Health Education Research, Vol. 14, No. 3, 357-370,
June 1999
© 1999 Oxford University Press
Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15–16 year olds, 1990–1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC)
Research Unit in Health and Behavioural Change, and
1 Medical Statistics Unit, Department of Public Health Sciences, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
 |
Abstract |
|---|
 Top Abstract IntroductionMethodResultsDiscussionConclusionReferences |
|---|
There is concern about the high prevalence of adolescent sexual health problems, such as sexually transmitted diseases (STDs) and unwanted pregnancies, that currently exist in the UK. If young people are to reduce their risk from HIV/AIDS and other STDs it is imperative, in the first instance, they know what the risks are and how they can avoid them. However, effective school-based sex education can only be delivered if there are accurate data on young people's current levels of knowledge and existing sex education needs. This paper details findings from the WHO: Health Behaviours of School-aged Children Study on the changes that have occurred between 1990 and 1994 in Scottish school-children's knowledge, attitudes and perceived educational needs in relation to HIV/AIDS. There have been significant changes in knowledge and attitudes that may affect their sexual behaviour, e.g. in their attitudes to condom use, risk of HIV/AIDS and other STDs, and also other sexual health problems, such as the risk of unwanted pregnancies and abortions. Finally, areas that require future research and recommendations for future sexual health education interventions are highlighted.
|
Introduction |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionReferences |
|---|
Sexual health including the prevention of HIV/AIDS has been identified as a key priority for action in Scotland (Scottish Office Department of Health, 1998
) and an area for specific strategy development in England (Department of Health, 1998). In Scotland there is concern about the high prevalence of HIV/AIDS in some cities (Wight, 1996). As many sexual health risks, including those related to HIV/AIDS transmission, could be reduced through the adoption of appropriate health behaviours, sex education has an important potential role to play in promoting adolescent sexual health. A recent survey in Scotland of young people's health education needs also found that adolescents reported that HIV/AIDS and sex education were two of their priority topics for health education provision in their schools (Devine, 1996).
Understanding young people's knowledge and attitude towards HIV-related issues and the provision of HIV education is important for a number of reasons. At the present time HIV can only be prevented through protective behaviour and behaviour change. If young people are to reduce their risk from HIV/AIDS and other sexually transmitted diseases (STDs) it is imperative that they know what risks exist and how to avoid them (EPI Centre, 1996). Effective sex education for young people can only be provided if there is accurate information on the scope and extent of young people's current knowledge and attitudes on sexual matters and sexual behaviour (Currie et al., 1997a). Practising safer sex also has the added advantage of reducing the other sexual risks of unwanted pregnancy, abortion and STDs. Finally, given the evidence that many young people do not discuss sexual issues with their parents (Currie, 1990; Currie and Todd, 1993; Devine, 1995; Currie et al., 1997a), it is important to determine whether schools are providing the vital information young people require to make healthy choices regarding their sexual behaviour.
This paper examines HIV/AIDS education, knowledge and attitudes among 15-year-old school pupils, using data from the `Health Behaviour in School-Aged Children: A WHO Cross-National Study' (HBSC). The HBSC study aims to develop the knowledge base of health behaviours and health indicators of adolescent schoolchildren within their social context. It is a cross-national study that conducts cross-sectional surveys at 4-year intervals in Europe and Canada (Currie et al., 1997b). A major advantage of this repeated survey is that changes over time in sex education provision, knowledge and attitudes can be investigated. There is strong evidence that young people are still lacking knowledge on important sexual health matters (EPI Centre, 1996). The information from the HBSC survey is therefore valuable for providers as it enables the identification of areas in current sex education that need to be enhanced or rectified.
