This outline suggests that program developers, policy-makers, researchers and practitioners should develop a holistic and deep understanding of the influences, determinants and multi-dimensional aspects of sexual health in order to develop more effective programs, policies and practices. This discussion has been organized because all too often the media, communities and institutions become too focused on the status of certain sexual health diseases or behaviours and therefore might misunderstand or miss entirely the key factors that will support young people.

This discussion is in keeping with one of the ten key points or strategies (International School Health Network, 2009) that underlie effective school health, safety and social development programs; namely that we should truly understand the nature of the issues, strengths, risks and factors associated with a health issue such as sexual health before and while we develop various interventions.

Here are some of the practical questions that arise at the outset of this discussion:

Influences, Determinants and Aspects	Data Sources & Most Recent Reports	Program, Practice & Policy Implications
Social Influences: How do young people learn about sexual health? What are their sources of information? What are the various social influences? (Media, parents, peers and trusted others, peer pressure, schools, health professionals etc. Are they able to access youth-friendly health services? What do they think about the sex education they are receiving in schools?	Canada Youth & AIDS Study (1988), Canadian Youth, Sexual Health, HIV/AIDS Study (2001)
Social Determinants: How does socio-economic status, family status, early childhood experiences, local community characteristics, gender, culture, minority/majority status, religious beliefs/spirituality/moral beliefs affect their sexual health?	Health Behaviors of School-aged Children(2010 in progress) National Longitudinal Survey of Children and Youth Survey of Young Canadians (First report in progress for age 1-9 yr olds)
Beliefs and Attitudes: What kinds of life goals, aspirations, normative beliefs and values are held by young people today? What are their experiences, beliefs and expectations about puberty, family life, intimacy, commitment, marriage, gender, gender equity and their reproductive health? How do these affect their choices about sexual health?		Recent research on abstinence -only programs indicates that having long-term life goals, (rather than just abstinence-related beliefs) will help to persuade young people to defer experimentation or to practice safer sex.
Knowledge, Skills, Behavioural Intentions What are the levels of functional knowledge, skills, behavioural action plans/intentions held by young Canadians about their relationships, sexual health, family life today? How do these affect their sexual health?
Relationships: How do their relationships affect their sexual health? how they are dating, if they can discuss and negotiate with their partners, are there significant age differences, teen abusive relationships, casual relationships, web-based relationships?
Behaviours: What are the important behaviours that we should seek to influence in our programs? regular access to sexual health information & services, age of first intercourse, age of regular sexual intercourse, oral sex, use of condoms, use of contraceptives, abortions, influence of alcohol and drugs, multiple partners, etc	Canada Youth & AIDS Study (CYAS), Canadian Youth, Sexual Health, HIV/AIDS Study (CYSHHAS) Canadian Community Health Survey (2003, 2005) Therapeutic Abortion Survey (2006) National Population Health Survey - Household Component - Longitudinal (2008-09)	Research indicates that the more specific we can be in our behavioural messages, the more likely young people will act on those messages.
Policies, Programs, System Capacity What is the status of current sexual health ministry, agency and school policies, services, educational programs, social support and various physical and practical factors that affect the sexual health of young people? How do these interventions support the positive choices being made by young people today?
Sexual Health Status: What are the important aspects of their sexual health status; teen pregnancies, STI and HIV rates, HPV rates and vaccinations, child sexual abuse
Sub-Populations: How are different sub-populations of youth doing? LGBT youth, youth with intellectual and physical disabilities, cultural minorities, aboriginal youth, elite athletes, youth living in low SES communities, youth who were abused or lived with family violence, children who are living in difficult divorce situations etc
Specific Issues: What are the specific issues that schools can help parents and communities to address? arranged marriages, genital mutilation, age of consent, adoption, fertility and health etc
Other Aspects: (Please add other aspects and issues here by using the Easy Edit tool at the top of the page or by starting a discussion using the "thread" tool found at the bottom of the page.)

Discussion Questions:

1. Should we worry about achieving a holistic understanding of sexual health and its application to program, practice or policy or should we focus more on urgent specific concerns and address them as they arise? Are the categories and types of questions suggested in the table above appropriate? What is missing or incorrectly described? If we were able to answer more of these questions, would we have a more complete and accurate portrait of the sexual health of young people in Canada?
   
