archives@tulane.edu / According to the definition developed by the Centers for Disease Control and Prevention in 2011, sexual health is an innate part of a person’s overall health and includes multiple dimensions of a person: physical, emotional, mental, social, and spiritual. As sexual health is an intrinsic part of a person’s health, understanding and improving it is important for a one’s quality of life and general well-being. However, despite high STI rates among college students in the United States (US), international students attending universities in the US have been neglected in the realms of scientific and programmatic research, making it difficult to understand their risks for negative sexual health outcomes, their sexual health needs, and their requirements for effective sexual health promotion programs. This dissertation is divided into three papers that addressed different aspects of international students and their sexual health outcomes. First, a comprehensive literature and programmatic review was conducted. There were 30 studies that were included in the analysis, and they found risk factors similar to domestic students, a number of barriers to accessing sexual health care, and some protective factors. The programmatic review covered the top 10 universities with the most international students enrolled and found no sexual health promotion programs focused on international students although they did have general programs for all students. The second paper described the implementation, analysis and results of the online international students’ sexual health survey at Tulane. The survey found moderate knowledge levels moderate levels of sexual permissiveness, discomfort with contraception and testing, conservative attitudes towards risky sexual behavior, and a number of sexual risk behaviors, such as inconsistent contraceptive use and participating in one-night stands. The last paper discussed an online-based sexual health promotion program for Tulane University international students developed based on the findings of the first and second paper. The program will be led by peer sexual health educators on a forum that includes static sexual health information along with interactive discussions of specific sexual health topics each week for six weeks. These topics are general sexual and reproductive health, STIs and prevention, pregnancy and prevention, healthy relationships, sexual health resources, and sexual violence on campus. / 1 / Chia-Chen Chang

The incidence of unplanned pregnancy has long been used as an indicator of sexual and reproductive health. However, because of dramatic social and demographic changes, existing measures have become outdated and no satisfactory contemporary measure of this status exists. The aim of this study was to develop a measure of unplanned pregnancy which is valid, reliable and appropriate in the context of contemporary demographic trends and social mores, and can be used to establish population estimates of unplanned pregnancy. To achieve this, a two-stage study design was employed: firstly, qualitative (inductive) methods in order to delineate the construct of pregnancy planning/intention, and secondly quantitative/psychometric methods to establish the means of measurement. At the qualitative stage, 67 depth interviews were carried out with pregnant (continuing pregnancy and abortion) and postnatal women. A conceptual model of pregnancy planning/intention was developed from these data and used as the basis for item development in the quantitative stage. Standard psychometric techniques were then employed to construct the measure and test its reliability and validity (the qualitative findings informing judgements about content and construct validity). Over 1000 women participated in the psychometric field testing. The result of the study is a six-item measure of unplanned pregnancy - the first psychometric measure of this construct. Psychometric testing demonstrated the measure's high reliability (Cronbach's alpha>0.90; test-retest reliability >0.90) and high face, content, and construct validity. Women may occupy a range of positions in relation to pregnancy planning, and these are represented in the measure by the spectrum of scores (zero to 12). These scores provide a more sophisticated level of information about pregnancy planning than was previously available. The measure is suitable for use with any pregnancy regardless of outcome (i. e. birth, abortion, miscarriage) and is highly acceptable to women.

To date, only one national study has examined patterns of adult sexual knowledge, attitudes and behaviour in New Zealand in the hope of improving sexual and reproductive health outcomes for all New Zealanders. This study was performed nearly two decades ago. The aim of this study is to explore current patterns of sexual health and wellbeing among a sample of adults from the Christchurch metropolitan area. Seven hundred and sixty seven participants were selected from the General and Maori electoral registers and invited to participate in an Internet-based self-administered anonymous survey. Data was collected on sexual health, knowledge, attitudes and behaviour and compared to five previous national studies in adult sexual health and wellbeing. Twenty-five men and 17 women responded to the survey. Overall, sexual health and wellbeing behaviours reported in this study are higher than those found in the five comparative studies. However, it is not clear whether this finding is an accurate reflection of the current sexual and reproductive health status of the sample population or whether participation bias has overestimated the rate of behaviours in question. In conclusion, the results from this study provide sufficient motive to continue on researching a possible shift in patterns of adult sexual health and behaviour over the last two decades in New Zealand.

