volume 2, issue 2 Sexuality Education Innovating in Sexual Health Education Insights from Research conducted by adults on sexual health education for youth often misses Youths’ categories of information youth feel they Anonymously need about sexual health and healthy sexu- Submitted ality. Meanwhile, state and federal laws set parameters for what can be taught in sexual Questions education curricula, further delimiting the inclusion of information important to youth. two educational sites and informs what sexual This brief reports on what Arizona youth said health curricula for youth should include. they wanted to learn about sexual health and Moreover, the types and content of anony- healthy sexuality when presented with the mous questions asked by youth indicates that opportunity to submit anonymous questions they are not simply interested in the act of sex about sex during a sexual health education but rather comprehensive information about course. While the types and content of ques- bodies, diverse sexualities, social/sexual rela- tions asked were quite diverse, results indi- tionships, and psychological well-being. cate consistency in questions asked across

The Context not permitted to engage in public school curriculum. AZ bill R7-2-303 limits Arizona Legislation R7-2-303, what can be taught. It does not, for example, SB 1309 and Sex Ed require the inclusion of information on con- Abstinence-based sex education has been traceptives or use as a way to pro- the norm for the past two decades in pub- tect against sexually transmitted diseases or lic schools in the United States, with some unplanned . AZ SB 1309 imposes states more restrictive than others regard- restrictions on who can participate in sexual ing what can be included in sex education education classes, requiring parental consent curricula. In Arizona, two laws define the for students to “opt-in” to sexual education content that is allowed along with who is/ is courses as well as any course in which sex and sexuality might come up as relevant top- ics. As a result, information on sexual health and healthy sexuality is lacking, and some students in Arizona do not receive any sex education in their schooling. What do youth want to know? Types and content of anonymous questions

Four types of questions Sex Education that Ad- dresses Youth We examined youth generated sex-related anonymous questions Concerns across two settings: a residential substance-abuse treatment pro- gram for adolescent females and a community-based program for The Importance of adolescent males and females. Questions were collected January Anonymous Questions 2009 - November 2010 and analyzed for both the type and content Youth-driven, relevant and flexible com- of questions asked. prehensive sexuality education is es- While questions were complex and include knowledge-seeking sential to the sexual health and healthy across categories, the four types of questions most commonly sexuality of young people. To advance asked by youth, in order of prevalence, concerned: curriculum and educational practice, many programs are looking for method- Technical (bio-medical) knowledge: Physiological or sexual ological frameworks and perspectives facts/processes, how something works (e.g. how a cervical cap that take into account the sexual op- works or how gonorrhea symptoms manifest), or rates of preva- pression often experienced by youth, lence of something. These questions seek “technical” or medical particularly those who are marginalized expertise/research. Example questions include “Can someone get due to their gender, , pregnant when they are 10 or 11 years old?” and “How long does it race, culture and class. The inclusion of take for your vagina to regain its good bacteria after you douche?” anonymous sex questions in the HEY Social knowledge: Gender roles, social norms, identity, differenc- curriculum gave participants a voice in es, social interaction, regional information, costs, rates or products. the curriculum and assured its relevan- Responses typically require facilitators to have knowledge of the cy to their lives. Young people utilized cultural context and an understanding of gender, sexuality and their personal agency to generate com- relationship norms and practices. Example questions include “Do plex and important questions about sex I tell my boyfriend [I have an STD] even though it’s curable?” and and sexuality. “Why is love such a neccity [sic]?” Gender assumptions Tactical knowledge: How to do something, or advice-seeking. The findings of this study counter tradi- These questions often included phrases such as “How do you tional gender assumptions that young do...?”, “What helps ...?”, “How can you...?”, and “How do you women are more interested in social use...?” Example questions include “What should I do when