Recent work has explored the intersection between sexual health as construed by the World Health Organization and others and public health domains of action in the United States of America. This paper reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles: Outcomes were classed in domains: We summarized data from 58 studies English language, adult populations, — by population adults, parents, sexual minorities, vulnerable populations across "Sexual health campaigns united." The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication.
Whether via direct action or through partnerships, incorporating principles from existing
Sexual health campaigns united health definitions in public health efforts may help improve sexual health.
These outcomes are mediated by a mixture of individual behaviors, relationship dynamics sexual relationships, but also friendships and care relationshipsand social factors.
Outcomes pertinent to sexual health are often framed "Sexual health campaigns united" negative terms: Consequently, public health goals and objectives tend to focus on reduction of adverse outcomes, and goals related to health promotion are typically instrumental to reducing adverse outcomes e. Public health intervention in sexual health tends to be either low-intensity and broadly-focused, or more intensive intervention conducted in the context of adverse events or
Sexual health campaigns united risk.
Examples include fact sheets for broad public consumption and risk reduction intervention conducted during STD partner notification investigations. In this paper, we examine the extent to which interventions based on a positively-framed and holistic definition of sexual health e.
These domains Figure 1 were drawn from a consultation on sexual health and public health at CDC and are: We derived common elements from existing sexual health definitions and used them to select studies for a systematic review of interventions designed around sexual health framed in positive terms.
The common elements across the three definitions Figure 2 are that: These two statements form the basis for selecting studies for review.
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Many existing risk reduction studies contain elements that are compatible with the definitions of sexual health, but fewer overtly incorporate the elements of sexual health in the content of the intervention.
We assessed the quality of evidence relevant to sexual health through a two-stage retrospective approach: The search terms comprised language from the sexual health definitions, and three adverse health outcomes: All unique studies from the three searches were written in English and published between and We chose as a
Sexual health campaigns united point because it is historically close to the emergence of international sexual health efforts i.
From intervention studies identified among thewe retained studies if
Sexual health campaigns united the abstract linked inputs to outcomes in one of the six domains Figure 1b the study population were adults drawn from the US or a country with comparable public infrastructure e. Two raters from a pool of three independently read each
Sexual health campaigns united the remaining studies and judged fit to the two sexual health principles derived from sexual health definitions.
We answered yes if the intervention content allowed that a if sexually active, the "Sexual health campaigns united" of having safe and fulfilling any of emotionally, socially, mentally, physically, spiritually sexual experiences, b acceptance that sexuality is a natural and healthy part of life and that sexual development is a normal part of maturation toward adulthood, c access to medically accurate and developmentally appropriate educational, programmatic, and confidential as needed clinical sexual health services for disease prevention and health promotion related to sexuality, or d respect for diversity of values and beliefs about sexuality, and structural, environmental, and societal factors that promote sexual health.
For the second principle, we asked: Does the intervention acknowledge that healthy sexual relationships require positive experiences for all parties involved? We considered an article aligned with the sexual health principles and therefore a test of those principles if raters independently judged that the intervention content overtly incorporated standards under one or both of the above criteria, but contradicted neither.
If both raters agreed, the study was retained or discarded; if the raters disagreed, all raters met to achieve consensus. For example, Robinson et al. Finally, Amirkhanian, Kelly, Kabakchieva, McAuliffe, and Vassileva designed a risk reduction study through social networks.
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We would not have construed the preventions messages per se as fitting the sexual health frame, but the means of doing so was to normalize discussions of sex and sexuality in a typically marginalized population of young MSM. Because the communication pertained to positive experiences for all parties and communication i.
Across all studies examined, pairwise agreements were Although the sexual health definition is designed to be widely applicable, some of its assumptions are not applicable to the entire population.
For other groups, special factors may alter the nature of the definition. For example, infected persons are at risk to transmit infection and therefore positive experiences for all parties implies added attention to disclosure and transmission risk reduction e. CASP applies judgment criteria e.
We also examined 20 randomly-selected studies eliminated on conceptual grounds to assess differential attrition by quality: Table 1 summarizes studies by population: We defined studies on vulnerable populations
Sexual health campaigns united studies specifically targeting persons facing one or more experiential problems e.
We categorized studies first by whether or not their populations qualified as vulnerable, and then by whether or not participants were defined as parents, college students or sexual minorities. The remaining studies fell into the adult category.
Sample sizes varied between 15 a qualitative study and Sample sizes
Sexual health campaigns united spread across this range; we observed 23 The most "Sexual health campaigns united" intervention across domains and populations was an individual or small-group face-to-face intervention, but there were also examples of other modes of intervention: Face to face approaches varied, with individual and group sessions, number of sessions varying from one to 16 most interventions were one or two sessionstwo embedded in college sexuality courses, counseling, seminar and workshop labels, clinical and community-based organization delivery settings, and theoretical bases including motivational interviewing and social cognitive theories.
Of the studies on adults Table 110 included women-only, and 6 included both genders. Overall trends for this group showed consistent increases in knowledge and pro-sexual health attitudes, although only half the studies measuring behaviors found positive effects. The principal sources of null findings for attitudes were in the realm of self-efficacy, where only four of nine studies measuring self-efficacy reported a positive change.
The 15 face-to-face interventions were more likely to report effects on behaviors and health outcomes, while the community and campus level interventions had more effect on attitudes or knowledge than on behaviors.
