Sexual Education Program for 12th grade Students to Increase Condom Use during Sexual Intercourse

Ba, C., Clark, S., Cruz, M.

Sexual Education Program for 12th grade Students to

Increase Condom Use during Sexual Intercourse

Program Plan for Westside High School in Health Zone 4 of Duval County
Jacksonville, Florida.

HSC6587: Public Health Program Planning

Authors: Cire Ba, Sarah Clark and Margaret Cruz

1
Sexual Education Program for 12th grade Students to Increase Condom Use during Sexual Intercourse
Ba, C., Clark, S., Cruz, M.

Introduction and Needs Assessment

According to Leigh E. Szucs, PhD, et al., (2019), preventing sexually transmitted diseases
(STDs), including human immunodeficiency virus (HIV) is a United States Public Health priority.
It is estimated that there are at least 20 million new STD cases per year and about half of those
cases are individuals who are between the ages of 15 and 24 years old (Healthy People, 2020).
According to Joyce C. Abma, Ph.D., and Gladys M. Martinez, Ph.D. (2018), this health priority is
most important among the adolescent population as they are most likely to start engaging in
sexual intercourse. By engaging in sexual behaviors at an early age, an individual is more likely
to have more sexual partners and are more likely not to use a condom during sexual
intercourse (Abma et al, 2017). In turn, this creates an increased risk of an individual
contracting an STD or HIV infection.

The CDC reported that most males and females had their first sexual intercourse by the
age of 18 years old (CDC, 2017). Since first sexual intercourse was reported to be by the age of
18, it is crucial to teach adolescents the importance of condom use. This needs assessment, will
focus on Duval County (Jacksonville) high school seniors in Health Zone 4 at West Side High
School. As high school students get older, the chances of them engaging in sexual behaviors
increases and for that reason, they should be taught about the importance of condom use. In
Health Zone 4, among high school students, only 45% reported using a condom during their last
sexual intercourse (YRBS, 2020).
In 2018, the Youth Risk Behavior Surveillance System (YRBS), reported that condom use
among students decreased from 61% to 54% (YRBS, 2019). Although this decrease may seem
small, when condoms are not used during every sexual intercourse, a person’s risk for
contracting an STD or an HIV infection increases significantly. This type of increase could lead to
a serious public health crisis among adolescents. In 2015, the CDC reported condom use among
students who attended a Duval County Public school which had the lowest rate of condom use
than students in other counties in the state of Florida (CDC, 2015). According to the CDC, Duval
County high school student’s rates of condom use were the lowest in the state of Florida and
the rate of STD’s was 1.7 times higher than Florida’s average rate (CDC, 2017). Behaviors that
can contribute to a decreased use of condoms include, having multiple sexual partners, those
who consumed alcohol prior to their last sexual intercourse or did drugs (CDC, 2015).
It is crucial to overcome predisposing and enabling factors. Reinforcing factors are also
necessary to increase condom use. Some predisposing factors for condom use can include
individual and family beliefs and education level (Pediatrics, 2013). Although there are more
predisposing factors, beliefs and education level play a significant role in the decisions people
make about their health. Enabling factors can include allowing the distribution of condoms to
students or informing them of where to find condoms. By overcoming these types of barriers,
students may be more willing to use condoms. Social support for condom use can provide
positive reinforcement to high school seniors. Social support can include talking about condom

2
Sexual Education Program for 12th grade Students to Increase Condom Use during Sexual Intercourse
Ba, C., Clark, S., Cruz, M.

use and making it more normal and easier to discuss. This can help make sexually active high
schoolers comfortable with using condoms and can help increase condom use.

Planning Model
This needs assessment will be using the Health Belief Model as it focuses on an
individual’s perceptions of the threat posed by a health problem, the benefits of avoiding the
threat and the factors that influence an individual’s decision to act. The threat in this needs
assessment is contracting an STD infection and/ or teen pregnancy. The benefits of using
condoms would be decreasing an individual’s chances of contracting an STD or an HIV infection.
The factors that would influence an individual's decision to use condoms during sexual
intercourse would be their confidence in using condoms, social support for using condoms and
having the resources in obtaining condoms.

