Rajiv Gandhi University of Health Sciences s8

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA

A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING SEX EDUCATION AMONG ADOLESCENT GIRLS IN SELECTED PRE UNIVERSITY COLLEGES, BENGALURU.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

IST YEAR M.S c NURSING PAEDIATRIC NURSING 2011-2012

K T G COLLEGE OF NURSING

BENGALURU

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA PROFORMA FOR THE REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF CANDIDATE MISS.ROSHLY MATHEW AND ADDRESS I YEAR M Sc NURSING

K T G COLLEGE OF

NURSING, BENGALURU 2 NAME OF THE K T G COLLEGE OF NURSING INSTITUTION 3 COURSE STUDY AND I YEAR M.SC. NURSING

SUBJECT PAEDIATRIC NURSING 4 DATE OF ADMISSION TO COURSE 5 TITLE OF THE TOPIC “A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING SEX EDUCATION AMONG ADOLESCENT GIRLS IN SELECTED PRE UNIVERSITY COLLEGES, BENGALURU”.

2 6. BRIEF RESUME OF THE INTENDED WORK INTRODUCTION

Young people are the future of every society and also great recourses for the nation. Reproductive health is a crucial part of general health and central feature of human development .One of the most distressing, disabling disease of this century is sexually transmitted disease (STD) especially HIV / AIDS. Nurses day theme for the year 1995, “Women’s health, Nurses pave the way”-is relevant always .An adolescents girls is the women and the mother of tomorrow, the health and well –being of future generation depend on her. She needs to be viewed as an asset not a liability.1

Puberty results in a physically mature individual whose body habits and secondary sexual characteristics usually testify unmistakably to maleness or femaleness and who is able to reproduce. The average age of onset of male puberty is 11 to 12 years, range 9 to 14 year. Females begin puberty at an average age of 10-11 years, slightly earlier than males, with a normal range of 8 to 13 year.2

With more than 4.5 million people infected by HIV, the virus that causes AIDS, India has become the world’s second largest hub of the disease, but some states are still in denial. That means that while India has the second-largest population of HIV sufferers after South Africa, a taboo on talking openly about sex has ensured that sex education is not taught in schools, and people, especially women, are reluctant to seek treatment for sexually transmitted diseases.2

Sex education is a broad term used to describe education about human sexual anatomy, sexual reproduction, sexual intercourse, and other aspects of human sexual behaviour. Common avenues for sex education are parents or caregivers, school programs, and public health campaigns.3

This is an important issue because teens are becoming sexually active at younger ages. The incidence of teenage sex and sexually transmitted diseases is

3 alarmingly high. By age seventeen, over 50 percent of teenagers have engaged in oral sex, between five percent and 30 percent of thirteen-year-olds have had sexual intercourse, and more than nine million new cases of STDs are contracted by Americans between the ages of fifteen and twenty-four every year (Shafer, 2006) the amount of teenage pregnancies is also very alarming. “The teen pregnancy rate in the U.S.is the highest among the most developed countries in the world… and despite recent declines in teenage pregnancy rates, 31 percent of American teens still experience pregnancy (Planned Parenthood, 2006).”4

Sex education, which is sometimes called sexuality education or sex and relationships education, is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. Sex education is also about developing young people's skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices. It is widely accepted that young people have a right to sex education. This is because it is a means by which they are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases and HIV and AIDS. It is also argued that providing sex education helps to meet young people’s rights to information about matters that affect them, their right to have their needs met and to help them enjoy their sexuality and the relationships that they form. 5

Recently HIV/AIDS is considered to be a unique development challenge all over the world. According to NACO (2007) there are 2.47 million people living with HIV/AIDS in India. In that 1.14 million of HIV positive is in the age group of 15-25 years.6

As per the HIV Estimations 2010,India is estimated to have 23.9 lakh people infected with HIV in 2009 at an estimated adult HIV prevalence of 0.31%.Adult HIV prevalence among men is o.36%,while among women ,it is 0.25%. Estimated Adult HIV Prevalence in Karnataka among male is 0.75% and females is 0. 51 %.7

6. 1 NEED FOR THE STUDY:

4 “ Prevention is better than cure’’.12 million people are affected with sexually transmitted diseases (STD) every year, out of which 25% are adolescents (Joyce .M .Black). 1

