Culturally Sensitive Best Practices for Sex Education Programs






Publication: National Association of School Psychologists. Communique
Author: D'Santiago, Verenice
Date published: March 1, 2012

Learning about sexuality is a lifelong process that begins in childhood and continues through the lifespan (NASP, 2003). Through family and peer interactions andmedia sources,youthlearn about sexuality and relationships, and develop their own values. The learning process and trajectory, however, may differ among youth from diverse cultures. In fact, differences in cultural values, identity, and experience as a minority person and unequal access to resources can influence sexual values and behavior, perhaps leading to increased risk of negative consequences of sexual behavior. Across ethnic and racial groups, there are a variety of important risk and protective factors related to sexual behaviors and outcomes. For instance, among youth from Latino and Black cultures, there is significantly less communication in the home about sexuality compared to families in White cultures (Lefkowitz, Romo, Corona, Au, & Sigma, 2000). As such, the school becomes an integral part of sexuality education, and for many youth from Latino and Black cultures, the only source of accurate information. Schools must tailor their sex education programs to fit the diverse needs of their students.

School psychologists' training in assessment, evidence-based decision-making, progress monitoring, and program evaluation makes us strong assets in the development and implementation of sex education curricula. These skills have potential to help schools achieve desired health goals. Many resources are invested in sex education programs that are not as effective when working with diverse populations because of a one-size-fits-all approach. For instance, one sex education program called "Be Proud! Be Responsible!," identified as effective for Black youth in nonschool settings (Jemmott, Jemmott, & Fong, 1992, 1998), was less effective when implemented in suburban areas with White and/or Hispanic youth (Borawski et al, 2009).

Sex education curricula are most effective when they intersect with the psychosocial risk and protective factors that affect the target youth's sexual behavior, including knowledge, perceived risks, values, attitudes, perceived norms, and self-efficacy (Kirby, 2007). One example of cultural sensitivity is that Latino populations face issues of limited access to healthcare, cultural importance of motherhood, and cultural norms encouraging childbearing (Blair, 1999). On the other hand, protective factors linked to a delay in sexual activity for Latina women include speaking Spanish as a first language and being a new immigrant to the United States (National Coalition of Hispanic Health and Human Services Organization, 1999) . In Black cultures, risk factors include early onset of sexual activities, perceived peer behaviors, and having sex with multiple partners (Johnson et al., 1994). In contrast, connectedness to church and spirituality (Haight, 1998), parenting styles including structure and well-defined roles (JohnsonGarner & Meyers, 2003), and positive aspects of masculinity are resiliency or protective factors. This article highlights the importance of understanding culture-specific sexual values and behavior to develop and implement sex education programs that are effective for youth from Latino and Black cultures.

GENDER-RELATED CULTURAL VALUES

Because the effectiveness of sex education programs is largely based on cultural sensitivity (Kirby, 2007), it is incumbent on school psychologists to understand how genderrelated cultural values impact adolescent's sexuality. For example, machismo and marianismo are gender-stereotyped values that greatly impact the development of sexual scripts of Latino youth. Machismo values include men having multiple partners, being in charge of frequency and type of sexual activity, and refraining from talking to women (other than one's partner) about sex (Marin, Tschann, Gomez, 8c Kegeles, 1993). Marianismo values modesty, faithfulness, and virginity as feminine ideals. In light of these values, Latinos are taught to express their sexuality, whereas Latinas are taught to repress it and to rely on their husband to teach them about sex (Gil 8c Vasquez, 1996) . This suggests that Latinas may not seek information about sexuality for fear of sacrificing their cultural image and, thus, maybe learning incorrect information from their partner. Latinas may also feel obligated to conceal past sexual experiences from their partner to avoid being labeled as promiscuous and may be less likely to seek sexual health services. Although Latinas report receiving negative messages about sexuality, they also receive positive messages about respecting their body, which may serve as a protective factor. Likewise, reinforcing the positive characteristics of machismo is essential in helpingyoung Latino men become involved in pregnancy prevention efforts. Hablando Caro: Con Carino y Respeto (Plain Talk: With Love and Respect) created a group for young men that encouraged the development of values related to responsible sexual activity (Annie E. Casey Foundation, 1998) . More recently, the Joven Noble curriculum, a developmental program aimed at addressing risk-related sexual behavior within a cultural context, has shown to be effective in reducing risky sexual behavior and in increasing knowledge about sexuality among Latino males (Tello, Cervantes, Cordova, 8c Santos, 2010).

