Health and Sexuality Education in Schools: The Process of Social Change.

Health and Sexuality Education in Schools: The Process of Social Change. By Steven P. Ridini. Westport, CT: Bergin & Garvey, 1998, 224 pages. Cloth, $59.95.

Stephen Ridini's book represents what undoubtedly had been a graduate thesis converted into material designed for a broader audience. Studying at Harvard's Graduate School of Education and School of Public Health, Ridini examined the attempts of two communities to adopt HIV/AIDS curricula into their public schools. In the forward written by Charles Willie (Ridini's mentor at Harvard), Ridini is praised for revealing that "success in public health or public education programs is attributed to interaction between individuals and groups or institutions" (p. xi). The two key findings from the study are that "(a) teaching and learning experiences about health and human sexuality are difficult to implement in public school systems and (b) teaching and learning experiences about health and human sexuality are possible in public education, if appropriate attention is given to the process of community decision-making" (p. x).

As an experienced health educator and sexuality educator, I knew that I would be fighting feelings of frustration from Willie's comments onward. I was initially struck by Willie's and Ridini's lack of historical perspective, although Ridini redeemed himself later in the book. Implementing quality sexuality education in the public schools has been a struggle for decades. Written guidelines and other support services have long been available to communities through The Sexuality Information and Education Council of the United States (SIECUS), formed in the mid-1960s. To read a book with a 1998 copyright "revealing" that the implementation of such programs would be difficult seems rather surprising, to say the least.

Furthermore, as a health educator I am concerned and, frankly, rather angry when the terms health education, sexuality education, and HIV/AIDS education are used interchangeably. The title of the book had prepared me to read about health education and sexuality education. What Ridini primarily focused on was HIV/AIDS education. Unfortunately, in the early 1990s many school systems around the United States were doing the very same thing--interchanging HIV/AIDS education efforts for health and/or sexuality education. Few school systems have ever truly implemented comprehensive health education for grades K-12, where students not only get information but also have the opportunity to examine how their belief systems impact their behavior. And what has been labeled sexuality education has too often been heavily skewed toward the safe topics of anatomy and physiology of the reproductive system, pregnancy and childbirth, and sexually transmitted diseases. With school systems (as in those communities Ridini studied) being encouraged and, in some cases, mandated to educate students about HIV/AIDS, curriculum efforts took on that more singular focus. It is important to distinguish clearly, however, between sexuality education, health education, and HIV/AIDS education. Ridini's title set up misleading expectations.

As I read further into Ridini's work, however, my fears that he did not understand the broader issues were somewhat allayed. Ridini, as a public health educator, was familiar with the U.S. Department of Health and Human Services' Healthy People 2000: National Health Promotion and Disease Prevention Objectives (1991). He had researched the factors that often interfered with the implementation of sexuality programs, namely fears that information led to earlier sexual behavior, concerns over open discussion of homosexuality, conflicts over religious teaching, and the belief that such education was the responsibility of parents. His study also followed the 1990 Massachusetts Departments of Education and Public Health directive to all school districts to create programs to teach about HIV/AIDS at all grade levels. The state had produced and distributed a resource Comprehensive Curriculum Guidelines on HIV/AIDS: Grades K-12 (Massachusetts Department of Public Health, 1991).

Ridini's research was designed to explore how and why community members worked to support or oppose the implementation of HIV/AIDS programs. His meticulous research and immersion in the two communities studied is commendable. He interviewed over 50 individuals in the two towns--referred to as Alpha and Beta--and read numerous books, journal articles, and newspaper accounts of the efforts to integrate new programs into the schools. What strikes me as extremely odd, however, is that anonymity is initiated by referring to the two communities as Alpha and Beta, but the names and titles of all those interviewed are provided. In addition, each town is described in such demographic detail that preserving its anonymity seems close to impossible, with the token gesture comical.

Alpha is described in detail in Chapter 2 as a city of 83,000 residents six miles from Boston. Ridini characterizes it as racially and culturally diverse, generally viewed as affluent with approximately one third of the residents having household incomes above $75,000. A student-initiated effort to expand what was accepted as an inadequate HIV/AIDS program, along with a desire to have condoms distributed in the high school, led to the development of the Health Education Task Force. Despite well-organized opposition to an expanded program, the Task Force succeeded in designing a comprehensive curriculum on sexuality (including HIV/AIDS) and having it implemented.

