Sex and Sexual Health Education

#### **Chapter 5**

## The School's Climate as a Mediator between the Principal's Personality and the Attitude toward Sex Education in the Arab Sector in Israel

*Yaser Awad, Shadia Oudeh,Tareq Murad and Jennifer Sheffield*

#### **Abstract**

This study examined the school climate as an intermediary between the principal's personality and the attitude toward sex education in the Arab sector. The main research question was to what extent can the school climate mediate between the personality and the principal's attitude toward sex education, in the Arab sector in Israel? The study involved 128 principals from the Arab sector in northern Israel. The principals answered four questionnaires: organizational climate, personality characteristics, sex education, and a demographics questionnaire.The findings of the study showed a relationship between the level of openness and extroversion of school principals and their attitudes toward sex education. As for the extroversion index, it was found that the relationship was positive among male principals and negative among female principals. The findings also showed that the personality of the school principal is mediated by the school climate when examining the extroversion measurement only. It was further found that the school climate does not mediate a change between the level of openness and the principal's attitudes toward sex education. These results can be useful for decision-makers, such as the Ministry of Education and management training institutions, for evaluating and delivering training for in-service principals.

**Keywords:** school's climate, principal's personality, sex education, Arabs

#### **1. Introduction**

Still a relatively new concept, sex education has historically, and still today, brought opposition concerning its engagement [1]. Sex education is the provision of reliable and comprehensive information about sexuality and sexual development and the concrete answers to the youth's questions and problems. Sex education can be seen as a significant part of the social process of youth. Throughout adolescents'sexual education in the family, at school and among their peers, they acquire behaviors,

habits, virtues and attitudes regarding sex and sexuality, solidify their sexual identity and address the accepted values in society. Today's society is a dynamic as there are changes in the traditional nuclear family structure, in accepted sexual identity and in gender roles. Youth are experiencing accelerated physical and emotional development associated with, among other things, increased exposure to content and information about sexuality by various means, some of which adults' control over is limited [2].

Firstster and Lapidot-Berman [3] emphasize that in recent years the Israeli media has flooded the public with many issues related to the ugly expression of human sexuality: sexual violence, child sexual abuse, sexual harassment; obscene acts and rape; children and teens using smartphones to send sex messages and distribute videos showing themselves naked or having sex. These situations require parental and educator involvement, and raise the question of sex education in schools as a targeted factor for healthy sexuality [4, 5].

However, parents and the education system ignore parental responsibility for educating, especially regarding sex education [6]. Accordingly, the school has an essential role in shaping student sexual identity, and the school principal is one of the main factors influencing the school's sex education. After all, the principal is responsible for all the pedagogical actions and organizational processes, and is decisive in determining the school's path. Moreover, the principal is expected to develop a positive learning climate and to develop and improve existing programs [7].

The significance of the study comes from the need to raise the important issue of sex education on the educational agenda in Arab society. Sex education is rarely researched in the Arab-Israeli community, and this study is among the first to examine this issue.

#### **2. Review of related literature**

#### **2.1 Sex education and explanation**

More than the biological explanation, sex education is defined as a learning process in which the topics of sexual reproduction, sex, sexual identity and gender are studied, as well as other aspects related to human sexual behavior.

Weisblai [2] defined sexuality as an essential component in the healthy development of children and adolescents. A person's attitudes about sexuality and their sexual behavior form from infancy and throughout adolescence. This learning is influenced by the accepted customs, norms and laws in the child's community, which differ in every society and period. The World Health Organization defines human sexuality as a central part of a person's being, and it includes gender identity and sexual orientation. Sexuality is expressed in thoughts, fantasies, desires, beliefs, values, and behaviors [3].

"Sexual information" is the information transmitted about the biological, psychological, and social aspects of sex and sexuality. The emphasis is on providing information, conveying an objective opinion and a concrete and factual answer to the questions of the target audience, without an educational message and intentional values. However, even neutral information is loaded with worldviews, ideologies and value messages. For example, it has been found that in biology texts, there are stereotypes and prejudices regarding relationships and the familial and societal roles of the sexes.

Education and explanation are inseparable because education is based on information and opinion in order to cultivate youth awareness and direct them appropriately.

*The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

Yet some see that education and information are a means of identifying and preventing psychosexual problems that "disturbed" parents cause the young child. Some see it as a means of strengthening family values; others, as a means of instilling order, obedience, discipline, and conformity. For today's educator, the concepts of sex education may relate issues such as life skills, safe sex, preventing the spread of infectious disease (such as HIV/AIDS), developing mutual respect, preventing abuse, and normalizing different lifestyles [8].

Firstster and Lapidot-Berman [3] argue that sex education contributes to shaping children's attitudes toward issues of sexuality. However, sex education, due to its values and moral questions, provokes disagreements between policymakers, educators, and parents about its nature and content. Although there is no consensus regarding the need for sex education, views have changed over time and there is less debate about whether a school should engage in sex education [2].

#### **2.2 Sex education in Israel**

The Israeli sexual education class is somewhat new, and the education system has recognized the need to provide clear, up-to-date, and authoritative information sensitively, and may be a decisive factor in youth sexual behavior [9]. The assumption was that sex education programs could effectively solve social problems, including premarital sex and sexually transmitted diseases, while also promoting sexuality and well-being education [8].

Two Israeli ministries are responsible for sex education, but do not have supervisory and enforcement authority:


In the educational aspect, the Department of Counseling Psychology emphasizes strengthening healthy sexuality to promote sexual health. This approach is based on a preventive and proactive approach and serves as the main infrastructure for the "Life Skills" program [10].

About 100 total hours are allocated to sex education programs in the entire state education system. The classes are integrated into the "Life Skills" program, with topics such as safe internet surfing, party behavior and alcohol. There are also separate classes on violence and sexual assault. Although the program is mandatory, a Ministry of Education survey confirms only 60–70% of public schools implement it. Even when implemented, only 10–20% of high schools fully comply with the program as designed. Most schools conduct one-off events or limited activities [2].

#### **2.3 Sex education in Arab sector**

The Arab population in Israel is an ethnic and cultural minority group not of immigrants, but of natives. Arab-Israelis face a constant conflict of identities consisting of: citizenship (Israeli), nationality (Palestinian), ethnicity (Arab) and religion (Muslim, Christian and Druze). In recent years, Arab society has undergone political and socio-economic transformations, alongside processes of advancement, modernization, and education. However, despite the increase in the levels of health and education, the gap between the Arab and Jewish populations remains unchanged [11].

Transformations in Arab society affect youth to a considerable extent. Many conflicts exist between traditionalism and secularism, between the values of Western/ Israeli society to which they are exposed and those of traditional Arab culture. In addition, they face the challenge combining a modern, interactive, and dynamic world with their traditional world, rooted in Arab culture. Shehadeh and Sinai [12] found differences between the experiences of Arab and Jewish adolescents, one being the linguistic expressions relating to issues of sexuality. This demonstrates the need to strengthen sex education programs in Arab society.

Public sexual discourse in Arab society, particularly among Muslims, is extremely poor. Arab schools have almost no sex education classes, and no educational institution has an orderly information system on sexuality [13]. Abu Baker [14] adds that the issue of sex education in Arab society is complex.

The Qur'an and the Sunnah addressed the issue of sex openly and clearly, emphasizing its being a human need, in addition to being a source of personal pleasure and a tool for the connection of love and kindness within marriage. However, Arab culture made the issue of sex a social taboo, limiting its discussion to the private arena. Eilwan [15] supports the claim that Islam attaches great importance to sex as a fundamental issue. That is why the "Islamic Sharia" has set norms to satisfy a person's sexual instinct. In contrast, Christianity viewed sex negatively, which could distance believers from the religion and the Church, and condemned it as sinful [16].

A large part of the sex education of adolescent Arab youth passes through conversations between peers or with older youth and by viewing pornographic and sexually explicit websites and magazines. Only a small proportion of teens receive sex education from their parents. Online sexual content does not represent reality, so such sex education may cause sexual dysfunction and violence. In 1996, the first Arabiclanguage sex education program was published under the title "We and Adolescence." This program discusses the issue of family life and sex education, and aims to impart knowledge and skills [16].

#### **2.4 Sex education in schools**

Harpaz [6] presents two opposing views on sex education: (1) the school is not prepared to engage in it nor is it within its role; (2) The school must address this, since ignoring the issue of sex in adolescence may fail to prevent destructive aspects of sexuality.

In most Western policies, a consensus is that sex education must be included in the curriculum and address a wide range of topics, from anatomy and physiology of the reproductive organs to gender identity, sexual orientation, prevention of sexually transmitted diseases, prevention of unwanted pregnancy, and reference to media stereotypes. It seems that structured sex education contributes to healthy sexual behavior [3].

Although some sex education curricula have been developed in Israel, their implementation is not optimal due to the lack of professionals or the lack of time and resources [17]. Even when it is included in the curriculum there is disagreement about the ages to which its content, character and goals should be directed [2].

#### *The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

Moreover, a sex education program should also consider the characteristics of society and the tradition of all students and teachers [18]. Abu Baker et al. [19] highlighted the issue of "Context" from the findings of research conducted among Israeli Jewish and Arab teachers and parents toward the implementation of the school's sex education program and examining their attitudes toward possible program content. They found that among teachers, there is a great awareness of sex education in both societies, in general, but in Jewish society, teachers are more aware of the existence of a sex education program and they pass the program on to students. Jewish teachers give students more freedom to make their own decisions once they are provided with the relevant information. The Arabs were found to be more supportive than their Jewish counterparts in setting boundaries on the issue of sex. They also expressed more concerns about discussing contraception, lest it encourage students to have sex. The results among Arab and Jewish parents showed large differences in attitudes toward sex education at cultural, social, sexual, and religious levels.

One of the major factors influencing sex education in a school is the school principal. According to Zak [20], the management style is an influential factor in the school. There is a connection between the dimension of leadership and characteristics of the organizational structure on the one hand, and of attitudes on the other.

Anyone in the school can propose sex education. The school principal has a significant responsibility regarding proposals for and implementation of sex education programs. Accordingly, the school principal's personality has a lot of influence. An important personality theory that has received a great deal of research is the fivefactor model known as Big-5: The Model of 5 Factor Personality [21].

#### **2.5 The five-dimensional model of the personality-Big-5**

Hilgard and Watkinson [22] defined personality as a configuration of individual traits and behaviors that determine an individual's unique adaptations to their environment. This includes typical patterns of thought, emotion, and behavior that are unique to each person.