Marianismo plays a role in the level of Latina's self-esteem, in that it is linked to how a woman believes others perceive her (Marano, 2000). Understanding the role marianismo plays in Latinas' self-esteem may have implications for the types of skills to be taught, as Latina adolescents within the poorest communities in the United States associate childbearing with self-worth and a feeling of respect (Blair, 1999). In addition, ambivalence about contraception and a bias against abortion influences teenage pregnancy in Latino communities (Blair, 1999). Moreover, many Latinas identify pregnancy with independence, and childbearing serves as a marker of social productiveness and worthiness of respect (de la Vega, 1990). As a result, sex education curricula are more effective when decision-making skills are taught, including cognitive, social, and cultural aspects.

Similarly, teaching decision-making and communication skills is best practice when working with youth from Black cultures (Kirby, 2007; Manlove et al., 2001; St. Lawrence et al., 1995), although different cultural values may need to be considered. For instance, gender schémas in Black cultures are strongly affected by media influences (i.e., music videos; Stokes, 2007; Ward, Hansbrough, 8c Walker, 2005). Thus, it is important to understand the portrayal of Black women in the media and how that informs the development of sexual scripts. Stephens and Phillips (2003) described eight scripts composed from political status and cultural meaning of Black womanhood, such as Diva, Gold Digger, Earth Mother, and Sister Savior (for further information regarding these scripts, see Stephens 8c Phillips, 2003). These scripts present a visual representation for categorizing women in stereotypical ways and provide scripts for their sexual behaviors and expectations. For example, Divas cultivate an image of sexuality as attractive but unattainable, and their sexuality is expressed through their seductive walk and body shaping outfits. In contrast, Sister Saviors' sexuality is grounded in the African American church.

These scripts are part of a life perspective that continues to develop through practice and self-awareness. They are important because people rely on scripts to understand how to behave sexually and which situations are sexual (Simon 8c Gagnon, 1987) . However, if a woman feels comfortable with herself, her sexuality, and her context, she may be more logically inclined when interacting with men. As such, nonconformity may allow for more flexibility for Black women to make decisions based on knowledge rather than stereotypical inclinations. Thus, to increase flexibility, best practice includes direct teaching of nonconformity to these stereotypes (i.e., through role-plays), decision-making skills, focus group discussions of schémas, and early intervention with youth engaging in behaviors incongruent with these stereotypes to increase flexibility (Ward et al., 2005). Youth developmental programs incorporating these skills have been shown to decrease pregnancy, increase connectedness to school and family, and teach girls from Black cultures how to play a more active role in their identity, specifically as the role relates to their sexuality. An example of such a program is the Seattle Social Development Program (Hawkins et al., 2007).

COMMUNICATION

As previously mentioned, parents from Black and Latino cultures have less frequent communication about sexuality with their children than do parents from White cultures. Because more open communication between mothers and teens about sexual beliefs and values predicts fewer adolescent sexual behaviors (Romo, Lefkowitz, Sigman, 8c Terry, 2002), it is important to understand cultural barriers to communication about sexuality. Communications between mothers and daughters in Latino and Black cultures are limited and typically focus on hygiene rather than issues about sex per se. Specifically, mothers from Black cultures tend to focus on pregnancy prevention in their communication about sexuality, whereas Latina mothers' communications focus on avoidance of sexual contact (O' Sullivan, Meyer-Bahlburg, 8c Watkins, 2001) . Parents' expectations are warnings rather than advice (Rafaelli8cOntai,200i). Challenges in communication about sex in the Latino culture include a cultural taboo in talking about sexuality, feeling that religious beliefs do not allow discussion of premarital sex, feeling a lack of control over the environment in which children are growing up, and lack of skills in communicating with their children about sexuality (National Campaign to Prevent Teen Pregnancy, 2001a). Hosting parent forums can provide opportunities to teach parents specific skills that can aid them in communicating with their children about sexuality, as well as provide parents with an opportunity to voice their concerns (National Campaign to Prevent Teen Pregnancy, 2001b). Furthermore, the best resource for Latina adolescents may include someone other than a parent, and thus, it may beneficial to identify a trusted older woman (O' Sullivan, Meyer-Bahlburg, 8c Watkins, 2001).

