Perspectives On Sex Ed

Cult Stud of Sci Educ (2013) 8:403431
DOI 10.1007/s11422-012-9451-x
Urban high school students perspectives about sexual

health decision-making: the role of school culture
and identity
Jennie S. Brotman Felicia Moore Mensah
Received: 31 August 2012 / Accepted: 31 August 2012 / Published online: 11 October 2012
Springer Science+Business Media B.V. 2012
Abstract Studies across fields such as science education, health education, health behavior,
and curriculum studies identify a persistent gap between the aims of the school curriculum and
its impact on students thinking and acting about the real-life decisions that affect their lives.
The present study presents a different story from this predominant pattern in the literature.
Through a year-long ethnographic investigation of a health-focused New York City public high
schools HIV/AIDS and sex education program, this study illustrates a case in which 20 12th
grade students respond positively to their education on these topics and largely assert that
school significantly influences their perspectives and actions related to sexual health decisionmaking. This paper presents the following interpretation of this positive influence: school
culture influences these students perspectives and decisions around sexual health by contributing to the formation of students identities. This paper further shows how science learning
in particular becomes important for students in relation to decision-making when it is linked to
issues of identity. These findings suggest that, in addition to attending to the design of
classroom curriculum, HIV/AIDS and sex education researchers and curriculum developers
(as well as those in science education focusing on other controversial science topics) might also
explore the kinds of relational and school-wide factors that potentially influence students
identities, decisions, and responses to school learning.
Keywords Decision-making Identity HIV/AIDS Sex education Biology
School culture
Across the globe, students report that HIV/AIDS and sex education are irrelevant to their lives,
not taken seriously, unsuccessful at teaching them what they really want to know, and
Lead Editor: M. Espinet
J. S. Brotman (&)
Teaching Matters, Inc., New York, NY, USA
e-mail: jsb2137@columbia.edu
F. M. Mensah
Department of Mathematics, Science, and Technology, Teachers College, Columbia University, New
York, NY, USA
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J. S. Brotman, F. M. Mensah
unlikely to influence their decisions around sexuality (e.g. Buckingham and Bragg 2004).
Students in these studies criticize curriculum for its focus on factual, scientific information and
its lack of attention to social and emotional concerns, and cite infrequent opportunities to get
questions directly answered. Studies also illustrate how sex education does not adequately
acknowledge cultural influences on sexuality and decision-making, making it particularly
lacking in addressing the concerns of immigrant and minority youth (Ward and Taylor 1992).
In addition to these qualitative findings, quantitative studies that aim to assess curricular
impacts by evaluating the extent to which programs change certain behaviors also struggle
to definitively identify positive curricular influences on young people. These studies are
much more common than qualitative investigations of students responses to and experiences participating in curriculum, particularly in the United States. Recent reviews of these
quantitative studies find that although an increasing percentage of programs positively
impact subsets of behaviors (Kirby, Laris, and Rolleri 2006), behavioral changes are shortterm, waning over time (DiClemente, Salazar, and Crosby 2007).
Furthermore, studies in the field of science education that investigate students interactions with other controversial science topics that, like HIV/AIDS and sexual health, also have
the potential to influence students personal and societal decisions, raise similar concerns
about the influence of school learning on real-life choices. That is, a growing body of
literature investigating students reasoning and decision-making about controversial science
topics that generate socioscientific and personal dilemmas shows that science learning,
particularly science learned in school, does not commonly factor into students decisionmaking processes. For example, Troy Sadler (2004), in a review of the empirical literature on
informal reasoning, identified multiple studies showing that students have a tendency to
compartmentalize scientific evidence and the information they use to make personal decisions, and exhibit an exclusion of science from the personal domain (p. 524).
Therefore, studies across fields such as science education, health education, health behavior,
and curriculum studies identify a persistent gap between the aims of the school curriculum and its
impact on students thinking and acting about the real-life decisions that affect their lives. The
present study presents a different story from this predominant pattern in the literature. Through a
year-long ethnographic investigation of a health-focused New York City public high schools
HIV/AIDS and sex education program, we illustrate a case in which 12th grade students respond
positively to their education on these topics and largely assert that school significantly influences
their perspectives and actions related to sexual health decision-making. In this paper, we draw on
focus groups, student and teacher interviews, and participant observation at multiple grade levels
over the course of approximately one school year to present an interpretation of this positive
influence. More specifically, we make the argument that school culture influences these students
perspectives about sexual health choices. Furthermore, we argue that school culture asserts this
salient influence by contributing to the formation of students identities. We discuss the implications of these findings for HIV/AIDS and sexual health education, as well as for science
education around controversial science topics more generally. In the next section, we discuss the
theoretical ideas about the relationship between learning, curriculum, school culture, and identities that inform this interpretation.