The five factors in personality are actually broad axes of personality lines, which incorporate specific traits and behaviors that make them up. The theory addresses the following five personality types:


curious, and attentive. In contrast, closed-minded people are defined as rigid and ignoring others' arguments.


It should be remembered that these are continuous dimensions, not dichotomous features, so the definition of each person consists of combinations to varying degrees [21]. Since it is not to be expected that all these features will characterize every school principal, researchers have tried to characterize typical principals; in reality, each principal's style is as unique as fingerprints [23].

An important variable that links the school principal's personality to her or his attitude toward teaching sex education is the school climate. "Attitudes are a set of beliefs, feelings, inclinations, views, how an individual reacts when faced with a particular occurrence or situation, which require or provoke a reaction or reference. Because attitudes originate in the basic structure of personality, they cannot be changed by conventional means" ([24], p. 20).

#### **2.6 The school climate**

The school climate is a set of environmental qualities: ecology, atmosphere, the social system in the organization and its culture [23]. The organizational behavior of schools can be described as:


There are several approaches to defining the organizational climate, but the dominant one today perceives climate as the quality and frequency of the interactions between the members of the organization and themselves and between them and the parents and students. The climate is expressed in words like warm, cold, interpersonal, hostile, harsh and closed, and is defined according to the characteristics of the schoolwork environment. The organizational climate consists of four dimensions:

1.The physical and material dimension in the organization.

2.The social dimension of the people in the organization.

3.The organizational and managerial structure of the organization.

4.The school culture, which relates to the values, beliefs, norms, and ways of thinking that characterize the teachers and principal [7].

The most famous measurement in the school's organizational climate is attributed to the work of Halpin and Croft [26], who asked teachers to describe the behavior of peers and principals, referring to the frequency with which certain behaviors occur in school. From these indices emerges a picture of "Open Climate" and "Closed Climate". The open climate is characterized by cooperation and mutual respect within the teachers' classroom and between the teachers and the principal. The principal listens to the teachers'suggestions, gives positive feedback and respects the professional ability of the staff. S/he gives teachers great autonomy and avoids the use of bureaucratic control over their work. Similarly, teacher behavior allows for open professional interaction between teachers; teachers form a close social group, and they are committed to their work in the school.

In contrast, the closed climate is the opposite of the open climate. The principal in this climate sets a particular routine that is obligatory for all teachers and students. Teachers generally react negatively and show low commitment to the school and the educational process. The principal uses rigid managerial control without professional support and hinders team development [7].

Therefore, the best qualities of the school principal, as noted by Bar-Lev [23] are: decisiveness, consistency, authority, patience and proper judgment of people and situations. But at the same time, they must listen to and consult with others, delegate powers and give praise and encouragement to subordinates. They also create a shared vision, maintain a learning atmosphere for students and staff, manage an environment that is safe and effective for the public, maintain good relations with parents and key people in the community, act honestly, fairly and ethically toward all; and influence the system politically, socially, economically, legally and culturally.

#### **2.7 The purpose of the study**

The purpose of the present study is to examine to what extent can the school climate mediate between the principal's personality and attitude toward sex education in the Arab-Israeli sector.

The research hypotheses derived are:


### **3. Methodology**

#### **3.1 The research method**

This study is based on the quantitative research approach, which assumes that knowledge is "there," awaiting discovery, and the researchers' role is to be "objective" and not allow their views, values, and beliefs to penetrate the research process. "Epistemologically quantitative research is deductive and affirmative" ([27], p. 210).

#### **3.2 The sample population of the study**

The study population is 128 principals in Arab public schools in the Northern District of Israel. **Table 1** shows that 64.8% of the study participants are men and 35.2% are women. The participants were aged 25 and over, with the majority being 45-55 years. In addition, most principals were married (85.2%) but some were single (7.0%) or divorced (6.3%). Muslims (54.7%), Druze (24.2%) and Christians (18.0%) participated in the study, with most participants being secular (43.0%) or traditional (47.7%).

#### **3.3 The research variables**


In general, the subvariables when the value is higher indicate the dominance of the attribute.

#### **3.4 Research instruments**

Four questionnaires were used in this study:

1.High School Organizational Climate Questionnaire—H-S Organizational Climate Index (Appendix B).

This questionnaire is for principals, and it has undergone many incarnations. First developed by Halpin and Croft [26], "The Descriptive Questionnaire of the Organizational Climate", it focused on measuring the important aspects of teacher-teacher and teacher-principal relationships. The 1989 questionnaire belongs to a research team from the University of Memphis and includes 30 items, which are divided into seven dimensions:



#### *The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

#### **Table 1.**

*Demographic and professional characteristics of the principals in the sample.*


The answers to the questionnaire are on a five-point Likert scale (5—strongly agree, 4—agree, 3—neutral, 2—disagree, 1—do not agree at all, 0—I have no opinion or the statement is irrelevant). Examples of items, "In my opinion, in the environment of this school I am encouraged to exchange information about solving school problems"; "In my opinion, in the environment of this school I am encouraged to improve school programs" ([23], pp. 188–189). For each index, the average of the items is calculated.

2.Big Five Index Questionnaire (BFI) (Appendix C)—The questionnaire belongs to McCare and John [28] and consists of 44 items answered through a 5-grade Likert scale where 1 means "do not agree at all" and 5 means "strongly agree"; the items are 5-dimensional characteristics of the various individual traits (**Table 2**). The following are examples of statements—Openness: "An original person who tends to come up with new ideas", with Cronbach's alpha internal consistency of .70. Conscience: "An employee who performs his/her job well" with .80. Pleasantness: "Tends to criticize and find flaws in others", with .68. Neuroticism: "Man is depressed and prone to sadness", with .81. For each index, the average of the items is calculated.


**Table 2.**

*Examples of characteristic scales for each of the five dimensions of individual attributes.*

*The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

	- a. Attitude toward the problematic nature of sexual aspects: Answer for the eight items by an ordinary scale with 5 levels so that 1—no problem at all, 2—small problem, 3—average problem, 4—big problem, 5—very big problem. Example question: "Unwanted pregnancy." A high rating of this dimension means an expression of the degree of severity of the attitude toward sexual aspects.
	- b. The extent of the effect of sex education on the same sexual aspects mentioned in the previous section, by a 5-level Likert scale, so that 1—does not affect at all, 2—does not affect, 3—affects moderately, 4—affects, and 5—very much affects. Example question "To what extent does sex education affect the issue—unwanted pregnancy"? A high rating of this dimension means a high impact of sex education on sexual aspects.
	- c. Answer regarding the degree of agreement for 14 statements, by a 5-level Likert scale, so that 1—do not agree at all, 2—do not agree, 3—neutral, 4—agree, and 5—strongly agree. Example question, "To what extent do you agree with the statement—having sex between adults before marriage is immoral"? A high rating of this dimension expresses a more positive perception toward sexual behavior and sex education.


**Table 3.**

*Mean, standard deviation, and Cronbach alpha values for all dimensions in the study.*

In addition, subjects were asked about their age, gender, marital status, years of education, and degree of religiosity (Appendix A).

**Table 3** shows the summary of dimensions, their level of reliability.

#### **3.5 Research process**

There was an application to an academic institution for its approval to distribute the questionnaires to the principals in its professional development courses. After receiving the approval, the questionnaires were distributed at the principals' meetings and the purpose of the research and the expected results were presented. The data collection procedure was spread over several weeks. All data were collected by the researchers.

#### **3.6 Ethics in research**

Care was taken to properly address the principals nominated for participation. School principals were recruited in person at their workplaces or study groups. After receiving their consent to participate in the study, they were given a brief explanation of the study purpose and were promised confidentiality and anonymity regarding their personal details, then asked to complete the questionnaires. Some principals refused to fill out the questionnaire, so it was explained to them that they were free to discontinue their participation in the study at any stage and of their own free will, and that their non-participation would not affect them and their status in any way. They were also assured that the data and findings would be used for academic research and would not be passed on to any official.

#### **4. Findings**

The purpose of the present study is to examine the extent to which the school climate can mediate between the personality and the principal's attitude toward sex education in Arab society in Israel.

The hypotheses examined in this study are:


First hypothesis: there is a connection between the school principal's personality and their attitudes toward sex education, so that the less neurotic and more extroverted, open, pleasant, and conscientious the school principal is, the more positive their attitudes toward sex education will be.

*The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*


#### **Table 4.**

*Pearson's correlation coefficients between school principal personality and sex education.*

To examine the relationship between the school principal's personality and their attitudes toward sex education, Pearson's correlation coefficient was used to examine the nature of the relationship between the variables measured (**Table 4**). It was found that there was a positive relationship at a moderate and significant level (Rp = 0.255, *P* < 0.004) between the level of openness measured in the personality questionnaire and the perception of behavior and sexual education. So, the more the principal is characterized by a developed imagination, curiosity, originality, broad horizons, high intelligence, and artistic sensitivity s/he tends to perceive sexual behavior and education more positively. In contrast, no correlation was found between the other dimensions of personality (extroverted, neurotic, pleasant or conscientious) and the dimensions of sex education.

Moreover, when examining the relationship by gender, it was found that among men only there is a positive and significant moderate relationship (Rp = 0.226, *P* < 0.040) between the level of extroversion of principals and the effect of sex education. That is, the more social principals have a need for connection, assertiveness, and a tendency to be active and talkative, the higher they rank the importance of the impact of sex education in school. It is important to note that no relationship was found between the level of openness and the attitude toward the dimensions of sex education among male principals. When we examine the relationship between the personality dimensions of principals and the dimensions of sex education, it is found that there is a moderate and significant negative relationship (Rp = 0.318, *P* < 0.033) between the level of extroversion of principals and the effect of sex education in school.

However, the more extroverted female principals are, the more likely they are to think that the impact of sex education in school is low. In contrast, a moderate and significant positive relationship was found (Rp = 0.324, *P* < 0.030) between the level of openness of female principals and the perception of behavior and sex education, so principals with a more open personality dimension significantly tend to perceive sexual behavior and education in a more positive way.

The study examined the impact of religion on the perception of sex education. Among Muslims, there is a moderate and significant relationship (*R*p = 0.245, *P* < 0.041) between the level of openness and the severity of the attitude toward

sexual aspects. In fact, it has been found that conservative Muslim principals tend to rate the severity of acts (e.g., unwanted pregnancies, sexually transmitted infections, etc.) more severely than what open-minded principals rated them.

