Alcohol misuse: tackling the UK epidemic - London

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38 Interventions in adolescent sexual health The health of the nation: a strategy for health in England, published in 1992, identified HIV/AIDS and sexual health as one of five priority areas, with specific objectives and targets being set. Objectives included reducing the incidence of HIV infection and gonorrhoea and halving the rate of conception among girls under 16 by 2000. Five years after the strategy was published, the gonorrhoea target had been achieved but most other sexually transmitted infections had increased and pregnancy rates had not decreased. 3 In June 1999 the Social Exclusion Unit published a report Teenage pregnancy examining teenage pregnancy and assessing interventions. The report’s 10-year action plan for England included a national campaign, ‘joined up action’, better prevention and better support for pregnant teenagers and teenage parents. The prevention element includes better education in and out of school, access to contraception and targeting of at-risk groups, with a new focus on reaching young men. 162 Following the report, a Teenage Pregnancy Unit was established at the Department of Heath to coordinate action across government to reduce teenage pregnancy in England. 162 Also in 1999, The National Assembly for Wales published A strategic framework for promoting sexual health in Wales. 181 In Scotland the white paper Towards a healthier Scotland identified sexual health and the development of a sexual health strategy as a public health priority. 96 The English government published its sexual health and HIV strategy for consultation in July 2001. This set out plans to: • reduce the transmission of HIV and STIs • reduce the prevalence of undiagnosed HIV and STIs • reduce unintended pregnancy rates • improve health and social care for people living with HIV • reduce the stigma associated with HIV and STIs. In response to the consultation a 27 point action plan was published in June 2002. 182 This strategy is now being implemented. Key elements include a model for sexual health services that can be delivered by every primary care trust and the evaluation of new one-stop sexual health services. A national information campaign has been launched, more money has been allocated to GUM and abortion services, and a chlamydia screening programme is under way. Despite these commitments, concern has already been expressed that the allocated resources are insufficient. 183 Current policy in the UK aims to halve the conception rate of under 18s and set a downward trend in the rate for under 16s by 2010. It also aims, in the light of evidence of poor social, economic and health outcomes for mother and child, to achieve a reduction in the risk of long term social exclusion of teenage parents and their children. 163 This involves a multifaceted approach which includes helping young people resist pressure to have early sex through improved sex and relationship education, increasing uptake of contraceptive advice through the development of easily accessible youth friendly advice services and support for parents in talking to their children about sex and relationship issues. A similar approach has been adopted in Wales through its Sexual Health Strategy. In Northern Ireland Myths and reality: teenage pregnancy and parenthood was published in 2000. The only country in the UK which has so far not set out its plans to reduce teenage pregnancy in a strategic document is Scotland, although this is currently under consideration. Scotland did set a target in 1994, reaffirmed in 1999, to reduce the pregnancy rate among 13 to 15 year olds by 20 per cent between 1995 and 2010. 4 The Sex and relationship education guidance for the national teaching curriculum in schools, states that sex and relationship education (SRE) should be firmly rooted within the framework for Personal, Social and Health Education (PSHE) and Citizenship. During key stages 3 and 4 (from 11 to 16 years), pupils should be given knowledge, understanding and the ability to recognise the physical and emotional changes that British Medical Association Adolescent health
take place at puberty. They should be taught how to manage these in a positive way, in a context of the importance of relationships, human reproduction, contraception, STIs, HIV and high-risk behaviours including early sexual activity. 184 Evaluating the effectiveness of interventions in adolescent sexual health This section attempts to evaluate the effectiveness of several interventions in adolescent sexual health. To date, most sexual health interventions for adolescents have not been evaluated; consequently there is not a great deal of reliable evidence regarding the effectiveness of different approaches. 185 A recent review of international variations in teenage pregnancies shows that even those adolescents in the most affluent areas of the UK have a higher birth rate than the average for the Netherlands or France. This, the authors suggest, leads to the possibility that teenage pregnancy is susceptible to policy interventions. 