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August 2004, Vol 94, No. 8 | American Journal of Public Health 1332-1335
© 2004 American Public Health Association

RESEARCH AND PRACTICE

Young Males' Sexual Education and Health Services

Marion Howard, PhD, Jackie Davis, MPH, Donnie Evans-Ray, MA, Marie Mitchell, RN and Marian Apomah, AA

Marion Howard, Jackie Davis, and Marian Apomah are with the Jane Fonda Center in the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Ga. Donnie Evans-Ray and Marie Mitchell are with the Teen Services Program at Grady Memorial Hospital, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to Marion Howard, PhD, Department of Gynecology and Obstetrics, Emory University, 1256 Briarcliff Rd, Atlanta, GA 30306 (e-mail: mhowa02{at}emory.edu).


   ABSTRACT
TOP
 ABSTRACT
References
 

This study examined the basis for one hospital’s decision to restructure its teen family planning clinical services. We examined results of surveys conducted from 1998 to 2003 with more than 2000 mostly African American eighth-grade boys. Most young males wanted to postpone sexual intercourse, but an even greater percentage were willing to use a method of protection. The hospital determined that it needed to give the same in-hospital clinical and counseling support to young males as it gives to young females.

Since 1985, a publicly funded hospital in a large southern city has carried out a sustained effort to reach eighth-grade adolescents in middle school (those aged 13 and 14 years) with information about abstinence and methods of protection against pregnancy and sexually transmitted diseases (Table 1Go). This outreach effort has been supported by the provision of family planning clinical services for teenagers (more than 1500 girls each year) at the hospital. By stretching its health education net across the schools at one level, over time, the hospital has ensured that all 13- to 19-year-olds (almost 20 000 teenagers) who currently attend or have attended city schools in its primary catchment area have been given such important information.


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  		TABLE 1— Changes Leading to Male Health Services
 
An earlier 5-year study (1985–1990) showed that the outreach educational program held promise.1 More recent data may indicate that the hospital is making progress. The county where the schools and hospital are located has shown a decline in teenage pregnancy (1997–2000) nearly twice that of a similar neighboring county where hospital staffing and funding have not permitted a similar effort.2

However, continuing needs for improvement recently motivated the hospital’s teen services program to try to better define the value of its programs to young males. The notion was that adding clinical reproductive health services for young males in support of its outreach education might produce even greater gains. To help make the decision about offering clinical services to teenaged males, data were gathered from more than 2000 eighth-grade boys representative of the 7000 mostly African American male students in the outreach education program during the period from 1998 to 2003 (89% of the studied males were African American).

Half of the teen services program’s presentation time in the public schools is spent on building the skills of youths to resist social and peer pressures toward sexual involvement. The goal of the effort is to provide reinforcement and support for continuing to postpone sexual involvement among those who have not had sexual intercourse and to give those who have had sexual intercourse an opportunity to rethink their behavior. (At pretest, the studied eighth-grade boys were fairly evenly split, with 52% stating that they have not had sexual intercourse and 48% stating that they have.) Role modeling by male high-school-aged leaders who coteach this part of the course is core to the effort. The teenaged leaders show younger boys that males can be popular and successful in the teenage world without becoming sexually involved.3

Over the last 5 years—postprogram—data showed that a consistent 83% of the young males stated that they gained new information about how to resist social and peer pressures, and two thirds thought that it would actually be easier to say "no" to sexual intercourse in the future. Moreover, following the program, data indicated that among those who have had sexual intercourse, the proportion who will continue to have sexual intercourse will significantly decrease (preprogram, 37% indicated that they would continue, whereas that was true for only 24% postprogram). Among those who have not had sexual intercourse, data did not significantly change (preprogram, 9% indicated that they intended to begin having sexual intercourse, compared with 7% postprogram).

