Women's Health Commons^™

Breastfeeding Media Coverage And Beliefs During The Covid-19 Pandemic In Mexico: Implications For Breastfeeding Equity, Mireya Vilar-Compte, P. Gaitán‐Rossi, E. C. Rhodes, V. Cruz‐Villalba, R. Pérez‐Escamilla

Department of Public Health Scholarship and Creative Works

Background: Because breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican …

The Yearly Financing Need Of Providing Paid Maternity Leave In The Informal Sector In Indonesia, Adiatma Y. M. Siregar, Pipit Pitriyan, Donny Hardiawan, Paul Zambrano, Mireya Vilar-Compte, Graciela Ma Teruel Belismelis, Meztli Moncada, David Tamayo, Grace Carroll, Rafael Perez-Escamilla, Roger Mathisen

Department of Public Health Scholarship and Creative Works

Background: The economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15–49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. Method: The costing methodology …

Impact Of The Covid-19 Pandemic On Loneliness And Social Isolation: A Multi-Country Study, Roger O’Sullivan, Annette Burns, Gerard Leavey, Iracema Leroi, Vanessa Burholt, James Lubben, Julianne Holt-Lunstad, Christina Victor, Brian Lawlor, Mireya Vilar-Compte, Carla M. Perissinotto, Mark A. Tully, Mary Pat Sullivan, Michael Rosato, Joanna Mchugh Power, Elisa Tiilikainen, Thomas R. Prohaska

Department of Public Health Scholarship and Creative Works

The COVID-19 global pandemic and subsequent public health social measures have challenged our social and economic life, with increasing concerns around potentially rising levels of social isolation and loneliness. This paper is based on cross-sectional online survey data (available in 10 languages, from 2 June to 16 November 2020) with 20,398 respondents from 101 different countries. It aims to help increase our understanding of the global risk factors that are associated with social isolation and loneliness, irrespective of culture or country, to support evidence-based policy, services and public health interventions. We found the prevalence of severe loneliness was 21% during …

The Financing Need For Expanding Paid Maternity Leave To Support Breastfeeding In The Informal Sector In The Philippines, Valerie Gilbert Ulep, Paul Zambrano, Janice Datu-Sanguyo, Mireya Vilar-Compte, Graciela Materuel Belismelis, Rafael Pérez-Escamilla, Grace J. Carrol, Roger Mathisen

Department of Public Health Scholarship and Creative Works

In low- and middle-income countries, almost three-fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non-contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non-contributory maternity cash transfer programme to the informal sector in the Philippines. Using …

Three Decades Of Research: The Case For Comprehensive Sex Education, Eva Goldfarb, Lisa D. Lieberman

Department of Public Health Scholarship and Creative Works

Purpose

School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education.

Methods

Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving …

How Much Can Mexican Healthcare Providers Learn About Breastfeeding Through A Semi-Virtual Training? A Propensity Score Matching Analysis, Mireya Vilar-Compte, Rafael Pérez-Escamilla, Meztli Moncada, Diana Flores

Department of Public Health Scholarship and Creative Works

Background: Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world. Methods: Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered …

Costos De La Licencia De Maternidad Para Apoyar La Lactancia Materna En Brasil, Ghana Y México, Mireya Vilar-Compte, Graciela M. Teruel, Diana Flores-Peregrina, Grace J. Carroll, Gabriela S. Buccini, Rafael Perez-Escamilla

Department of Public Health Scholarship and Creative Works

Objective To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women’s weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given …

Laws Restricting Access To Abortion Services And Infant Mortality Risk In The United States, Roman Pabayo, Amy Ehntholt, Daniel M. Cook, Megan Reynolds, Peter Muennig, Sze Yan Liu

Department of Public Health Scholarship and Creative Works

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and …

Laws Restricting Access To Abortion Services And Infant Mortality Risk In The United States, Roman Pabayo, Amy Ehntholt, Daniel M. Cook, Megan Reynolds, Peter Muennig, Sze Yan Liu

Department of Public Health Scholarship and Creative Works

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and …

Association Between Breastfeeding And Child Stunting In Mexico, Ana Paola Campos, Mireya Vilar-Compte, Summer Sherburne Hawkins