Beta, in contrast, was not as successful in broadening health education within its schools. It is described in Chapter 3 as a community twelve miles from Boston, the birthplace of presidents John Adams and John Quincy Adams as well as John Hancock, "situated at the crossroads of 1-93 (Route 128) and Route 3" (p. 37). With a population of approximately 34,000, the community is made up of lower-income families with Cape-Cod style homes as well as wealthier areas with stately Victorian homes. The population is primarily white, of Irish and Italian decent. A School Committee member is quoted as describing the town as a "Catholic town" (p. 38); in fact, all members of the School Committee at the time of the study were Catholic. Such detail obviously makes determining the location of Beta relatively easy.

Beta's efforts to improve the HIV/AIDS education offered its students was led by a school administrator who recognized the inadequacy of the existing curriculum. An AIDS Advisory Committee was formed from the community to work on developing a new, comprehensive program. Over a period of years, two vocal parent groups were formed--one which supported health education but wanted abstinence-based sexuality education, and another which was concerned that comprehensive health education programs meet the needs of all children, including those already sexually active. The latter group's focus embraced HIV/AIDS education and sexuality education across the grades. After years of public debate, the community improved its health education curriculum at the lower elementary grades and ran out of grant money that would have enabled it to implement a more comprehensive health education program at the high school level. The specific goals that HIV/AIDS be discussed across all grades and that better opportunities to discuss sexuality issues in high school be provided did not succeed.

By the end of Chapter 3, the reader has a fairly good understanding of what transpired in these two communities. However, six chapters in the book remain. Because this book evolved from a graduate thesis, Ridini proceeds with reviewing all that happened within the theoretical framework tested. As a result, there is a lot of repetition and increasing confusion as both communities are discussed in a comparative style. While the chapters that deal with obtaining community support or dealing with public opposition are important, Ridini's critical points get buried in numerous quotes attributed to specific people. Individuals are referred to by name; acronyms for community groups are developed; and despite the tables which initially provide names, titles, and names of organizations, it becomes exhausting to keep the groups straight.

The theoretical framework for Ridini's study is that of community organization theory. After demonstrating an impressive knowledge of the various theories available, Ridini somewhat inexplicably chose Sower's Community: i Action model; too many other models apparently emphasize the decision-making structure within a community rather than the process of social change. Sower's (1957) model has three stages: (a) Initiation, (b) Legitimation, and (c) Implementation. The initiation stage refers to the process where individuals with similar interests form a group which develops common goals and objectives and a proposal for action, and forges connections with the community. The legitimation stage involves getting approval for the plan, and winning support from the community by demonstrating supposed benefits from the plan. Finally, the implementation stage involves executing the plan by having adequate personnel and resources.

Ridini wisely recognizes that Sower's model requires a fourth stage, Evaluation, in order to be complete. While it would seem that more current theories on community action could have been utilized, the addition of evaluation brings the model closer to contemporary concerns. The essential step of evaluating one's efforts, both individually and collectively, is so much a part of today's research that by its very omission I would have suspected Sower's work to appear dated. However, Ridini uses the model and takes the reader through Alpha's and Beta's efforts for each stage. It would have been better and clearer had each community been discussed more thoroughly at the outset.

Had there been less repetition of content, Ridini's book would have been a more coherent study of two communities. If, instead of integrating so many quotations from the over 50 people interviewed, Ridini had written more broadly of the perspectives of the students, parents, and administrators, the narrative would have been less confusing. While the two communities studied were both suburbs of Boston, I found myself questioning the validity of testing a theory and contrasting the results when the differences between the communities seem significant. Finding that curriculum change was easier in the more diverse community compared to a community with a strong, conservative, religious base came as no surprise. While the trigger for change was the need to address HIV/AIDS issues in the schools, what the controversy really focused on were issues of sexuality. Sadly, what Ridini's work confirms is that the challenges faced for decades over the implementation of comprehensive sexuality education remain with us.

REFERENCES

Massachusetts Department of Public Health (1991, September). Comprehensive curriculum guidelines on HIV/AIDS: Grades K-12. Boston, MA: Author.

Sower, C., Holland, J., Tiedke, K., & Freeman, W. (1957). Community involvement. New York: The Free Press.

U.S. Department of Health and Human Services/Public Health Service (1991). Healthy people 2000: National health promotion and disease prevention objectives. Washington, DC: Government Printing Office.

Jean Levitan, Ph.D., Department of Community Health, William Paterson University of New Jersey, Wayne, NJ,07470; e-mail: [e-mail].