PEERS

Minimal communication between adolescents and their parents about sex is associated with a greater adherence to peer norms regarding sexual behavior (Whitaker 8c Miller, 2000). In communities where Latino-descent youth are primarily first and second generation students in the United States, lack of parent communication about sexuality may be more prevalent than in communities where Latino-descent youth are third and fourth generation. In Black cultures, the peer group is particularly informative and powerful for urban Black males, encouraging them to have sex with multiple partners to achieve status (Anderson, 1989). Overall, behavior patterning occurs across ethnicities (Get Real About Pregnancy, 2002), and preventive norms could be challenged when the norms and behaviors of peers promote sexual activity without contraceptive use. As a result, the incorporation of peer discussion and mentoring groups is considered best practice (Manlove et al., 2001). Because adolescents tend to seek out friends with similar attitudes and values (Manlove et al., 2001), one method is to develop focus groups including individuals with similar sexual values and to provide assignments that match their needs to increase comfort and communication. Providing opportunities for open communication in an educational setting decreases the likelihood that misinformation will be transmitted. Several programs also identify small groups of individuals who are well liked by peers and have well developed leadership skills. These individuals can be trained in the content and delivery of sex education and can lead class lessons.

CREATING A SAFE ENVIRONMENT

All youth enrolled in a sex education program should feel that their environment is safe when learning about sexuality. Kirby (2007) found that programs that effectively created a comfortable environment began by establishing a set of ground rules in the classroom, such as avoiding asking personal questions and showing respect for individual opinions. In working with youth from Latino and Black cultures, awareness of cultural issues and adoption of particular strategies can increase comfort. For instance, in light of gender-specific values and scripts, some effective programs separate participants by gender during certain instructional activities, whereas others deliver the entire curriculum in groups segregated by gender. As indicated by Kirby (2007), best practice dictates that it is important to select staff with desirable characteristics, such as confidence in communicating about sex, to create a confident and comfortable environment where youth feel it is appropriate to disclose and share opinions, as well as ask questions. In addition, direct and clear communication about sexuality in the context of a comfortable environment may be particularly beneficial for Latino youth to help overcome vergüenza (i.e., embarrassment in communication about sex).

CULTURALLY SENSITIVE SERVICE DELIVERY

In developing an effective curriculum, it is important to understand how culture-specific values may affect the delivery of services, as well as identify protective factors that may strengthen the program. For example, vergüenza affects Mexican-descent adolescents' communication about sexuality, specifically communication between parents and adolescents. Thus, in addition to creating a safe environment, best practice is to involve family and community in curriculum activities, such as homework assignments where direct interactions are required for completion. For example, one community-based sex education program called Hablando Claro: Con Carino y Respeto (Plain Talk: With Love and Respect) helped parents develop the skills necessary to effectively talk to their children about reducing risky sexual behavior. Incorporating the family highlights one of the strengths of Latino cultures and applies it to their role in sex education. Such protective factors are beneficial in buffering risk factors specific to Latino cultures, including marianismo, machismo, and vergüenza. As suggested by Kirby (2007), programs that are culturally sensitive to such values are more effective in responding to the values of Latino adolescents.

Conditions contributing to high teenage pregnancy rates include low educational attainment and future aspirations (Annie E. Casey Foundation, 1999). Thus, it may be helpful for school psychologists to be aware of the residency status of youth when delivering services, as it is possible that for undocumented youth, educational aspirations maybe lower than youth who have greater access to financial and admission resources. A college education has the greatest positive effect on Hispanic youth, translating to fewer teenage pregnancies (Kirby, Coyle, & Gould, 2001). Hispanic teenage mothers may not see the importance of becoming self-sufficient (Johns, Moncloa, & Gong, 2000), so encouraging and implementing academic support plans for Latina teenage mothers is best practice. Other best practices in Latino teenage pregnancy prevention service-delivery include community-wide campaigns (Johns, Moncloa, & Gong, 2000); involvement of male students, family, and other caring adults in prevention efforts; and content aligned with traditional Latino values (Denner, Kirby, Coyle, & Brindis, 2001; Johns, Moncloa, & Gong, 2000).

Best practice also requires differences in program service delivery that acknowledges differencesin the developmental trajectory of sexuality across contexts and cultural groups. For example, research has shown that the progression of Black adolescents' sexual behavior is significantly faster than that of White teens (Kirby, 2007; Smith & Udry, 1985), with sexual initiation typically ranging from 12 to 15 years of age for Black adolescents and 14 to 15 years for White adolescents. According to Smith and Udry (1985), the delay in the progression of sexual behavior among White youth serves as an adjustment period to recognize the increased likelihood of having sex and to prepare for it through increased knowledge and awareness. Thus, youth from Black cultures may not be emotionally prepared for sexual debut and may lack general knowledge of sexuality and safe practices. Moreover, they may have limited awareness of community resources. It is important to use curricula that are developmentally appropriate for Black youth to provide them with the knowledge about sexuality prior to their initiation of sex. For example, Cleveland (Ohio) Metropolitan School District (CMSD) developed a Responsible Sexual Behavior initiative that included three curricula beginning in the fourth grade. Each curriculum component included its own goals and taught specific skills that were developmentally appropriate for Black adolescents. For example, from the fourth grade to sixth grade, skills included saying no, talking to parents about sex, decision making, and sex in the media. In the seventh and eighth grades, the same skills continued to be taught, andlessons regardingreasons to have a baby were introduced, as well as discussions of peer pressure and community resources. At the high school level, the skill that was specifically targeted was condom negotiation, and the behavioral intent changed from delaying sex to sexual refusal and intent to use condoms. Additionally, characteristics of other effective programs include implementing activities to recruit and retain teens, if necessary. It is important to overcome barriers that prevent youth's involvement by publicizing the program, offering food or other incentives, and obtaining parental permission. Obtaining permission may be more tenuous in those cultures that value sex education as a responsibility of the family (Kirby, 2007). Recent theoretical applications have suggested that involving youth in sex education implementation can promote agency in youth, resulting in positive results.