Positive changes in attitudes typically occurred with positive changes in behaviors; in only one case did a study report attitudinal change with no behavioral change Robinson et al. There was no clear relationship between the intensity or duration of the intervention sessions and positive findings.
One study included investigation of physical abuse experience no change at post-testalthough this measurement was intended only to check for an unintended consequence increased abuse as a function of safer sex negotiation. Four of six studies measuring communication outcomes among adults reported positive effects: College samples included two studies based in classroom experiences Brigham et al.
As a group, the interventions were efficacious in whatever outcomes they measured; college studies were also characterized by efforts to produce more mutually honest and
Sexual health campaigns united relationships; every study met one of the standards for the second principle. In one of these studies, students increased condom use, but also abstinence and monogamy Brigham et al. The distinguishing characteristics of these interventions 4 pre-post designs, 2 RCTs were that all six studies aimed to facilitate communication skills with children or adolescents and all six had uniformly positive effects: Five studies were based on small-group sessions for parents, sometimes described as workshops, while one used video and audio methods in CDs mailed to parents.
Compared to control group parents or on pre-intervention measures, participants showed increased comfort, confidence or self-efficacy discussing sexual health and were more likely to do so with their children. The participants were most often gay, bisexual or other men who have sex with men MSMwith one study of transgendered individuals Bockting et al.
Of the 11 MSM studies, 4 clearly referenced gay men 2 of which identified gay and bisexual ; therefore, this section is essentially a review of sexual health studies for MSM.
Most studies were also conducted in assorted small-group settings workshops, retreats and seminars with behavioral content in the intervention most often unprotected sex. Three included peer outreach or counseling.
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Interventions with this population were mostly effective in increasing protective sexual behaviors, although almost half had a mix of null results
Sexual health campaigns united positive findings.
The most common measures were condom use and unprotected sex — studies did not generally focus on partner reduction. Null results were varied: The sole study not to report any positive behavioral effects had only 43 participants, and behavior was only a secondary measure Shepherd et al.
Attitudinal changes were mixed, with only 3 of 6 studies reporting any positive attitude change, typically toward condoms and associated safer sex norms. The 18
Sexual health campaigns united on vulnerable populations in Table 1 comprised 16 RCTs and 2 pre-post designs.
All three RCTs measuring STD incidence reported positive findings associated with the sexual health intervention arm, and the one RCT that measured housing stability and employment found positive effects of the intervention on both variables.
Effects on depression and grief were more mixed. Only one study reported null effects: Several studies provided evidence that a sexual health-focused intervention could affect more than one issue at
Sexual health campaigns united time; for example, decreased unprotected sex and drinking or drug use Velasquez et al. Among studies of HIV-infected populations, some interventions were successful in increasing use of partner selection algorithms that reduce transmission risk e.
In contrast, studies on vulnerable populations were less likely than studies of other populations to measure variables from the first three domains.
Sexual health campaigns united that did measure variables in these domains increased knowledge, but attitude change was inconsistent. The principal question assessed in this review is whether interventions overtly incorporating elements of sexual health had positive effects in any of several domains relevant to public health and individual health Figure 1.
The findings also suggest that such interventions are strongest in select areas defined by population characteristics, domain, and by which behaviors were targeted. After addressing limitations, future directions, and how interventions in this review fit with other prevention activities, we conclude with implications for these findings in the context of public health roles in sexual health interventions.
The strongest and most consistent effects by population were among those we classed as vulnerable. These studies all used a behavioral or an adverse health outcome or both, and virtually all demonstrated predominantly positive effects in the intervention group with little emphasis on attitude change, compared to other populations.
The interventions were more effective in changing sexual behavior in terms of risk per act than in changing the amount of sexual behavior. In particular, interventions were largely successful in increasing contraceptive use, increasing condom use or decreasing the amount of unprotected sex, but only sometimes affected numbers of partners. Interventions generally did not appear to affect overall frequency of sex, which was also less commonly measured. Such results are consistent with intervention content in which sex and sexuality are considered normal parts of being healthy: Of interest, some sexual health interventions for vulnerable populations also had positive impacts on outcomes such as housing status, employment status and alcohol use, suggesting a mixture of sexual
Sexual health campaigns united and impact upon social determinants may be beneficial to participants. The Great American Condom Campaign...
The link between variables such as stable housing and less risky lifestyles is well documented in the literature Fitzpatrick-Lewis et al. Although prospective work would need to be added to studies reviewed here, the incorporation of social determinants into sexual health prevention efforts may even be a useful avenue for public health involvement — the public health organizations involved do not have to be explicitly tasked with sexual health or STD prevention.
Similar to those we classed as vulnerable, interventions with LGBT populations almost exclusively gay men or other men who have sex with men: MSM addressed mainly behavioral outcomes, although a smaller proportion addressed adverse outcomes and a larger proportion measured attitudes. Attitudinal change was mixed, although this may have been partly due to high baseline scores on variables like condom use efficacy. Sexual health education can affect public health and societal for us to help improve sexual health education in both
Sexual health campaigns united United States and abroad.
" comprehensive sexuality education," according to the campaign website. About 1 of 4 sexually active teenage girls
Sexual health campaigns united infected with a sexually transmitted infection (STI) such as chlamydia or human papillomavirus.
Campaign Examples. The links below provide NPIN Campaigns Database The National The Sexual Health Resource Exchange · External Web Site Policy.