Among the Druze principals, it was found that there was a moderate and significant positive relationship (Rp = 0.368, *P* < 0.041) between their level of extroversion and the effect of sex education. This means that the more extroverted the Druze principals are, the higher they rank the importance of the impact of sex education in the school. Among Christian principals, there is no relationship between their personality dimensions and their attitude toward sex education.

Finally, it was found that there is a positive and significant relationship (Rp = 0.445, *P* < 0.0001) between the level of openness and perception of behavior and sexual education. The more secular principals with a higher level of openness tend to perceive sex education in a more positive way. In contrast, no association was found between personality dimensions and attitudes toward sex education among the traditional or religious.

Second hypothesis: The school climate will mediate between the principal's personality and her/his attitudes toward sex education, so that the less neurotic and more extroverted, open, pleasant, and conscientious the school principal is, the more positive the school climate will be. On the other hand, the more positive the school climate, the more positive the principal's attitudes toward sex education.

To examine the degree of mediation of the school climate between the components of personality and the attitudes toward sex education, the Sobel test was used.

To test the hypothesis that the school climate will mediate between the principal's personality and their attitudes toward sex education, the relationship between the school climate and the principal's personality was first examined (**Table 5**). It was found that there is a strong positive and significant relationship between the level of extroversion of the principal and the level of openness of the school (Rp = 0.525, *P* < 0.0001), the effort to succeed at work (Rp = 0.389, *P* < 0.0001), a supportive school environment (Rp = 0.440, *P* < 0.0001), encouragement for personal responsibility (Rp = 0.275, *P* < 0.0002), self-feedback (Rp = 0.178, *P* < 0.045), and consistency (Rp = 0.178, *P* < 0.044).


**Table 5.**

*Pearson's correlation coefficients between school principal personality and school climate.*

#### *The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

The level of neuroticism of the school principal was found to be positively and significantly associated (Rp = 0.248, *P* < 0.0001) with self-feedback. The degree of pleasantness expressed in courtesy, flexibility, confidence and trust, comfortable temperament, cooperation, forgiveness, and tolerance, was found in a positive and weak correlation with the level of openness of the school (Rp = 0.198, *P* < 0.025), and the effort to succeed at work (Rp = 0.201, *P* < 0.023). The level of conscientiousness of the principal was found to be positively correlated with the level of openness of the school (Rp = 0.307, *P* < 0.0001), effort to succeed at work (Rp = 0.195, *P* < 0.027), supportive school environment (Rp = 0.211, *P* < 0.017). Finally, the level of openness of principals was found to be highly and positively correlated with the school climate dimension, such as the level of openness of the school (Rp = 0.447, *P* < 0.0001), effort to succeed at work (Rp = 0.347, *P* < 0.0001), and a supportive school environment (Rp = 0.422, *P* < 0.0001).

When examining the relationship between the school climate and sex education (**Table 6**), it was found that there is positive relationship between the openness of the school climate and the perception of behavior and sex education (Rp = 0.181, *P* < 0.040). There is also a positive and significant relationship between the openness of the school climate and the effect of sex education (Rp = 0.239, *P* < 0.007). It was also found that there is a positive relationship between the effort to succeed at work and the perception of behavior and sexual education (Rp = 0.238, *P* < 0.007). Also, a positive and significant relationship was found between the effort to succeed and the effect of sex education (Rp = 0.189, *P* < 0.033).

Another positive relationship was found between the structure of the school environment and the perception of behavior and sexual education (Rp = 0.196, *P* < 0.026), and the effect of sex education (Rp = 0.231, *P* < 0.009). Similarly, a positive association was found between the recognition of success and the perception of behavior and sex education (Rp = 0.252, *P* < 0.004), and the effect of sex education (Rp = 0.266, *P* < 0.002). Finally, a positive and significant relationship was found between the consistency of the structure and the perception of behavior and sexual education (Rp = 0.204, *P* < 0.021), and the effect of sex education (Rp = 0.300, *P* < 0.001).

To examine whether the school climate mediates between the principal's personality (in dimensions: openness, extroversion) and sex education (in dimensions: behavioral perceptions and sex education, the effect of sex education) a linear regression analysis was performed when the two principal personality variables (in the two dimensions above) and school climate are independent variables and sex education (in both dimensions above) as a dependent variable. Notably, the two dimensions of sex education examined in this hypothesis are those that were dominant in their correlation with the two dimensions of personality traits (**Table 4**).

The following are the options tested through the Sobel test:

1.When the effect of the openness dimension on the "perception of behavior and sexual education" dimension in the regression model in all principals was examined, it was found that the regression coefficient value of the openness dimension is positive and significant (*B* = 0.255, *P* < 0.004). When the dimensions of the school climate are added, it is found that the effect of the openness dimension increases (B = 0.385, *P* < 0.0001). After adding the dimensions of the school climate, the explained variance of the model increased (Rp = 0.382, *P* < 0.001). Therefore, the school climate dimensions do not mediate the relationship between the dimension of openness and the dimension of "perception of behavior and sexual education", but rather the dimensions of


#### **Table 6.**

*Pearson's correlation coefficients between sex education and the school climate.*

the school climate make a unique contribution to the regression model among all principals.


#### **5. Discussion**

The purpose of this study is to examine the extent to which the school climate can mediate between the personality and the principal's attitude toward sex education in the Arab-Israeli community. The study was based on the "Big Five" model. In education, the principal is perceived as a leader whose leadership depends on personal qualities and skills, including the ability to fulfill tasks [30]. Therefore, the school atmosphere is greatly influenced by the principal's behavior toward the staff and students and their parents, and even how the climate is defined as a work environment (cold, friendly, hostile, or closed).

The prevailing assumption is that the perceptions of teachers, students, parents, and principals of the social, physical and pedagogical environments in the school may influence the school's educational processes, outputs, and outcomes. Recognition of these perceptions is important for school principals, who are required to control the organizational processes and discover the areas in which intervention is needed to improve the school atmosphere [7].

According to Raichel [31], the principal should know the school's educational staff and students, and get to know their feelings, attitudes and needs. Tadmor [32] adds that the task of formal education is to engage in the multifaceted design of the student, on the one hand to develop the knowledge, skills, values, and behavioral aspects, and on the other hand to develop each student's unique personality.

The centrality of the school will be expressed, therefore, in that it will serve as a social agent, imparting the primary culture above and beyond its traditional functions as imparting disciplinary knowledge. In other words, the school takes on tasks that were previously taught at home. The great responsibility of the school for shaping the image of the future graduate in the modern age lies in the deteriorating state of the traditional family, the undermining of powers, and the growing pluralism of values.

Additionally, parents have an important and primary role in their children's sexual development through a process of sexual socialization in which children absorb the social norms associated with sexual behavior. Schools and health professionals must support the role of parents, and parents must support schools in promoting sex education for their adolescent children [33].

Flower et al. [34] also emphasize the need for schools to raise children who can sexually communicate directly, openly, honestly, prominently, and spontaneously. In doing so, children develop self-confidence in their sexuality with sensitivity to the needs, rights, and preferences of other people.

First hypothesis: Based on the findings, it was found that there is a relationship between the level of openness and extroversion of school principals and their attitudes toward sex education. It has been found that principals with a high level of openness tend to perceive sex education in a more positive way. Similarly, this relationship is stronger among secular principals.

This finding indicates that the dimension of high openness to experiences has a great influence on the principal's attitudes toward sex education. This is consistent with the findings in Raichel's [31] study, that a person with high-intensity traits is creative and enterprising with a penetrating vision in depth and for the long term future. A proactive person, open to change, who does not wait to be motivated, but initiates and motivates others, has broad horizons, mental flexibility, and originality. Raichel adds that successful managers have characteristics such as perseverance, creativity, openness, empathy, patience, compassion, transparency, integrity, consistency, determination, risk-taking and awareness of others and themselves.

In addition, their values are often of a social-democratic or liberal-humanist nature and aimed at equal opportunities. Therefore, the principal's liberal nature promotes tolerance toward the different, for example, students with same-sex orientation [3].

About secular principals, it was found that there is a strong connection between their level of openness and their attitude toward sex education. This finding is consistent with the findings of Brosh [35], who found that there is a link between the level of religiosity and attitudes toward sex education: about 9% of the religious and traditional teaching students in her study underestimated the importance of sex education in school, compared to only 1% of seculars. Only about a quarter of religious and traditional students supported the provision of sex education for kindergarten and elementary school children, while about 36% of secular students supported it. Cabalion [8] also emphasizes that there is a cultural gap between the values of secular and traditional society. While secular society views sexual education as an act of progress and enlightenment, the other sees it as an expression of moral corruption.

As for the relationship between the extroversion dimension and the "effect of sex education" dimension, it was found that there is a positive relationship between them among the principals, and an inverse relationship was found among the women principals. The more extroverted male principals are, the higher they rank the "impact of sex education" dimension in school. In contrast, extroverted female principals tend to give little importance to the "impact of sex education" dimension in school.

This finding reinforces the assumption that personality traits are not dichotomous and can move along a spectrum. A person with a high level of extroversion, characterized as an assertive, energetic, cheerful, talkative, spontaneous, social person who is interested in relationships. In contrast, a person with low extroversion is perceived as withdrawn, segregated, alienated, restrained and not interested in relationships [36].

Based on the rating of the traits, it is likely that male principals with a high level of extroversion participated in the study, compared to female principals with a low level of extroversion, which created a difference in attitudes between the two sexes. This finding is inconsistent with the findings as mentioned by Brosh [35], which examined the attitudes of 135 male and female educators in the Arab sector toward education for family life and sex life. In the Arab sector there is great general support for education for family life, however, not all subjects were perceived as suitable for school.

Some researchers believe that male and female principals are different in the way they manage people and exercise their leadership, even though the differences are not innate but the result of different social processes and life experiences. Contrary to this approach, others argue that there is unequivocal evidence of gender differences in school management. Conversely, there are studies that indicate that male and female principals are not different in their professional behavior. When there are gender differences, they are marginal and concentrate mainly on the different career experiences of women and men ([7], pp. 257–258).

According to Hertz-Lazarowitz and Shapira [37], one of the weaknesses of the feminist-gender approach to understanding educational leadership stems from its disregard for environmental and cultural influences on the leader's behavior and its focus on gender as a major factor in assessing the behavior of a female school principal as an educational leader.

Abu Baker [38] argues that the issue of sex education in the Arab-Israeli education system is still subject to the personal decisions of school principals and the degree of personal courage within their communities. In most cases, principals prefer not to get into a confrontation that will undermine their status and condemn their decisions. She added that this is due to the common assumption that sex education teaches students how to have sex, and parents see this as an obscene goal and not within the school's purview.