Globally, nearly half of the new HIV cases occur in the young people aged 15- 29. Also a large percentage of new STD occurs in this age group. The irony is that methods to empower these young people and to reduce their vulnerability are well known. Although promoting the use of condom is one of the visible strategies, imparting Sexuality and HIV related education and provision of health services is a proven strategy for prevention of HIV/ STD.8

WHO on Sex Education back in 1993, a survey of 35 sex education projects conducted by the World Health Organisation (WHO) showed that sex education in schools did not encourage young people to have sex at an earlier age or more frequently. Rather importantly, the survey showed that early sex education delays the start of sexual activity, reduces sexual activity among young people and encourages those already sexually active to have safer sex. The WHO published a review of 1,050 scientific articles on sex education programmes. The report called Effects of Sex Education on Young People’s Sexual Behaviour says. This report was commissioned by the Youth and General Public Unit, Office of Intervention and Development and Support, Global Program on AIDS, and the WHO.9

According to Dr Balaji, advisor to the National Council of Education Research and Training (NCERT), the NCERT has so far been playing it safe because of the explosiveness of the issue of sex education, which cannot be separated from AIDS education. "Too many people think that neither is compatible with their notion of Indian culture."9

Mohammad Al-Shaeea, a sociologist at Qassim University, defined sex education as “a dynamic social procedure that aims to provide the individual with information about sex that is consistent with religious values, society norms and correct behaviour.” Al-Shaeea considers sex education as an essential part of basic

5 social development. Al-Shaeea said that a study of new students at Qassim University showed that 76.6 percent felt sex education is important.10

The Kaiser Family Foundation conducted a survey of parents and the public regarding their opinions on sex education among other things. Ninety eight percent of parents agreed that AIDS, HIV and STD information is appropriate to include in such classes; 94 percent also wanted students to be taught how and where to be tested for such diseases. Ninety four percent wanted information on birth control and methods of preventing pregnancy to be included in school sex education classes and 87 percent wanted information included on where to get such resources. Ninety five percent of those surveyed wanted teachings to include the idea of waiting until you are older to have sexual intercourse. Eighty two percent of respondents also stated that sexual education in school makes it easier for them to discuss sexual issues with their children.11

In a meta-analysis, Dickenson et al. have compared comprehensive sex education programs with abstinence-only programs. Their review of several studies shows that abstinence-only programs did not reduce the likelihood of pregnancy of women who participated in the programs, but rather increased it. Four abstinence programs and one school program were associated with a pooled increase of 54% in the partners of men and 46% in women (confidence interval 95% 0.95 to 2.25 and 0.98 to 2.26 respectively).12

A cross sectional comparative study using a self-administered questionnaire covering 1825 students in public schools 1385 in Private aided schools to compare their respective outlook towards sex education. Majority of the students in public (63.06%) and private Schools (48.80%) felt that sex education should be included in the Curriculum. 57.9% of students in public schools and 63.8% of students in private

schools would like to attend sex education program and they rank it as important. This study concluded that has a potential to promote parent approved Sex education as students in private (81.44%) and public (68.76%) clearly state that Sex Education will not prompt them to have Sex.13 6 In a report to Congress in April 2008, the American Academy of Paediatrics (AAP) recommended appropriate comprehensive sex Education based on approaches that research has proven effective. Sexuality education for adolescents should emphasize abstinence but also provide age-appropriate, medically accurate discussions and information about sexual behaviour. The AAP suggested this approach would help youth practice healthy sexual behaviours as adults and also would encourage avoidance of early or risky sexual activity as teenagers. This strategy would help youth avoid health problems such as sexually transmitted infections (STIs) that include acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV).14

“Prevention is better than cure,” comprehensive sexuality education and access to contraceptive services can help young people protect their health and well-being. So the researcher is interested to do research work on this topic to create awareness regarding sex education among nursing students.

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process. This refers to the activities involved in searching for information on a topic and developing a comprehensive picture of the state of knowledge on that topic. The written literature 7 review provides a background for understanding what has already been learned on a topic and illuminates the significance of the new study.

Review of literature is a critical summary of research on a topic of interest generally prepared to put a research problem in context or to identify gaps and weakness in prior studies so as to justify a new investigation.15

The review of literature for the present study has been organized under the following headings.