A report from the 1990 HBSC survey (Currie and Todd, 1993) revealed that about a quarter of 15 year olds reported not having had HIV/AIDS education in school, just under half of the pupils had never discussed HIV/AIDS with their parents and one-third had never discussed it with their friends. On the whole, the pupils surveyed in 1990 were found to have good knowledge about biological aspects of HIV/AIDS, transmission and prevention, but there were some exceptions. In contrast, knowledge about the epidemiology of HIV/AIDS and a cure for AIDS was generally poor. The report concluded that many of the misconceptions would affect young people's estimations about their own risk of contracting HIV/AIDS and therefore required to be tackled in HIV/AIDS education programmes. Other studies have also identified similar patterns and levels of knowledge. It has been found that whilst young people generally understand the main routes of transmission and how to minimize their risk of infection, their knowledge is uneven (Clift et al., 1988; Warwick et al. 1988; Buysse, 1996). For example, uncertainty about issues such as the risk of infection from donating blood has been identified amongst young people (Gilbert, 1994; Denman et al., 1995). Buysse (Buysse, 1996) has argued that young people are particularly confused about issues concerning how HIV is not transmitted. Research by Memon (Memon, 1990) also found that although young people knew the main routes of transmission of HIV they also showed some uncertainty regarding the actual mechanisms and prevention of the virus. In terms of beliefs and attitudes concerning HIV/AIDS, it was found that girls were generally more alert to the threat of HIV/AIDS and boys were more optimistic about the early development of a vaccine. Girls also exhibited a greater tolerance towards people with HIV/AIDS than boys (Currie et al., 1993).
In terms of perceived educational needs, the majority of respondents in 1990 agreed that they should be taught how to protect themselves from HIV/AIDS. However, half of the respondents reported that they had not received enough education at school and three-quarters said they required a lot more information about the subject (Currie and Todd, 1993).
The aim of this paper is to examine the changes in HIV/AIDS education, knowledge and attitudes among 15-year-old Scottish schoolchildren between 1990 and 1994.
|
Method |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionReferences |
|---|
The Scottish surveys reported here form part of the larger, mainly European HBSC study. The sample selection methods and data collection methods are based on those detailed in the HBSC study protocols and reports (Aaro and Wold, 1989
; Wold et al., 1994; Currie and Todd, 1993; Currie et al., 1997a,b). The HBSC survey is based on a self-complete questionnaire that is administered within the school setting. Whilst the HBSC survey is conducted amongst 11, 13 and 15 year olds, the questions relating to sex education and HIV/AIDS were only administered to the 15-year-old pupils in the fourth year of senior/high school.
The questionnaires
The questions on sex education, including discussion about HIV (and other personal and sexual matters) at school, with parents and with friends were contained within the main HBSC survey questionnaire (Currie et al., 1997b), while a second questionnaire included all the items on HIV/AIDS knowledge and attitudes (Currie et al., 1997a). Each questionnaire required a full classroom period (40 min) to ensure completion by all pupils.
The samples
Schools in 10 out of the 12 Scottish education authorities, and in addition a sample of independent schools, participated in the main HBSC survey in both 1990 and 1994. Data are available from these schools on the questions relating to discussion about HIV/AIDS at school, with parents and with friends (i.e. in the first questionnaire). Table I shows the geographical distribution of the samples in 1990 and 1994, and Table II gives an age and gender breakdown of the two samples. In 1990 the numbers of pupils absent were not recorded. In 1994 the unexplained absence rate was recorded at 5% for all pupils and the explained absence rate (i.e. due to reported sickness or absence for a reason) was recorded at 2% (separate information on 15 year olds is not available).
|
|
In the 1990 HBSC survey, the second questionnaire on HIV/AIDS knowledge and attitudes was optional, since it took up another whole class period and there was concern that participation in the study might be jeopardized by requiring two periods of to be made available. In 1994 the HIV/AIDS survey was not made optional and all but one region agreed to participate. Independent schools took part in both 1990 and 1994.
