Exploring Adolescent Sexual Health In Queensland, Australia

Health Promotion Project Plan: Sexual Health Education

Understanding Adolescent Sexual Health

This project aims to explore and understand the contributing factors leading to sexual health issues associated with the adolescents aged 10 to 19 years in the Queensland Australia and be able to analyze the health issue and provide a health promotional project to improve the sexual health literacy and awareness among the target population. The project is intended to be completed within 1 years, within a budget of $15 000. 

Sexual health can be defined as “an approach to sexuality founded in accurate knowledge, personal awareness, and self-acceptance, where one’s behavior, values, and emotions are congruent and integrated within a person’s wider personality structure and self-definition”. According to a report by WHO, around 1 million underage women below the age of 15 gives birth across the globe every year and around 3 million underage girls have been reported to be going through unsafe abortion. It has to be mentioned that the sexual health of the adolescents had developed as a significant public health priority globally and the Australian demographics is no exception to that either (1). According to the reports of the Australian government conducted survey of 2014, approximately a quarter of Year 10 students (23%), one third of Year 11 students and a half of Year 12 students had experienced sexual intercourse. And  in the target community close to 23.2% of the sexually active adolescent students have been found to be having sex with three or more sexual partners. It is evident that sexual activities are common rates are very high among adolescences and the lack of proper health literacy and sexual health literacy makes the adolescents very vulnerable to sexually transmitted infections or diseases. The most common sexually transmitted diseases include Human Papillomavirus and HIV (3). The Australia has also been ranked 22^nd in global teen pregnancy rates and along with that, in the past year close to 6011 cases of STIs have been reported in the age group of under 20 years old. Hence, the lack of sexual health promotional behavior and literacy is undoubtedly alarmingly low among the target population of adolescents of the Queensland and there is need for extensive health issue analysis for the target population (11). 

Priority setting is a very important aspect of any health promotional project in order to justify the health issue selected for the project (5). The health issue selected in this health promotional project is the poor sexual health of the adolescents in the Queensland.

Priority Setting for Health Promotion

The first criterion selected is the frequency. Now it has to be mentioned that for any health issue to be a priority, it is crucial for the health issue to understand the frequency impact of the health issue in the region (6). In the target, the adolescents belonging to year 10 or 12 have been found to be sexually active and most of them had been found to be engaging with multiple partners. According to the reports, the STI rates have risen 32% in the past year, and more than half of the rise in the percentage had been contributed by the age group of 15 to 29 (12). As the adolescents are a significant part of the mentioned age group the rise in frequency of the STI is critically linked with the health issue selected, it is undoubted a pressing health priority.

The second priority is the severity, which discusses the severity of the chosen health and how it serves as the health priority in this situation. According to the government document , for the chosen demographics, close to half of the youngsters engaged in physical intimacy have had more than two sexual partners at a time (12). 37.3% of the year 10 students and 56.7% of the year 12 students have been engaged in oral sex. Along with that, it has to be mentioned that close to 10% have been reported to use no contraception or protection measure (14). Hence, considering the severity of the issue, it can be stated that the lack of sexual health awareness and education has lead to significant risky sexual behavior among the target group. Hence enhancing their sexual health literacy is a significant health priority for the population.

The third criteria is the cost, the burden of the diseases has contributed significantly to the total burden of the health care. Researchers are of the opinion that the Queensland has become the Chlamydia capital of Australia and along with that, the health strategy of the local government has already decided a $18 million for the sexual health strategy to combat the rising health issues in the nation. However it has to be mentioned that without behavioral changes in the target population the sexual health strategy will not be useful.

The fourth criteria selected for the project is demographics, first and foremost, it has to be mentioned that Queensland has become the Chlamydia capital of the company. Considering all different age groups, in the year of 2016, close to 27500 residents of Queensland had been diagnosed with some form of sexually transmitted infection, most of them had been due to Chlamydia along with other disease types (7). According to the authors, it has to be mentioned that the patients have been found to be having up to 10 sexual partners with limited awareness regarding STI and along with that limited inclination towards the safe sex practices (13). The northern Queensland area has been found to be in the midst of a syphilis outbreak as well from the past year. Hence the demographic data suggests poor education, literacy and healthy behavior among population, especially in the youth; prioritizing their sexual health. The last criteria selected for the project is the incidence rate. Considering the data shared by the Queensland government, the incidence rate of Chlamydia has increased by a 10% from 2015 to 2016, contributing 82% of the total STI rates (14). The incidence rates of Gonorrhea have also risen by a 32% in the past couple of years with more that 4000 people in Queensland being diagnosed with Gonorrhea. According to the research, use of protection or contraception is a common issue among the teens in the region adding to the incident rate of the STIs. Hence, there is a significant gap in the sexual health promotion of the target group in Queensland and there is a pressing need for enhancing their sex education and be able to change their perception of safe sexual practices (13).

