Perceptions of a School-Based Sexuality Education Curriculum: Findings from Focus Groups with Parents and Teens in a Southern State S. Alexandra Marshall, Heather K. Hudson, and Lorraine V. Stigar Abstract School-based sexuality education is widely supported by most Americans. However, there is debate over the topics that should be taught. Also, a better understanding of desires adolescents and parents have for equipping youth to make healthy decisions is needed. This study gathered perceptions from parents and students about the sexuality education curriculum being implemented in selected, priority high schools in Arkansas. Separate parent and student focus groups were conducted at four of the fifteen priority high schools with high rates of sexually transmitted infection (STI) and teen pregnancy. Common themes included: 1) sex education should be comprehensive and is currently inadequate; 2) characteristics valued in friendships are not currently reinforced in schools leaving a disconnect for students when it comes to healthy romantic relationships; 3) students feel ill-equipped to pursue healthy dating relationships and lack realistic role models for healthy dating relationships; and 4) many teens are believed to be in abusive dating relationships. A comprehensive sexuality education curriculum is recommended to better address all relationship types and equip students to make healthy decisions in the context of their relationships. *S. Alexandra Marshall, PhD, MPH, CPH, CHES® Introduction Assistant Professor Sex education delivered through Department of Health Behavior and Health schools is widely supported by most Education, Americans (Heller & Johnson, 2013; Kaiser University of Arkansas for Medical Sciences, Family Foundation (KFF), 2004; Landry, Little Rock, AR 72205 Darroch, Singh, & Higgins, 2007; Planned Email: [email protected] Parenthood, 2014). Parental opinions of Heather K. Hudson, PhD, MPH, MCHES®, CSE appropriate sex education have been well- Associate Professor assessed (Barr, Moore, Wilson, Parisi Department of Health Sciences & McCann, 2017; Eisenberg, Bernat, University of Central Arkansas, Bearinger, & Resnik, 2008; Gizlice, Conway, AR 72032 Owen-O’Dowd, Foust, Leone, & Miller, Email: [email protected] 2006; KFF, 2000; Kantor & Levitz, 2017; Lorraine V. Stigar, MPH, CHES® Yarber, Milhausen, Crosby, & Torabi, Graduate Assistant 2005) and most parents are agreeable to a Department of Health Behavior and Health comprehensive curriculum in schools (Barr Education, et al, 2017; KFF, 2004). Yet the need for University of Arkansas for Medical Sciences, comprehensive sexuality education (CSE) Little Rock, AR 72205 remains a critical public health issue. Email: [email protected] Arkansas ranks first in the United *Corresponding Author States for teen birth (Martin, Hamilton, Spring 2020, Vol. 52, No. 1 The Health Educator 37 Osterman, Driscoll, & Mathews, 2017), second sexual health topics along with communication, for teen pregnancy (Kost, Maddow-Zimmet, negotiation, and safer sex skills (KFF, 2000); Arpaio, 2017) and has STI rates above the valuable skills given the rise in adolescent dating national average among ages 15-24 (Centers for violence and abuse (ADVA) (Stonard, Bowen, Disease Control and Prevention [CDC], 2013). Walker, & Price, 2015). Even though students Despite this, Arkansas law does not require who received CSE were more likely to report schools to teach sexuality education (Guttmacher being “very prepared” on preparedness questions Institute, 2019; Population Institute, 2018; Sex, (i.e., questions regarding communicating about Etc., 2017). If sexuality education is taught, sexual health issues, accessing birth control, how abstinence must be emphasized but local school to use contraceptives, dealing with emotional leaders decide what content is taught (Sexuality issues and consequences of being sexually active, Information and Education Council of the including the pressures surrounding sex, and United States [SIECUS], 2017). The Division of deciding to abstain or wait), these adolescents Adolescent and School Health, National Center did not feel prepared enough to handle sexual for Chronic Disease Prevention and Health decision-making, and the majority of them did Promotion, and CDC identified 19 recommended not demonstrate sufficient topical knowledge in topics for sexuality education programs, yet sex education when assessed (KFF, 2000). only 38% of high schools in Arkansas taught all If curriculum leaders ignore topics students 19 (Arkansas Department of Education [ADE], are interested in, adolescents often turn to their 2016). Additionally, only 18% of middle schools peers (Baheiraei et al., 2014) or the Internet that taught sexuality education taught all 19 (Buhi, Daley, Oberne, Smith, Schneider, & topics (ADE, 2016). Fuhrmann, 2010; Simon & Daneback, 2013) for Recommendations have been made by sexual health information. The latter is especially various councils, organizations, and experts true among sexual minority adolescents (Guse, on what topics ought to be taught in sexuality Levine, Martins, Lira, Gaarde, Westmorland, education (CDC, 2014; Oregon Department of & Gilliam, 2012). This is problematic because Education, 2015). However, topics adolescents these adolescents are at high risk for poor sexual want to learn to feel equipped to make healthy health outcomes (Wilson, Maness, Thompson, decisions are less known. Rosen, McDonald & Wiley, 2018) with different Only one nationally representative study sex education topical preferences from their asked students in the US about desired topics. heterosexual peers (Wilson, Rosen, Thompson & In 2000, The Kaiser Family Foundation [KFF] Maness, 2017). surveyed students, parents, sexuality educators, The purpose of this project was to assess the and principals nationwide asking about sex perceptions of a sexuality education curriculum in education and sex issues. Of the students who selected, priority high schools in Arkansas, with had taken sex education in seventh through attention to how well the curriculum addressed twelfth grades, about half responded they wanted “healthy relationships” (e.g. friendships, romantic more information about 40% of the specified relationships, etc.). The Arkansas Department of topics. The results showed students wanted Education (ADE) was interested in identifying more information on STIs, HIV/AIDS, STI/HIV and promoting a curriculum that incorporated all testing, what to do if they or a friend were sexually types of healthy relationships. The researchers assaulted, dealing with emotional consequences queried if students believed they were being taught and issues of being sexually active, and partner what they needed to make healthy decisions in all communication about STIs and contraception of their relationships, and how both parents and (KFF, 2000). This study indicated adolescents students perceived the current curriculum. desired more information about traditional 38 The Health Educator Spring 2020, Vol. 52, No. 1 Materials and Methods into domains addressing friendships, dating Fifteen high schools in Arkansas were relationships, and sexuality education. For previously identified and prioritized for having example, questions posed to parents under the high STI and teen pregnancy rates by ADE. In domain “healthy dating relationships” included: order to evaluate how well the curriculum being 1) Tell me what comes to your mind when I say, implemented was perceived by students and “healthy dating relationships.” 2) Tell me what parents, the School Health Coordinator at ADE comes to your mind when I say, “unhealthy partnered with the researchers to conduct focus dating relationships.” 3) What do you think groups of parents and students. Focus groups were your children are being taught in regard to these conducted at four of the 15 priority schools. The types of relationships? 4) In terms of dating researchers selected the four schools to provide relationships, what do you want your children to a demographically diverse sample. Schools learn in school? 5) At what age do you feel it is differed by size and location. The smallest district necessary for the schools to teach your children had approximately 600 students in a rural part about healthy dating relationships? of the state while the largest district had a little For students, some questions in this domain over 22,000 students) in an urbanized area of the were the same but some differed including: state (United States Department of Agriculture 1) Have there been any lessons or activities [USDA], 2017). that you can recall about dating? If yes, what Participants identified by the school health were they like? 2) Who do you look to as role coordinator at each site were parents from models for healthy dating relationships? 3) Since volunteer lists and were willing and able to relationships are a part of human sexuality, participate in the focus group at the date and time what else would you want to know to be better designated by the coordinator. Students were equipped to have a healthy dating relationship? identified in a similar manner. Additional follow-up questions or probes were The institutional review board at the asked occasionally to gain clarity on participant University of Arkansas for Medical Sciences responses. approved this study (IRB#206499 approved All focus groups were audio recorded March 1, 2017). The researcher described the and transcribed by a professional transcription purpose of the study to, and received verbal service. The