This research is based on a case study of young people's identities, practices and discourses, and takes sexuality as a focus for interrogation. It aims to reveal the issues and processes that impact on young people's conceptions of self (both current and future) by looking at private and public realms of experience. In so doing, social lives, home lives and schooling (particularly sex education), are explored to reveal how far they operate in young people's interest. Lack of acknowledgement of young people's authentic lives in mainstream debates and practice forms a main focus of my critique. I adopt a qualitative methodology that is congruent with feminist principles for research, and am committed to exposing the knowledge creation process. Data are deployed from observations and interviews with 15 - 16 year old, African-Caribbean, Pakistani, Somali and white, secondary school students. Data from other sites provides corroboration and comparison. The thesis challenges the various critiques and representations of youth and argues for a dynamic model of understanding based on appreciating the connectedness between 'concrete' and 'generalised' constructs of identity and practice. The theoretical base is provided through a reading of Foucault, Giddens, Smith, Habermas, and Benhabib. Concepts of 'expert systems', 'colonisation' (Habermas 1986, 1987), 'fabrication' (Ball 1997), and 'fateful episodes' (Giddens 1991) have been given specific scrutiny. The resulting analysis is used to make recommendations for practice, policy and research in sex education.

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According to Durham Region Public Health Department, 40% of youth, aged 15-19 years, living in Durham Region said that they had engaged in sexual intercourse in the last year, with 570 youth becoming pregnant. In Durham Region 2.3/100,000 youth between the ages of 15 and 24 years are infected with HIV/AIDS annually. Chlamydia rates have also been steadily increasing with 1,250 cases reported in 2009 in Durham Region, with the rates of STIs in Canada being the highest in youth ages 15 to 24 years. This study was undertaken as a capacity building venture to engage youth in Durham Region and allow them to identify their sexual needs and priorities for HIV prevention and healthy sexual development. The study also had four objectives: (1) To assess whether youth know about the sexual health services that are available to them; (2) To discover how youth perceive the sexual health services they are aware of; (3) To identify where youth currently receive sexual health resources; and (4) To understand where, how and from whom youth would like to receive sexual health resources. The Durham Region Healthy SexYouthality Project was a community-based research study conducted by the Durham Region Healthy SexYouthality Coalition. The Project was a qualitative research study that employed focus group sessions to engage youth in discussions pertaining to their sexual health. The study sample included 32 participants ranging from 15 to 24 years of age, with the mean age of 18.96 years. Of the 32 participants, 19 were female, 12 were male and 1 identified as transgender. The coalition identified four populations within Durham Region; urban, rural, semi-rural and LGBTQ youth, which resulted in 10 focus groups. The size of each meeting ranged from four to nine participants and each was audiotaped. The data was transcribed and then analyzed using open coding with the NVivo 9 software. Several themes about sexual health services emerged from the study. They include: lack of knowledge of services, the need for increased awareness; the perceptions youth have about health services including that they are inaccessible, not anonymous, not confidential, not knowledgeable, are judgemental but are youth-friendly; where youth currently receive information including the internet, media, friends/peers, school, parents and health professionals; and how youth would prefer to receive sexual health education such as through trustworthy internet sources, improved sexual education in schools and new community programs. In conclusion, youth in Durham Region need more information about the sexual health services that are available to them and changes need to be made to make them more accessible, anonymous and confidential. Youth also prefer to access information about sexual health through convenient and reliable sources and it is up to organizations working with youth to ensure that these needs are best being met. / UOIT