With respect to the analysis of data on HIV/AIDS knowledge and attitudes (i.e. from the second questionnaire), only data from the regions that participated in both years are included, together with comparable data from independent schools. Table III shows the geographical distribution of the two samples and Table IV gives the age and gender breakdown.
|
|
Sample differences between 1990 and 1994 and statistical analysis
As is apparent in Tables I and III
, there are some differences between the 1990 and 1994 data sets in terms of the proportion of independent schools and in regional representation. Logistic regression analyses have been undertaken in order to detect real changes in categorical variables between the two surveys after controlling for region and state/independent school status (Currie et al., 1997a). Since absentee rates were not known for the 1990 sample differences in absentee rates by region could not be controlled for in this model. It is acknowledged therefore that absenteeism/participation bias is a possibility and could account for some of the small differences observed in knowledge/attitudes in some cases. Linear regression analysis was used where comparisons were made between questions with ordinal response categories (Table V). Percentages given in tables are unadjusted. The 
2 test has been used to test for gender differences in responses. In this paper only statistically significant differences are reported. Use of the shorthand `significant difference' should therefore be taken to mean statistically significant difference. For logistic regression the percentage for response categories being tested for statistical difference are in bold in the tables. Because of multiple significant testing, results at P < 0.05 should be considered less robust. The marking of the statistically significant differences in the paper are as follows: *P < 0.05; **P < 0.01; ***P < 0.001. In the tables, `Reg sig' implies significant change as indicated by logistic regression analyses
|
Sampling procedures
The sampling unit employed in this survey is the school class. The sample was systematically selected from a national list of school classes (state and independent schools in 1994, state schools only in 1990) in alphabetical school name order for each age group, stratified by region. In larger regions classes were additionally stratified by geographical areas within the region. As stated above, independent schools were over-sampled in 1990 and therefore over-represented in the final sample, and statistical procedures were subsequently used to take account of this when comparing survey results. In 1994, independent schools were listed together and treated as another `region' and subjected to the same sampling procedures. The sample is therefore representative. Where a class of fewer than 10 pupils was selected, the previous class on the list was selected also. Schools themselves selected which mixed ability class of the appropriate age group should complete the questionnaire and all pupils who were present in that class on the day when the questionnaire was administered completed a questionnaire.
Survey administration
The questionnaire was administered between March and June in 1990 and 1994. Teachers administered the survey in the classroom under examination conditions, i.e. no conferring, and confidentiality was assured. Pupils completed the questionnaires independently, with the supervising teacher instructed to respond only to children's queries about procedure. All pupils were provided with individual envelopes in which to seal their anonymous questionnaires after completion.
Questionnaire items
Education about HIV/AIDS
The school pupils were asked how often they had discussed HIV/AIDS at school, with their parents and with their friends. The response categories for these questions were `no', `yes, once', `yes, a few times' and `yes, many times'. The pupils were also asked how many hours of class time they thought had been spent discussing HIV/AIDS. (This question was in the second questionnaire.)
Knowledge of HIV/AIDS
A series of true/false statements tested knowledge on a variety of HIV/AIDS-related issues. The response categories were `true', `false' or `uncertain'. Although the same knowledge questions have been used in both surveys the wording is slightly different in some of the statements used in 1994, to bring them up to date.
Attitudes towards HIV/AIDS-related issues
The young people were also asked to respond to a series of attitudinal question relating to HIV/AIDS. The response categories were `strongly agree', `agree', `uncertain', `disagree' and `strongly disagree'.
|
Results |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionReferences |
|---|
Provision of HIV/AIDS education
In all the tables, results for boys and girls are presented together, unless there were gender differences in patterns of change between the 2 years.
The pupils were asked to estimate how many hours had been spent learning about AIDS during the previous school year. Table V shows that there has been a highly significant trend (P < 0.001) towards more class hours spent on HIV/AIDS education at school between 1990 and 1994.
Discussion of HIV/AIDS at school, with parents and with friends
Table VI also shows there has been a significant increase in the discussion of HIV/AIDS at school since 1990, but a decrease among young people in discussing HIV/AIDS with their parents. There has been no significant change in the proportion discussing HIV/AIDS with friends and levels remain high at 81% in 1994.
|
Educational needs with respect to HIV/AIDS
Table VII
demonstrates that, while the overwhelming majority of young people still believe they need to be taught how to protect themselves, a significantly lower percentage of pupils reported in 1994 that they feel they require to know a lot more about AIDS or that they have not been taught enough about AIDS at school.