A. STUDY RELATED TO PUBERTAL CHANGES DURING ADOLESCENTS

B. STUDY RELATED TO SOURCES OF INFORMATION ABOUT SEXUALITY AND PHYSIOLOGY OF REPRODUCTION

C. STUDY RELATED TO SEXUAL RISK BEHAVOIUR AMONG THE ADOLESCENTS

D. STUDY RELATED TO TEENAGE PREGNANCY, STD INCLUDING HIV AND ITS PREVENTION. E. STUDY RELATED TO NEED FOR SEX EDUCATION F. STUDY RELATED TO PARENTRAL GUIDANCE ABOUT SEX EDUCATION

A.STUDIES RELATED TO PUBERTAL CHANGES DURING ADOLESCENTS A Study conducted to estimate the Prevalence differences in depressive symptoms between the sexes typically emerge in adolescence, with symptoms more prevalent among girls. This study used a genetically informative, longitudinal

8 (assessed at ages 12, 14, and 17) sample of Finnish adolescent twins (N = 1214, 51.6% female) to test whether etiological influences on Depressive symptoms differ as a function of pubertal status. Results indicated that pubertal development moderates environmental influences on depressive symptoms.16

A study was conducted to assess menarche age of pubertal girls in Turkey. The pace of decline in menarche age has been estimated using multiple linear regression analysis, controlling for year of birth and other variables. Results shows that Mean age at menarche was estimated at 13.30 (95% CI = 13.26-13.35). It was estimated at 13.17 years (95% CI 12.95-13.38) for the youngest birth cohort (1989-1993), as opposed to 13.44 (95% CI 13.37-13.52) years for the cohort born in 1959-1968. The study concluded that regression analysis indicated a decrease of 1.44 months per decade, providing evidence of a secular trend in menarche age in Turkey. 17

B.STUDIES RELATED TO SOURCES OF INFORMATION ABOUT SEXUALITY AND PHYSIOLOGY OF REPRODUCTION

A cross sectional study on sexuality and sexual behaviour to identify ,the awareness regarding STDs including AIDS among 13 to 17 years male adolescents in a secondary municipal school at western Mumbai .The subjects comprised of 158 adolescents .Finding reported that 98.3% replied negatively on parental reaction to reproduction and sexuality, where as 1.67% expressed their opinion that ,they discussed with their parents .it was found 87.5% expressed that, they receive information from peers, elderly ,and friends ,22.5% from television. About (60%) reported no concerns of reproductive health and sexuality most of them (70%) reported that masturbation cause weakness in the body.18

A study was conducted to assess the educational needs of the adolescent girl students regarding their reproductive health. The data were collected by administering an open-ended self-administered questionnaire to the participating students seeking their opinion on several issues related to adolescent reproductive health. The results show that students preferred their teachers next only to doctors as health educator.

9 Two most important areas of their concern are safe motherhood and AIDS. The study concluded that need exists for reproductive health education.19

C. STUDIES RELATED TO SEXUAL RISK BEHAVIOUR AMONG ADOLESCENTS

A cross-sectional study was conducted to assess the prevalence of sexual behaviours and the correlates among the early adolescents of migrant workers in China. A total of 2821 adolescents aged 14.06 ± 0.93 years (8.9% of migrant workers vs. 91.1% of general residents) participated from 10 junior high schools, in the survey .The results showed that the percentage of adolescents who ever had sexual intercourse or had sexual intercourse in last three months was 7.2% and 4.3% in adolescents of migrant workers, respectively; in contrast, 4.5% and 1.8% in their peers of general residents, respectively. 47.3% adolescents of migrant workers and 34.3% of those adolescents of general residents reported no condom use in sexual intercourse during last three months.20

A study was conducted to the adaptation of an alcohol and HIV school-based prevention program for teens. The goal for School-based Teenage Education Program (STEP) was to demonstrate that a HIV/AIDS and alcohol abuse educational program built with specific cultural, linguistic, and community-specific characteristics could be effective. Utilizing the Train-the-Trainer model, the instructors (17-21 years) were trained to present the 10 session manualized program to primarily rural and tribal youth aged 13-16 years in 23 schools (N = 1,421) in the northern state of Himachal Pradesh in India. Their intention to continue STEP beyond extra funding shows that utilizing the local community in designing, implementing and evaluating programs promotes ownership and sustainability.21