One relevant theory, positive youth development (PYD; Larson, 2006) , strives to empower protective factors in the youth's development and encourages relationships with adults, mentors, teachers, and other support figures to facilitate the teen's development and encourage prosocial behaviors. PYD corresponds with the idea of developmental sex education programs. In addition, this model strengthens youth's positive response to developmental changes and can provide the motivation needed for adolescents to apply knowledge and skills learned from the sex education curriculum (Gavin, Catalano, 8c Markham, 2010) . As suggested by PYD, youth involved in developing and/or implementing sex education curricula develop agency and maybe less likely to take behavioral risks. Furthermore, encouraging positive adult relationships within a sex education curriculum can provide youth with resources and support, as well decrease the likelihood that youth will jeopardize future goals or harm important relationships (Gavin et al., 2010). Although many sex education programs have not yet utilized this theory, PYD has important implications for the delivery of culturally sensitive sex education programs (i.e., encouraging protective factors existent within the youth's culture). One example using PYD theory is the Joven Noble curriculum (Tello et al., 2010).

THE ROLE OF SCHOOL PSYCHOLOGISTS

It is important for school psychologists to understand how to develop effective sex education programs that are culturally relevant for adolescents. Our training in human development, as well as psychological and learning principles, allow us to assume a leadership role when developing a sex education curriculum that is culturally and developmentally appropriate. It is important to remember that effective sex education programs incorporate a developmental trajectory, and should be implemented during the elementary and secondary years. The content during the early elementary years includes healthy eating and exercise and healthy relationships. Content progresses to teach about puberty during middle childhoodyears and sexuality during the secondary school years, as well as communication and cognitive skills. Conducting needs-based assessments can clarify the appropriate trajectory indicated at a particular school, as well as identify culturally sensitive content and service delivery. A needs-based assessment can include parent and staff interviews, review of pregnancy and HIV/STI prevalence rates both in the community and school (paying close attention to age as a factor), as well as a review of other programs that are implemented in the community.

Another key factor in our training that is important in creating effective sex education program is our expertise in consultation and collaboration. Because the family (familismo) may serve as a protective factor in the Latino culture, the school should provide multiple opportunities to engage parents, as these opportunities can increase openness and comfort in communicating about sex and serve as parent education opportunities. Increasing community collaborations in Black cultures can help create a more flexible climate that fosters healthy sexuality. Communities shouldbe involved, and promoting positive youth development is a multifaceted intervention approach (Sieving et al., 2011). In addition to community collaboration, collaboration within the schools can help increase teacher buy-in and create a positive climate towards sex education, as well as increased positive connectedness between students and adults (Kirby 2001; Kirby, Coyle, & Gould, 2001). School psychologists have the necessary skills to develop and implement sex education programs that are appropriate for children's development and cultural identities (NASP, 2003). Sex education programs that increase responsiveness to cultural values promote healthy mental, academic, and social-emotional development among youth of diverse backgrounds. It is important to involve parents and youth, to adopt a developmentally and culturally appropriate model, to use research as a guide, and to create an environment where students can succeed.*

Resources

The Michigan Department of Community Health (MDCH) Teenage Pregnancy Initiative http://www.michigan.gov/teenpregnancy

The National Campaign to Prevent Teen and Unplanned Pregnancy http://www.thenationalcampaign.org

Sexuality Information and Education Council of the United States (SIECUS) http://www.siecus.org

Sex Education Library: Lesson Plans http://www.sexedlibrary.org

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Author affiliation:

VERENICE D'SANTIAGO is an advanced doctoral student in school psychology at Illinois State University interested in culture and diversity issues. ALYCIA M. HUND, PhD, is an associate professor of psychology at Illinois State University who studies cognitive development during childhood, as well as broader developmental themes.

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