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School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT

Maria Lohan Orcid Logo, Kathryn Gillespie Orcid Logo, Áine Aventin Orcid Logo, Aisling Gough Orcid Logo, Emily Warren Orcid Logo, Ruth Lewis Orcid Logo, Kelly Buckley Orcid Logo, Theresa McShane Orcid Logo, Aoibheann Brennan-Wilson Orcid Logo, Susan Lagdon Orcid Logo, Linda Adara Orcid Logo, Lisa McDaid Orcid Logo, Rebecca French Orcid Logo, Honor Young Orcid Logo, Clíona McDowell Orcid Logo, Danielle Logan Orcid Logo, Sorcha Toase Orcid Logo, Rachael M Hunter Orcid Logo, Andrea Gabrio Orcid Logo, Mike Clarke Orcid Logo, Liam O’Hare Orcid Logo, Chris Bonell Orcid Logo, Julia V Bailey Orcid Logo, James White Orcid Logo

Public Health Research, Volume: 11, Issue: 8, Pages: 1 - 139

Swansea University Author: Kelly Buckley Orcid Logo

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DOI (Published version): 10.3310/ywxq8757

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BackgroundThe need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.ObjectivesTo evaluate the effects of If I Were J...

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Published in: Public Health Research
ISSN: 2050-4381 2050-439X
Published: National Institute for Health and Care Research 2023
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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>65346</id><entry>2023-12-20</entry><title>School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT</title><swanseaauthors><author><sid>4e077ae96592c197ac0b44e05b387f5a</sid><ORCID>0000-0002-8862-3776</ORCID><firstname>Kelly</firstname><surname>Buckley</surname><name>Kelly Buckley</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2023-12-20</date><deptcode>CSSP</deptcode><abstract>BackgroundThe need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.ObjectivesTo evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes.DesignA cluster randomised trial, incorporating health economics and process evaluations.SettingSixty-six schools across the four nations of the UK.ParticipantsStudents aged 13–14 years.InterventionA school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE.Main outcome measuresSelf-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12–14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours.ResultsThe analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI –£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI –£15.60 to –£3.83).LimitationsThe trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01).ConclusionsWe present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12–14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective.Future workFuture studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings.</abstract><type>Journal Article</type><journal>Public Health Research</journal><volume>11</volume><journalNumber>8</journalNumber><paginationStart>1</paginationStart><paginationEnd>139</paginationEnd><publisher>National Institute for Health and Care Research</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2050-4381</issnPrint><issnElectronic>2050-439X</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-09-01</publishedDate><doi>10.3310/ywxq8757</doi><url/><notes>Extended Research Article Report</notes><college>COLLEGE NANME</college><department>Criminology, Sociology and Social Policy</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>CSSP</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01.</funders><projectreference/><lastEdited>2024-03-26T14:53:53.3590937</lastEdited><Created>2023-12-20T07:57:51.4294976</Created><path><level id="1">Faculty of Humanities and Social Sciences</level><level id="2">School of Social Sciences - Criminology, Sociology and Social