D. STUDIES RELATED TO TEENAGE PREGNANCY, STD INCUDING AIDS AND ITS PREVENTION

A study conducted to assess the prevalence of AIDS stigma and HIV

10 transmission among adolescents in United States. Telephone surveys were conducted to 1309 adolescents in 1996-97 and 1998-99.Finding showed that over expression of stigma declined through out 1990s and one third of respondents expressed discomfort and negative feeling towards people with AIDS.22

A study conducted to examine different methods of assessing pregnancy intention among adolescents in California. A longitudinal cohort study of 354 sexually experienced adolescents females attending either a STD clinics or other clinics were included .Chi-square analysis, assessed associations between baseline pregnancy intentions and subsequent pregnancy. The adolescents pregnancy plans and their assessments of pregnancy likelihood different from one another (chi-square =50.39, df =1, p < 0.001).It was concluded that to reduce adolescents child bearing, we must assess pregnancy intentions in multiple ways.23

A Retrospective study to assess the risks associated with teenage pregnancy conducted in maternity home, Thane to examine the pregnancies in women coming for delivery to the clinic and less than 20 years of age were studied. The total number of deliveries in this period was 1663.Out of these, 108 were found to be of less than 20 years of age giving a percentage of 6.49% of teenage pregnancies.108 women above 20years of age and delivering in the unit immediately after the teenage mother delivered were included as control. The results showed that there was increase in the incidence of anaemia and low birth weight in teenage mothers.24

E. STUDIES RELATED TO NEED FOR SEX EDUCATION

A study conducted to assess awareness of child sexual abuse prevention education among parents of grade 3 elementary school pupils in Fuxin city, china. To fill the gap, knowledge, attitudes and practice of CSA prevention education were explored in 385 parents by self-administered anonymous questionnaires. Among this sample, more than 80% of parents approved of school CSA prevention education. However, at the same time, 47.3% of parents expressed some concern that this

11 education may induce the children to learn too much about sex. Only 4.2% of parents had provided books or other material about CSA prevention for their children.25

A study was conducted to examine whether exposure to formal sex education is associated with three sexual behaviours: ever had sexual intercourse, age at first episode of sexual intercourse, and use of birth control at first intercourse. The sample included 2019 never-married males and females aged 15–19 years. The results showed that receiving sex education was associated with not having had sexual intercourse among males (OR = .42, 95% CI = .25–.69) and postponing sexual intercourse until age 15 among both females (OR = .41, 95% CI = .21–.77) and males (OR = .29, 95% CI = .17–.48). Males attending school who had received sex education were also more likely to use birth control the first time they had sexual intercourse (OR = 2.77, 95% CI = 1.13–6.81); however, no associations were found among females between receipt of sex education and birth control use.26

A cross sectional study conducted to evaluate adolescent school girls' knowledge, perceptions and attitudes towards STIs/HIV and safer sex practice and sex education and to explore their current sexual behaviour in south Delhi, India. The self- administered questionnaire was completed by 251 female students from two senior secondary schools. The result shows that More than one third of students in this study had no accurate understanding about the signs and symptoms of STIs other than HIV/AIDS. The study concluded that though controversial, there is an immense need to implement gender-based sex education regarding STIs, safe sex options and contraceptives in schools in India.27

F.A STUDY RELATED TO PARENTAL GUIDANCE ABOUT SEX EDUCATION

A study conducted to assess acceptability of parents/guardians of adolescents towards the introduction of sex and reproductive health education in the community and schools in Kinondoni Municipality, Tanzania. A multi-stage random sampling technique was used to get 150 participants for this study. The analysis of the findings

12 shows that there is a mixed feeling on the introduction of sex and reproductive health education in schools. When the data were analysed by faith of the religions of the participants, 64% were in favour of introducing sex education and reproductive health, but were opposed to use of condoms to their adolescents.28

A study was conducted to compare the impact of sex education provided by parents to female adolescents against the same education provided in formal settings to female adolescents. Females, 16–24 years old, 110 respondents were attending an adolescent medicine clinic in an urban area of the South were recruited prior to examination. The Results shows that in controlled, multivariate, analyses, adolescents not communicating with parents on all four topics were nearly five times more likely to report having multiple sex partners in the past three months . Findings suggest that teen females (attending teen clinics) may experience a protective benefit based on communication with parents.29

6.3 STATEMENT OF THE PROBLEM

13 “ A Study to assess the effectiveness of self instructional module on knowledge regarding sex education among the adolescent girls in selected pre university colleges, BENGALURU”.