Department of Public Health Scholarship and Creative Works

Background: Globally, the prevalence of child stunting has been decreasing over the past decades. How-ever, in low-and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective: To examine the association between breastfeeding (defined as never breastfed, any breast-feeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico. Methods: Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed-and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings: Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breast-feeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions: According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

Costing A Maternity Leave Cash Transfer To Support Breastfeeding Among Informally Employed Mexican Women, Mireya Vilar-Compte, Graciela Teruel, Diana Flores, Grace J. Carroll, Gabriela S. Buccini, Rafael Pe ́Rez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Investing in maternity protection for working women is an important social equity mechanism. Addressing the maternity leave needs of women employed in the informal sector economy should be a priority as more than half of women in Latin America, South Asia, and sub-Saharan Africa are employed in this sector.

Objective: To develop a costing methodology framework to assess the financial feasibility, at the national level, of implementing a maternity cash transfer for informally employed women.

Methods: A World Bank costing methodology was adapted for estimating the financial need to establish a maternity cash transfer benefit. The methodology estimates the …

Determinants Of Severe Maternal Morbidity And Its Racial/Ethnic Disparities In New York City, 2008–2012, Renata E. Howland, Meghan Angley, Sang Hee Won, Wendy Wilcox, Hannah Searing, Sze Yan Liu, Emily White Johansson

Department of Public Health Scholarship and Creative Works

Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. The study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008–2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by …

Syndemics Of Severity And Frequency Of Elder Abuse: A Cross-Sectional Study In Mexican Older Females, Mireya Vilar-Compte, Pablo Gaitán-Rossi

Department of Public Health Scholarship and Creative Works

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency.

Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships.

Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had …

The Effects Of The Yes You Can! Curriculum On The Sexual Knowledge And Intent Of Middle School Students, Joseph Donnelly, Robert Horn, Michael Young, Andrada E. Ivanescu

Department of Public Health Scholarship and Creative Works

BACKGROUND

The purpose of the study was to examine the effects of the “Yes You Can!” (YYC) curriculum on sexual knowledge and behavioral intent of program participants.

METHODS

Participants included students ages 10‐14 from schools in a northeast US urban area. Yes You Can! program lessons were designed to support healthy relationships. The curriculum was taught by trained instructors. The testing instrument was a 30‐item questionnaire, which included sexual knowledge and intent items. Students completed the questionnaire before program implementation, immediately following intervention, and a third time at follow‐up. Data were analyzed using analysis of covariance. …

Know Your Value: Negotiation Skill Development For Junior Investigators In The Academic Environment—A Report From The American Society Of Preventive Oncology's Junior Members Interest Group, Allison B. Burton-Chase, Maria C. Swartz, Stephanie A. Navarro Silvera, Karen Basen-Engquist, Faith E. Fletcher, Peter G. Shields

Department of Public Health Scholarship and Creative Works

The American Society of Preventive Oncology (ASPO) is a professional society for multidisciplinary investigators in cancer prevention and control. One of the aims of ASPO is to enable investigators at all levels to create new opportunities and maximize their success. One strategy adopted by ASPO was to develop the Junior Members Interest Group in 1999. The Interest Group membership includes predoctoral fellows, postdoctoral fellows, and junior faculty members who are provided career development and training opportunities (1). Responsibilities of the members of the Junior Members Interest Group include serving on the ASPO Executive Committee and the Program Planning …

Family Preservation And Healthy Outcomes For Pregnant And Parenting Teens In Foster Care: The Inwood House Theory Of Change, Lisa D. Lieberman, Linda Lausell Bryant, Keneca Boyce

Department of Public Health Scholarship and Creative Works

Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data …

A Community Conversation On Adolescent Pregnancy And Parenting Services: Networks Of Support, Gatekeepers To Care, And Non-Compulsory Fathering In A Black Urban Community, Tamara Leech, Elizabeth A. Adams, Marci Littlefield

Department of Public Health Scholarship and Creative Works

This study employed Community-Based Participatory Research (CBPR) methods to document needs and capacity around adolescent pregnancy and parenting in one predominately Black, low-income urban community. Using an iterative focus group method, we engaged 60 participants in a two-day community conversation. Quantitative data from an enrollment questionnaire and qualitative transcripts of the discussions are analyzed. Our results indicate that the community’s greatest capacity lies in a network of women. Men tend to participate in parenting more holistically once formal paternity is established. Neighborhood women typically introduce adolescents to prenatal care, so delays in revealing the pregnancy to them serve as a …