The very fact that the present study found a difference between the attitudes of extroverted males and extroverted female principals in the "impact of sex education" dimension in school may support the ideology of the dominant gender, which dictates the content, division of roles and social statuses. Rosen [39] mentioned that social interactions are how individuals learn what the expectations are directed at them according to their gender. Therefore, despite the controversy in the literature, gender plays some role in understanding the world of male and female principals [7]. It is possible that the extroverted female principals were reserved in their responses due to gender norms.

Among the Druze principals, a positive relationship was found between their level of extroversion and the "impact of sex education" dimension. The more extroverted the Druze principals are, the higher they rated the "impact of sex education" dimension in the school.

This finding may indicate that the Druze society has undergone great change. It was shaped for many years by religion when the social-traditional framework and living conditions determined the individual's connection to community [40]. The social situation today has changed fundamentally. Most of the young Druze men and women have opened to the modern world in institutions of higher learning, workplace and military service. What was taken for granted in the past does not today satisfy the needs of Druze youth. The traditional leadership loses its powers, with the younger generation of Druze in daily contact with Jewish society, which brings about a change in the lifestyle and views of the Druze youth. Today, young Druze often ask many and varied questions about their identity, affiliation, values, religion and more, and are not satisfied with "simple" answers. They require serious attention to their questions and concerns. The community clergy, elders, leaders, and officials are unable to provide the answers to all the questions. Community segregation further exacerbates the difficulties of dealing with the gaps between the old and the new. It highlights the conflict between the preservation of culture and unique identity and the pressures arising from modern culture ([41], p. 5).

Second hypothesis: It was found that the school climate does indeed mediate between the school principal's personality in the extroversion dimension and the "effect of sex education" dimension. However, as for the openness dimension, the school climate has not been found to mediate between the openness dimension and the "impact of sex education" dimension.

In order to illustrate these differences, we will examine the nature of the relationship between the dimensions of personality and school climate, in addition to the dimensions of sex education. The extroversion dimension was found to be positively associated with the "effect of sex education" dimension, so extroverted men tend to rank higher the "effect of sex education" dimension, as well as among Druze principals, the higher the extroversion level, the higher they rank the dimension "The Impact of Sex Education". When the dimensions of the school climate are added to the model, it is found that this relationship disappears, which indicates a full mediation of the school climate dimension, between the extrovert dimension and the "effect of sex education" dimension.

This finding reinforces the hypothesis that the more extroverted the school principal, the more positive the school climate dimensions will be, and the more positive the principal's attitudes toward the "impact of sex education" dimension will be.

Friedman [42] argues that extroversion is the ability to turn outward, target people around the person, and show humanity and consideration toward them. This ability allows the adult to understand other people's intentions and identify their aspirations, even when they are hidden, and potentially act on that information.

Therefore, it is likely that this finding highlights the critique that focused on personal traits and did not address the work environment, which led to the existence of the situational approach. The situation approach that rejected the traits approach and the assumption that people are born leaders and began to look for unique characteristics in the work environment that influence the leader's behavior and level of performance. The situational approach claims that there are several variables that can influence a principal's behavior such as the structural characteristics of the organization, job characteristics, subordinate characteristics, external environment, and internal environment including values, level of participation, openness, culture, and school climate [7].

As a critique of the personal trait model and the situational attitude model, Opletka [7] noted that they were developed a different approach to describing and measuring the organizational climate based on understanding the need to simultaneously measure a person's traits and the characteristics of the environment in which the person lives and operates. This led to the formulation of six factors in the school's organizational climate index: (1) intellectual climate; (2) a climate of achievement criteria; (3) a climate that emphasizes personal support; (4) organizational effectiveness; (5) a climate that emphasizes order; and (6) a climate of great control over chance.

The literature review shows that the school climate is of great importance and has a profound effect on the physical and mental health of students. A positive school climate strongly influences motivation for learning, and contributes to reducing violence, bullying and sexual harassment and as a factor that protects learning and overall positive development of young people [43].

In contrast, when we examine the dimension of openness of principals, that there is a positive relationship between it and the dimension of "perception of behavior and sexual education". The same is true among the secular, the higher the dimension of openness, the more positive the "perception of behavior and sexual education". It is important to note that after the addition of the school climate dimensions, the unique contribution of the openness dimension to the regression model stood out even more. Thus, the openness dimension and the school climate dimension make a unique and separate contribution to predicting the "perception of behavior and sexual education" dimension in school, and the school climate dimension does not mediate the relationship between the openness dimension and the "perception of behavior and sexual education" dimension in school.

Friedman [42] reinforces this finding and emphasizes that a person with developed skills in human relations controls communication with others. Aware of their own positions and assumptions and those of others and able to find benefit even in possible disagreements. Such a person works to create an atmosphere of in which subordinates feel safe and free to express themselves without fear of criticism or humiliation. This person allows their colleagues and subordinates to participate in the planning of the things that directly affect them and their execution. They are aware of the motivation of the people and their needs in the organization and is considerate of all these.

Raichel [31] adds that a condition for principal leadership is to create a good atmosphere that the staff members will feel that they are in a good, necessary, valued, meaningful, belonging place and that they have constant support. A principal can create the atmosphere in which disagreements are resolved in a conversation that one learns from the different opinions and that there is room for everyone.

#### **6. The contribution of research to the management of the education system**

The findings of the present study offered empirical evidence to support the impact of the school climate as an intermediary between the personality dimensions of the principal and the attitude toward sex education in the Arab schools in Israel. The study relied on the Big-Five model of personality and shed light on the school principal's desired traits and attitudes toward sex education in Arab society specifically.

According to Friedman [42], the principals, as head of the school, are perceived as a key accelerator in the organization's performance and largely determine its directions of development, how it is managed and organizational behavior. Therefore, the principal is must not only demonstrate technical management skills, but also skills for participatory management and building a team culture. Hence, stellar leaders are open, accessible people, expressing fairness, transparency, honesty, and aware of others; they are actually realizing in their actions the models of ideal educational leadership [7].

The study demonstrates that in addition to pedagogical education, the Ministry of Education must include sex education in its training and appointing principals. In addition, the issue of personal qualities and their empowerment can be emphasized in the training of principals (or in the framework of professional development). The combination of personal qualities (natural talent), training and experience can build a third model (hybrid) for a school principal who may be more competent and skilled in school management, since performing management tasks effectively requires the acquisition of specific skills.

#### **7. Conclusions**


Ignoring the field of sex education is irresponsible and could be seen as covert approval for any behavior.

4.The process of sexual socialization that begins at home by the parents is not enough to instill in children the healthy behaviors in this area. Children are exposed to community norms and misleading information, hence the need to have sex education programs in school and educate on society's norms in family and sex life, cultivate tolerance for unusual behaviors, and promote healthy and safe sexual behavior.

#### **8. Summary**

The research literature reviewed sheds light on the importance of sex education in modern schools; however, in practice, the implementation of programs in this field is partial. This topic is gaining momentum in Arab society in Israel, where the issue of sex education is culturally and ethically sensitive. It seems that while research findings indicate the role of educational counselors in promoting sex education in schools, research dealing with the role of Arab educational counselors in the subject is almost non-existent [44].

Youth are always replete with questions related to sexuality, and therefore they should be provided with answers to all the problems and clarifications to various concepts [45]. Domb [46] argues that one of teachers' concerns is that students will ask them personal questions, and they are unsure what way to answer such questions, and since the issue is emotionally charged, it turned out that "dry" information is insufficient and that every fact must undergo an emotional processing that will allow it to be internalized. Therefore, breaking down the embarrassment depends on the ability of educators and counselors to talk about the issue without getting anxious and scared.

Considering this, the professional literature places great emphasis on the principal being an innovator and a promoter of change. Various researchers have pointed out that among the tasks of a school principal are developing, supervising, and providing assistance to the staff in their work. In addition, principals are expected to cultivate a supportive work environment.

Therefore, the principal is now required not only to present technical management skills, but to perform management tasks in an effective manner that requires the acquisition of specific skills, including in sex education. At the same time, the lack of a theoretical framework that clearly defines the skills required of those involved in school management leaves room for different approaches in the training of principals [7].

#### **A. Demographic questionnaire**

No. of examinee: \_\_\_\_\_\_ **Research on School Climate Dear Participant,**

My names are \_\_\_\_\_\_\_ from Advanced Studies Unit in Sakhnin College. The research we are conducting deals with the school climate as a mediator between the personality and the position of the principal towards sex education in the Arab sector. The data is collected anonymously and will not be passed on to any other party.

Your participation is a great contribution to our research.

*The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

**Thank you from the bottom of my heart for your cooperation! The research team Personal details questionnaire Circle the appropriate digit:** Sex: (1) Male (2) Female Age: (1) 25 -35 (2) 35-45 (3) 45-55 (4) 55 and up Marital Status: (1) Single (2) Married (3) Divorced (4) Widowed Religion: (1) Muslim (2) Christian (3) Druze (4) Other Degree of religiosity: (1) secular (2) traditional (3) religious Education: (1) Bachelor (2) Master (3) Ph.D. (4) Other Principal: (1) Elementary School (2) Secondary School (3) High School (4) Other Seniority in management: (1) 1-3 years (2) 4-10 years (3) 11-20 years (4) 21 years and over

In what type of locality do you live: (1) city (2) village (3) other

#### **B. School climate questionnaire**

Answer the statements according to the degree to which you agree with each of them. Levels: 5 = Strongly agree, 4 = Agree, 3 = Neutral (neither agree nor disagree), 2 = disagree, 1 = strongly disagree, 0 = I have no opinion or the statement is irrelevant




**The questionnaire has 7 categories. The statements are arranged according to their topics, and the number indicates their position in the questionnaire.**

#### **1. The openness of the school climate**

5. In my opinion, in the environment of this school I am encouraged to express my views on school issues.

14. In my opinion, in the environment of this school I am encouraged to take responsibility for improving the school.

19. In my opinion, in the environment of this school I am encouraged to help solve school problems as soon as they arise.

20. In my opinion, in the environment of this school I am encouraged to exchange information regarding school problem solving.

21. In my opinion, in this school environment I am encouraged to improve school programs.

26. In my opinion, in the environment of this school I am encouraged to contribute to the preservation of a positive school climate

29. In my opinion, in the environment of this school I am encouraged to consider suggestions regarding my work as steps for improvement and not as personal criticism.

