Importance and Limits of This Study
4 The Importance and Limits of This Study
The recent statistics on the transmission of HIV (Health Canada, 1996) suggest strongly that the teen years are a critical time for prevention programs. The median age of HIV infection has dropped from age 32 to age 23. With the incubation period for the appearance of the disease being about ten years, this indicates that teenage years are when much infection occurs.
The Canada Youth and AIDS Study (King et al, 1988) reported that adolescents are practicing unsafe sexual behaviours. They also reported that youth seek information about their sexual health from schools as well as other sources.
There is considerable research showing that school programs and services (either based in or linked with the schools) can influence the health behaviours of children and youth Institute of Medicine, 1997; Mackie & Oickle, 1996). Large scale studies of health education (Connell et al, 1985; Harris, 1988), as well as specific studies of sexuality education programs (Barret, 1990; Baldwin et al, 1990; Munro et al, 1994, King et al, 1996), tell us that well-planned, well-delivered programs can improve health behaviours.
As well, studies on the efficacy of preventive health services (Sisk et al, 1988; Hughes et al, 1989; O’Reilly & Aral, 1985) report that information, counselling, screening and referral services can reduce the number of adolescents contracting sexually transmitted diseases (STD).
Further, researchers such as Fisher (1990) and others (Hanvey & Kinnon, 1993) have noted that the impact of such sex education or sexual health services is enhanced when the two are delivered in coordination. The research on using the school as a setting within the community to integrate and deliver such education and services, in combination with a healthy physical environment and organized forms of social support such as peer programs and parental involvement, has recently been compiled by the Institute of Medicine (1997) in the United States. This Comprehensive School Health (CSH) approach is consistent with the Population Health approach now used by governments across Canada (Health Canada, 1994) in that the combined interventions can influence more than just one of the determinants of health.
Further, Health Canada (1994) and national professional organizations (Canadian Association of School Administrators, 1992) have established or recommended standards of professional care and education that include having schools work closely with health units to prevent HIV among adolescents.
It is not surprising, therefore, that education and health ministries across Canada have required school districts and public health units to provide sexuality education and sexual health services.
In Canada, there have been a considerable number of studies documenting that adolescents are at risk of HIV from unsafe sexual behaviours. The Canada Youth and AIDS Study (King et al, 1988) was the most significant, but there have been several others.
However, there are few studies documenting the policies and programs in place within Canada. In the United States, the health and education authorities are cooperating to report more consistently on the status of school-related policies and programs. The School Health Polices and Programs Study (SHPPS) (Kolbe et al, 1995), funded by the Centers for Disease Control, is entering its second round.
In Canada, there are several trends that underline the need for this study. The Council of Ministers of Education, Canada (CMEC), acting on behalf of the provinces and territories, has been working with several departments to strengthen the country’s capacity to report on school performance. Industry Canada has funded the development of science standards, Human Resource Development Canada has funded literacy and numeracy indicators and the CMEC is working closely with Statistics Canada through the Canada Education Statistics Council. Student health has been identified as a topic for investigation as part of the CMEC Pan-Canadian Research Agenda. This study could become a component of that issue.
Within Health Canada, the results of this study could inform several national initiatives. The National AIDS Strategy has just been renewed with clearly established strategic directions. The Report of the Royal Commission on New Reproductive Technologies (Shannon & McCall Consulting, 1991) called for a national strategy on reproductive health, an element of which is the prevention of STD.
This report describes the activities of education and health ministries, school districts and public health units and schools, public health nurses and teachers. The focus groups with parents and students provide some of the voices to which we need to listen.
The data reported here are compelling in showing how 23 large public systems (the Alberta education ministry declined to participate in the study), comprised of ministries, agencies and frontline workers, are struggling to fulfill their respective mandates in preventing HIV and promoting sexual health. Swept up in system reorganizations, facing reductions in resources, and dealing with a complex and sensitive issue, professionals, agency administrators and government officials are continuing to find innovative ways to cope and to deliver programs.
Although, we had considerable difficulty in locating the appropriate officials and arranging the interviews, the response rates to our request for telephone interviews was eventually very high, especially considering the limits and constraints faced by these professionals. The challenges we faced appear to be similar to those encountered in the SHPPS Study in the US (Kolbe et al, 1995).
However, we must note that the data show that reorganization and change is currently a dominant feature of these two systems. We were and are, tracking a moving target. For example, some jurisdictions have already embarked upon or have recently completed reviews of their health curricula during or subsequent to this study.
This study does not present a complete examination of all the policies, programs, services and activities in Canadian society that can prevent HIV. We have previously referred to the role of parents, of the community, of the media and of other agencies and organizations. Schools and public health department cannot prevent HIV on their own.
This study does provide, however, a clear and comprehensive report on the current status of policies, programs and practices at the provincial/territorial, community and school levels. We now know what the two major systems involved in prevention are actually doing.
It should also be noted that the focus group reports cannot and should not be considered in the same light as the telephone interviews and questionnaire results. The focus groups involved selected and self-selected groups of students and parents. The issues raised and the analysis of their perceptions can lead us to important questions and eventually to answers, but they are not necessarily the same as the views of all parents and students. However, the perceptions and views recorded in this study reflect those found in similar studies.
As well, the response rate to the written teacher questionnaire that used a different methodology are far lower than the telephone interviews. Rather than telephone interviews, the responding school principals were asked to identify a teacher who would be asked to complete a written questionnaire. These written questionnaires were mailed directly to the teachers with assurances that their replies would remain confidential. Consequently, the statistical confidence levels (intervals) for teacher responses vary more than those from the telephone interviews.
The specific response rates and statistical analyses are available in the detailed technical reports. As well, provincial/territorial findings will be reported to the provinces and territories in separate reports.
This study can help to set a baseline of current policies, programs and practices in school and public health systems related to HIV and STD prevention and sexual health promotion. These findings can form the basis for comparisons over time and be part of an Indicators program monitoring schools and public health systems. As well, given the similarities with the SHPPS Study in the United States, these Canadian data can be compared to those results as well.
The Council of Ministers of Education, Canada appreciates the opportunity to conduct this examination and appreciates the support and cooperation received from the AIDS Prevention and Community Action Programs of Health Canada.