Abstract
Real Education for Healthy Youth Act of 2019 is a bill initially sponsored by Junior Senator Cory Booker that promotes comprehensive sex education in higher education institutions. The act is associated with bringing considerable benefits to both providers and consumers. On the one hand, consumers are expected to experience a decrease in unwanted pregnancies, abortions, HIV/AIDS cases, and occurrences of STIs as well as a reduced number of violence cases and stigma associated with sex and sexuality. On the other hand, providers will experience additional money flow, which will help to improve their credibility, prestige, and job satisfaction of employees. However, there are also drawbacks to the act associated with the organization of such courses and attitudes towards comprehensive sex education. Even though there are different opinions on the matter, evidence shows that comprehensive sex education can positively impact gender health.
The legislation enters a comparatively hostile environment, which does not support the progression of the bill. The review of sociocultural, political, economic, and ethical considerations revealed only minor support to the provisions of the act. However, the analysis demonstrates that the bill can be enhanced by altering the target audience and places of program delivery. Such changes are expected to improve the chances of the bill to pass the commission. The act is among the first legislations that promote comprehensive sex education as a health promotion measure that empowers the youth by improving their decision-making abilities by providing relevant information about sex and sexuality.
Introduction
Health promotion connected with sex education among adolescents is an issue widely discussed by health professionals. US Senate Bill 1524 (2019) titled “Real Education for Healthy Youth Act of 2019” was designed to address the problem of healthy sex relationships of the youth. The central theme discussed in the act is the promotion of physical and emotional health among adolescents by providing education concerning sex and sexuality (S. 1524, 2019). The act provisions grants for organizations that create programs promoting healthy decisions and providing information concerning “gender stereotyping, gender roles, stigma, and socio-cultural influences” (S. 1524, 2019). In general, the bill discusses what sex education programs should include, who can qualify for the grants, and how the money should be spent.
In order to qualify for the grant, public entities should file an application to the Secretary. Not later than six months after enactment of the bill, the Secretary should evaluate the entities in terms of expected output and outcome measures and select appropriate applicants. The organizations that received the grant are expected to report about the outcomes of the created program to the Secretary annually for six years.
While the act does not mention nurses or nurse practitioners (NPs) as central stakeholders, it is evident that the bill will directly affect nursing practice in the US. The bill targets higher education institutions and encourages them to organize sexual education courses on campus (S. 1524, 2019). However, the bill also encourages public entities to create comprehensive training for teachers for them to pass the knowledge to adolescents (S. 1524, 2019). Moreover, the act does not exclude hospitals from the list of possible entities that can qualify for the provisioned grants. According to Ko, Burson, and Mianecki (2019), one of the roles of advanced practice nurses (APNs) is “working at the macro level to improve healthcare practices and patient outcomes locally or within a healthcare system” (p. 28). Since health promotion and patient education are also often provided by APNs, these health professionals are most qualified to educate both teachers and adolescents. Therefore, in case a hospital wins a grant mentioned in the reviewed act, APNs will deliver sex education.
Environment
Sociocultural
The views on sex education of adolescents differ depending on the cultural background. While some communities believe that comprehensive sexual education is of extreme importance, others claim that the provision of such education to children and adolescents promotes immoral and sexual behaviors (Cense, de Neef, & Visscher, 2018, p. 9). In particular, many religious dogmas and values of traditional cultures prohibit sex before marriage, putting these cultures at odds with sexual rights for all, which is the backbone of the reviewed act. Since the US is home to many cultural minorities and the US Constitution protects their rights, sex education is to be provided with respect to the norms and beliefs of these cultures. However, Cense et al. (2018) suggest that failure to deliver comprehensive sexual education may be connected with a decreased ability of girls to manage menstruation and an increased number of unwanted pregnancies and HIV/AIDS cases. In short, the reviewed law faces many controversies associated with the sociocultural environment.