Linking learning, curriculum, school culture, and identities

Theories of situated cognition that link learning with identity formation (Wenger 1998)
underlie this study. Etienne Wenger argues that through our learning via participation in
different communities of practice, we take on particular identities:
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Because learning transforms who we are and what we can do, it is an experience of
identity. It is not just an accumulation of skills and information, but a process of
becomingto become a certain person or, conversely, to avoid becoming a certain
person. (p. 215)
From this point of view, for school learning to be meaningful, it must address issues of
identity that relate to students learning and becoming inside and outside of the classroom.
Wenger articulates that schools gain relevance not just by the content of their teachingbut by the experiments of identity that students can engage in while there (1998,
p. 268). Nancy Brickhouse (2001) applies these ideas to science education, arguing that
science learning is not simply a matter of acquiring scientific understandings but instead
requires that students view scientific identities as compatible with their broader forming of
identities as people in the world.
In a related vein, Stanton Wortham (2003) further articulates how curriculum has the
potential to influence the development of students social identities, which he views as both
reflective of broader sociohistorical themes and categories but also constructed in local
contexts and situations. In an ethnographic study of a ninth grade class, Wortham analyzes
how one students emerging social identity depended on curricular categories (p. 229).
More specifically, he shows how connections made during class discussions between this
student and a particular theme being discussed in the curriculum (namely the relationship
between individuals and communities) helped to construct this individuals identity as a
disruptive outcast from the classroom community (p. 228). Thus, the academic content
being covered was used to position this student in a certain way. Based on this analysis,
Wortham argues that we must pay closer attention to the interdependence of academic
learning and social identity development (p. 244).
We use and extend Worthams lens to explore how not just classroom curriculum and
academic learning, but broader features of school culture, influence the formation of a
particular identity in the participants of this study. In conceptualizing school culture, we
draw upon the literature on organizational culture, specifically Edgar Scheins (2004)
articulation of three levels of culture of an organization that include artifacts,
espoused beliefs and values, and underlying assumptions (p. 26). Artifacts, the
visible organizational structures and processes (p. 26) of a group, are the easiest to
observethey are what one sees, hears, and feels when one encounters a new group with
an unfamiliar culture (p. 25). Espoused beliefs and values include the strategies, goals,
and philosophies (p. 26) of an organizationthey are how members of the organization
articulate what they think is important. Finally, the third level of culture, underlying
assumptions, includes the unconscious, taken-for-granted beliefs, perceptions, thoughts,
and feelings (p. 26) that are the least explicitly articulated but the most fundamental to the
way the organization functions. For Schein, these assumptions are rooted in deep ideas
about what is real, how to determine the truth or falsity of something, how to measure
time, how space is allocated, what human nature is, and how people should get along with
each other (p. 137). We extend and apply Scheins multi-layered framework to schools
and argue that this combination of levels of culture in a school (from the observable to the
unconscious) serves to position students in certain ways and thus foster their adoption of
certain identities. Thus, the ways in which schools overtly and implicitly make possible
certain identities for their students is integral to our conception of school culture.
In highlighting the formation of students identities, we do not mean to suggest that
students identities are singular, unchanging, or uniform in all situations. Instead, we take a
poststructuralist perspective that views identities as multiple as opposed to unitary
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(Davies 2000, p. 55). That is, someone can take on one identity in one context and another
identity in a different context. As articulated by Bronwyn Davies (1989), people can have
different possible selves located in different story-lines (p. 229). Similarly, James Paul
Gee (1997) argues that, We are different situated selves, and discusses how people can
feel like, act like, and look like different people depending on the situation (p. xiii).
Wengers (1998) conceptualization of identity is consistent with these ideas as well, as he
does not view identity as static, as some primordial core of personality that already
exists or something we acquire at some point in the same way that, at a certain age, we
grow a set of permanent teeth (p. 154). Instead, identity is a constant becoming and
something we constantly renegotiate during the course of our lives (p. 154).
