Alcohol misuse: tackling the UK epidemic - London

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The timing of educational interventions appears to be important: young people who are already sexually
active at the commencement of interventions are less likely to change their contraceptive behaviour. 173
Although school education reaches a large proportion of the adolescent population, its impact as an agent
of change is affected by variable political and social constraints. It is important to remember that schoolbased
programmes for sexual health promotion are not uniformly administered. They may also lack
components shown to enhance the learning of sexual health information and skills. 190
Peer education has proved popular among adolescents. This can ensure that sex education is delivered in
a language and style that adolescents can related to. The House of Commons Health Committee has
recommended that the Department for Education and Skills and the Department of Health should work
together to promote peer education in all schools, as a supplement to formal schools-based relationships
and sex education. 4
Sexpression, a national organisation based in UK medical schools, run mostly by
medical students, provides good quality, peer-led sex education in local schools.
Public health campaigns
The decline in the number of STIs in the late 1980s and early 1990s in response to government publicity
about the HIV epidemic illustrates the importance of continually conveying the ‘safer sex’ message to
maintain the public’s awareness of STIs. Popular television programmes aimed at adolescents may be able
to raise the issues of STIs and family planning. 160
Community-level programmes using social networks and institutions (such as the media) and providing a
supportive environment have led to reductions in sexual risk behaviour as well as to the maintenance of
low-risk behaviours over time. 190
Improving access to services
Check-ups for STIs should be encouraged among all those who are sexually active, including adolescents.
The BMA publication Consent, rights and choices in health care for children and young people 191
offers
comprehensive practical guidance on the ethical and legal issues which arise in the healthcare of patients
under 16 years of age. In the UK, adolescents under the age of 16 can, with some exceptions, be provided
with contraceptive care even if unwilling to inform their parents. Nonetheless, many adolescents express
doubts about confidentiality in these circumstances as well as fear of being judged. 192
It is important that
adolescents understand professional confidentiality and are reassured that their consultations will remain
private.
Immediate treatment of STIs can help to identify and treat sexual partners, avoid complications, and
prevent potential onward transmission. 3
Offering sexual health promotion counselling to individuals
newly diagnosed with an STI is also important because of the association between a history of STI and the
likelihood of re-infection. Theoretically-based, individual counselling programmes in clinical settings have
been shown to reduce sexual risk behaviours and STI re-infection. 190
Studies show an association between conception rates and the level and type of contraceptive services
available locally. Recent evidence suggests that variations in teenage pregnancy rates may be associated
with local general practice characteristics. A survey of pregnancies of 13 to 19 year olds in Trent between
1994 and 1997 found that general practices with female doctors, young doctors or more nurse time had
lower teenage pregnancy rates. 193
Services appear to have a more positive effect on adolescent sexual
health when they are provided by (youth-oriented) clinics. 173
One study found that most adolescents who
became pregnant attended general practice in the year before pregnancy; many had sought contraceptive
advice. There was an association between the provision of emergency contraception and pregnancy
ending in termination, suggesting the need for continuing follow up of teenagers consulting for this form
of contraception. 194
British Medical Association Adolescent health