30. In my opinion, in the environment of this school I am encouraged to express my views in solving difficult school problems.

#### **2. Effort to succeed at work**

7. In my opinion, in the environment of this school I am encouraged to collect data and process them for my work.

12. In my opinion, in the environment of this school I am encouraged to reward students for effective performance.

16. In my opinion, in the environment of this school I am encouraged to work "beyond what is required in the job definition".

17. In my opinion, in the environment of this school I am encouraged to reward students for special services they perform.

25. In my opinion, in the environment of this school I am encouraged to take personal responsibility for decisions I make in relation to issues concerning the school.

**3. The structure of the school environment**

1. In my opinion, in the environment of this school I am encouraged to use consistent ways of treating students who regularly break the rules.

3. In my opinion in the environment of this school I am encouraged to examine the performance of my work.

11. In my opinion, in the environment of this school I am encouraged to consider the school regulations when I make decisions.

15. In my opinion, in the environment of this school I am encouraged to take fair, determined and consistent steps when school regulations are violated.

23. In my opinion, in the environment of this school I can conclude that the management is aggressive towards anyone who violates the regulations.

27. In my opinion, in the environment of this school I can conclude that the management is fair and consistent towards those who violate the regulations.

#### **4. Providing encouragement for personal responsibility**

6. In my opinion, in the environment of this school I am encouraged to trust my personal judgments when I make routine day-to-day decisions.

9. In my opinion, in the environment of this school I am encouraged to trust my personal feelings in decision making.

13. In my opinion, in the environment of this school I am encouraged to make personal decisions in response to problems related to my professional roles.

*The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

#### **5. Self-feedback**

2. In my opinion, in the environment of this school I am encouraged to consider whether my role is one of the causes of school problems.

8. In my opinion, in the environment of this school I am encouraged to see in my actions/opinions possible causes of problems in the school.

28. In my opinion, in the environment of this school I am encouraged to ask myself whether I have contributed to the problems of the school.

#### **6. Recognition of success**

4. In my opinion, in the environment of this school I receive a special reward when my work is done in an extraordinary way.

22. In my opinion, in the environment of this school I receive a special reward for effective performance.

#### **7. Consistency of the structure**

10. In my opinion, in the environment of this school I am encouraged to check with others before I deviate from the existing school guidelines.

18. In my opinion, in the environment of this school I am encouraged to seek the consent of others before I make changes in my work.

24. In my opinion, in the environment of this school I am encouraged to trust the judgments of others and not decide for myself.

#### **C. Big Five questionnaire: self-description**

Here is a list of sentences or descriptions that characterize different people and these may or may not be true about you. For example, do you that you are a person who likes to spend time in the company of others?

Write next to each description the number that indicates the degree of your consent or disagreement with the description.

5 = Strongly agree, 4 = Agree, 3 = Neutral (neither agree nor disagree), 2 = disagree, 1 = strongly disagree


**Please check: Did you write a number next to each description sentence?**

#### **D. Sex education questionnaire**

Here are some problems that adolescents face. For each problem, circle the degree of its severity according to the following scale:

1 = not a problem at all, 2 = a small problem, 3 = an average problem, 4 = a big problem, 5 = a very big problem.


*The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*


2. Rank, by a circle, how much the sexual education that the adolescents receive in the school affects each of the topics we discussed in the previous question, according to the following scale:

1 = does not affect at all, 2 = does not affect, 3 = affects to an average degree, 4 = affects, 5 = greatly affects.


Here are some sentences. For each sentence, rate the degree of your agreement with him, by circling the degree of consent and according to the following scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.



Circle the choice that indicates to what age adolescents should wait for sex, according to the following scale: 1 = up to age 16, 2 = up to age 18, 3 = up to age 21, 4 = until marriage, 5 = depending on the boy's/girl's desire.


*The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

#### **Author details**

Yaser Awad<sup>1</sup> \*, Shadia Oudeh<sup>1</sup> , Tareq Murad<sup>2</sup> and Jennifer Sheffield<sup>3</sup>

1 Advanced Studies Unit, Sakhnin Academic College for Teacher Education, Israel

2 The Department of Pedagogical Training, Sakhnin Academic College for Teacher Education, Israel

3 The Center for Quality and Excellence in Teaching, Sakhnin Academic College for Teacher Education, Israel

\*Address all correspondence to: awad\_y@netvision.net.il

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **References**

[1] Erhard R. Sex education in adolescence. In: Ziv A, editor. The Unusual Age: New Israeli Articles on Adolescence. Tel Aviv: Papyrus; 1992. pp. 79-47 (Hebrew)

[2] Weisblai A. Sex Education in the Education System. Knesset Research and Information Center, Jerusalem: Kiryat Ben Gurion; 2010 (Hebrew)

[3] Firstster A, Lapidot-Berman Y. Sex education - for what? The contribution of a course in human sexuality to students. Multi-shades, Research and Discourse. 2018;**16**(3):53-81 (Hebrew)

[4] Harari D. We will never think they are too young. Echo of Education. 2010; **84**(6):58-60 (Hebrew)

[5] Harpaz J. The loss of education is also the loss of sex education. Echo of Education. 2010a;**84**(6):38-41 (Hebrew)

[6] Harpaz Y. A kind of dilemma. Echo of Education. 2010b;**84**(6):6 (Hebrew)

[7] Opletka Y. Fundamentals of the Education Administration - Leadership and Management in the Educational Organization. Haifa: Pardes Publishing; 2010 (Hebrew)

[8] Cabalion C. The background to the institutionalization of sex education and sexual information in Israel. In College - Study and Creative Research. 2007;**19**: 105-146 (Hebrew)

[9] Birnbaum M, Bar-Guy A. Behavior and Attitudes of Young People in the Field of Sex Education. Jerusalem: Ministry of Education and Culture; 1988 (Hebrew)

[10] The Counseling Psychological Service (CBS). Couple sexuality and gender. 2016. Available from: http://cms. education.gov.il/EducationCMS/Units/ Shefi/Hitpatchut/ (Hebrew) [Retrieved: June 20, 2019]

[11] Rudnitzki A. Arab Citizens of Twenty-First Century: Memorandum 139. Tel Aviv: Institute for National Security Studies; 2014 (Hebrew)

[12] Shehadeh P, Sinai M. The consultant's perception of her role in promoting the issue of sex education in Arab society. Educational Counseling - Journal of the Association of Educational Counselors in Israel. 2017;**20**:164-186 (Hebrew)

[13] Jubran S. Attitudes about sex education among Christian and Muslim mothers [thesis for a master's degree]. Kiryat Tivon: Oranim Academic College; 2008 (Hebrew)

[14] Abu Baker H. Arab women, sex, and sexuality: The presence of Arab society and culture in psychological and couple therapy among Palestinian women - the New East. In: Gerber H, Fuda A, editors. Jewish-Arab Relations in Palestine. Magnes: The Hebrew University of Jerusalem; 2002. pp. 245-230 (Hebrew)

[15] Eilwan A. Raising Children in Islam. Vol. 2. Cairo Egypt: Dar Al Salam for printing, publishing, and distribution. 2002. p. 427. (Arabic)

[16] Jubran S, Marcus A, Avital A, Ram A. Parents' positions in the Arab sector on sex education at school. Education and Its Surroundings: The Kibbutzim Seminar Yearbook. 2011;**33**:73-103 (Hebrew)

[17] Tzvi'eli-Efrat A. Secrets and fears being a LGBT in school. Echo of Education. 2010;**84**(6):82-84 (Hebrew) *The School's Climate as a Mediator between the Principal's Personality… DOI: http://dx.doi.org/10.5772/intechopen.105213*

[18] Rojas-Guylar L, King KA. Sexuality education among Latinas: Experiences, preferences, attitudes and risk behavior. American Journal of Sexuality Education. 2007;**2**(4):25-41

[19] Abu Baker H, Rachel A, Biadsa A. Attitudes of teachers and parents towards sex education: An intercultural perspective. 2012. (Hebrew) Retrieved on 04.02.2019 from: http://www.yvc.ac.il

[20] Zak A. School Is Also the World of the Teacher. Ramot: Tel Aviv University; 1985 (Hebrew)

[21] Livni A. The relationship between the choice of "social applications" (applications) by users of social networks on the Internet and their personal interests and features [thesis for a master's degree]. Haifa: Faculty of Education, University of Haifa; 2010 (Hebrew)

[22] Hilgard A, Watkinson C. Introduction to Psychology. Tel Aviv: Otzar Lemura; 1972 (Hebrew)

[23] Bar-Lev A. School Climate: Reality and Vision. Be'er Sheva: Published by the National Center for the Training of Teaching Staff in the Fields of Spirituality and the "Beit Yatziv" Society and the Kay Academic College of Education, (Hebrew); 2007. pp. 189-188

[24] Gloverzon A, Carmi A. People in the Organization: Human Resource Management. Tel Aviv: The Director's Library; 1982 (Hebrew)

[25] Ubben G, Hughes L, Norris C. The Principal Creative Leadership for Effective School. 4th ed. London: Allyn & Bacon; 2001

[26] Halpin AW, Croft DB. The Organizational Climate of Schools. Washington, DC: U.S. Office of Education; 1962

[27] Friedman J. Chapter "Discussion" in a research report, evaluation study and empirical scientific article. Imagination and Act, 15, 207–220. Academic Achva College. 2013a. (Hebrew)

[28] McCare RR, John OP. An introduction to the five-factor model and its applications. Journal of Personality. 1992;**60**:175-215

[29] Blendon R. In: Adler NE, Newman K. Sex Education in America, General Public Parents Survey. National Public Radio/ Kaiser Family Foundation/Harvard University, John F Kennedy School of Government. Menlo Park, CA: Kaiser Family Foundation; 2004. Retrieved on 19 August 2019 from https://www.kff.org/ wp-content/uploads/2013/01/sexeducation-in-america-general-publicparents-survey-toplines.pdf

[30] Bugler R. Leadership and Its Applications in Education. Tel Aviv: The Open University; 2000 (Hebrew)

[31] Raichel N. The principal of the desired school and his roles in the glasses of the educational staff. Studies in the Administration and Organization of Education. 2015;**34**:111-132 (Hebrew)

[32] Tadmor Y. Qualities for the Divine in Human Beings – Existentialist-Religious Education in the Doctrine of Joseph Shechter. Tel Aviv: Reshafim Publishing; 1994

[33] Hochhizer M, Zaitsev Y, Feldman A, Klontrov S. Intervention program for healthy sexuality in the education system in Israel compared to developed countries in the world: Review article. Journal of the Association of Educational Consultants in Israel. 2019;**2019** (February):57-80 Published by Sha'anan - The Religious Academic College of Education. (Hebrew)