I have relationships, including gender roles a STD?” and “Who do you talk to if something happened to you and sexual norms, than are men. These when you ran away but your [sic] scared to tell?” findings also suggest that the types of questions asked in a mixed-gender Pleasure knowledge: Achieving and experiencing sexual or sex- group (compared to an all-female related pleasure or the workings of sex-related pleasure. These group) are not “silenced” when mem- questions were about feeling good, having , being horny, bers of the opposite sex are present. aroused nipples, vibrating products, etc. Example questions in- The anonymity of the questions seems clude “What is the most pleasurable way for a female to take it?” to promote level among participants, and “Are there any ‘for his pleasure’ ?” allowing them to ask whatever type of sex-related questions they feel they need answered.The study also indi- cates that young men ask just as frequently about socially constructed sex-related issues Content of Questions as young women, again countering traditional Questions asked by youth reflected six principal types of gender assumptions about what males and content, listed here in order of prevalence: females most want to know. Body: Questions about male and/or female physical bod- Youth and knowledge- ies (e.g. anatomy and puberty) and social bodies (e.g. seeking breast size), physiological processes (e.g. orgasms, arous- The highest percentage of questions asked al and pain) and bodily functions and fluids (e.g. bacteria, by youth concerned the body, suggesting that sperm and breast milk). Example questions: “Why does comprehensive sexuality programs should fo- rubbing your nipples make them hard?” and “Does a man cus on topics such as anatomy, puberty, body ever run out of sperm?” variations, physiological processes and bodily Identity/Relationships: Questions about sexual norms functions. Young people across the board had (e.g. rates of sex behaviors and expected sex behaviors), a particularly large number of questions about identity (e.g. masculinity, femininity and ) the female body and female sex-related anato- and interactions (e.g. communication, trust, power and my, suggesting another category of information ). Example questions: “Whats[sic] the percent vital – and likely inaccessible – to youth. of people that use female condoms?” and “How do you Participants also asked a number of questions tell your parents that you’re BI?” about standards and health, sexual norms; Health: Questions about sexual health (e.g. safety and sex interactions and well-being; and psychological products), addiction (e.g. alcohol or drugs and sex), illness well-being. Clearly, young people are interest- (e.g. STI/HIV and blood clots) and psychological ed in a broad sexual health agenda and are not well-being. Example questions: “Does having your period simply focused on the act of sex or the preven- increase your chances of getting ovarian cancer?” and “Is tion of pregnancy and/ or disease. sex healthy?” Our study showed that youth across various Reproduction: Questions about fertility (e.g. fertilization, settings ask similar questions, suggesting that eggs and sperm), offspring (e.g. fetal health and breast there may be core sets of knowledge desired milk) and pregnancy. Example questions: “Can you always by a broad range of youth. In addition, these get pregnant if a male’s sperm is in you?” and “Is it true types of youth-generated questions challenge that if the boy’s balls don’t drop, they can’t have kids?” beliefs and fears often prevalent among adults – that youth only want information that con- Prevention: Questions about prevention technologies tributes to their sexual prowess (technical, or (IUDs, condoms, dental dams and pills), sex tactical knowledgel.) The types and contents of abstinence and testing (e.g. pap smear, STI/HIV and preg- questions indicate that young people are not nancy tests). Example questions: “Is the Hep A vaccine simply interested in the act of sex but rather good for life or do you have to get re-vacinated [sic]?” and seek broader information about bodies, nor- “If a man wears a condom and makes a hole in a dental mative/non-normative sexuality, social/sexual dam and puts his penis through it, will it increase the ef- relationships, and psychological well-being. fectiveness of not getting an STI? Will it work?” Sex: Questions about specific kinds of sex or sex acts (e.g. ; oral, anal and vaginal sex), sex toys/ lubrication and virginity. Example questions: “How many orgasms may a girl have during sex? What is the longest ?” and “Is it safe to use toys while having sex?” The Hey model Health Education for Youth (HEY) was devel- that youth have submitted anonymously during oped by personnel at the University of Arizona’s the previous session. Southwest