|
Knowledge of HIV/AIDS
Biology and transmission of HIV
Where 75% or more of the sample population answered a statement correctly, this was considered to be a high level of knowledge on the particular issue. Table VIII
presents the statements to which at least 75% of young people responded correctly in 1990 and the corresponding percentages in 1994. As these tables illustrate, young people still show very high levels of knowledge on the important issues that they need to understand if they are to protect themselves from HIV.
|
As in 1990, the vast majority of young people in the 1994 survey have a very good understanding of both the main routes of transmission of HIV and how young people can prevent themselves from becoming infected with the virus. However, there have been some changes in knowledge, such that in 1994 knowledge levels that were high in 1990 are now classified as low, i.e. less than 75% of young people answering the question correctly. In 1990, 86% of young people responded correctly to the statement `once infected with HIV a person can potentially infect others for the rest of his or her life' (Table VIII
); in 1994, only 74% answered this statement correctly. There was also a significant decrease in the proportion giving a correct answer to the statement `a person who looks healthy but who has HIV can pass it onto other people' (86–74%; Table VIII).
Turning attention now to areas of low knowledge in 1990, Table IX illustrates the issues that remain low in 1994. Although there is a very highly significant increase in knowledge among girls with respect to the statement `most people with HIV will die of an AIDS-related illness', nevertheless only 64% answered this correctly in 1994.
|
Epidemiological knowledge, knowledge of transmission of HIV/AIDS, and prevention and cure of HIV/AIDS
Table X
looks at other areas of knowledge that have remained low since 1990, i.e. epidemiological issues, knowledge of transmission of HIV/AIDS, and knowledge on prevention and cure. As Table X shows, less than half of the pupils correctly answered the statements concerning the main cause of death in Scotland, the number of deaths from AIDS-related illnesses or the prevalence of HIV among homosexual men. Furthermore, over time there has been a significant decrease in the proportion of young people being able to provide the correct answer for three of the four statements.
|
Whilst young people have shown consistently high levels of knowledge on the main issues concerning transmission of HIV in the 1994 survey, they also show a lack of knowledge with regard to the more marginal issues for transmission of the virus. Table X
demonstrates that young people lack knowledge on many issues and that this knowledge has significantly decreased over time. Of particular concern is poor knowledge concerning the risk of blood donation. In 1994 only a third of young people recognized that one cannot become infected with HIV by donating blood.
Table X also shows changes in young people's knowledge about prevention. There have been significant decreases in the percentages of correct responses relative to the impact of early diagnosis on a cure for AIDS and the development of a vaccine to prevent HIV.
There have also been some significant decreases in knowledge levels in other areas. Table XI shows areas of knowledge that were high (i.e. over 75%) in 1990 but have since dropped to be defined as low levels of knowledge in 1994. These changes have occurred amongst girls only. In 1990, 77% of girls understood that AIDS could not be cured if diagnosed early, whereas in 1994 this figure has significantly decreased to 60%.
|
To summarize, the tables presented on knowledge of HIV/AIDS show that the gaps in knowledge that existed in 1990 have largely remained unchanged or actually worsened in the subsequent 4 years.
Attitudinal change
On some issues attitudes have remained constant over the 4-year period, whilst other issues have generated significant attitudinal change. Where the pattern of change has been similar for boys and girls for particular statements, the data are again presented in one table. Since 1990 there has been no significant change in the very high percentage of young people who believe they should be taught how to protect themselves from HIV/AIDS (96% in both years). However, there have been significant changes amongst pupils in response to the other questions asked on perceived educational needs. As Table XII shows, a significantly lower proportion of boys and girls in 1994, compared to 1990, believe that they need to know a lot more about AIDS or that they have not been taught enough about AIDS at school.
|
Beliefs about the nature of the disease
Table XII
also shows that a significantly lower proportion of young people in 1994, than in 1990, believe that AIDS is the most serious disease in the UK or that a vaccine to prevent HIV infection will be developed by the year 2000.