Economic
The act is being introduced in the difficult economic environment of the United States. The US healthcare system is known to be one of the most expensive in the world. The rising cost of care is one of the most significant bothers for US citizens, and the American Medical Association, together with other governmental and non-governmental entities, put considerable effort into decreasing the growth of healthcare costs (Rama, 2019). As a result, in 2017, the growth expenditures was only 3.9%, which is less than in 2015 (4.8%) and 2016 (5.8%) (Rama, 2019). The decreased cost of care may be associated with a relative success of preventative medicine. In particular, Adams, Park, Twietmeyer, Brindis, and Irwin Jr. (2018) suggest that preventative measures among the youth are associated with improved healthcare outcomes, which, in turn, decreases the number of healthcare visits. Therefore, even though the act faces an economic environment that pushes for the reduction of healthcare costs, the bill is coherent with the current trends in economic policies in healthcare.
Ethical
The bill addresses various ethical matters central to modern US society. For instance, the act promotes awareness about ethical issues concerning sexuality, as it dispels myths, confronts biases, and fosters informed decision-making among adolescents (S. 1524, 2019). However, there are issues that may prevent the act from being an effective measure of health promotion. First, the bill provisions sex education in higher education institutions, which creates problems with social justice. According to Henry (2019), children from low-income households have lower awareness concerning sexuality and gender education (p. 372). The Real Education for Healthy Youth Act of 2019 may increase the disparities of sexual education depending on wealth since only households with high incomes can afford higher education for their children. Second, as mentioned above, representatives of different cultures may not want their children to have such classes due to their beliefs. Finally, the act may be considered a danger to autonomy since students will be pushed to take sexual education classes (Henry, 2019, p.374). Therefore, the ethical environment is controversial, and it may both support and limit the progression of the bill.
Political and Legislative
The political and legislative environment is questionable for the progression of the reviewed act. A vast majority of US citizens agree that sex education is of extreme importance for the US youth (Janfaza, 2020). The administrations of previous presidents, together with Trump’s administration, have continuously supported acts that foster sex education and community levels; however, the education was based on abstinence-only-until-marriage principle (Janfaza, 2020). At the same time, together with the reviewed bill, Youth Access to Sexual Health Services Act is also in progress, which implies that the issue of the sexual health of adolescents is a front matter for policymakers (Janfaza, 2020). However, the bill is introduced by democrats, which lowers its chances of becoming a law (GovTrack.us, 2020). Since there is significant opposition to the promotion of comprehensive sex education, the political and legislative environment is not supportive of the reviewed bill.
Passage and Progression of the Bill
Sponsors
Even though the bill includes vital provisions that can improve patient outcomes and awareness about issues of sexuality among adolescents, it has a limited number of sponsors. The bill was initially promoted by the Cory Booker, a Junior Senator for New Jersey, in May 2019 (GovTrack.us, 2020). Cory is known to advocate for equal justice for all Americans, expansion of access to health care, and awareness about environmental issues. (“About Cory,” n.d.). Cory was the original sponsor of the Equality Act that protects the rights of the LGBTQ and Environmental Justice Act that strengthens legal protections against the environmental injustice of minority communities (“About Cory,” n.d.). The politician is devoted to the Real Education for Healthy Youth Act of 2019 since it was initially introduced in 2016 and reintroduced in 2017 but failed to pass the committee (GovTrack.us, 2020). Booker is supported by 12 democrats from California, Massachusetts, Minnesota, Connecticut, New Jersey, Hawaii, New York, Illinois, Ohio, and Wisconsin, who enlisted as sponsors of the act (GovTrack.us, 2020). While twelve sponsors may be enough for an act to pass the committee, it does not seem to be the case with the reviewed bill.
