By Melinda Young
A reproductive health team at the University of California, San Francisco (UCSF) has been working for five years with community partners in rural, farming communities to provide sexual health and education to the young people living in agricultural communities. Their efforts resulted in successful implementation of comprehensive sexual health education among Latino youth. The results included strong attendance, program satisfaction, and positive changes, the study found.1
“We built this partnership because we know people growing up in rural communities have the same sexual health and information needs as all others, but they often do not have access for a variety of reasons, including their geography,” says Nancy Berglas, DrPH, a public health social scientist and an associate professor of Advancing New Standards in Reproductive Health, department of obstetrics, gynecology, and reproductive sciences at UCSF in Oakland.
The team built a broad-based program for young people as they transition to adulthood. The program is for 9th and 10th graders and has built-in workshops with parents and other caregivers. “There is some education for 12th graders as they make that transition to adulthood, as a booster program, and we also work with clinic staff in the area and think of the community as a whole,” Berglas says.
“It’s absolutely critical as school-based sex-ed; parents and caregivers — the whole environment — supports youth in their sexual and reproductive health,” she adds. “There are a lot of programs that have been developed and have been shown to have positive effects for teens, but they weren’t developed for rural youth and predominately Latino/Hispanic youth.”
For a year and a half, the program served more than 1,000 high school students, tracking their attendance, collecting data, and giving them surveys before and after their participation.1 “They reported back that the classes are interesting and relevant to them, and we also see positive change in their lives and in their understanding of where to go to get clinical services if they need them,” Berglas says. “This foundational project is to show this is a good fit for these communities.”
In California, minors can access family planning services at no cost and without obtaining parent or guardian permission. But the challenge is to reach rural youth with information and referrals to services. For instance, rural youth may live far away from sexual and reproductive health services. Or they may have one clinic in their area, but they are hesitant to go there because they may know some of the staff, making it awkward, Berglas explains.
“We reinforce with students that these programs are there whenever they need them; they are confidential and do not need guardian permission to get these services, which include sexually transmitted infection (STI) testing, pregnancy testing, and contraception,” she adds. UCSF staff trained health educators who work at the rural county’s office of education.1
“Our health educator travels across the county all school year long and makes sure high school students are getting quality sex education,” Berglas says.
The program, called Teen Pregnancy Prevention Program, received funding from the federal Office of Population Affairs of the U.S. Department of Health and Human Services (HHS). “They gave us her salary to do this work in schools and to also do workshops and other projects, including UCSF work for administrative and evaluation — this study,” Berglas says. “We did interviews with community stakeholders and focus groups of teens to understand what the needs are in the community and to understand what types of programs are needed, and we work with our partner to make sure we’re understanding their needs.”
They held group discussions with teens and one-on-one interviews with youth-serving professionals. They had interviews with parents, as well. “It’s been so fascinating,” Berglas says. “I love talking to people and [hearing] their feedback on what works and what doesn’t.” The discussions led to clinicians and researchers learning more about the community’s health concerns that were separate from reproductive health but fit under the umbrella of social determinants of health issues.
“We’ve learned so much in thinking about sexual health, but they also say, ‘Yes, we also need mental health services and support and help with transitioning to jobs and interview skills and things like that,” Berglas says. “These are things that young people don’t think of as sexual health, but they are part of their lives and their overall health and wellbeing.”
The project included a youth advisory council and community advisory board. Eight to 10 teens across different rural communities worked with the team throughout the year. They provided their feedback and help in testing out new activities, she adds. Their findings could help reproductive health clinicians and providers who work with adolescents and youth.
“Some things we’ve heard over the years is a need for comprehensive sexual health education like this,” Berglas says. “But they say, ‘We need a refresher because what we learned in 9th grade and by the time we’re in 12th, we have new experiences and may not remember everything.’ Or some things that were relevant then may not be relevant now.” Based on that feedback, the team built a booster education program for 12th graders.
They also incorporated some information about mental health into the 12th grade curriculum based on feedback from youth. Along with the refresher information, the program for 12th graders includes information about sexual health, consent, healthy relationships, and mental health. Educators help students understand more about anxiety, depression, and when they have symptoms that suggest they need more services. They give them basic information and tell them how to access mental health services in their area.
“They want to know what resources are available to them while they’re in high school or as they become young adults, and we’ve really tried to respond to what they said to us,” Berglas says.
The education curriculum follows Positive Prevention Plus, a widely used and well-known curriculum that has been shown to be effective at helping teens, she notes. The curriculum has eight to 10 sessions of one hour per session, and it is designed to fill in gaps and provide resources to schools with limited resources.
“One thing we’ve learned a lot through this project is how much school is a trusted hub for community members,” Berglas says. “Having services in hand and knowing who to go to in their school for additional support and knowing that person can connect them with additional support is important.”
Attendance to the health educator’s sessions was high. There were more than 1,200 students in 9th and 12th grades, and they attended an average of 92% of sessions. Students reported positively about the program: 94% said it was interesting; 97% said it was useful.1
“We saw improvements in sexual health knowledge, knowing how to access sexual health services, and knowing they don’t need to pay and can get family planning services for free without parental permission,” Berglas says.1 “We asked them if they would be willing to get services if they needed them, and we saw an increase in the percent of students who said yes, they would,” she adds. “Those knowledge outcomes highlight this program is a good fit and can be implemented to meet some needs previously unmet.”
The program is continuing with another five-year grant, Berglas notes. “We are hopeful to keep doing this work,” she says. “It’s a great partnership, and we’re doing what we can to support youth and help them make health decisions as they grow up.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
Reference
1. Berglas NF, Gutmann-Gonzalez A, Wilson K, Decker MJ. Replication of a comprehensive health education curriculum in rural Latino communities. J Sch Health. 2025;95:490-497.
A reproductive health team at the University of California, San Francisco has been working for five years with community partners in rural, farming communities to provide sexual health and education to the young people living in agricultural communities. Their efforts resulted in successful implementation of comprehensive sexual health education among Latino youth.
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