Program Goal and Objectives:

Program Goal: Reduce the rates of unprotected sex among 12th grade students at Westside high
school by abstaining from sex or using condoms to prevent unintended pregnancy and the
spread of HIV and other STD’s/STI’s.
Impact learner objective: Immediately after the program 12th grade students at
Westside High School will be aware of situations that can lead to unprotected sex,
unintended pregnancy and HIV or other STD’s/STI’s.
Impact behavioral objective: Three months after the program there will be a 25%
increase among 12th grade students at Westside High School abstaining from sex, and a
25% increase in sexually active students that report condom use with their last sexual
intercourse.
Outcome objective: Six months after the program 75% of sexually active 12th grade
students at Westside High School will report using a condom with their last sexual
intercourse.

Cultural Awareness
According to the National Center of Education Statistics (NCES), race demographics of
students at Westside high school consist of 66% Black, 16% White, 12% Hispanic and 2% Asian.
This program focuses on 12th grade students at Westside High, for the sake of missing
demographic data breakdown of each grade level we will infer demographic data to the 12th
grade population in relation to the demographic of the entire school. With that being said, the
high minority population at the school as well as the young age group made up of 17 - 18-year-

3
Sexual Education Program for 12th grade Students to Increase Condom Use during Sexual Intercourse
Ba, C., Clark, S., Cruz, M.

old students make the cultural awareness even more important to the success of this program.
To ensure the success of the program, it is designed to be culturally sensitive and culturally
appropriate for this group. We will first prioritize a search for minority health educators to
conduct this program. All health educators will have required cultural diversity and inclusion
training that will best engage all participants. Other factors will include diverse individuals in
the pictures being used in advertising and educating the students. Surveys and handouts will be
created in English and Spanish to ensure validity and accessibility to all diverse individuals.
Lastly, it’s best to acknowledge the young adults as individuals who can make sound decisions
while using language that best suits the audience. Facilitated dialogue and group activities are
best suited to educate students.

Evidence-based program
In the state of Florida sexuality education is required by law in public schools and Duval
County has policies that support sexuality education (The Jacksonville Partnership for Promoting
the Health of Emerging Adolescents, 2020). The Florida Department of Health (FL DOH) in Duval
County has sites and health teen centers at schools for students to access for free and without
parental consent (Florida Health Duval County, 2020). Westside High School has a teen health
center every other Thursday after school where students can drop in for HIV or STD testing,
support groups, education, contraceptives, and condoms) (Florida Health Duval County, 2020).
Evidence based programs are effective in decreasing teen pregnancies, increasing condom use
and reducing the rate of HIV, STD’s, and STI’s (CDC, 2020). High Schools in Duval County are using
evidence based curricula Reducing the Risk (RTR) (The Jacksonville Partnership for Promoting the
Health of Emerging Adolescents, 2020).

To further improve the program, exploring other similar programs that share some of our
goals is vital to determine what works and what doesn’t work with 12th grade students. Since this
program is for 12th grade students, RTR is an example of an effective sexual education program
that has been in 3 studies. RTR is designed with 16 sequential lessons that are taught 2-3 times
each week for 45-60 minutes long for a class of up to 30 students (etr, 2020). RTR provides
students with the skills and knowledge to protect themselves from teen pregnancy and the
transmission of HIV and STD’s. RTR has 3 components used with its facilitated dialogue including
activities that make things personal (workbooks), communication and decision-making skills in
reference to reproduction and contraception, as well as practice applying skills in difficult
circumstances (etr, 2020). Benefits of RTR include a reduction in unprotected sex rates with an
increased use of contraceptives and/or condoms, or by a delayed initiation of intercourse among
inexperienced students up to 18 months after the program (Kirby D, Barth RP, Leland N, Fetro JV,
1991). RTR is also shown to reduce the rate of teen pregnancies (etr, 2020). RTR is usually taught
by teachers during the school day. This program will differ by being a shorter series taught after
school. Intervention methods could be adopted from RTR for use by this program and will

4
Sexual Education Program for 12th grade Students to Increase Condom Use during Sexual Intercourse
Ba, C., Clark, S., Cruz, M.

concentrate on using protection when you are sexually active. Since this program is after school
it is important that it includes fun activities such as art, physical activity and group work. Free
condoms will be available to participants in this after school program.

