学校关系与性健康干预对性行为不成熟的影响：整群随机试验

Effects of a whole-school relationships and sexual health intervention on non-competent sexual debut: cluster-randomised trial

——《流行病学与社区健康杂志》第80卷，第3期，2026年3月——

<Journal of Epidemiol & Community Health> Volume 80, Issue 3, March 2026

【摘要】背景：性与关系教育（RSE）对某些性行为有影响，但可通过融入全校参与的方式（例如，提高参与度、提供避孕措施）来加强。这些措施可以预防怀孕和性传播感染，但在英国学校尚未得到评估。方法：一项名为“积极选择”（Positive Choices）的整群随机试验将其与英国中学的常规做法进行了比较。干预措施包括：性与关系教育、由学生参与的学校健康促进委员会、根据学生需求数据定制服务、学生主导的宣传活动、性健康服务审查以及家长信息。主要结果是预防不成熟的性行为（缺乏决策自主权、对时机判断不当、伴侣双方意愿不一致或未采取避孕措施）。结果：在受邀的2845所学校中，50所（1.76%）同意参与，其中1所学校在分配后退出。在25所对照组学校和24所干预组学校中，有4所学校在试验结束前退出。基线调查时有6970名学生（77.3%）参与，33个月随访结束时有6268名学生（77.9%）参与。全校各组成部分的执行情况欠佳。没有学校达到“良好”的执行率；两所学校在所有组成部分中达到了“合格”的执行率。11所学校在特定组成部分（学生需求报告、学校健康促进委员会会议、课程、家长信息）中达到了“合格”的执行率。对照组学校开展的活动与干预组学校类似。在基线调查和随访结束时共有780名（12.44%）学生发生了性行为，其中对照组有268名（64.42%）学生报告性行为不成熟，干预组有240名（65.93%）学生报告性行为不成熟（风险差=0.020（95%CI -0.05至 0.09））。未发现对次要结局的影响。每所学校的增量成本为1337英镑（每名学生 10英镑）。结论：与常规的性教育相比，积极选择并未阻止不成熟的性行为初体验（主要结果），也未对次要结果产生影响，这可能是由于全校要素的执行力度不足和/或对照学校的全面性教育不够完善所致。

[Abstract] Background: Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools. Methods: A cluster-randomised trial of ‘Positive Choices’ compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners’ equal willingness or contraception). Results: Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved ‘good’ fidelity; two achieved ‘adequate’ fidelity across components. 11 achieved ‘adequate fidelity on selected components’ (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI −0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student). Conclusion: Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools.

论文原文：Ruth Ponsford, Rebecca Meiksin, Joanna Sturgess, et al. (2026). Effects of a whole-school relationships and sexual health intervention on non-competent sexual debut: cluster-randomised trial. Journal of Epidemiol & Community Health, Volume 80, Issue 3, Pages 192-201. March 2026.

https://doi.org/10.1136/jech-2025-225004

（翻译兼责任编辑：MARY）

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