   
2. What are the better or most recent explanations (theories, models, overviews) of sexual health and have they been applied to Canadian youth?
   
   
3. What are the most significant factors that influence adolescent sexual health development and do we know enough about those factors? Do we have good and regular Canadian data on those factors?
   
   
4. What are the most urgent emerging or ongoing problems (or opportunities/strengths) and do we have data to document those needs and/or to justify immediate action to address these topics?
   
   
5. How can local agencies, provincial/territorial ministries, researchers and program developers access the various data sources in order to inform their work?
   
   
6. Are we making progress towards regular monitoring and reporting on the sexual health of Canadian youth? Have we identified the individual and environmental indicators? Do we have a clear sense of the knowledge, attitudes, beliefs, skills, behavioural intentions that can be influenced by school-based education programs and are we moving closer to monitoring them? Do we have reports on the status and capacities of education, health and other systems to intervene to support youth sexual health in Canada?
   
   
7. What are the actions that the CASH SSH Community of Practice, sexual health NGO's, government departments and ministries, research programs and research funding programs take to help local agencies and education/health/other professionals in accessing, analyzing and using the available data on the sexual health of Canadian youth.
   
   
8. Are there behavioral theories and models that have applied to the sexual health development of young people that can help us to determine what is more important or urgent in regards to data sources and analysis related to the sexual health of Canadian children and youth?
   

Selected Resources & References

Boyce W, Doherty-Poirier M, MacKinnon D, Fortin C, Saab H, King M, Gallupe O (2006) Sexual Health of Canadian Youth: Findings from the Canadian Youth, Sexual Health and HIV/AIDS Study The Canadian Journal of Human Sexuality, Vol. 15 (2) 2006

Hampton MR, Jeffery B, McWatters B, Smith P (2005) INFLUENCE OF TEENS’ PERCEPTIONS OF PARENTAL DISAPPROVAL AND PEER BEHAVIOUR ON THEIR INITIATION OF SEXUAL INTERCOURSE The Canadian Journal of Human Sexuality, Vol. 14 (3-4) 2005

International School Health Network (nd) Web Bibliography/Toolbox on Prevalence, populations, nature, strengths, assets, risks and aspects of sexual health of youth, World School Health Encyclopedia

Maticka-Tyndale E (2008) Sexuality and sexual health of Canadian adolescents: Yesterday, today and tomorrow The Canadian Journal of Human Sexuality, Vol. 17 (3) 2008

McKay A, Barrett M (2008) Rising reported rates of chlamydia among young women in Canada: What do they tell us about trends in the actual prevalence of the infection? The Canadian Journal of Human Sexuality, Vol. 17 (1-2) 2008

McKay A (2006) Trends in teen pregnancy in Canada with comparisons to U.S.A. and England/Wales The Canadian Journal of Human Sexuality, Vol. 15 (3-4) 2006

Pancham A, Dunn S (2007) Emergency contraception in Canada: An overview and recent developments The Canadian Journal of Human Sexuality, Vol. 16 (3-4) 2007

Rotermann M (2008) Trends in teen sexual behaviour and condom use. Health Matters. Statistics Canada, Catalogue no. 82-003-XPE • Health Reports, Vol. 19, no. 3, September 2008

Saewyc EM, Taylor D, Homma Y, Ogilvie G (2008) Trends in sexual health and risk behaviours among adolescent
students in British Columbia The Canadian Journal of Human Sexuality, Vol. 17 (1-2) 2008

Statistics Canada (nd) Teenage pregnancy: Guide to the latest information, Author, Ottawa

Statistics Canada (2008) Life after teenage motherhood Perspectives on Labour and Income, May 2008, Catalogue no. 75-001-XWE, Vol. 9, No. 5

Taylor C, Peter T (2009) Youth Speak Up about Homophobia and Transphobia The First National Climate Survey on
Homophobia in Canadian Schools Phase One Report Egale Canada

Wong JP (2006) Age of consent to sexual activity in Canada: Background to proposed new legislation on “age of protection” The Canadian Journal of Human Sexuality, Vol. 15 (3-4) 2006