5
Sexual Education Program for 12th grade Students to Increase Condom Use during Sexual Intercourse
Ba, C., Clark, S., Cruz, M.

References

About Teen Pregnancy. (2019, March 01). Retrieved October 18, 2020, from
https://www.cdc.gov/teenpregnancy/about/index.htm

Adolescence, C. (2013, November 01). Condom Use by Adolescents. Retrieved October 18,
2020, from https://pediatrics.aappublications.org/content/132/5/973

Adolescent and School Health: Teen Health Centers. (2019). Retrieved October 18, 2020, from
https://www.cdc.gov/healthyyouth/stories/pdf/2019/DASH-
SuccessStoriesDuvalCounty.pdf
CDC. (2020, February 3). What Works: Sexual Health Education. Retrieved from
https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm
Contraceptive Use in the United States. (2020, April 17). Retrieved November 18, 2020, from
https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
Etr. (2020). Reducing the Risk. Retrieved from https://www.etr.org/ebi/programs/reducing-the-
risk/
Ethier, PhD, K. A., Kann, L., & McManus, T. (2018, January 04). Sexual Intercourse Among High
School Students - 29 States and United States Overall, 2005–2015. Retrieved October 18,
2020, from https://www.cdc.gov/mmwr/volumes/66/wr/mm665152a1.htm
Florida Health Duval County. (2020). Teen Health Resources. Retrieved from
duval.floridahealth.gov
K irby D, Barth RP, Leland N, Fetro JV. Reducing the risk: impact of a new curriculum on sexual
risk-taking. Fam Plann Perspect. 1991 Nov-Dec;23(6):253-63. PMID: 1786806.
Layzer, PhD, C., Rosapep, M.A., L., & Barr, Psy.D., Psy.M., S. (2014, March 01). A Peer Education
Program: Delivering Highly Reliable Sexual Health Promotion Messages in Schools.
Retrieved November 18, 2020, from https://www.jahonline.org/article/S1054-
139X(13)00851-3/fulltext

Martinez, PhD, G. M., & Abma, PhD, J. C. (2017, June 22). Over Half of U.S. Teens Have Had
Sexual Intercourse by Age 18, New Report Shows. Retrieved October 18, 2020, from
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2017/201706_NSFG.htm

National Center for Education Statistics. (2018). Retrieved October, 2020, from
https://nces.ed.gov/ccd/schoolsearch/school_detail.asp?Search=1&DistrictID=1200480&
SchoolPageNum=14&ID=120048000762

6
Sexual Education Program for 12th grade Students to Increase Condom Use during Sexual Intercourse
Ba, C., Clark, S., Cruz, M.

Szucs, PhD, L. E., Lowry, MD, R., Fasula, PhD, A. M., Pampati, MPH, S., Steiner, PhD, R. J.,
Koumans, MD, E. H., . . . Copen, PhD, C. E. (2020, August 21). Condom and Contraceptive
Use Among Sexually Active High School Students — Youth Risk Behavior Survey, United
States, 2019. Retrieved October 18, 2020, from
https://www.cdc.gov/mmwr/volumes/69/su/pdfs/su6901a2-H.pdf
The Jacksonville Partnership for Promoting the Health of Emerging Adolescents. (2020).
Sexuality Education & Health Services in Schools Fact Sheet, Duval County 2020-2021.

Youth Online. (n.d.). Retrieved October 18, 2020, from

https://nccd.cdc.gov/YouthOnline/App/Results.aspx?TT=B
Zellner Lawrence, T., Henry Akintobi, T., Miller, A., Archie-Booker, E., Johnson, T., & Evans, D.
(2016, December 24). Assessment of a Culturally-Tailored Sexual Health Education
Program for African American Youth. Retrieved October, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295265/%E2%80%AF%E2%80%AF