Therefore, in discussing how school culture influences identity formation, we are not
arguing that this forms one core, static identity in students. Instead, we argue that factors
related to school culture provide opportunities for students to position themselves and to be
positioned as particular selves in particular situationsand that this positioning influences their responses to their school learning and their perspectives about sexual health
decision-making. These theoretical perspectives shape the interpretation that we use to
answer the primary research question guiding this study: In a health-focused school, how
does school culture influence urban high school students perspectives about sexual health
decision-making?
Research approach: striving to root interpretation in data

This was a qualitative study, using ethnographic research methods, including focus groups,
student and teacher interviews, and participant observation. Research participants included
20 12th grade students, each of whom participated in one 24 person focus group. To allow
for more prolonged and in-depth discussion with a subset of students, 4 of the participants
also participated in additional focus groups and individual interviews; we refer to these 4
students as the extended focus group. In order to gain a deeper understanding of the
school culture and curriculum around HIV/AIDS and sex education, we also spent one
school year conducting participant observation in health and science classes at multiple
grade levels. Additionally, we interviewed the three health and science teachers whose
classes we observed.
Our decision to spend an extended period of time in the school was very purposeful. In
part, it was based on Yvonna Lincoln and Egon Gubas (1985) recommendation that
prolonged engagement in the research setting is one way of ensuring the trustworthiness
of qualitative research. But beyond this, we felt that building rapport with students over
time was essential to having meaningful conversations about the personal and sensitive
issues of sexual healthconversations that both showed ethical respect for students and,
from a methodological perspective, provided trustworthy data. To this end, we intentionally spent a full semester prior to beginning the formal data collection phase of the
study observing and getting to know students, in order to facilitate their comfort with the
first author as a researcher and to provided insight that allowed for the composition of
focus groups that were safe and comfortable environments for students. Finally, the prolonged time spent in the research setting was a way for us to get to know other staff
members through informal conversations and spend time in the school outside of class
time, all of which provided further insight into the school culture and environment.
This study is an interpretive inquiry in which researchers make an interpretation of
what they see, hear, and understand (Creswell 2007, p. 39). Based on careful analysis of
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multiple sources of data, we offer our interpretation of the influence of school culture on
students perspectives and actions regarding sexual health decision-making. We
acknowledge our role as researchers in influencing this interpretation, as well as in
influencing the data collection itself. Therefore, we also acknowledge that ours is not the
only possible interpretation.
With that said, we also aim to make a strong and compelling argument for the interpretation we present, one that is supported by extensive evidence based on our prolonged
time in the school. We turned to the methodological literature on qualitative research for
insight, strategies, and theory that we argue helped us to achieve this aim. First, consistent
with the recommendations of Lincoln and Guba (1985), we provide rich, thick description of our data, so that the basis of our arguments is clearly articulated and can be
evaluated by others. Second, we drew upon aspects of a grounded theory research approach
to facilitate our desire for creating convincing arguments for our interpretations. Specifically, consistent with a grounded theory approach as discussed by Anselm Strauss and
Juliet Corbin (1998), we carefully studied the data both during and after the period of data
collection. We also used grounded theory techniques to conduct a rigorous, thorough,
systematic analysis of the data, one that was both iterative and ongoing throughout the
study.
However, we found the objectivist epistemology of traditional conceptualizations of
grounded theory, such as Barney Glaser and Anselm Strausss (1967) original articulation
of grounded theory, to be inconsistent with our social constructivist epistemological perspective. That is, we view knowledge as a social construction influenced by researcher and
context, as opposed to an objective account of the truth or reality of a situation.
Therefore, we turned to Kathy Charmazs (2006) more recent articulation of grounded
theory, which she calls constructivist grounded theory. According to Charmazs conceptualization of constructivist grounded theory, both data and analyses are social constructions that reflect what their production entailed and any analysis is contextually
situated in time, place, culture, and situation (p. 131). As articulated by Charmaz, any
theoretical rendering offers an interpretive portrayal of the studied world, not an exact
picture of it (p. 10). We found that by drawing heavily upon Charmazs version of
grounded theory, we were able to reconcile our interpretive theoretical lens that
acknowledges our influence as researchers on both the construction and interpretation of
the data we collected, with our desire for a research approach that facilitated the making of
strong, supported arguments for our interpretations that are heavily rooted in our data and
experiences in the research setting.
Participants and setting
This study was conducted at a New York City public school, which enrolls approximately
479 students in grades 7 through 12. The following ethnicities, as listed on the schools
website at the time this study was conducted are: 65 % Hispanic, 30 % Black, 2.5 %
Asian/Pacific Islander, 1.25 % American Indian, and 1.25 % White. Seventy-five percent
of the students are eligible for the free lunch program, and approximately 10 % are English
Language Learners. In addition, about three quarters of the student population is female.