6.4 OBJECTIVES OF THE STUDY

 To assess the existing knowledge regarding sex education among selected adolescents .

 To evaluate the effectiveness of Self Instructional Module on sex education among adolescents by post-test knowledge.

 To associate the findings with the selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

Assess: It refers that the organized systematic and continuous process of collecting data from the nursing students.

Knowledge: It refers to level of understanding regarding sex education among nursing students.

Effectiveness: It refers to optimum knowledge acquired by the nursing students regarding sex education after administering self instructional module.

Self instructional module: It refers to systematically organized instructional aid for nursing students on sex education consisting sexuality, human sexual behaviour, teenage pregnancy and STD including AIDS.

Sex education: It is the education about human sexual anatomy, sexual Reproduction, sexual intercourse, and other aspects of human sexual behaviour .

Adolescents: It is the period from puberty to maturity during which physical, emotional and psychological changes occur in boys and girls. 14 6.6 ASSUMPTION  Nursing students may have inadequate knowledge regarding sex education.  Self Instructional Module may have effect on knowledge of nursing students regarding sex education

6.7 HYPOTHESIS

H1 There is a significant difference between pre and post test level of knowledge regarding sex education among pre university students.

H2 There is a significant association between post test levels of knowledge of pre university students with selected demographic variables.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

Data will be collected from mothers in selected areas, BENGALURU.

. Research approach : quasi experimental approach

. Research Design : One group pre-test, post test

Research design

. Setting of the study : Study will be conducted at selected pre- - university colleges in BENGALURU.

15 . Sample Technique : Probability ,simple random sampling

Technique.

. Sample size : 60 . Selected Variables Independent Variables : Self Instructional Module Dependent Variables : knowledge of pre university female students regarding sex education. Demographic variables : Age, educational status, family income Source of information, religion, type of family. . Population : Students15-17 years in Selected colleges, BENGALURU. . Sample Criteria  Inclusion criteria : Female students who were aged between 15-17 year.

: Students who were available during data collection.

: Students who are willing to participate.

 Exclusion Criteria : Students who are not willing To Participate. : Students above the age of 18 years

7.2 Methods of Data collection

The data will be collected within prescribed time from students having age group of 15-17 years using structured interview schedule to assess the knowledge regarding sex education from the pre university colleges. A Written permission will be

16 obtained from the administrative authority prior to the onset of the study. The purpose of the study and the method of data collection will be explained to the participants and informed consent will be taken. Confidentiality will be assured to all subjects to get their cooperation. Data will be collected from 60 students as per the inclusion criteria of the study. At the end of the post-test subjects will be thanked for their cooperation.

Tool for Data collection: The tool consists of following sections

Section A: Demographic Proforma of nursing students like age, educational status, family income, religion, source of information. Section B: Structured self administered questionnaire to assess the knowledge of nursing students regarding sex education. Section C: Self instructional module on sex education.

Method of data analysis and Interpretation: The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics Frequency, percentage distribution, Mean, median and standard deviation will be used to assess the knowledge of nursing students regarding sex education.

Inferential statistics Paired t-test will be used to compare the pre test and post test knowledge. Chi- square will be used to associate the knowledge of nursing students with selected demographic variables Duration of the study : four weeks.

17 7.3 Does the study require any investigation or intervention to be conducted On the patient or other human beings or animal?

Yes, the study will be conducted on adolescents having children between 15-17years of age regarding the assessment of knowledge on sex education.

7.4 Has ethical clearance has been obtained from your institution?

Yes, Permission will be obtained from ethical committee’s report.

18 8. REFERENCES:

1. Mary Lucita ,Adolescents and STD. The official journal of trained nurses association of India, Kerala branch . 2006 October-December; 1( 1): 49-50.

