Abstract

Scope and objectives. School-based sexuality education (SE) can be used to prevent sexual health problems and to promote the formation of positive attitudes in youths. This study reviews the thoroughness and diversity of SE provided to the pupils in the Estonian primary education system. Survey results from school pupils are used to analyse connections between schoolbased SE and the knowledge and attitudes of today’s youths.
Methods. This study is based on the data of a 2021 school survey of the Estonian National Institute for Health Development “Sexual Health of Estonian Youth: Knowledge, Attitudes and Behaviour”. The survey encompassed 2791 pupils in the 7th to 9th grade (mainly 14–15-year-olds) of the Estonian primary education system. Data analysis used the answers of 2224 students giving an 80% response rate. The handling of SE topics was assessed using the selected 22 topics listed in World Health Organization’s Standards for Sexuality Education in Europe. A SE score (high, medium and low level of SE) was calculated based on the thoroughness and diversity of topics that had been discussed at school. The prevalence of students with proper sexuality, HIV and sexually transmitted infections related knowledge and attitudes towards people living with HIV, condom use and different aspects of sexual relationships was calculated. The associations between pupils’ SE score and their knowledge and attitudes were calculated. Pupils’ overall evaluation of school-based SE was assessed and their experiences regarding teaching methods were analysed. For statistical analysis, SPSS 22.0 was used. In bivariate analyses, frequencies (n, %) and mean were calculated. Pearson’s chi-square test and Bonferroni’s test were used to evaluate differences between groups. Logistic regression analysis was used to investigate the associations between different knowledge and attitudes items and exposure to SE score.
Results and conclusions. According to the pupils’ answers, all topics mentioned in the survey had been discussed in school lessons but with inconsistent diversity and insufficient thoroughness indicating that SE in Estonian schools in on uneven level. Pupils with a high and medium SE score (more diverse and thorough handling of topics) had better overall knowledge coupled with more accepting attitudes towards people living with HIV, more positive attitudes towards condom use and more open and responsible attitudes in a hypothetical sexual relationship than pupils with medium and low SE score. The associations decreased after adjusting for class level but remained statistically significant. Pupils mainly rated school SE positively, but suggested to discuss more topics, more thoroughly, more seriously and with more positive approach, and to use different active teaching methods. This study indicates the need for a more diverse and thorough handling of SE topics in schools.