The schools mission is to prepare students for health professions. Consistent with this
mission, students wear medical scrub tops as school uniforms; teachers wear white lab
coats, and students participate in weekly internships at local hospitals and other healthrelated organizations. The school was in its fourth year at the time of this study, and the
12th grade participants of this study were the schools first class as ninth graders.
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Participants in the study came from a class of 29 students in one 12th grade cohort,
which was chosen using purposeful or purposive sampling (Merriam 1998, p. 61). We
chose this cohort, which travels together to all classes, because three of their classes were
relevant to the topics of HIV/AIDS and sexual health. All 29 students in this cohort were
invited to join the study, and 20 consented to participate, including 18 females and 2 males
(indicative of the high proportion of females that attend this school). Participants identified
their ethnicities as follows: 7 Latino(a), 7 African American, 3 African, and 3 West Indian.
Eight students were born outside the United States and have lived here between 4 and
17 years. All but one girl attended this school since ninth grade. All participants were 17 or
18 years of age, except one girl who was 16.
Overview of HIV/AIDS and sex education curriculum
HIV/AIDS and sex education were included in the school curriculum at multiple grade
levels; however, the most direct and prolonged study of these topics occurred in ninth
grade, during an approximately 2-month-long unit, taught once per week. This unit was
taught by Mr. P, with the schools social workers and guidance counselors also attending
and co-teaching lessons. The unit covered topics including HIV/AIDS biology and
transmission, symptoms and treatment of HIV/AIDS and other Sexually Transmitted
Infections (STIs), HIV/STI testing and medical services, contraception, and pregnancy.
Although not covered the year we observed this ninth grade unit, students and Mr. P spoke
about how, when our participants were in ninth grade, the curriculum also included discussions of coercive statements used to pressure people in sexual situations. Mr. P consulted New York Citys mandated HIV/AIDS curriculum in designing the ninth grade unit,
but he did not explicitly follow the city curriculum and aimed to expand upon it.
In 11th grade, the participants of this study also took a year-long health course focused
on health careers, taught by Mr. P, which again addressed the topics of contraception and
pregnancy, in the context of discussions about obstetrics and gynecology. This course was
not offered at the time of this study. Students also took a Regents biology class, taught by
Ms. L, which covered HIV/AIDS biology and transmission, the immune system, and the
reproductive system, including male and female anatomy, the menstrual cycle, pregnancy,
and embryonic development.
In 12th grade, students took a health class that covered a variety of topics, some related
to sex and relationships, such as the characteristics of healthy and unhealthy relationships,
abuse, communication, and infidelity. This class met twice a week during the first half of
the year and three times a week during the second half of the year, and was taught by
Ms. A, one of the schools English teachers. HIV/AIDS and STIs came up occasionally but
were not direct objects of the course of study. In 12th grade, participants also took an
honors-level medicine class twice a week, taught by Mr. P, which focused on medical
terminology and human body systems. HIV/AIDS and STIs came up periodically during
this class in a medical context, such as in relation to body system functions and disorders,
but were not a focus of instruction.
Collecting data from multiple perspectives
In the following sections, we describe each of the data collection methods used in this study
in detail. These include focus groups, extended focus groups, individual student interviews,
individual teacher interviews, and participant observation in health and science classes.
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Gathering students perspectives: focus groups and interviews

While researchers qualify the definition of focus groups in various ways, we adopt David
Morgans (1997) broad definition of focus groups as a research technique that collects
data through group interaction on a topic determined by the researcher (p. 6). There are
several reasons for our choice to use focus groups as one primary method of data collection. First, given the sensitive and personal nature of the topic of sexual health, a group
setting can be a more comfortable way to initially broach these issues. Second, we
expected that peer interaction and dialogue would provide insight into these issues that
could be different than the insights gained from one-on-one conversations with students.
We imagined that students would likely trigger ideas in one another and that the interactive
nature of the groups would provide a rich context within which to understand students
perspectives. This is consistent with Morgans (1997) claim that, integral to the use of
focus groups in qualitative research is the explicit use of group interaction to produce data
and insights that would be less accessible without the interaction found in a group (p. 2).