In order to improve the chances of the bill passing the commission, the text of the act was improved. However, according to Skopos Labs, the text of the bill does little to affect its chances of being enacted (GovTrack.us, 2020). In other words, the sponsor had little success in revising the law. As for the opposition to the law, the review of press and government publications revealed that no individual actions of politicians that openly oppose the bill. However, as mentioned by Janfaza (2020), Trump administration supports the abstinence-only-until-marriage approach, which implies that the Republican Party will not vote for the bill. According to Santelli et al. (2017), the US government continuously supports abstinence-only-until-marriage practices despite overwhelming scientific evidence of the practice being ineffective and stigmatizing. Since Trump’s administration continues to fund such programs, they will oppose the bill. In short, the analysis revealed that even though there is no active opposition to the reviewed act, Booker and his followers need to put more effort into the bill to become a law.
Stakeholders
The primary stakeholders are also divided into those who support sex education and those who reject it. On the one hand, an overwhelming amount of evidence supports the idea of sexual education on all levels. For instance, the American Public Health Association (2014) has not changed its opinion about sexual education in K-12 for the past six years. Its primary concern is that “people need the knowledge, attitudes, and skills necessary to avoid HIV, other sexually transmitted infections (STIs), and unintended pregnancy so that they can become sexually healthy adults” (American Public Health Association, 2014, para. 1). American Medical Association (2018) also actively supports comprehensive sex education instead of an abstinence-only-until-marriage approach for the same reason. In general, all medical workers, politicians, and policymakers who rely on rigorous scientific methods support the legislation, even though it is not immediately evident. These stakeholders make numerous publications in public media and scientific journals, providing empirical support for their claims.
On the other hand, there are conservative people who believe that sex education provokes interest in sex among children and adolescents. The most evident stakeholders are parents, who claim that sex education “rapes children of their innocence” (Associated Press, para. 4). The majority of religious organizations support the parents in their resistance to comprehensive sex education promoted by the reviewed act. National Coalition Against Censorship (n.d.) claims that Christian religious groups try to impose their views on sexual orientation, non-marital sex, contraception, and abortion to all students. Parents and religious groups actively oppose comprehensive sex education during meetings and political debates providing scriptural and historical evidence of the abstinence-only approach. Moreover, they make publications in social media and community press about the importance of resisting sexual temptation. Even though the stakeholders mentioned in the present section of the analysis do not openly support or oppose the reviewed act, their influence in society can be the reason for passing or killing the bill. In general, it should be mentioned that the Real Education for Healthy Youth Act of 2019 did not receive much attention in the media and press.
Projected Timelines
There can be two timelines, which include optimistic and pessimistic approaches. According to the pessimistic timeline, the act will not pass the commission and will die before spring recess on April 2. However, in case of an optimistic scenario, the bill may be signed by the President as soon as May 25, 2020. The optimistic timeline is presented in Figure 1 below. While there is a possibility for the act to be enacted as is, it is more likely that the best-case scenario is that the bill will be revised by the House of Representatives and enacted with considerable changes.
Potential Consequences
For Providers
Healthcare providers are likely to feel both positive and negative effects of the legislation if it is signed by the President. Immediately after the bill is enacted, providers will need to create offers to apply for the grants of health promotion. Therefore, while the benefits will not be felt, administrative personnel and APNs will experience an increased workload with a raise in reimbursement. If a provider wins a grant, it will need to establish effective communication with communities and higher education institutions to organize sex education programs. This task will also add workload to the administrative personal and APNs of care hospitals and other care providers associated with stress and burnout. However, in the long run, the legislation will bring additional money flow to healthcare institutions. The additional money can be spent on hiring more personnel, which will improve the quality of care, and therefore the credibility of hospitals. Additionally, the improved patient outcomes may be associated with the decreased workload in improved job satisfaction (Zamanian, Roshan Sarvestani, Sedaghati, Ghatmiri, & Kouhnavard, 2016). In short, while the legislation may bring negative short-term changes, the long-term outcomes are expected to be mostly positive.