Attitudes to people with HIV/AIDS
Young people were asked to respond to a series of attitudinal statements about people who have HIV or AIDS. For some statements no attitudinal change occurred between 1990 and 1994, while other attitudes appear to have altered. As gender differences existed in the pattern of response, data for boys and girls are presented separately. Table XIII suggests an increased tolerance towards people with HIV/AIDS. For example, there has been a significant increase in the number of young men who disagree with the statement `people with AIDS or HIV should not be allowed to become teachers' (54 to 66%). There has also been an increase in tolerance amongst young women. For example, in 1990, 13% of young women agreed with the statement `I don't feel sorry for people who have caught HIV because it is their own fault'. By 1994, the percentage reporting that they agree with this statement has decreased to just 5%.
|
Attitudes to AIDS and personal relationships
The pupils were asked to respond to four statements concerning personal relationships within the context of HIV/AIDS. Table XIV
details their responses. For all statements there have been similar significant attitudinal patterns and changes amongst both boys and girls. A significantly greater percentage of young people in 1994, compared to 1990, disagree that young people should avoid sexual relationships because of AIDS and with the statement `sex without love is not satisfying'. Furthermore, a significantly lower proportion of young people believed that they would only have sex with one partner for the rest of their lives or that they would talk to their partner about their past sexual experience before having sex with them.
|
Attitudes to condoms
The pupils were also asked to respond to a series of statements on condoms (Table XV
). Whilst some of the responses have not changed significantly since 1990, e.g. attitudes on ease of use of condoms and their effectiveness in reducing the risk of unwanted pregnancies, some changes have been noted. Whilst over three-quarters of boys believe they could easily get a condom if they needed one and almost half still disagree with the statement `I don't feel comfortable carrying condoms with me', there has been a negative shift in attitude for two of the other statements amongst boys. Thus, whilst girls' views on the cost of condoms have remained unchanged, a significantly greater proportion of boys feel that condoms are too expensive to use regularly and a greater percentage of boys in 1994 reported that they would be embarrassed to buy a condom.
|
Table XV
does indicate a more positive attitude towards condoms among girls for two of the statements. The proportion of girls who disagree with the statement `I don't feel comfortable carrying condoms with me' has more than doubled between 1990 and 1994. A significantly greater percentage also believe that they could easily get a condom if they needed one. |
Discussion |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionReferences |
|---|
The findings from our survey indicate a significant increase in the provision of HIV/AIDS education in Scottish schools between the years 1990 and 1994, as reported by school pupils. The results also show that young people in Scotland possess high levels of knowledge about many HIV/AIDS-related issues. In general, they have an excellent understanding of the main transmission routes of the virus and how to protect themselves from becoming infected. However, young people still lack knowledge about many issues. This conclusion reinforces findings from other studies in this area (Bagnall and Lockerbie, 1995
; Buysse, 1996; Denman et al., 1996; EPI Centre, 1996). Moreover, areas of knowledge that were poor in 1990 have often significantly worsened in the following 4 years despite the increase in the provision of AIDS education. This is particularly true of young people's epidemiological understanding of HIV and AIDS. On the basis of our results it could be argued that young people may have gathered less knowledge and therefore have less understanding of epidemiological issues, as these issues are not directly related to their lives. It is feasible that they may have focused more on the information they require to protect their own sexual health. Young people also seem less knowledgeable in 1994, compared to 1990, about the likelihood of a cure or vaccine for HIV/AIDS. This could also be due to the fact that it is not of immediate consequence to their own daily lives. However, their lack of knowledge could also be linked to considerable media coverage, sometimes conflicting, of developments in AIDS research regarding possible future clinical interventions. The complexity of information regarding a treatment and cure for AIDS may have resulted in the communication of mixed messages that confuse young people.
The HBSC study shows, that for young people, friends are both the easiest people to talk to about sexual issues and their main source of information (Currie et al., 1997a). Moreover, in comparison with the 1990 survey, there has been a highly significant increase in the proportion of young people in 1994 reporting that their friends are the easiest people to talk to (Currie et al., 1997a). However, peers may be providing inaccurate information to their friends (Buysse, 1996). Young people themselves are often aware of the limitations of the knowledge they receive from their friends (Allen, 1987) and this could be one explanation for a decrease in AIDS knowledge. Holland et al. (Holland et al., 1991) found that young women turned to friends and magazines due to inadequacies in their school-based sex education. Young people's negative attitude to school sex education has been extensively documented in many studies (Allen, 1987; Thomson and Scott, 1991; Woodcock et al., 1992; Wight and Scott, 1994; Jowett, 1995; Bagnall and Lockerbie, 1995; Thomson, 1996) and requires addressing if the school is to become more effective as a setting for reducing these gaps in knowledge.