Policy</level></path><authors><author><firstname>Maria</firstname><surname>Lohan</surname><orcid>0000-0003-3525-1283</orcid><order>1</order></author><author><firstname>Kathryn</firstname><surname>Gillespie</surname><orcid>0000-0001-5272-392x</orcid><order>2</order></author><author><firstname>Áine</firstname><surname>Aventin</surname><orcid>0000-0001-5849-0506</orcid><order>3</order></author><author><firstname>Aisling</firstname><surname>Gough</surname><orcid>0000-0002-4201-7316</orcid><order>4</order></author><author><firstname>Emily</firstname><surname>Warren</surname><orcid>0000-0002-9117-844x</orcid><order>5</order></author><author><firstname>Ruth</firstname><surname>Lewis</surname><orcid>0000-0002-6768-6188</orcid><order>6</order></author><author><firstname>Kelly</firstname><surname>Buckley</surname><orcid>0000-0002-8862-3776</orcid><order>7</order></author><author><firstname>Theresa</firstname><surname>McShane</surname><orcid>0000-0003-1284-1272</orcid><order>8</order></author><author><firstname>Aoibheann</firstname><surname>Brennan-Wilson</surname><orcid>0000-0002-6652-6238</orcid><order>9</order></author><author><firstname>Susan</firstname><surname>Lagdon</surname><orcid>0000-0003-0477-2297</orcid><order>10</order></author><author><firstname>Linda</firstname><surname>Adara</surname><orcid>0000-0002-0015-3942</orcid><order>11</order></author><author><firstname>Lisa</firstname><surname>McDaid</surname><orcid>0000-0002-7711-8723</orcid><order>12</order></author><author><firstname>Rebecca</firstname><surname>French</surname><orcid>0000-0002-1962-5022</orcid><order>13</order></author><author><firstname>Honor</firstname><surname>Young</surname><orcid>0000-0003-0664-4002</orcid><order>14</order></author><author><firstname>Clíona</firstname><surname>McDowell</surname><orcid>0000-0002-7644-7197</orcid><order>15</order></author><author><firstname>Danielle</firstname><surname>Logan</surname><orcid>0000-0002-3932-3654</orcid><order>16</order></author><author><firstname>Sorcha</firstname><surname>Toase</surname><orcid>0000-0003-1799-5588</orcid><order>17</order></author><author><firstname>Rachael M</firstname><surname>Hunter</surname><orcid>0000-0002-7447-8934</orcid><order>18</order></author><author><firstname>Andrea</firstname><surname>Gabrio</surname><orcid>0000-0002-7650-4534</orcid><order>19</order></author><author><firstname>Mike</firstname><surname>Clarke</surname><orcid>0000-0002-2926-7257</orcid><order>20</order></author><author><firstname>Liam</firstname><surname>O’Hare</surname><orcid>0000-0002-4453-2880</orcid><order>21</order></author><author><firstname>Chris</firstname><surname>Bonell</surname><orcid>0000-0002-6253-6498</orcid><order>22</order></author><author><firstname>Julia V</firstname><surname>Bailey</surname><orcid>0000-0002-5001-0122</orcid><order>23</order></author><author><firstname>James</firstname><surname>White</surname><orcid>0000-0001-8371-8453</orcid><order>24</order></author></authors><documents><document><filename>65346__29832__3ea1437f4107445c87adc3415f665ba8.pdf</filename><originalFilename>65346.VOR.pdf</originalFilename><uploaded>2024-03-25T13:45:50.7467533</uploaded><type>Output</type><contentLength>4956691</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 65346 2023-12-20 School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT 4e077ae96592c197ac0b44e05b387f5a 0000-0002-8862-3776 Kelly Buckley Kelly Buckley true false 2023-12-20 CSSP BackgroundThe need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.ObjectivesTo evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes.DesignA cluster randomised trial, incorporating health economics and process evaluations.SettingSixty-six schools across the four nations of the UK.ParticipantsStudents aged 13–14 years.InterventionA school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE.Main outcome measuresSelf-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12–14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours.ResultsThe analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI –£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI –£15.60 to –£3.83).LimitationsThe trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01).ConclusionsWe present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12–14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective.Future workFuture studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Journal Article Public Health Research 11 8 1 139 National Institute for Health and Care Research 2050-4381 2050-439X 1 9 2023 2023-09-01 10.3310/ywxq8757 Extended Research Article Report COLLEGE NANME Criminology, Sociology and Social Policy COLLEGE CODE CSSP Swansea University Another institution paid the OA fee This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01. 