Evidence for goal, objectives and sub-objectives (150 words per goal, objective and sub-objective) 

For goal:

• Unsafe sex practices and unplanned pregnancies have become a growing sexual health concern for Australian adolescents (8)
• The adolescents contribute more than one thirds of the total risevionb tue incidence rate of STIs in the chosen demographics of Queenslands (11)
• The STI rates have risen by 10% in 2016 from what it had been in 2015 and is projected to rise even further in the years to come, and the risky and unsafe sexual behavior of the adolescents is a significant risk to the same (12)
• The lack of use of contraception or protective devices had been discovered as the key issue contributing to the lack of adherence to safe sexual practices (10)
• The limited awareness among the adolescents regarding the need for safe sex practices and the impact of unsafe sexual interaction and resultant STIs has been reported as the main contributing factors (6)

Objective one and two:

• In order to better understand the need for improving the sexual health education of the adolescents, proper understanding of their level of awareness and knowledge is required (15)
• Institution can be the best setting for screening the awareness levels with respect to age groups and sexual activity (8)
• The impact of parental discretion and upbringing is a contributing factor to behavior and perception of the school aged youth (16)
• Home based one-on-one interview based survey involving the parents can help in discovering the impact of lack of parental discretion and education on their sexual behaviors (12)
• As per the article, lack of funding on the promotional campaigning serves as a significant challenge to the improving the awareness of the target population (18)
• The lack of cultural safety and accessibility has led to the STI rates being 2.8 timers higher in Aboriginals (22).

Sub-objective one and two:

• Sexual health literacy screening has helped in improving the sexual health status of the adolescents, especially in the culturally diverse communities (9).
• The marginalized population has been reported to be at higher risk of deteriorated sexual health all across Australia (12)
• According to the article by Vivancos et al. (2012), school based sex education helped in reducing the rate of STIs, risk reduced overall by approximately 11%, indicating the benefits of school based sexual health screening and education (20).
• According to Chin et al. (2012), home based sexual health literacy and awareness screening has helped in improvement of the sexual education planning for marginalized adolescents (19)
• Additional government sponsored funding has helped in enhancing the spread of the health promotional campaigns by 18% in rural areas, in turn decreasing the STI rates as well (21).
• Enhancing the cultural appropriateness and accessibility of the educational programs have also been reported to enhance inclusion of marginalized population and contributed to decreasing the STI rates as well (11).
• Hence there is need for enhanced funding and cultural appropriateness of the promotional campaigning. 

Health promotion is a very important aspect of this project and it is crucial for any health promotional project to be taking the assistance of a health promotional model. One of the most impactful health promotional models is the OTTAWA charter developed by the WHO. This promotional model has five key areas of action such as building a social policy, re-orienting health services, creating supporting environment, developing individual skills, strengthening community action. This project will attempt to develop an extensive integrated health promotional plan for enhancing the awareness and educational practices of the target population with goals that address each of the action area of the OTTAWA charter (17).

Primary stakeholders:

Can be defined as the list of individuals that are directly associated with the details of the project and are affected by the issue and are going to be living with this issue. The primary stakeholders are usually marked by the risk markers of the health issue analysis.

The primary stakeholders for this project are the school age adolescents living in Queensland (10-19) years.

Secondary stakeholders:

Secondary stakeholders are the people that are indirectly associated with the outcome of the project and will be indirectly impacted by the issue or the problem of the situation. The secondary stake4hol;edres for this project are going to be:

• Parents of the adolescents involved in the campaigning
• Schools involved in the screening program
• Hospitals involved in the screening and their employees
• Social workers involved in the survey
• health and human service workers such as the youth workers, and social welfare activists
• Community volunteers belonging to varied capacities
• policy makers and government health authorities
• cultural diversity liaison officers
• youth therapists and counselors

Goal: To increase the frequency of the sex education awareness program for the adolescents in Queensland by at least 30% by 2019 and improve the sexual behavior and practices of the adolescents.

