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性别转换关系和性教育对减少青少年怀孕的影响(JACK 试验):一项整群随机试验。

Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial.

机构信息

School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.

School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.

出版信息

Lancet Public Health. 2022 Jul;7(7):e626-e637. doi: 10.1016/S2468-2667(22)00117-7.


DOI:10.1016/S2468-2667(22)00117-7
PMID:35779545
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7613971/
Abstract

BACKGROUND: The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex. METHODS: This cluster-randomised trial with process and economic evaluations tested a school-based intervention entitled If I Were Jack versus standard RSE (control) for students (aged 14-15 years) in UK schools. Schools were randomly allocated (1:1) and masked to allocation at baseline. The primary outcome was self-reported avoidance of unprotected sex (sexual abstinence or use of reliable contraception at last sex) after 12-14-months. We analysed the data using intention-to-treat mixed effects regression models. FINDINGS: Of 803 schools assessed for eligibility, 263 schools were invited by letter, of which 66 schools agreed to be randomly assigned, of which 62 schools completed follow-up. The trial was done between Feb 1, 2018, and March 6, 2020. 8216 students participated at baseline in 2018; 6561 (79·85%) provided 12-14 months follow-up. There was no significant difference in the primary outcome of avoidance of unprotected sex: 2648 (86·62) of 3057 in the intervention group avoided unprotected sex versus 2768 (86·41%) of 3203 in the control group (adjusted odds ratio [aOR] 0·85 [95% CI 0·58-1·26], p=0·42). Exploratory post-hoc analysis of the two components of the primary outcome showed that significantly more intervention students used reliable contraception at last sex compared with control students and there was no significant difference between the groups for sexual abstinence. No adverse events were reported. INTERPRETATION: The intervention had a null effect on the primary outcome of preventing unprotected sex (increasing sexual abstinence or use of reliable contraception) in the whole student population. However, the results showed significant increases in use of reliable contraceptives for sexually active students. Engaging all young people early through RSE is important so that as they become sexually active, rates of unprotected sex are reduced. FUNDING: National Institute for Health Research.

摘要

背景:世界卫生组织(WHO)倡导让男孩参与性别转变型关系和性教育(RSE),以减少青少年怀孕。我们旨在测试一种干预措施,该措施采用性别转变方法使青少年参与 RSE,以防止发生无保护性行为。

方法:这项基于群组的试验,采用了过程和经济评估方法,对一项名为“如果我是杰克”的学校干预措施进行了测试,该干预措施针对的是英国学校 14-15 岁的学生。学校采用 1:1 随机分组,在基线时进行分组并进行分组掩盖。主要结局是在 12-14 个月后自我报告避免发生无保护性行为(性行为禁欲或最后一次性行为使用可靠的避孕措施)。我们使用意向治疗混合效应回归模型分析数据。

结果:在评估合格性的 803 所学校中,有 263 所学校通过信件被邀请,其中有 66 所学校同意被随机分配,其中有 62 所学校完成了随访。该试验于 2018 年 2 月 1 日至 2020 年 3 月 6 日进行。在 2018 年基线时,有 8216 名学生参与;其中 6561 名(79.85%)提供了 12-14 个月的随访。在避免发生无保护性行为这一主要结局方面,干预组和对照组之间没有显著差异:2648 名(86.62%)干预组学生避免了无保护性行为,2768 名(86.41%)对照组学生避免了无保护性行为(调整后的优势比[aOR]0.85[95%CI0.58-1.26],p=0.42)。对主要结局的两个组成部分的探索性事后分析表明,与对照组学生相比,干预组学生在最后一次性行为中使用可靠避孕措施的比例显著增加,而两组学生在性行为禁欲方面没有显著差异。没有报告不良事件。

解释:该干预措施对整个学生群体中预防无保护性行为(增加性行为禁欲或使用可靠避孕措施)的主要结局没有产生影响。然而,结果显示,性行为活跃的学生使用可靠避孕措施的比例显著增加。通过 RSE 尽早让所有年轻人参与进来很重要,这样当他们变得活跃时,无保护性行为的发生率就会降低。

资金来源:英国国家卫生研究院。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a48e/7613971/c6809fcb0d37/EMS158437-f002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a48e/7613971/63fab29c1757/EMS158437-f001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a48e/7613971/c6809fcb0d37/EMS158437-f002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a48e/7613971/63fab29c1757/EMS158437-f001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a48e/7613971/c6809fcb0d37/EMS158437-f002.jpg

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[6]
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[7]
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Campbell Syst Rev. 2023-1-13

本文引用的文献

[1]
What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis.

PLoS One. 2022

[2]
Sex Education in the Spotlight: What Is Working? Systematic Review.

Int J Environ Res Public Health. 2021-3-4

[3]
Assessing the costs and outcomes of control programmes for sexually transmitted infections: a systematic review of economic evaluations.

Sex Transm Infect. 2021-8

[4]
Gender-transformative programming with men and boys to improve sexual and reproductive health and rights: a systematic review of intervention studies.

BMJ Glob Health. 2020-10

[5]
Early sexual debut and risky sex in young adults: the role of low self-control.

BMC Public Health. 2019-11-8

[6]
Interventions addressing men, masculinities and gender equality in sexual and reproductive health and rights: an evidence and gap map and systematic review of reviews.

BMJ Glob Health. 2019-9-11

[7]
JACK trial protocol: a phase III multicentre cluster randomised controlled trial of a school-based relationship and sexuality education intervention focusing on young male perspectives.

BMJ Open. 2018-7-28

[8]
Can Teenage Men Be Targeted to Prevent Teenage Pregnancy? A Feasibility Cluster Randomised Controlled Intervention Trial in Schools.

Prev Sci. 2018-11

[9]
Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission.

Lancet. 2018-6-30

[10]
Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-analysis.

Prev Sci. 2018-5

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