As our findings also show, there has been considerable change in the attitudes of young people to HIV/AIDS issues. Despite a decrease in some areas of knowledge, there has also been a significant decrease in the proportion of young people who feel they require more information. The results also indicate that young people in 1994 do not see AIDS as such a serious a disease as in 1990 and this could be one reason why many of them do not see a need for more education. It could be argued that young people do not perceive a need for further education as they may believe they have enough knowledge already. However, this study and others show that there are still important gaps in knowledge that require addressing. Further research is required to understand this discrepancy in young people's perceived needs and their knowledge. Two possible reasons that could be explored are misinformation from friends who are themselves not well informed and the complexity of the media coverage of the issues.
There has also been a shift in other attitudes within the context of HIV/AIDS. In general, there has been an increase in tolerance towards people with HIV/AIDS although there remains a considerable degree of negativity.
The importance of attitude in relation to intended and actual behaviour has been well documented in health promotion (Fishbein and Ajzen, 1985; Freidman, 1989). The results from this study show that there have been important changes in attitudes towards relationships in the context of HIV/AIDS. These attitudinal changes are of importance to sexual health educators as they may be directly related to young people's intended or actual sexual behaviour. This is particularly so for the finding that significantly fewer young people intend to discuss previous sexual behaviour with a new sexual partner. These changes in attitude indicate that young people in 1994 are perhaps not taking the risk of HIV as seriously as they did in 1990 in terms of their personal relationships. Perceived risk, or perceived vulnerability to disease, can be an important factor in determining health behaviour outcomes (Becker, 1984). The evidence from many studies, however, is that young people repeatedly perceive others, but not themselves, to be at risk from HIV/AIDS (Memon, 1990; Ford, 1992; Denman et al., 1996). Furthermore, the possession of knowledge of risk factors alone does not necessarily ensure that young people perceive themselves to be at risk or lead to the avoidance of risk-taking behaviours including the practice of safer sex (EPI Centre, 1996). This has to be an area of consideration for policy makers and providers of any sexual health intervention.
Given the high prevalence of STDs and the high rate of teenage pregnancy amongst young people in the UK, condoms have a key role to play in the promotion of adolescent sexual health. Young people's attitudes to condoms are therefore of great importance to health educators. Our findings show that there have been inconsistent changes in attitude towards condoms. On the one hand, girls have shown some positive changes in attitude in respect of carrying and buying condoms. This area has been shown to present frequent difficulties for young women (Wight, 1992). On the other hand, boys have indicated some negative attitude shifts in terms of cost and embarrassment in buying condoms.
The importance of addressing attitudes in addition to imparting knowledge in sex education has been highlighted by many researchers (Wight, 1990; Whitbeck et al., 1993; Tones, 1995). Although Kegeles et al. (Kegeles et al., 1989) found no relationship between increasing belief in the preventative effects of using condoms and increased motivation to use them, they did report that factors such as how easy it is to buy condoms were associated with intentions to use condoms. Young people's attitudes and their subjective norms on condoms require further attention in order to reach a better understanding of the decision-making processes in respect to this issue.
|
Conclusion |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionReferences |
|---|
Future health education interventions need to attempt to reverse the trend of decreasing knowledge in some areas whilst also ensuring that current high knowledge levels in other areas remain high. HIV/AIDS educational interventions should focus on attitudes to issues such as personal relationships in addition to imparting knowledge. Employing active learning techniques and group discussions have been shown to be very effective methods in understanding young people's perspectives on many issues (Downie et al., 1990
; Ewles and Simnett, 1992; Naidoo and Wills, 1994). Future research could also help to ascertain the reasons for young people's changes in attitudes and the relationship to perceived risk and related sexual health risk behaviours.