4 Over the past four decades, fluctuations in the adolescent fertility rate seem to track intervention-related factors such as access to, and use of, contraceptive services, and the general climate surrounding the sexual health of young people. 156 This also seems to demonstrate the potential of interventions in improving, or harming, adolescent sexual health. Education The UK has a poor record of sex education in comparison to some other European countries. 186 However, school-based lessons are now, according to respondents in NATSAL, the main source of information about sexual matters for adolescents. 156 School-based physical, health and social education can encourage behaviour modification in adolescents to help prevent unwanted pregnancy and the transmission of STIs. Education can focus on increasing awareness of STIs and birth control. It can also develop social skills, such as negotiating in relationships and accessing and using sexual health services. 160 Some people recommend that sex education for adolescents should focus on abstinence. In the US, medical journals regularly publish articles encouraging healthcare professionals to recommend abstinence and giving detailed advice on how to do so most effectively. 187 Abstinence-based educational approaches generally develop decision-making and refusal skills and rarely provide information on contraceptive methods or services. 173 Reservations about abstinence-based education have been expressed by those who believe adolescents want practical information and help with sexual health rather than didactive approaches emphasising anatomical or moral aspects of sexual behaviour. 185 One review of educational approaches to the prevention of teenage pregnancy found that, in comparison to usual sex education, abstinence programmes had no additional effect on either delaying sexual activity or reducing pregnancy. 173 Evaluative studies of educational strategies show that school-based sex education can be effective in reducing teenage pregnancy, especially when linked to access to contraceptive services. School-based skills building, combined with factual information and programmes encouraging vocational development, may also help to reduce rates of unwanted teenage pregnancy. The most reliable evidence shows that sex education does not increase sexual activity or pregnancy rates. 173 Early intercourse and non-use of contraception is more common among adolescents whose main source of information about sex is not lessons at school. 156 One analysis of NATSAL concluded that the association between school sex education and risk reduction provides grounds for optimism regarding the role of education in improving adolescents’ sexual health. 156 Interviews with pregnant adolescents in inner London found that the major causes of unintended teenage pregnancy are failures to anticipate personal risk and error in the use of contraception. 188 Successful school sex education needs to combine clear advice about contraceptive methods and how and when to access services, with educational techniques designed to help teenagers assess personal risk. 189 British Medical Association Adolescent health 39
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BMA Board of Science Alcohol misuse
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Page 112 and 113: vi Contents Introduction...........
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Page 116 and 117: 2 heavier smoking, drinking and mor
Page 118 and 119: 4 Nutrition, exercise and obesity N
Page 120 and 121: 6 The data for 1998 shows a 21 per
Page 122 and 123: 8 Interventions in adolescent nutri
Page 124 and 125: 10 The efficacy of traditional educ
Page 126 and 127: 12 The treatment of individuals wit
Page 128 and 129: 14 Smoking, drinking and drug use A
Page 130 and 131: 16 The use of illicit substances, a
Page 132 and 133: 18 smoking prevalence was highest a
Page 134 and 135: 20 Interventions in adolescent drug
Page 136 and 137: 22 be expensive given the amount co
Page 138 and 139: 24 is potential to use the media, n
Page 140 and 141: 26 Summary Adolescents in the UK ar
Page 142 and 143: 28 Mental health problems in adoles
Page 144 and 145: 30 Risk factors for conduct, depres
Page 146 and 147: 32 Currently, specialist mental hea
Page 148 and 149: 34 Sexual health Adolescents and se
Page 150 and 151: 36 interferes with the adolescent
Page 154 and 155: 40 The timing of educational interv
Page 156 and 157: 42 Helping adolescent parents The h
Page 158 and 159: 44 are more difficult to reach than
Page 160 and 161: 46 The way forward This report has
Page 162 and 163: 48 Annex 1 BMA policy on adolescent
Page 164 and 165: 50 References 1 Lobstein T J, James
Page 166 and 167: 52 56 Social Exclusion Unit (1998)
Page 168 and 169: 54 115 Charles Gallichan (2003) Pub
Page 170 and 171: 56 173 NHS Centre for Reviews and D
Page 172 and 173: Subject: Young People and Alcohol D
Page 174 and 175: Call for Evidence: Children and You
Page 176 and 177: 5. Do you know of any international
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