2024-03-26T14:53:53.3590937 2023-12-20T07:57:51.4294976 Faculty of Humanities and Social Sciences School of Social Sciences - Criminology, Sociology and Social Policy Maria Lohan 0000-0003-3525-1283 1 Kathryn Gillespie 0000-0001-5272-392x 2 Áine Aventin 0000-0001-5849-0506 3 Aisling Gough 0000-0002-4201-7316 4 Emily Warren 0000-0002-9117-844x 5 Ruth Lewis 0000-0002-6768-6188 6 Kelly Buckley 0000-0002-8862-3776 7 Theresa McShane 0000-0003-1284-1272 8 Aoibheann Brennan-Wilson 0000-0002-6652-6238 9 Susan Lagdon 0000-0003-0477-2297 10 Linda Adara 0000-0002-0015-3942 11 Lisa McDaid 0000-0002-7711-8723 12 Rebecca French 0000-0002-1962-5022 13 Honor Young 0000-0003-0664-4002 14 Clíona McDowell 0000-0002-7644-7197 15 Danielle Logan 0000-0002-3932-3654 16 Sorcha Toase 0000-0003-1799-5588 17 Rachael M Hunter 0000-0002-7447-8934 18 Andrea Gabrio 0000-0002-7650-4534 19 Mike Clarke 0000-0002-2926-7257 20 Liam O’Hare 0000-0002-4453-2880 21 Chris Bonell 0000-0002-6253-6498 22 Julia V Bailey 0000-0002-5001-0122 23 James White 0000-0001-8371-8453 24 65346__29832__3ea1437f4107445c87adc3415f665ba8.pdf 65346.VOR.pdf 2024-03-25T13:45:50.7467533 Output 4956691 application/pdf Version of Record true This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence. true eng https://creativecommons.org/licenses/by/4.0/
title School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT
spellingShingle School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT
Kelly Buckley
title_short School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT
title_full School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT
title_fullStr School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT
title_full_unstemmed School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT
title_sort School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT
author_id_str_mv 4e077ae96592c197ac0b44e05b387f5a
author_id_fullname_str_mv 4e077ae96592c197ac0b44e05b387f5a_***_Kelly Buckley
author Kelly Buckley
author2 Maria Lohan
Kathryn Gillespie
Áine Aventin
Aisling Gough
Emily Warren
Ruth Lewis
Kelly Buckley
Theresa McShane
Aoibheann Brennan-Wilson
Susan Lagdon
Linda Adara
Lisa McDaid
Rebecca French
Honor Young
Clíona McDowell
Danielle Logan
Sorcha Toase
Rachael M Hunter
Andrea Gabrio
Mike Clarke
Liam O’Hare
Chris Bonell
Julia V Bailey
James White
format Journal article
container_title Public Health Research
container_volume 11
container_issue 8
container_start_page 1
publishDate 2023
institution Swansea University
issn 2050-4381
2050-439X
doi_str_mv 10.3310/ywxq8757
publisher National Institute for Health and Care Research
college_str Faculty of Humanities and Social Sciences
hierarchytype
hierarchy_top_id facultyofhumanitiesandsocialsciences
hierarchy_top_title Faculty of Humanities and Social Sciences
hierarchy_parent_id facultyofhumanitiesandsocialsciences
hierarchy_parent_title Faculty of Humanities and Social Sciences
department_str School of Social Sciences - Criminology, Sociology and Social Policy{{{_:::_}}}Faculty of Humanities and Social Sciences{{{_:::_}}}School of Social Sciences - Criminology, Sociology and Social Policy
document_store_str 1
active_str 0
description BackgroundThe need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.ObjectivesTo evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes.DesignA cluster randomised trial, incorporating health economics and process evaluations.SettingSixty-six schools across the four nations of the UK.ParticipantsStudents aged 13–14 years.InterventionA school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE.Main outcome measuresSelf-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12–14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours.ResultsThe analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI –£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI –£15.60 to –£3.83).LimitationsThe trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01).ConclusionsWe present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12–14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective.Future workFuture studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings.
published_date 2023-09-01T14:53:50Z
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