|
Acknowledgments |
|---|
The authors would like to thank Professor Stephen Platt and Dr Odette Parry for their helpful comments on an earlier draft. The HBSC study in Scotland is funded by the Health Education Board for Scotland (HEBS). The Research Unit in Health and Behavioural Change is funded by the Chief Scientist Office of the Scottish Office Department of Health and HEBS; however, the opinions expressed in this communication are those of the authors, not the funding bodies.
|
References |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionReferences |
|---|
Aaro, L. E. and Wold, B. (1989) A WHO Cross-National Survey; Research Protocol for the 1989–90 Study. University of Bergen (available from RUHBC, University of Edinburgh).
Allen, I. (1987) Education in Sex and Personal Relationships. Policy Studies Institute, London.
Bagnall, G. and Lockerbie, L. (1995) HIV/AIDS education: are senior pupils losing out? Education and Health, 13, 37–42.
Becker, M. H. (1984) The Health Belief Model and Personal Health Behaviour. Charles B. Slack, Thorofare, NJ.
Buysse, A. (1996) Adolescents, young adults and AIDS: a study of actual knowledge vs. perceived need for additional information. Journal of Youth and Adolescence, 25, 259–71.
Clift, S. M., Stears D. F., Legg, S., Memon, A and Ryan, L. (1988) The HIV/AIDS Education and Young People Project. Report on Phase I: (HIV/AIDS: the Knowledge, Beliefs, Attitudes and Behaviour of Secondary School Pupils in the South of England). AVERT, Horsham.
Currie, C. (1990) Young people in independent schools, sexual behaviour and AIDS. In Aggleton, P., Davies, P. and Hart, G. (eds), AIDS: Individual, Cultural and Policy Dimension. Falmer Press, Hampshire.
Currie, C. and Todd, J. (1993) Health Behaviours of Scottish Schoolchildren: Report 3: Sex Education, Personal Relationships, Sexual Behaviour and HIV/AIDS Knowledge and Attitudes. RUHBC and HEBS, Edinburgh.
Currie, C., Todd, J. and Thomson, C. (1997a) Health Behaviours of Scottish Schoolchildren: Report 6: Sex Education, Personal Relationships, Sexual Behaviour and HIV/AIDS Knowledge and Attitudes in 1990 and 1994. RUHBC and HEBS, Edinburgh.
Currie, C., Todd, J. and Thomson, C. (1997b) Health Behaviours of Scottish Schoolchildren: Report 5: Comparisons of national patterns in 1990 and 1994. RUHBC and HEBS, Edinburgh.
Denman, S., Pearson, J., Moody, D., Davis, P. and Madeley, R. (1995) Theatre in education on HIV and AIDS: a controlled study of schoolchildren's knowledge and attitudes. Health Education Journal, 54, 3–17.
Denman, S., Pearson, J., Davis, P. and Moody, D. (1996) A survey of HIV-and-AIDS-related knowledge, beliefs and attitudes among 14-year olds in Nottinghamshire. Educational Research, 38, 93–99.
Department of Health (1998) Our Healthier Nation—A Contract for Health. A Consultation Paper. The Stationery Office, London.
Devine, M. (1995) Health Education: What Do Young People Want to Know? Interchange No. 31, The Scottish Council for Research in Education. The Scottish Office Education Department, Edinburgh.
Devine, M. (1996) Focus on findings. Schools and health education. Research in Education. Information of Findings, Ideas, Projects across Scotland. Scottish Council for Research in Education, Edinburgh.
Downie, R. S., Fyfe, C. and Tannahill, A. (1990) Health Promotion Models and Values. Oxford University Press, Oxford.
EPI Centre (1996) Evaluation of health promotion and social interventions. 1996. Review of effectiveness of sexual health promotion interventions for young people. Social Science Research Unit, London University Institute of Education, London.
Ewles, L. and Simnett I. (1992) Promoting Health: A Practical Guide. Scutari Press, London.
Fishbein, M. and Ajzen, I. (1985) Belief Attitude, Intention and Behaviour: An Introduction to Theory and Research. Addison-Wesley, Reading, MA.
