curriculum

equivalent across all states. Future research might compare the effectiveness and/or acceptability

of interventions that incorporate the recommendations of the current study and interventions

available.

Limitations: Our findings should be considered in the content of study limitations due to

multiple factors. The research proposal goal is to focus on implementation of a pilot program of

sexual health curriculum amongst public schools within the State of Mississippi. Based off the

data collected we could determine the need of a full sexual health curriculum that does not solely

include abstinence only promotion but provides alternative methods of birth control which can

also reduce the risk for sexually transmitted infections. Answers provided by students are

considered a limitation due to self-reporting. Recall bias is also a limitation for participants as

they try to answer the survey.


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References:

1. “About Teen Pregnancy | CDC.” Centers for Disease Control and Prevention, Centers

for Disease Control and Prevention, www.cdc.gov/teenpregnancy/about/index.htm.

2. Dittus, De Rosa, Jeffries, Afifi, Cumberland, Chung, . . . Ethier. (2014). The Project

Connect Health Systems Intervention: Linking Sexually Experienced Youth to Sexual

and Reproductive Health Care. Journal of Adolescent Health, 55(4), 528-534.

3. Blackman, Kate, and Samantha Scotti. State Policies on Sex Education in Schools,

www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx.

4. “Comprehensive Sexual Health & HIV/AIDS Instruction.” Comprehensive Sexual Health

& HIV/AIDS Instruction - Health (CA Dept of Education), www.cde.ca.gov/ls/he/se/.

5. Sabia, & Anderson. (2016). The effect of parental involvement laws on teen birth control

use. Journal of Health Economics, 45, 55-62.

6. Tucker, J., Ober, A., Ryan, G., Golinelli, D., Ewing, B., & Wenzel, S. (2013). To use or

not to use: A stage-based approach to understanding condom use among homeless

youth. AIDS Care, 26(5), 1-7.

7. “Forrest.” Teen Health Mississippi, teenhealthms.org/county-stats/forrest/.

8. Caal, Guzman, Berger, Ramos, & Golub. (2013). "Because You're on Birth Control, It

Automatically Makes You Promiscuous or Something": Latina Women's Perceptions of

Parental Approval to Use Reproductive Health Care. Journal of Adolescent Health,53(5),

617-622.

9. Kassab, V., Acevedo-Polakovich, I., Grzybowski, M., Stout, S., Richards, A., Barnett,

M., . . .Saxena, S. (2014). Views on Sex and Sex Education Among Gang-Involved

Latino Youth in the United States. Qualitative Health Research, 24(5), 654-664.
PILOT PROGRAM OF SEXUAL HEALTH CURRICULUM 10

10. Ocasio, Feaster, & Prado. (2016). Substance Use and Sexual Risk Behavior in Sexual

Minority Hispanic Adolescents. Journal of Adolescent Health, 59(5), 599-601.

11. Yoost, Hertweck, & Barnett. (2014). The Effect of an Educational Approach to

Pregnancy Prevention Among High-Risk Early and Late Adolescents. Journal of

Adolescent Health, 55(2), 222-227.

12. “Mississippi Legal Ages Laws.” Findlaw, statelaws.findlaw.com/mississippi-

law/mississippi-legal-ages-laws.html.

13. Oman, Vesely, Aspy, Tolma, Gavin, Bensyl, . . . Fluhr. (2012). A Longitudinal Study of

Youth Assets, Neighborhood Conditions, and Youth Sexual Behaviors. Journal of

Adolescent Health, 52(6), 779-785.

14. Boustani, Frazier, & Lesperance. (2017). Sexual health programming for vulnerable

youth: Improving knowledge, attitudes, and behaviors. Children and Youth Services

Review, 73, 375-383.

15. O&Amp;Apos, Uhuru, Deborah J., Santiago, Vivian, Murray, Lauren E., Travers,

Madeline, & Bedell, Jane F. (2017). Bronx Teens Connection's Clinic Linkage Model:

Connecting Youth to Quality Sexual and Reproductive Health Care. Journal of

Adolescent Health, 60(3), S38-S44.

16. Cohen, Sheeder, Kane, & Teal. (2017). Factors Associated With Contraceptive Method

Choice and Initiation in Adolescents and Young Women. Journal of Adolescent

Health,61(4), 454-460.Dittus, De Rosa, Jeffries, Afifi, Cumberland, Chung, . . . Ethier.

(2014). The Project Connect Health Systems Intervention: Linking Sexually Experienced

Youth to Sexual and Reproductive Health Care. Journal of Adolescent Health, 55(4),

528-534.
PILOT PROGRAM OF SEXUAL HEALTH CURRICULUM 11

17. Tipwareerom, W., & Weglicki, L. (2017). Parents' knowledge, attitudes, behaviors, and

barriers to promoting condom use among their adolescent sons. Nursing & Health

Sciences, 19(2), 212-219.

18. Matta Oshima, Narendorf, & Mcmillen. (2013). Pregnancy risk among older youth

transitioning out of foster care. Children and Youth Services Review, 35(10), 1760-1765.

19. Barcelos, C. (2018). Culture, Contraception, and Colorblindess: Youth Sexual Health

Promotion as a Gendered Racial Project. Gender & Society, 32(2), 252-273.

20. Hyde, Fullerton, Lohan, Dunne, & Macdonald. (2016). The role of knowledge in the

contraceptive behaviour of sexually active young people in state care. Sexual &

Reproductive Healthcare, 8, 37-41.


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Appendix:

Research survey for implementation of Pilot Program on Sexual Health in Forrest County

All information collected is anonymous and will remain confidential and will only be used
for the sole purpose of this research. The purpose of this survey is to understand the knowledge
and birth control choices of youth ages 12- 19 years of age.

1. What is your age group?


 Under 12 years old
 12-15 years old
 15- 19 years old

2. What is your gender?


 Female
 Male

3. What best describes your race/ethnicity?


 Caucasian
 African American
 Hispanic or Latino
 Native American or American Indian
 Asian/Pacific Islander
 Other (Please Specify): _________________

4. Within the last 3 months have you been sexually active?


 Yes
 No
 Prefer not to answer

5. Are you aware of any type of sexual education within your school?
 Yes
 No

6. Do you know of any sexually transmitted infection barrier methods except abstinence
only?
 Yes
 No

7. Are you using any type of birth control except abstinence only?
 Yes
 No

8. What type of birth control do you use if any?


_______________________________
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9. Why did you choose this type of birth control?


 Costs less money
 More readily available
 More privacy
 Other, please specify: ________________

10. If you are not using a birth control method what made you make this decision? (Select all
that apply)
 Lack of privacy
 Cost of birth control method
 Stigma about birth control
 Other, please specify:_________________

11. Do you have any comments or recommendations:


________________________________________________________
________________________________________________________
________________________________________________________

Thank you for taking this survey.