The other half of the presentation time in the schools is spent discussing male and female reproductive systems, potential negative consequences of sexual involvement, where to obtain methods of protection, and how to use them. Postprogram, a fairly consistent 92% of all young males affirmed that they received new information about teenage pregnancy, sexually transmitted infections, and the risks of sexual intercourse. Over the 5 years studied, postprogram, 94% of all teenaged males said that they would be more likely to use protection the next time they have sexual intercourse because of what they have learned. Cross-year data suggest that this result rests not only on improved knowledge and attitudes postprogram (Table 2Go) but also on a consistent preexisting notion among 4 out of 5 young males that teenage pregnancy could negatively interfere with their future plans and limit how they might be able to live their lives in the future.


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  		TABLE 2— Gains in Positive Knowledge, Attitudes, and Intended Behaviors, 5-Year Data Set: Eighth-Grade Adolescent Boys
 
The survey information, especially the data indicating each year that 94% of the young males stated that they were willing to use protection, ultimately led the teen services program to increase its efforts to assist young males in being safer by providing more support. Recently, a new hospital clinic site that is "teen-friendly" for both males and females opened for use. A major goal is to be able to give more personal assistance to young males in handling their sexual behaviors positively over time (both abstinence and use of protection). The added services also have an important potential for better meeting the needs of homosexual young males as well as young men who have been sexually abused.4,5

Nationwide, the trends among young people are toward less sexual risk taking through both increased use of condoms and more delay in sexual involvement; as a result, adolescent pregnancy and childbearing have declined.6,7 Through its long-term practice of investing in the health education of young African Americans, in addition to the current increased emphasis on young males by offering clinical services to them, the hospital hopes to continue to add to that trend.


   Acknowledgments
 
Funding for this project came from the US Office of Population Affairs and the Fonda Family Foundation.

Human Participant Protection
Data collection for this study was approved by Emory University’s institutional review board.


   Footnotes
 
Contributors
M. Howard conceived the study and focus group, developed questionnaires, synthesized data, and drafted the brief. J. Davis assisted with all phases of the study and managed data entry and data analysis. D. Evans-Ray assisted in questionnaire development, supervised outreach staff who collected data, and selected focus group participants. M. Mitchell assisted in questionnaire development, arranged for data collection in schools, conceptualized the makeup of focus groups, assigned staff to contact potential youth participants, coordinated arrangements for focus groups, and reviewed and approved content for discussion. M. Apomah was responsible for data entry and management. All authors helped to conceptualize ideas, interpret findings, and review drafts of the brief.

Peer Reviewed

Accepted for publication November 21, 2003.


   References
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 ABSTRACT
 References
 
1. Howard M. Delaying the onset of intercourse among adolescents. In: Coupey S, Klerman L, eds. Adolescent Medicine: State of the Art Reviews. Philadelphia, Pa: Hanley & Belfus Inc; 1992:181–193.

2. Teen Births, Induced Abortions, Fetal Deaths, Georgia 1990–1997. Atlanta: Division of Public Health Epidemiological Unit, Department of Human Services, State of Georgia; 2000.

3. Green T. Peer Education Programs, Adolescent Health Research Updates. Anchorage: Alaska Department of Health and Social Services; 1998:1–7.

4. Rich J, Ro M. A Poor Man’s Plight: Uncovering the Disparity in Men’s Health. Battle Creek, Mich: WK Kellogg Foundation; 2002:3–8.

5. Street S. Adolescent male sexuality issues. Sch Couns. 1994;41:319–325.

6. Sonenstein F, Ku L. Young Men’s Sexual and Reproductive Health: Toward a National Strategy. Washington, DC: The Urban Institute; 2000:61–65.

7. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: final data for 2000. Natl Vital Stat Rep. February 12, 2002;50(5):1–101.





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Right arrow Citing Articles via ISI Web of Science (1)
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Right arrow Articles by Howard, M.
Right arrow Articles by Apomah, M.
Related Collections
Right arrow Adolescent Health
Right arrow Contraception
Right arrow Health Promotion
Right arrow Access to Care
Right arrow Prevention
Right arrow Health Education
Right arrow African Americans/Blacks
Right arrow Sexual Health
Right arrow Men's Health

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