Morgan also highlights the synergy that can prompt discussion and insight that one
could not obtain in an individual interview (p. 13). Finally, using focus groups gave us the
opportunity to hear from many students, providing multiple perspectives in an efficient
way.
We audio-recorded all focus groups and interviews and transcribed them in their
entirety. We also took field notes after each focus group or interview that described our
initial reflections and impressions as well as observations about tone and body language,
aspects that would not be captured by the tape recording alone. Focus groups and interviews were conducted by the first author after school, lasted approximately 1 hour, and
were semi-structured. Broad, open-ended questions were used as a guide, accompanied by
possible probing questions that were used as needed to prompt further conversation. The
first author reviewed the focus group and interview agenda with the schools health teacher, Mr. P, to ensure that the school was comfortable with and supportive of the questions
discussed with students. In addition, the first author organized the scheduling of groups
during health class. Beyond this, teachers did not play a role in the organization, promotion, or enactment of focus group discussions.
The first author aimed to create a safe, trusting environment for focus groups, where
students felt comfortable sharing ideas about sensitive issues confidentially. As mentioned,
she had been a participant observer in the school for several months before beginning these
groups, which allowed for the development of rapport with students. Groups were purposefully composed with attention to creating safe environments for students; that is, based
on knowledge of the students and their relationships with one another, we were mindful to
avoid grouping students who might not feel comfortable talking in front of one another.
During the groups, the first author facilitated group agreements regarding confidentiality,
encouraged dialogue among the participants, and made clear that they could express or
withhold any opinion or idea they had without censor or pressure. Questions related to
decision-making were intentionally framed broadly, asking participants perspectives on
high school students sexual health decision-making, in order to protect the privacy of
participants speaking in front of their peers; however, several students chose to bring
personal information into the conversations without prompting.
Initial focus groups took place in a classroom. Because we found that one struggle of
this setting was occasional interruption by teachers and students, extended focus groups
took place in a hallway area outside the schools auditorium that was more private. The
first author provided food, and students conversed with her and each other in a casual,
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conversational manner. Students provided positive feedback on the focus groups,

explaining that they appreciated the opportunity to discuss important issues in an open
manner. Extended focus group participants in particular described how they learned from
and became closer to their peers through the experience.
Hearing a range of student perspectives: initial focus groups
Sixteen of the 20 participants took part in one initial focus group, for a total of five initial
group discussions. Each focus group contained three or four participants, with the exception
of one group that contained two participants because of scheduling issues. This study is part
of a larger investigation of students learning and decision-making related to HIV/AIDS
(Brotman 2009). Focus group questions therefore covered topics related to students learning
about HIV/AIDS in multiple contexts of life, including school at multiple grade levels, as
well as their perspectives on how high school students make decisions related to sexual
health. Students were also asked directly how they think school learning influences high
school students decisions at their school, as well as what they think would make school
learning more relevant/influential to their lives and decisions (see Appendix for focus
group questions; questions about decision-making are also presented in Brotman, Mensah,
and Lesko 2010, and questions about learning are also presented in Brotman, Mensah, and
Lesko 2011). The first authors experience as a participant observer also facilitated further
investigations into students school learning experiences. We read through field notes before
focus groups, noting salient observations to inquire into with students.
Delving deeper with the extended focus group
We chose four girls (Hana, Illisha, Dina, and Kasandra; all are pseudonyms) to be part of
the extended focus group. As described above, the rationale for doing this was to have
the opportunity to delve deeper into these topics with a smaller subset of students, in order
to pursue more thoroughly the themes that were raised by the range of perspectives elicited
during initial focus groups. These four girls participated in three 1-h focus group discussions, over the course of 3 weeks. We composed this group based on participants availability and interest in participating, and we also considered group dynamic issues. During
the three discussions with this extended focus group, we addressed the same topics as in the
initial groups, using the same basic protocol as presented in the Appendix; however,
because we had a longer period of time, we were able to spend more time discussing each
topic and therefore go into greater depth. For instance, we spent 1 h-long session discussing their responses to and perceptions of the influence of school learning at multiple
grade levels. Students were asked to elaborate on their learning in each teachers class,
using the following questions for each teacher as a starting point:
Tell me about learning about HIV/AIDS and sex education from Ms. As class.
Did you ever think about what you learned with Ms. A outside of school? When?
How?
How do you think Ms. As class has affected/influenced you?
What suggestions do you have for improving sex education in Ms. As class?