Institute for Research on Women The basic HEY curriculum includes the top- (SIROW), and takes into consideration the many ics of: sex; sexuality and gender; self-esteem; personal and environmental factors that col- sexual/reproductive anatomy and physiology; lectively influence youth knowledge, behaviors, puberty; STIs and HIV/AIDS; safer sex protec- attitudes, beliefs and experiences. The HEY tion methods; and communication skills and curriculum, which is typically conducted in eight personal relationships. The HEY curriculum can sessions over eight weeks, was developed from be expanded or condensed as necessary to fit focus groups with parents and youth that ex- various program needs. This curriculum includes plored what youth want and need to know about a complexity not usually found in standard sex sexual health and healthy sexualities. The cur- education curricula, particularly around the top- riculum is flexible and responsive to new topics ics of sex, sexuality and identity, gender, and or inquiries from students. power. In the HEY model, each session starts with the HEY participants are welcome to ask questions collaborative establishment of ground rules. aloud during sessions, but the use of an “anony- At the beginning of each of the eight sessions, mous questions” box is critical to the program: young people review, discuss, add on to and the box provides a safe alternative for partici- agree on HEY Rights and Responsibilities, a list pants who are nervous or self-conscious about of guiding statements that establishes a safe questions covering topics within or outside of the learning environment. The next activity in ev- formal curriculum. Anonymous questions may be ery HEY session is a youth-led check-in circle submitted at any time during class. At the end of that elicits how participants and facilitators are every session, the facilitators ask each partici- feeling that day. These practices create a sense pant to write a questions about of consistency, safety and focus for the group. and put it in the anonymous question box. If the Participants are also encouraged to control the participant does not have a question, the facili- degree to which they interact with the curriculum tator provides an alternative writing option (e.g. with an option to opt-in to or opt-out of HEY write about something learned in the session) so activities. After youth and adults together create that everyone puts something in the box, pro- a safe and respectful space for dialogue, sexual tecting the anonymity of those who do submit health educators read and address the questions questions. The Crossroads Collaborative, funded by the Ford ships Education Policy and Provision. Sex Education Foundation, brings stories and numbers together through 10(4): 423-435. action-oriented research with academics, youth-serving McGuire, J.K., M. Walsch, and C.W. LeCroy. 2005. organizations, and youth from the community to develop Content Analysis of Title V Abstinence-only Education knowledge, increase understanding, amplify youth voice, Programs: Links Between Program Topics and Partici- and share what we learn with the broader community. pant Responses. Sexuality Research & Social Policy 2(4): Sources 18-31. Centers of Disease Control and Prevention (CDC). 2010. Stevens, S., Thompson, E. M., Vinson, J., Greene, A., Educating Teenagers about Sex in the United States. Powell, C., Licona, A.C., and Russell, S. (2013). Informing NCHS Data Brief No. 44, September. http://www.cdc.gov/ sexuality education though youth generated anonymous nchs/data/databriefs/db44.htm questions. Sex Education: Sexuality, Society and Learn- Fine, M. and S. McClelland. 2006. Sexuality Education and ing, 13, 51, 84-98. Desire: Still Missing After All These Years. Harvard Educa- Crossroads Connections 2.1 tional Review 76(3): 1-34. Stevens, S., Stauber, L.S.,Vinson, J. and the Crossroads Flowers-Coulson, P.A., M.A. Kushner and S. Bankowski. Collaborative* (2013). Youth and legislation: Sexuality 2000. The Information is Out There But is Anyone Getting Education: Insights from Youths’ Anonymously Submitted it? Adolescent Misconceptions about Sexuality Education Questions. Crossroads Connections, 2(1), 1-4. Tucson, and and the Use of the Internet to AZ: The University of Arizona. Get Answers. Jourmal of Sex Education and Therapy 25(2): *The Crossroads Collaborative also includes: Adela C. 178-188. Licona, Stephen Russell, Amanda Fields, Shannon Snapp, Formby, E., J. Hirst, J. Owen, M. Hayter and H. Stapleton, Jason Rivera, Jenna Vinson & Ryan Watson. 2010. Selling it as Holistic Provision and Not Just About Condoms ... Sexual Health Service in School Settings: Cur- For more on the Crossroads Collaborative: rent Models and Their Relationship with Sex and Relation- http://mcclellandinstitute.arizona.edu/crossroads