Objectives and Sub-objectives

References

1. Currie C, Zanotti C, Morgan A, Currie D, de Looze M, Roberts C, Samdal O, Smith OR, Barnekow V. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the. 2009;2010:271.
2. Starrs AM, Anderson R. Definitions and Debates: Sexual Health and Sexual Rights. Brown J. World Aff.. 2015;22:7.
3. Slater C, Robinson AJ. Sexual health in adolescents. Clinics in dermatology. 2014 Mar 1;32(2):189-95.
4. World Health Organization. Measuring sexual health: Conceptual and practical considerations and related indicators.
5. Avery L, Lazdane G. What do we know about sexual and reproductive health of adolescents in Europe?The European Journal of Contraception & Reproductive Health Care. 2010 Dec 1;15(sup2):S54-66.
6. Dessie Y, Berhane Y, Worku A. Parent-Adolescent Sexual and Reproductive Health Communication Is Very Limited and Associated with Adolescent Poor Behavioral Beliefs and Subjective Norms: Evidence from a Community Based Cross-Sectional Study in Eastern Ethiopia [Internet]. PLOS ONE. Public Library of Science; [cited 2018May3].
7. Crosby R, Noar SM. What is a planning model? An introduction to PRECEDE? Journal of public health dentistry. 2011 Jan 1;71(s1).
8. Evans D. No Health Without Sexual Health; No Education Without Sexual Health Education. The Journal of Sexual Medicine. 2017;14(5)
9. Scott ME, Wildsmith E, Welti K, Ryan S, Schelar E, Steward?Streng NR. Risky adolescent sexual behaviors and reproductive health in young adulthood. Perspectives on Sexual and Reproductive Health. 2011 Jun 1;43(2):110-8.
10. Ali MM, Dwyer DS. Estimating peer effects in sexual behavior among adolescents. Journal of adolescence. 2011 Feb 28;34(1):183-90.
11. Chlamydia Trachomatis Infections | Queensland Health [Internet]. Health.qld.gov.au. 2018 [cited 26 May 2018]. Available from: https://www.health.qld.gov.au/cdcg/index/chlamydiatrachomatis
12. Internet dating to blame for rise in STIs, doctor says [Internet]. ABC News. 2018 [cited 26 May 2018]. Available from: https://www.abc.net.au/news/2017-01-13/chlamydia-and-gonorrhoea-cases-up-in-queensland-as-doctors-fear/8178730
13. Action plan to tackle rising STI rates in North Queensland | Queensland Health [Internet]. Health.qld.gov.au. 2018 [cited 26 May 2018]. Available from: https://www.health.qld.gov.au/townsville/media-releases/2016/160525-sti-funding
14. qld.gov.au. (2018). Queensland Sexual Health Strategy 2016-2021 (Consultation). [online] Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0025/442681/sexual-health-strategy-consult.pdf [Accessed 26 May 2018].
15. Pownall JD, Jahoda A, Hastings RP. Sexuality and sex education of adolescents with intellectual disability: mothers’ attitudes, experiences, and support needs. Intellectual and developmental disabilities. 2012 Apr;50(2):140-54.
16. Guilamo-Ramos V, Bouris A, Lee J, McCarthy K, Michael SL, Pitt-Barnes S, Dittus P. Paternal influences on adolescent sexual risk behaviors: A structured literature review. Pediatrics. 2012 Oct 1:peds-2011.
17. World Health Organization. Ottawa Charter for Health Promotion. Geneva: WHO, 1986.
18. Vivancos R, Abubakar I, Phillips-Howard P, Hunter PR. School-based sex education is associated with reduced risky sexual behaviour and sexually transmitted infections in young adults. Public Health. 2013 Jan 1;127(1):53-7.
19. Chin HB, Sipe TA, Elder R, Mercer SL, Chattopadhyay SK, Jacob V, Wethington HR, Kirby D, Elliston DB, Griffith M, Chuke SO. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services. American journal of preventive medicine. 2012 Mar 1;42(3):272-94.
20. Lindberg LD, Maddow-Zimet I. Consequences of sex education on teen and young adult sexual behaviors and outcomes. Journal of Adolescent Health. 2012 Oct 1;51(4):332-8.
21. Tolli MV. Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies. Health education research. 2012 May 28;27(5):904-13.
22. Australian Social Trends, Jun 2012 [Internet]. Abs.gov.au. 2018 [cited 29 May 2018]. Available from: https://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4102.0Main+Features10Jun+2012

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