Diversity In Times Of Austerity: Documenting Resistance In The Academy, Tamara Leech, David Moscowitz, Terri Jett, Terri Carney, Ann Savage

Department of Public Health Scholarship and Creative Works

What happens to feminism in the university is parallel to what happens to feminism in other venues under economic restructuring: while the impoverished nation is forced to cut social services and thereby send women back to the hierarchy of the family, the academy likewise reduces its footprint in interdisciplinary structures and contains academic feminists back to the hierarchy of departments and disciplines. When the family and the department become powerful arbiters of cultural values, women and feminist academics by and large suffer: they either accept a diminished role or are pushed to compete in a system they recognize as antithetical …

Sexuality Information Needs Of Latino And African American Ninth Graders: A Content Analysis Of Anonymous Questions, Francisca Angulo-Olaiz, Eva Goldfarb, Norman A. Constantine

Department of Public Health Scholarship and Creative Works

This study used qualitative content analysis to examine anonymous questions about sex and sexuality submitted by Latino and African American adolescents in Los Angeles, California, classrooms. The majority of questions asked about sexuality and sexual behavior, or anatomy and physiology, with fewer questions about pregnancy and pregnancy prevention, sexually transmitted infections, and condoms. Overall, a notable mix was found of questions implying exposure to or awareness of a wide range of sexual activities, together with questions demonstrating fundamental misunderstandings or confusion about some of the most basic aspects of sex and sexuality. Gender differences emerged across topics, subtopics, and question …

Area Specific Self-Esteem, Values, And Adolescent Sexual Behavior, Michael Young, Joseph Donnelly, George Denny

Department of Public Health Scholarship and Creative Works

This study examined area-specific self-esteem scores by sexual behavior relative to adolescents' values concerning participation in sexual intercourse as an unmarried teenager. The sample consisted of 332 students in grades 7–12 from a Southern rural school district. Students were asked if they had ever had sexual intercourse (yes/no) and if they had participated in sexual intercourse in the last month (yes/no). Respondents also indicated on a 4-point scale their response to the statement “It is against my values to have sex as an unmarried teenager.” Data were analyzed using a 2 × 4 (behavior x values) analysis of variance for …

Risky Sexual Behavior: A Race-Specific Social Consequence Of Obesity, Tamara Leech, Janice Johnson Dias

Department of Public Health Scholarship and Creative Works

Scant attention has been given to the consequence of actual weight status for adolescents' sexual wellbeing. In this article, we investigate the race-specific connection between obesity and risky sexual behavior among adolescent girls. Propensity scores and radius matching are used to analyze a sample of 340 adolescents aged 16-17 who participated in the National Longitudinal Survey of Youth Young Adult Survey in 2000 or 2002. Nearly even numbers of these participants identified as white and black (183 and 157, respectively). We find that compared to their non-obese white peers, obese white adolescent girls exhibit higher rates of multiple sex partners …

Everything's Better In Moderation: Young Women's Gender Role Attitudes And Risky Sexual Behavior, Tamara Leech

Department of Public Health Scholarship and Creative Works

Purpose This study examines the association between gender role attitudes and risky sexual behavior among young women. Previous studies have posed seemingly contradictory arguments: that either traditional attitudes or egalitarian attitudes are associated with riskier behavior. Methods Data are based on the children of the National Longitudinal Survey of Youth, representing 520 sexually active 18–19-year-old women. Propensity radius matching was used to assess differences in rates of multiple sexual partners and sex outside of a committed relationship. Results Relative to moderate gender role attitudes, both egalitarian gender role attitudes and traditional gender role attitudes are associated with higher rates of …

Intake Of Coffee And Tea And Risk Of Ovarian Cancer: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

There is some evidence from case-control studies that coffee consumption might be positively associated with ovarian cancer risk, whereas the epidemiologic evidence regarding tea consumption and ovarian cancer is inconsistent. To date, there have been few prospective studies of these associations. Therefore, we examined ovarian cancer risk in association with both coffee and tea intake in a prospective cohort study of 49,613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food frequency questionnaire between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending …

Glycaemic Index, Glycaemic Load And Ovarian Cancer Risk: A Prospective Cohort, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

Background

There is some evidence that plasma insulin levels might influence ovarian cancer risk. Glyacemic index (GI) and glycaemic load (GL) are measures that allow the carbohydrate content of individual foods to be classified according to their postprandial glycaemic effects and hence their effects on circulating insulin levels. Therefore, we examined ovarian cancer risk in association with GI and GL, and intake of dietary carbohydrate and sugar. Methods

The study was conducted in a prospective cohort of 49 613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food-frequency questionnaire (FFQ) between 1980 and 1985. …

Glycaemic Index, Glycaemic Load And Ovarian Cancer Risk: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

Background

There is some evidence that plasma insulin levels might influence ovarian cancer risk. The glycaemic index (GI) and glycaemic load (GL) are measures that allow the carbohydrate content of individual foods to be classified according to their postprandial glycaemic effects and hence their effects on circulating insulin levels. Therefore, we examined ovarian cancer risk in association with GI and GL, and intake of dietary carbohydrate and sugar.

Methods

The study was conducted in a prospective cohort of 49 613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food-frequency questionnaire (FFQ) between 1980 and …

Benign Proliferative Epithelial Disorders Of The Breast: A Review Of The Epidemiologic Evidence, Stephanie A. Navarro Silvera, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

Nearly one in four breast cancers is diagnosed before the age of 50, and many early-stage premalignant lesions are present but not yet diagnosed. Therefore, we review evidence to support the strategy that breast cancer prevention efforts must begin early in life. This study follows the literature review methods and format. Exposures during childhood and adolescence affect a woman’s long-term risk of breast cancer, but have received far less research attention than exposures that occur later in life. Breast tissue undergoes rapid cellular proliferation between menarche and first full-term pregnancy, and risk accumulates rapidly until the terminal differentiation that accompanies …

A Cohort Study Of Reproductive And Hormonal Factors And Renal Cell Cancer Risk In Women, Gc Kabat, Stephanie A. Navarro Silvera, Ab Miller, Te Rohan

Department of Public Health Scholarship and Creative Works

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were …

Energy Balance And Breast Cancer Risk: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Jain Meera, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

While there is evidence that breast cancer risk is positively associated with body mass index (in postmenopausal women) and energy intake and inversely associated with physical activity, few studies have examined breast cancer risk in association with energy balance, the balance between energy intake and expenditure. Therefore, in the cohort study reported here, we studied the independent and combined associations of vigorous physical activity, energy consumption, and body mass index (BMI), with breast cancer risk. The investigation was conducted in 49,613 Canadian women who were participants in the National Breast Screening Study (NBSS) and who completed self- administered lifestyle and …

Carotenoid, Vitamin A, Vitamin C, And Vitamin E Intake And Risk Of Ovarian Cancer: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

It is thought that oxidative stress resulting to repeated ovulation may increase the risk of ovarian cancer by inducing DNA damage (1). Consumption of antioxidants may, therefore, decrease ovarian cancer risk by counteracting oxidative stress and the resultant DNA damage (2, 3). Currently, the epidemiologic evidence regarding associations between antioxidants and risk of ovarian cancer is mixed (4-12). Of the two prospective studies, Kushi et al. (4) and Fairfield et al. (7) both reported no association between β-carotene and ovarian cancer risk. In addition, Fairfield et al. …

What Is Comprehensive Sexuality Education Really All About? Perceptions Of Students Enrolled In An Undergraduate Human Sexuality Course, Eva Goldfarb

Department of Public Health Scholarship and Creative Works

The purpose of this study was to use qualitative evaluation techniques to explore the perceptions of students enrolled in undergraduate human sexuality classes regarding their expectations for the course as well as outcomes. One hundred forty-eight students were surveyed at the beginning and again at the end of the semester-long course. While pregnancy and STI prevention were considered important components of their courses, other outcomes associated with positive, healthy sexuality were given greater emphasis. Results suggest that while primary and secondary level sexuality education have been increasingly focused on abstinence-only education with a focus on pregnancy and STI reduction, this …