[34] Flowers C, Horsman G, Schwartz B. Sex Education for Your Child. Tel Aviv: Or-Am; 1983 (Hebrew)

[35] Brosh A. Sex education: Yes, in our school. Education and Its Surroundings. 2007;**29**(29):91-107 (Hebrew)

[36] Melamed G. Influence of personality traits on conflict management. 2005. Available from: http://www.haskama. co.il/mediation/document/personality. pdf (Hebrew) [Retrieved: August 31, 2019]

[37] Hertz-Lazarowitz R, Shapira T. Muslim women's life stories: Building leadership. Anthropology & Education Quarterly. 2005;**36**(2):165-181

[38] Abu Baker H. Locating children's victims of abuse and neglect Introduction between culture and Arab society. Jerusalem: Ashalim; 2007 (Hebrew)

[39] Rosen A. Male culture and the status of women in technology. In: Maor E, editor. Women the Rising Power. Bnei Brak: Hapoalim Library; 1997. pp. 124-137 (Hebrew)

[40] Yitzhak L. Druze in Israel: A historical and spatial aspect. 1998. Available from: http://www.e-mago.co. il/e-magazine/druze.html (Hebrew) [Retrieved: September 7, 2019]

[41] Kurt D, Abbas R, Walters J. Identity patterns and educational aspirations in Druze adults and young people: Intergenerational research on attitudes and perceptions. Ministry of Education. 2012. (Hebrew)

[42] Friedman J. The talented manager: Personal traits and skills Studies in the administration and organization of education 33, 67-104. University of Haifa. 2013b. (Hebrew)

[43] Thapa A, Cohen J, Guffey S, Higgins A. A review of school climate research. Review of Education Research. 2013; **83**(3):357-385

[44] Fisherman S. Identity crises among national religious adolescents. Lecture presented at the National Religious Youth Conference at Risk, Characteristics and Challenges, May 2017. Ariel: Ariel University; 2017

[45] Zacks S. Sex Education for Disabled Young People: Education for Family Life. Tel Aviv: Yavneappendi; 1987

[46] Domb L. Sex Education: You have to talk about it. Free Lesson. Issue 107. 2014. (Hebrew)

#### **Chapter 6**

## Sexual Health Education for Youth with Disabilities: An Unmet Need

*Shanon S. Taylor and Tammy V. Abernathy*

#### **Abstract**

Individuals with disabilities experience higher rates of mental, emotional, physical, and sexual abuse than those without disabilities. Children with disabilities are 3.4 times more likely to experience sexual abuse than their peers without disabilities. Although a variety of resources have been created to help improve the sexual health of people with disabilities, one area that is seriously lacking is access to sexual health information and education. Previous work has identified several barriers to providing sexual health education to adolescents and youth with disabilities, including lack of teacher preparation, lack of teacher knowledge that leads to fear, concern, and anxiety, parental anxiety and fear, the lack of valid and reliable sexual health education materials for students with disabilities, and the sexuality of students with disabilities viewed as deviant. This chapter will review those issues and discuss methods to improve sexual health education for youth with disabilities.

**Keywords:** sexual health education, disabilities, adolescents, teacher preparation, parents

#### **1. Introduction**

Sexual health is part of the human experience, yet it is often ignored, especially regarding students with disabilities [1–3]. Sexual health education for people with disabilities is important to help and ensure the capacity of each individual to make informed and educated choices regarding personal safety, developing and maintaining healthy relationships, and understanding how to maintain sexual health and hygiene. The application of self-determination skills plays an integral role in the ability of students with disabilities to attain sexual health [4–8].

Educators are fearful and anxious when they attempt to educate students with disabilities (SWD) about their sexual health [3, 5, 6]. There are numerous and valid reasons for this fear and anxiety. General and special educators report not feeling qualified to teach sexual health education, fear of repercussions from administration, questions over obtaining parental consent and liability, a lack of professional knowledge, concern that they will do more harm than good, and a lack of awareness on how to help a student develop a positive sexual identity [9–13]. This discomfort originates in cultural taboos, rules, and restrictions embedded in school and state policy, and an overall lack of preparation. **Figure 1** outlines critical facts regarding the sexual health of individuals with disabilities (IWD).


#### **Figure 1.**

*Facts regarding sexual health of individuals with disabilities (IWD) [1–3, 6, 14–18].*

### **2. Barriers to sexual health education for SWD**

Over the last decade, there has been growing acknowledgment of the need for sexual health education for SWD, especially in the United States [4, 7, 8, 15, 19]. However, researchers have identified several existing barriers that have made providing this education difficult [10–13, 16, 19]. First and foremost would be the social and political controversy that exists in the United States over comprehensive sexual health education (CSE) for all students, much less SWD. Funding for school-based sexual health education programs is only provided for programs that are abstinence-based, despite research demonstrating that CSE programs that cover safer sex methods to prevent sexually transmitted infections, issues of consent, and methods of preventing pregnancy are more effective in reducing rates of adolescent sexual activity, pregnancy, and sexually transmitted infections [3, 19–22].

Additional barriers exist specifically in providing sexual health education to SWD. The primary barriers that researchers have identified include—the sexuality of SWD viewed as deviant, the lack of valid and reliable sexual health education materials for students with disabilities, parental anxiety and fear, lack of teacher preparation, and lack of teacher knowledge that leads to fear, concern, and anxiety [19].

#### **2.1 Views of sexuality of IWD as deviant**

A key barrier to providing sexual health education to SWD is the view that IWD is asexual or that sexuality for IWD is abnormal or deviant [8, 23]. IWD finds that they are often portrayed as having libidos that are uncontrollable, particularly those with intellectual disabilities [24, 25]. When sexual health education is provided to IWD, it is primarily focused on preventing abuse or pregnancy, and generally does not discuss *Sexual Health Education for Youth with Disabilities: An Unmet Need DOI: http://dx.doi.org/10.5772/intechopen.104420*

relationships or entertain the idea that IWD might enter into sexual relationships for pleasure [26–28]. Finally, when sexual health education is provided to IWD, it is typically only presented as heterosexual sexual health information. IWD can present as LGBTQ+, just as nondisabled individuals can, and they are entitled to sexual health education on those issues. Caregivers have reported homosexual behaviors as experimentation [29], and individuals with intellectual disabilities reported confusion about what it means to be gay and having questions about LGBTQ+ individuals, indicating a need for clearer education [30].

#### **2.2 Lack of valid and reliable sexual health education materials for SWD**

Materials to provide sexual health education to SWD generally lack reliability and validity, and when used, they are not implemented with fidelity [6, 31]. Materials that are promoted to provide sexual health education for SWD sometimes are more focused on the students' disabilities than actually providing the needed information regarding sexual health [32]. Other researchers have attempted making adaptations and modifications to existing sexual health curricula using methods, such as Universal Design for Learning principles [33]; however, since most prepared curricula rely heavily on written materials, adapting these for SWD who have limited literacy or are nonverbal will be extremely difficult, and again, will lack validity and reliability.

#### **2.3 Parental anxiety and fear**

A key component in providing sexual health education to SWD is parental consent and support. Many parents of SWD either believe their children do not require sexual health education because they view their child as an asexual being or they simply have fears and anxiety about their child engaging in sexual activity [9–11, 34–38]. In discussing their own fears about their child engaging in sexual activity and how to properly educate their child on sexual health matters, parents will often voice views that contradict other views. In some cases, parents state that they do not know enough to be able to properly provide sexual health education to their child with a disability [39], while in other studies, they clearly indicate a preference for being the primary providers of sexual health information to their child [37]. In cases where parents do provide information, IWD often reports that the information is provided in late adolescence or adulthood and is focused on avoiding pregnancy, sexually transmitted infection, or abuse, and that they need more information on how to establish and maintain healthy sexual relationships with others [38]. Parents need to be provided information on how to teach their children with disabilities about sexual health and what the proper information is to teach and when it should be taught [40].

#### **2.4 Lack of teacher preparation and teacher knowledge**

Teachers receive a great deal of training to teach content in a number of areas, but sexual health is typically not one of them. When asked about their comfort levels to provide sexual health education in general, teachers report feeling unprepared and having little to no formal training to do so [6, 8, 41, 42]. This becomes more acute when teachers are asked to provide sexual health education to students with disabilities. Even special educators, trained to provide education to SWD, report feeling unprepared to provide sexual health education to those students while acknowledging the necessity of the material [43].

This lack of preparation leads to low rates of teacher knowledge about the necessary components of comprehensive sexual health education and how to teach it to SWD, as well as anxiety and fear about teaching the content to SWD [44]. Studies have found teachers are afraid to teach sexual health education in the general education setting, fearing parental responses and lack of support from the administration [41, 45]. These fears intensified when examining teaching sexual health education to SWD [11]. Instructors have reported feeling that family members do not want sexual health information provided to their child with a disability until the child acts out in some sexual manner or shows interest in a relationship, then the professionals feel they are responding in only a reactionary way, not educating [46].

#### **3. Issues in sexual health education for IWD worldwide**

These barriers outlined in the sections above are not unique to the United States or the European Union. While some parts of the world may have introduced comprehensive sexual health education earlier than others, the concept is now worldwide. Additionally, recognition of the need to educate IWD about sexual health is also widespread and is being researched in many countries outside of the United States and Europe. Typically, researchers find some of the same barriers in African and Asian countries that have been demonstrated previously, such as the contradiction between parents' desire to teach children sexual health education themselves and their ability to do so [36, 37]. Researchers in countries as widespread as Canada, Ghana, and China report that sexual health education for IWD is limited in those countries by the typical belief that IWD is asexual and do not need information regarding sexual practices [47–49]. Additionally, cultural and religious beliefs in many countries make comprehensive sexual health education difficult, as it would not be accepted to discuss sexual intercourse outside of marriage, birth control, or topics related to LBTQ+ relationships, and in some cultures even discussing sex at all is unusual [36, 47, 48]. However, it is encouraging that researchers are examining the need for sexual health education for IWD in countries worldwide and how parents, caregivers, and professionals are addressing the need within their own cultural and religious landscapes.

#### **4. The need for sexual health education**

Sexual health education includes the teaching of issues relating to human sexuality including human sexual anatomy, sexual reproduction, sexual intercourse, or other sexual activity, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, and birth control [3, 50]. Common avenues for sexual health education are parents or caregivers, formal school programs, and public health campaigns.