Ford, N. (1992) The sexual and contraceptive lifestyles of young people: parts I and II. British Journal of Family Planning, 18, 52–55.
Freidman, H. L. (1989) The health of adolescents: beliefs and behaviour. Social Science and Medicine, 29, 309–315.
Gilbert, S. (1994) Is the message getting across? Effectiveness of health education at informing young people about HIV and AIDS. Professional Nurse, 9, 765–769.
Holland, J., Ramazanoglu, C. and Scott, S. (1991) Sex, Risk, Danger: AIDS Education Policy and Young Women's Sexuality. Wrap Paper 1. Tufnell Press, London.
Jowett, S. (1995) Sex education in Berkshire Secondary Schools. National Foundation for Educational Research, Berkshire.
Kegeles, S. M., Adler, N. E. and Irwin, C. E. (1989) Adolescents and condoms. Associations of beliefs with intentions to use. American Journal of Diseases of Children, 143, 911–15.
Memon, A. (1990) Young people's knowledge, beliefs and attitudes about HIV/AIDS: a review of research. Health Education Research, 5, 327–35.
Naidoo, J. and Wills, J. (1994) Health Promotion. Foundations for Practice. Balliere Tindall, London.
Scottish Office Department of Health. (1999)Working Together for a Healthier Scotland—A Consultation Paper. The Stationery Office, Edinburgh.
Thomson, C. (1996) Young people's perceptions of sex education. Unpublished MSc dissertation, University of Edinburgh.
Thomson, R. and Scott, S. (1991) Learning about Sex. Tufnell Press, London.
Tones, K. 1995. Making a change for the better. Healthlines, 27, 17–19.
Warwick, I., Aggleton, P. and Homans, H. (1988) Young people's health beliefs and AIDS. In Aggleton, P. and Homans, H. (eds), Social Aspects of AIDS. Falmer Press, London.
Whitbeck, L. B., Conger, R. D. and Kao, M. Y. (1993) The influence of parental support, depressed affect and peers on the sexual behaviours of adolescent girls. Journal of Family Issues, 14, 261–278.[Abstract]
Wight, D. (1990) The impact of HIV/AIDS on young people's heterosexual behaviour in Britain: a literature review. Medical Sociology Unit Working Paper 20. Glasgow University.
Wight, D. (1992) Impediments to safer heterosexual sex: a review. AIDS CARE, 4(1), 11–21.[Web of Science][Medline]
Wight, D. (1996) Does sex education make a difference. MRC News, Spring, 29–32.
Wight, D. and S. Scott. (1994) Mandates and Constraints on Sex Education in the East of Scotland. Preliminary Study for a Sex Education Initiative. Report to the Health Education Board for Scotland, Edinburgh.
Wold, B., Aaro, L. and Smith, C. (1994) A WHO Cross-National Survey; Research Protocol for the 1993–94 Study. University of Bergen (available from RUHBC, University of Edinburgh).
Woodcock, A., Stenner, K. and Ingham, R. (1992) `All these contraceptives, videos and that...': young people talking about school sex education. Health Education Research, 7, 517–31.
Young, I. (1995) Education for sexuality—the role of the school. Paper presented at the UK Institute of Biology, Edinburgh.
Received on November 10, 1997; accepted on June 12, 1998
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. Chen Measures Needed to Strengthen Strategic HIV/AIDS Prevention Programmes in China Asia Pac J Public Health, March 1, 2007; 19(1): 3 - 7. [PDF]
|
|
|
|
 |
|
 J. S. Tucker, A. E. Fitzmaurice, M. Imamura, S. Penfold, G. C. Penney, E. v. Teijlingen, J. Shucksmith, and K. L. Philip The effect of the national demonstration project Healthy Respect on teenage sexual health behaviour Eur J Public Health, February 1, 2007; 17(1): 33 - 41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. F. Dias, M. G. Matos, and A. C. Goncalves Preventing HIV transmission in adolescents: an analysis of the Portuguese data from the Health Behaviour School-aged Children study and focus groups Eur J Public Health, June 1, 2005; 15(3): 300 - 304. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||