For Consumers
The consumers are likely to deal with a similar situation. Initially, comprehensive sex education programs may have a negative effect on society. Even though the primary demand for comprehensive sex education programs is sensitivity to cultural differences, the first programs are likely to be low performing on the matter. Therefore, people may feel offended and experience psychological trauma (Henry, 2019). Moreover, the lack of active cooperation between education providers may make the first programs ineffective. However, in the long run, as evidence shows, comprehensive sex education practices will prove their efficiency (Williams, 2018). Consumers will experience improved health outcomes connected with a decreased number of unwanted pregnancies, abortions, HIV/AIDS cases, and occurrences of STIs (American Medical Association, 2018). At the same time, the legislation will decrease the number of sex-related violence and stigma associated with the matter (S. 1524, 2019). In the long run, the policy is expected to create a healthier society by addressing biases and stereotypes associated with gender relationships.
Sex Education in Ontario
In Ontario, Canada, sex education is a mandatory subject in schools for grades 1 through 8. While there are some non-government organizations that promote comprehensive sex education (Action Canada for Sexual Health and Rights, n.d.), the program of human development and sexual health education in Ontario is based upon the same principle as in the US (Government of Ontario, 2019). Health promotion is based upon the idea of delaying sexual life for as long as possible (Government of Ontario, 2019). However, it should be mentioned that sex education in Ontario is more progressive than in the US. Gender identity is mentioned in the curriculum multiple times, and there are references to masturbation and anal intercourse (Jones, 2019). Even though Canadian parents are given a chance to have their children opt out of individual teaching blocks, they regard the new curriculum as unethical (Jones, 2019). In short, the promotion of healthy sexual behavior in Ontario has an emphasis on schools rather than higher education institutions, which is promoted by the Real Education for Healthy Youth Act of 2019.
It should be noticed, however, that the reviewed act includes vital information about abortions, which is omitted in Ontario’s curriculum. Education about unwanted pregnancies and the consequences of abortion are of extreme importance for gender health. However, even though some states in Canada cover the topic, Ontario does not provide information on the subject in schools or universities (Abortion Rights Coalition Canada, 2017). The non-government organizations are not offered support from the government, which is provisioned in the reviewed act, and organizations like Action Canada for Sexual Health and Rights are generally financed from donations. Therefore, the benefits provisioned by Real Education for the Healthy Youth Act of 2019 are not fully realized in Ontario, and the state can benefit from the introduction of similar legislation.
Options for Refining
There several options for improvement that can enhance the benefits provided by the act to the consumers. On the one hand, the act should choose another target audience since providing sex education to students is associated with several limitations. First, delivering preventative services on campuses of higher education institutions limits their accessibility. People with higher income have a higher awareness about sex and sexuality and less likely to engage in risky sexual behavior (Henry, 2019, p. 372). Therefore, it seems more efficient to provide preventative services to at-risk populations than to university students. Second, providing sex education to students may be too late, as adolescents have their first sexual intercourse in school (Santelli et al., 2017). Therefore, it would be more efficient to target children and adolescents of school age. In summary, rather than providing sex education to students at higher education institutions, the act should focus on children and adolescents of school age. A similar approach is adopted by the Government of Ontario (2019), and it met moderate success in achieving its goals.
On the other hand, the act should consider changing the place for delivering sex education. Delivering comprehensive sex education in higher education institutions and public schools may face opposition from parents and religious organizations. Therefore, sex education can be moved to public places. Providing information about sexuality in museums and hospitals has proven to be an efficient practice for the Netherlands, as it is among the most gender-equal countries, according to United Nations Development Program Gender Inequality Index (Rough, 2018). Moreover, hospitals have professionals, such as APNs, that can deliver education programs using less financial resources from the government, which can improve the cost-efficiency of the program. Therefore, the reviewed act can be refined by altering the place of sex education.
Conclusion
Real Education for Healthy Youth Act of 2019 is among the first comprehensive sex education bills introduced in the US Senate. Since the act enters a relatively hostile environment that supports the abstinence-only-until-marriage approach, the probability of it passing the commission is low. However, the bill can become a turning point in sex education in the US that will allow considerable benefits both to consumers and providers. The act can improve its chances by changing the target audience and place of delivery.
References
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