Educating IWD about sexual health issues is critical for their own personal health, safety, and because as with any individual, they are entitled to self-agency to make decisions about their own bodies. When working with IWD, we call this concept self-determination. Self-determination is a life goal for persons with disabilities. It is a set of attitudes and skills that allow a person to care for themselves and carve out goals to achieve as much independence as possible. Self-determination is essentially the ability of a person to be responsible for their life. The components of self-determination include: self-awareness and self-awareness; goal setting and attainment

#### *Sexual Health Education for Youth with Disabilities: An Unmet Need DOI: http://dx.doi.org/10.5772/intechopen.104420*

skills; independence, risk-taking, and safety skills; self-observation, evaluation, and reinforcement; self-instruction, self-advocacy and leadership skills; internal locus of control; and positive attributions of efficacy [51].

The teaching of sexual health to SWD is not typically included in the curriculum of self-determination. However, learning about sexuality embodies the very core of self-determination. While many of the self-determination components have been incorporated into the curriculum for SWD since the 1990s, sexual health has not been directly included [8, 52]. It is easy to deny SWD opportunity and access to sexual health education if it is assumed that students will generalize their selfdetermination strategies to include sexual health. Educators understand that the generalization of skills and strategies must often be explicitly taught to students with disabilities [53]. Educators need to connect sexual health with self-determination for SWD.

#### **5. Potential solutions to improve sexual health education for IWD**

While early research was focused on spotlighting the need for sexual health education for IWD, more recent areas of research have focused on how this education can be effectively delivered. This area of research is much more recent and still relatively recent. There appear to be two primary methods of delivering this education to IWD: preparing parents/caregivers of IWD to provide sexual health education and preparing educators to provide sexual health education. These do not have to be separate tracks of preparation. Even if educators will be providing sexual health education, it is important to also prepare parents/caregivers, because they need to have a perception and understanding of their child with a disability as an individual who is a sexual being with needs and feelings [8].

#### **5.1 Preparing parents**

It is recognized that the most effective means of proving sexual health education to SWD involve partnerships between parents/caregivers and education professionals [40, 48, 49]. This will be especially true in cultures in which parents prefer to be the main provider of sexual health information to their children, but perhaps are unsure of what information to provide or when [37]. Additionally, collaborating with parents/caregivers on functional life skills that students will need as they transition into adult life is already a recognized evidence-based practice [51, 52], so including sexual health education along with the discussion on job skills and independent living may make it a more comfortable conversation for parents to have with educators.

Several studies have piloted workshops or education programs educators can use to prepare parents/caregivers to provide sexual health education to their children with disabilities [34, 40, 54–56]. These studies are not limited to the United States and Europe, but worldwide, and all have demonstrated that when parents participate in preparation programs, they gain a greater appreciation of the need to provide sexual health education to their child and gain knowledge on how to provide that education themselves. The modalities of these programs vary (online, booklets, in-person groups), but one study conducted in Iran demonstrated that training conducted with mothers in group settings was more effective than via other modalities [56]. Another set of researchers is currently piloting a full curriculum that can be used to

lead in-person trainings with parents to prepare them to comfortably provide sexual health education to their children with disabilities [57]. This research will further support collaboration between parents and professionals.

#### **5.2 Preparing teachers**

A significant barrier to teaching sexual health to students with disabilities is the teacher's discomfort with the topic and a general lack of pre-service and/or in-service preparation [6, 9, 10]. The only way to move through this barrier is to have the teacher become comfortable with the uncomfortable. Below, we will provide an example from our own experience as teacher educators that address this issue.

To start this process, sexual health for students with disabilities was added to special education teacher education coursework. One course within the teacher education program was identified by the program coordinator as appropriate for this project. The course included content on self-determination, transition, and methods for teaching students with disabilities in secondary schools. The course was positioned in the program during the last semester of coursework prior to internship (student teaching) with 25–30 students typically enrolled. Students in the course completed their teacher education program as a soft cohort, meaning most of the students took their courses together. All students took at least one course with the cohort prior to this course. The fact that students were well known to each other was an important consideration in selecting the course. This allowed students to feel safe and comfortable discussing sexuality and expressing their concerns. It is important to note that in this configuration the professor was often the only person in the room that was unknown to the students.

Sexual health is a topic that is presented in the course syllabus, but it is always placed at the end of the semester. This allows time for the professor to create a safe environment and to build rapport with the students. When students are asked to look through the course topics and talk about what excites them and what concerns them, sexual health is consistently mentioned as a concern. It is never a topic the student teachers are excited to learn about. There is anxiety regarding the topic. This informal data point is important in terms of building community and preparing for the topic.

To prepare pre-service teachers for instruction in sexual health, the course included short mini-lectures reviewing adolescent development. Additionally, preservice teachers completed a series of community and school observations focusing on body language, touching, sexual innuendo, followed by a review of media and music that adolescents find engaging.

The course focused on strategies teachers could use to develop self-determination and student engagement in the individualized education program (IEP) and transition process. This section of the course was essential, as it developed specific skills, and perhaps equally important was the development of a teacher's disposition to promote self-determination development in all students with disabilities [58, 59].

Observations combined with instruction and skill development in self-determination served as precursors to instruction in sexual health. By this time in the course, pre-service teachers and the professor had formed a strong and comfortable relationship. Further, pre-service teachers had enough practicum and substitute teaching hours to have encountered sexual health situations that they had felt unprepared to address. This confluence of professional experiences reduced the pre-service teachers' anxiety about sexual health as a course topic.

#### *Sexual Health Education for Youth with Disabilities: An Unmet Need DOI: http://dx.doi.org/10.5772/intechopen.104420*

To provide the sexual health content, the professor of the course collaborated with a health educator, who had training in sexual health and special education. The health educator worked within the College of Education and was familiar with the teacher education program. This model demonstrated to the pre-service teachers that collaboration and partnerships can be an effective approach when teaching topics in which they lacked expertise. Collaboration with the health educator bridged the knowledge between special education and sexual health education. Instruction in sexual health was provided by the health educator during a guest lecture and was divided into two sections. Initially, pre-service teachers were introduced to the topic through a more traditional lecture presentation merging the topic of sexuality in relation to selfdetermination for students with disabilities. After the lecture section, the pre-service teachers participated in a structured activity that included six real-life dilemmas practicing special education teachers had encountered. This activity was designed to develop teacher confidence in the topic.

A class activity entitled the "Real Life Dilemma" was introduced. The class was divided into six groups with each group receiving one unique dilemma. Each dilemma was an actual situation that had occurred locally or nationally within the past 6 years in the United States. The class was given 30 min to review a dilemma and make a decision (i.e., what action will you take?). Each group shared with the class their dilemma, the key issues discussed, and their decision. After the conclusion of each such discussion, the health educator shared the actual outcome with the class. The actual outcome was then discussed and evaluated in a short debriefing of the dilemmas. The discussions were led by both the health educator and the course professor. The following questions were posed during the debriefing of the activity:


Pre-service teachers responded to the dilemmas within a positive self-determination framework in 8 out of 12 responses (67% of the responses were positive). In four instances, pre-service teachers' responded with a solution that did not promote selfdetermination for students with disabilities. The actual outcomes of the six dilemmas were situations involving practicing special education teachers. Those teachers took action within a positive self-determination framework in 4 out of the 6 dilemmas (67% of the responses were positive). For both groups the responses that did not promote self-determination were ambivalent, or safe responses, perhaps reflecting the anxiety teachers feel when approaching sexual health topics.

Pre-service teacher responses favored solutions promoting self-advocacy, selfawareness, and self-efficacy. These are considered more internally focused components of self-determination. These components are not directly taught, but rather they must be facilitated over a long period of time and in a variety of situations. Teachers whose responses were the actual outcomes in this project used decision-making and goal setting as the favored self-determination components. Interestingly, pre-service teachers in the course focused their responses more on the student-centered components of self-determination, whereas, practicing teachers focused more on student thinking and planning. These components could be directly taught. Most importantly, self-determination components were strongly represented throughout the dilemmas in terms of how teachers and students should solve dilemmas related to sexual health for students with disabilities.

#### **6. Conclusions**

Great advances have been made in the last two decades in teaching sexual health education to individuals with disabilities and this means we are making advances toward recognizing IWD as self-determined individuals with autonomy and rights over their bodies. But while we have done much to illuminate the need for sexual health education for IWD and identify existing barriers, our next steps must be in researching the most effective ways to provide it. Current research indicates that we should take a twopronged approach: prepare both parents and educators to work together and be able to provide knowledgeable, appropriate sexual health education to students with disabilities.

#### **Acknowledgements**

The authors wish to thank Anna Treacy, Ph.D. for the passion and inspiration she gave us as we were developing this work.

### **Conflict of interest**

The authors declare no conflict of interest.

### **Author details**

Shanon S. Taylor\* and Tammy V. Abernathy University of Nevada, Reno, Reno, Nevada, United States of America

\*Address all correspondence to: shanon@unr.edu

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Sexual Health Education for Youth with Disabilities: An Unmet Need DOI: http://dx.doi.org/10.5772/intechopen.104420*

#### **References**

[1] Alriksson-Schmidt AI, Armour BS, Thibadeau JK. Are adolescent girls with a physical disability at increased risk for sexual violence? Journal of School Health. 2010;**80**:361-367

[2] Murphy NA, Elias ER. Sexuality of children and adolescents with developmental disabilities. Pediatrics. 2006;**118**:398-403 Available from: http://www.pediatrics.org

[3] SIECUS: Sexuality Information and Education Council of the United States. Promoting adolescent sexual health education and advance sexuality education. 2017. Available from: http://www.siecus.org

[4] Kirby D, Coyle K, Forrest A, Rolleri L, Robin L. Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs. Scotts Valley, California: ETR Associates; 2011

[5] Klein A, Breck SE. 'I wish I had known the truth sooner' middle school teacher candidates' sexuality education experiences. Research at Middle School Level Education. 2010;**33**:1-10

[6] Preston M. "Very very risky": Sexuality education teachers' definition of sexuality and teaching and learning responsibilities. American Journal of Sexuality Education. 2013;**8**:18-35. DOI: 10.1080/15546128.2013.790223

[7] Slocum V., Eyres R.M., Harkins E. A. 2016. To puberty and beyond: Sexuality education for ALL students. Paper session presented at the Annual Conference of the Teacher Education Division (TED) of the Council for Exceptional Children (CEC), Lexington, KY