2. www.Google.com

3 http://www.tendertiger.com, sex education in India

4. http:// www.advocateforyouth.or/rrr/definitions.htm

5. United Nations Universal declaration of human rights. www.un.org/rights/HRT today (Accessed 06.10.09)

6. Mrs.sahaya selvi. Sex education.Indian journal of holistic nursing. 2010 march; 5(4):23-26. 7. http://pib.nic.in/newsite/PrintRelease.aspx?relid=67292

. 8 www.indiatimes.com Sex education: Why India should go all the way - The Times of

India, http://timesofindia.indiatimes.com/home/sunday-toi/view-from-venus/Sex- education-Why-India-should-go-all-the way/articleshow/4449680.cms#ixzz1EQGSUFCq

9. Sex education in India, www.pubmed.com

10. Watta Hawari, sex education needed, Arab news, 2010 April 14.

11. National Public Radio/Kaiser Family Foundation/Harvard University Kennedy School of Government 2004 Poll. Sex Education in America. Retrieved 2007 November 12.www.plannedparenthood.

19 12. Dickenson A. Adolescents: Systematic of Randomized Controlled Trials. British Medical Journal. 2002: 324-1426.

13. Easter Thamburaj JS, Satish Kumar SK, Edwin A, Ganesh AK, Suniti S. Students perspective on sex education: A comparative study from Chennai. International Conference on AIDS, India. 2000 july: 9-14.

14. Margaret J. Blythe, MD, FAAP, FSAM.Testimony before the Committee on

Oversight and Government Reform. 2008 April 23. www.aap.org/advocacy/washing

15. Polit D F, Beck C T, Nursing Research Principles and Methods. New Delhi, Wotters kluwer Health India. 2007; 7 : 88

16. Edwards AC, Rose RJ, Kaprio J.Dick DM. Pubertal Development Moderates the Importance of Environmental Influences on Depressive Symptoms in Adolescent Girls and Boys. Journal of youth adolescence. 2010 December 7.www.pubmed .com

17. Adali T, Koc I.Menarche age in Turkey: Secular trend and socio-demographic correlates.Ann Hum Biol. 2011 February 15.www.pubmed .com

18. Datil Chaturvedi and Mulkar. Sexuality and sexual behaviour in male adolescents.2002.http/www.hhj org /journal .

19. Roy S.Education of adolescents on reproductive health: which way to go?.Journals of Nepal Medical Association.(JMNA). 2010,January-March; 49(177): 88-91.

20. Shenghui Li,Hong Huang,Yong Cai ,Gang Xu ,Fengrong Huang ,Xiaoming Shen. Characteristics and determinants of sexual behaviour among adolescents of migrant workers in Shangai (China ). BMC Public Health. 2009; 9: 195. doi: 10, 1186/1471- 2458-9-195

21. Chhabra R, Springer C, Leu CS, Ghosh S, Sharma SK,Rapkin B. Adaptation of an alcohol and HIV school-based prevention program for teens. AIDS BEHAVIOUR. 2010, Aug 14, : 177-84.

20 22.Herek,GM, Capitanio J P, Widaman K F.HIV related stigma and knowledge in U S prevalence and trends 1991-1999.American Journal of public health. 2002; 92(3):371- 376.

23. Rosengard C,Phipps M G, Alder N E.Adolescents pregnancy intentions and pregnancy out comes. Journal of adolescent’s health. 2004, December; 35(6) : 453-61.

24.Dr.Dikshit Sameer .Teenage pregnancy-an analysis of 108 cases. Prism’s nursing practise .2007 ;2 (1): 4-7.

25. Chen Jing Qi.Child Abuse and Neglect.the international Journal. 2007; 31(7): 745-755.

26. Trisha E. Mueller, Lorrie E. Gavin, Aniket Kulkarni .The Association Between Sex Education and Youth’s Engagement in Sexual Intercourse, Age at First Intercourse, and Birth Control Use at First Sex. Journal of Adolescent Health. ,January 2008; 42(1) : 89-96.

27. McManus A, Dhār L.Study of knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex and sex education: (a cross sectional survey of urban adolescent school girls in South Delhi, India).BMC Women’s Health. 2008 July 23 :8- 12.

28. Mbonile L Kayombo E,Assessing acceptability of parents / guardians of adolescents towards introduction of sex and reproductive health education in schools at Kinondoni Municipal in Dar es Salaam city. Journals of Public Health. 2008 April; 5(1): 26- 31.

29. R. Crosby, A. Hanson, K. Ranger, the Protective Value of Parental Sex Education: A Clinic-Based Exploratory Study of Adolescent Females. Journal of Paediatric and Adolescent Gynaecology. 2009; 22(3): 189-192.

21 9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THE PRINCIPAL

12.2 SIGNATURE