Contact Name
Barbara Dietsch
562-985-9488

Contact Email
bdietsc@WestEd.org

Gregory Austin, Ph.D., Director
Barbara Dietsch, Ph.D., Research Associate
Human Development Program, WestEd

Increasingly, schools and community agencies are required to demonstrate that they are using data to assess needs, develop programs, and monitor progress in achieving program goals related to adolescent health-risk behaviors, such as those related to sex and pregnancy. Schools and communities need a thorough understanding of the scope and nature of these behaviors to develop effective prevention and health programs and to promote positive youth development and resilience. To these ends, the California Department of Education (CDE) funded the development of a California Healthy Kids Survey (CHKS). A major focus is assessing sexual behavior and risks for teen pregnancy, HIV, and other sexually transmitted diseases.

Developed by WestEd with the assistance of an Advisory Committee of researchers, school practitioners, and state and federal health agency representatives, the CHKS is designed to assist local education agencies in meeting the needs assessment and reporting requirements of the federal Safe and Drug Free Schools and Community Act (Title IV). More generally, the CHKS grew out of CDE's commitment to promote safe, drug-free, healthy, and successful development of the state's youth. As its name reflects, the CHKS is designed to promote the development of coordinated school health programs and send a positive message to students, schools and communities about the importance of healthy behaviors and their link to positive school and life outcomes. While the survey is primarily intended to support school programs, it also assesses health risks and assets within the community, and is intended to help promote the community awareness and collaboration necessary to ensure the success of school prevention efforts.

The CHKS is unique in using a set of topic-specific optional modules that allows for schools to configure a survey to meet local needs, interests, and standards, while at the same time preserving standardization and comparability across local data sets. In addition to a general, required core module and the option to create a customized module, there are five topic-specific modules:

• tobacco use;
  
• alcohol and other drug use, violence and safety, including suicide;
  
• nutrition, physical activity, and general health;
  
• sexual behavior, pregnancy, and HIV risk; and
  
• resilience assessment.

The nineteen items on the sexual behavior module were based primarily on the Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey (YRBS), which allows for national comparison. These items cover such behaviors and attitudes as age of onset of sexual activity, number of partners, contraceptive use, history of pregnancy, and use of drugs or alcohol before having sexual intercourse. The CDE's Teen Pregnancy Prevention Grants Program and the California Department of Health Services' Maternal and Health Branch assisted in developing additional items assessing intent to have sexual intercourse in the near future, perception of peer norms, and the degree of communication with adults about sexual behavior.

Use of the multiple modules enables sexual behavior risks to be assessed in relation to other risk behaviors and resilience attributes. This is the first step in developing an integrated prevention or coordinated school health approach. CHKS recognizes the importance of assessing youth sexual behavior. Teen pregnancy prevention programs especially need an assessment tool. A separate module was developed to highlight the importance of collecting data on sexual behavior. Feedback from districts using the module has been favorable. Most of these districts had pregnancy prevention programs. However, there is still resistance to including these questions on health surveys. This resistance is evident in the small number of districts (less than 10%) choosing to administer the optional sexual behavior module.

A total of 10 districts pioneered the CHKS sexual behavior module in Fall 1998 (n= 911 students). Although this is a small, and therefore potentially biased, sample, the preliminary results are illustrative of the importance of assessing youth sexual behavior and addressing their needs.

• 28% of 9th and 53% of 11th graders responded having had sexual intercourse
  
• Of those reporting ever having had sex, 26% of 9th and 30% of 11th graders responded that they had drunk alcohol or used drugs before the last time they had sexual intercourse
  
• 64% of 9th and 58% of 11th graders reported that they used a condom, but 19% of 9th and 15% of 11th graders did not use any method to prevent pregnancy the last time they had sex
  
• 47% of 9th and 50% of 11th graders had ever talked with their parents or other adults about how their lives would change if they became a teen parent.

This type of data is valuable to program developers at the local level. Funding agencies are requiring not only that programs be monitored for effectiveness, but that they be research-based. They need data to describe what health risks their youth are exposed to; to support program funding; and to guide program content development. The CDC reminds us that early sexual activity is associated with unwanted pregnancy and sexually transmitted diseases, including HIV/AIDS. Alcohol and drug use are often predisposing factors for initiation of sexual activity and unprotected sex. These high risk behaviors are correlated with morbidity and mortality among youth. The challenge is to educate local decision makers, parents and the community at large about the value of this type of data to health education programs and to alleviate some of the fears associated with asking youth about their sexual attitudes and behaviors.

The reality is that many surveys ask about onset of sexual behaviors without experiencing negative consequences. The CDC's YRBS has asked these questions since 1995, and while districts may opt out of asking the questions about sexual behaviors, most keep them in the survey. Both parents and students have the right to decline participation in the CHKS. However, most parents sign the active consent forms allowing their children to take the survey. The hope is that as more and more districts use this module they will develop more confidence, and use of the module will increase.

Although developed and copyrighted for California's schools, the service is available to, and can be adapted for, schools and communities outside California for a fee. For further information see the CHKS Website (www.wested.org/hks) or, within California, call toll-free at 888.841.7536.