[8] Travers J, Tincani M, Whitby P, Boutot AE. Alignment of sexuality education with self-determination for people with significant disabilities: A review of research and future directions. Education and Training in Autism and Developmental Disabilities. 2014;**49**:232-247

[9] Barnard-Brak L, Schmidt M, Chesnut S, Wei T, Richman D. Predictors of access to sex education for children with intellectual disabilities in public schools. Intellectual and Developmental Disabilities. 2014;**52**:85-97

[10] Eisenberg M, Madsen N, Oliphant J, Sieving R. Barriers to providing the sexuality education that teachers believe students need. Journal of School Health. 2013;**83**:335-342

[11] Rohleder P. Educators' ambivalence and managing anxiety in providing sex education for people with learning disabilities. Psychodynamic Practice. 2010;**16**:165-182

[12] Treacy AC. A mixed methods study of sexual health education for students with disabilities. Doctoral dissertation. 2016. Available from: ProQuest Dissertations and Theses Global. (1870038073)

[13] Eisenberg M, Madsen N, Oliphant J, Sieving R. Barriers to providing the sexuality education that teachers believe students need. Journal of School Health. 2013;**83**:335-342

[14] Skarbek D, Hahn K, Parrish P. Stop sexual abuse in special education: An ecological model of prevention and intervention strategies for sexual abuse in special education. Sexuality & Disability. 2009;**27**:155-164. DOI: 10.1007/ s11195-009-9127-y

[15] Boehning A. Sex education for students with disabilities. Law & Disorder. 2006;**1**:56-66

[16] Wilkenfeld B, Ballan MS. Educators' attitudes and beliefs towards the sexuality of individuals with developmental disabilities. Sexuality and Disability. 2011;**29**:351-361. DOI: 10.1007/s11195-011-9211-y

[17] Schaafsma D, Kok G, Stoffelen JMT, Curfs LMG. People with intellectual disabilities talk about sexuality: Implications for the development of sex education. Sexuality and Disability. 2017;**35**:21-38

[18] Center for Disease Control and Prevention (CDC). Disability and Health: Healthy Living. 2017. Available from: https://www.cdc.gov/ncbddd/ disabilityandhealth/healthyliving.html

[19] Treacy A, Taylor ST, Abernathy TV. Sexual health education for individuals with disabilities: A call to action. American Journal of Sexuality Education. 2018;**13**:65-93

[20] Kirby D. The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior. Sexuality Research and Social Policy. 2008;**5**:18-27

[21] Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health. 2008;**42**:344-351

[22] Santelli JS, Kantor LM. Introduction to special issue: Human rights, cultural, and scientific aspects of abstinenceonly policies and programs. Sexuality Research and Social Policy. 2008;**5**:1-5

[23] Gill M. Already Doing it: Intellectual Disability and Sexual Agency. Minneapolis, MN: University of Minnesota Press; 2015

[24] Martino AS, Campbell M. Exercising intimate citizenship rights and (re)

constructing sexualities: The new place of sexuality in disability activism. In: The Routledge Handbook of Disability Activism. New York: Routledge; 2019. pp. 97-109

[25] Kulick D, Rydström J. Loneliness and Its Opposite. Durham, NC: Duke University Press; 2015

[26] Azzopardi-Lane C, Callus A. Constructing sexual identities: People with intellectual disability talking about sexuality. British Journal of Learning Disabilities. 2015;**43**:32-37. DOI: 10.1111/ bld.12083

[27] Brown M, McCann E. Sexuality issues and the voices of adults with intellectual disabilities: A systematic review of the literature. Research in Developmental Disabilities. 2018;**74**:124- 138. DOI: 10.1016/j.ridd.2018.01.009

[28] Friedman C, Arnold CK, Owen AL, Sandman L. "Remember our voices are our tools:" Sexual self-advocacy as defined by people with intellectual and developmental disabilities. Sexuality and Disability. 2014;**32**(4):515-532. DOI: 10.1007/s11195-014-9377-1

[29] Löfgren-Mårtenson L. The invisibility of young homosexual women and men with intellectual disabilities. Sexuality and Disability. 2009;**27**(1): 21-26. DOI: 10.1007/s11195-008-9101-0

[30] Hole R, Schnellert L, Cantle G. Sex: What is the big deal? Exploring individuals' with intellectual disabilities experiences with sex education. Qualitative Health Research. 2021;**32**(3):453-464. DOI: 10497323211057090

[31] Grievo A, McLaren S, Lindsay WR. An evaluation of research and training resources for the sex education of people with moderate to severe learning disabilities. British Journal of Learning

*Sexual Health Education for Youth with Disabilities: An Unmet Need DOI: http://dx.doi.org/10.5772/intechopen.104420*

Disabilities. 2007;**35**:30-37. DOI: 10.1111/j.1468-3156.2006.00401.x

[32] Winges-Yanez N. Discourse analysis of curriculum on sexuality education: FLASH for special education. Sexuality and Disability. 2014;**32**:485-498

[33] Grove L, Morrison-Beedy D, Kirby R, Hess J. The birds, bees, and special needs: Making evidence-based sex education accessible for adolescents with intellectual disabilities. Sexuality and Disability. 2018;**36**:313-329

[34] Kok G, Akyuz A. Evaluation of effectiveness of parent health education about the sexual developments of adolescents with intellectual disabilities. Sexuality and Disability. 2015;**33**:157-174

[35] Suter S, McCracken W, Calam R. Sex and relationships education: Potential and challenges perceived by teachers of the deaf. Deafness and Education International. 2009;**11**:211-220

[36] Kamaludin NN, Muhamad R, Mat Yudin Z, Zakaria R. Barriers and concerns in providing sex education among children with intellectual disabilities: Experiences from Malay mothers. International Journal of Environmental Research and Public Health. 2022;**19**:1070

[37] Bartin L, Çağla GÜR, Cahit NURİ. Examining the views of parents with special needs children regarding their children's sex education (North Cyprus sample). Turkish International Journal of Special Education and Guidance & Counselling. 2021;**10**:125-140

[38] Kammes RR, Douglas SN, Maas MK, Black RS. Parental support for sexuality education and expression among adults with an intellectual disability. Sexuality and Disability. 2020;**38**:669-686

[39] Gürol A, Polat S, Oran T. Views of mothers having children with intellectual disability regarding sexual education: A qualitative study. Sexuality and Disability. 2014;**32**:123-133

[40] Rooks-Ellis DL, Jones B, Sulinski E, Howorth S, Achey N. The effectiveness of a brief sexuality education intervention for parents of children with intellectual and developmental disabilities. American Journal of Sexuality Education. 2020;**15**:444-464

[41] Eisenberg M, Madsen N, Oliphant J, Sieving R. Barriers to providing the sexuality education that teachers believe students need. Journal of School Health. 2013;**83**:335-342

[42] Klein A, Breck SE. 'I wish I had known the truth sooner' middle school teacher candidates' sexuality education experiences. Research at Middle School Level Education. 2010;**33**:1-10

[43] Howard-Barr EM, Rienzo BA, Pigg RM Jr, James D. Teacher beliefs, professional preparation, and practices regarding exceptional students and sexuality education. Journal of School Health. 2005;**75**:99-104

[44] Fader Wilkenfeld B, Ballan MS. Educators' attitudes and beliefs towards the sexuality of individuals with developmental disabilities. Sexuality and Disability. 2011;**29**:351-361

[45] Goldman JD, Coleman SJ. Primary school puberty/sexuality education: Student-teachers' past learning, present professional education, and intention to teach these subjects. Sex Education. 2013;**13**:276-290

[46] Lafferty A, McConkey R, Simpson A. Reducing the barriers to relationships and sexuality education for persons

with intellectual disabilities. Journal of Intellectual Disabilities. 2012;**16**:29-43

[47] Shamrock OW, Ginn HG. Disability and sexuality: Toward a focus on sexuality education in Ghana. Sexuality and Disability. 2021;**39**:629-645

[48] Wu J, Zeng S. Sexuality education for children and youth with disabilities in Mainland China: Systematic review of thirty years. Children and Youth Services Review. 2020;**116**:1-6

[49] Davies AW, Balter AS, van Rhijn T, Spracklin J, Maich K, Soud R. Sexuality education for children and youth with autism spectrum disorder in Canada. Intervention in School and Clinic. Advance online publication. DOI: 10.1177/10534512211051068

[50] Future of Sex Education Initiative (FoSE). National sexuality education standards: Core content and skill K-12 (a special publication of the Journal of School Health). 2012. Available from: http://www.futureofsexed.org/

[51] Wehman P. Life beyond the Classroom: Transition Strategies for Young People with Disabilities. 5th ed. Baltimore, Maryland: Paul H. Brookes Publishing Co., Inc.; 2012

[52] Smith TE, Gartin B, Murdick NL. Strategies for teaching self-determination skills with adolescents with disabilities. In: Smith TE, Gartin B, Murdick NL, editors. Including Adolescents with Disabilities in General Education Classrooms. Boston, MA: Pearson; 2012

[53] Wehmeyer ML, Martin JE, Sands DJ. Self-determination and students with developmental disabilities. In: Parette HP, Peterson-Karlan GR, editors. Research-Based Practices in Developmental Disabilities. 2nd ed. Austin, TX: Pro-Ed; 2008. pp. 99-122

[54] Yıldız G, Cavkaytar A. Effectiveness of a sexual education program for mothers of young adults with intellectual disabilities on mothers' attitudes toward sexual education and the perception of social support. Sexuality and Disability. 2017;**35**:3-19

[55] Venkat Lakshmi H, Navya S. Assessment of knowledge attitude and practices of parents towards imparting sexual health education for their intellectually challenged children. Language in India. 2012;**12**(12):595-606

[56] Goli S, Noroozi M, Salehi M. Comparing the effect of two educational interventions on mothers' awareness, attitude, and self-efficacy regarding sexual health care of educable intellectually disabled adolescent girls: A cluster randomized control trial. Reproductive Health. 2021;**18**:1-9

[57] Frank K, Sandman L. Supporting parents as sexuality educators for individuals with intellectual disability: The development of the home BASE curriculum. Sexuality and Disability. 2019;**37**:329-337

[58] Treacy A, Abernathy TV. Sexual Health Education and Self-Determination. Lexington, KY: Paper presented at the Teacher Education Division of CEC Annual Meeting; 2016

[59] Treacy A, Abernathy TV. Utilizing Self-Determination Skills to Improve Sexual Health Education. CEC Annual Meeting, Myrtle Beach, SC: Paper presented at the Division of Career Development and Transition; 2016

Section 5