Students were also asked to discuss specific lessons and learning experiences that the
first author observed and to make suggestions and recommendations for the HIV/AIDS/sex
education program overall at their school. Extended focus group participants also shared
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more personal experiences and connections to the topics, as additional time allowed for
enhanced rapport and comfort level.
After the three extended focus group discussions were completed, we interviewed each
of the four girls in the extended group individually. During these interviews, we followed
up on and addressed in more depth what was discussed during the extended focus groups.
Given the sensitive nature of the subject matter, doing individual interviews also allowed
students the opportunity to discuss topics they may not have been comfortable sharing with
the group. Conversations therefore included more about their personal experiences with
sexual health decision-making.
Gathering teachers perspectives
At the conclusion of the school year we also conducted interviews with three health and
science teachers whose classes were observed: Mr. P, Ms. L, and Ms. A (all are pseudonyms
and follow the schools frequent practice of calling teachers by the first letter of their last
name). Mr. P was the participants health teacher in 9th, 11th, and 12th grade. He was also
the school nurse, the point person for the schools condom availability program, and the 12th
grade guidance counselor. Part of the founding team of the school, Mr. P played an influential role in the school, both on a visionary and a day-to-day practical level. Ms. L was the
11th and 12th grade biology teacher. Ms. A, whose primary role was as a ninth grade English
teacher, taught the 12th grade health course described above. We designed a different set of
questions for each teacher, based on his or her particular role and observations of his or her
classes across the year. Teachers were asked about their experiences teaching relevant topics,
their goals for relevant units, how they prepared for those units, and their opinions of the
schools strengths and challenges. Like student focus groups and interviews, teacher interviews were also semistructured and conversational, lasting approximately 1 hour each.
Incorporating researchers perspective through participant observation
The first author observed three 12th grade classes with potential relevance to the topics of
HIV/AIDS and sexual health for one school year, including Ms. Ls biology class on
forensics, Ms. As health course, and Mr. Ps honors-level medicine course. During the first
half of the year, the first author informally observed and got to know students and the school.
During the second half of the year, she began the formal data collection phase and spent
increased time at the school. In addition to observing our participants in their current health
and science classes, the first author also observed the above-described 9th and 11th grade
classes that our participants had taken in prior years. These included Mr. Ps 9th grade HIV/
AIDS and sexuality unit, which met once a week for approximately 2 months, and Ms. Ls
11th grade biology units on HIV/AIDS, the immune system, and the reproductive system,
which took place daily for approximately 1.5 months. In the ethnographic field notes written
after each class session observed, we incorporated both description and reflection, noting our
interpretation of what was going on, as well as confusions or questions that arose.
Constructivist grounded theory as a tool for systematic data analysis

As discussed above, aspects of grounded theory (Charmaz 2006) were incorporated into
data analysis to facilitate a thorough, systematic study of the data. We iteratively analyzed
data as it was collected and used multi-stage coding techniques, assisted by the qualitative
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data analysis software Atlas.ti (Muhr 1997/2005). First, data analysis took place inductively and throughout the entire period of data collection. After we transcribed a focus
group or interview, we read the transcript multiple times and put together preliminary lists
of emerging themes and ideas. We read transcripts closely and broadly, paying heed to
Charmazs (2006) suggestion to include a close line-by-line read (p. 50) as well as to
Wendy Hollway and Tony Jeffersons (2000) warnings not to ignore interpretation of the
whole (pp. 6869) by focusing too much on pieces or fragments of data. Reflective
writing done after each focus group or interview also helped formulate initial interpretations and identify areas of confusion during this phase. We also read over and reflected
upon field notes during the data collection phase.
After the data collection period, we followed Charmazs (2006) model of systematically
conducting initial and focused coding. We used Atlas.ti during initial coding to
code all transcripts and field notes, stick[ing] closely to the data (p. 47). Through this
initial, exploratory process, we categorized data into numerous codes, such as:
already knowing everything, applying learning to self, getting resources from school,
going into health professions, hating science/loving health, influence of science class,
relationships with teachers, school influence on choices/actions, school was useful,
us vs. other schools, wanting to be knowledgeable
We next began to synthesize and explain larger segments of data during focused
coding (p. 57). At this stage, we grouped codes together into code families to identify
patterns and connections. For instance, we created a family called Identity: Knower,
mentor, educator that included codes such as, wanting to be knowledgeable,
spreading the word/educating others, and positioning as medical professionals, and a
family called Positives about school that included codes such as getting resources from
school, relationships with teachers, and school was useful. For a complete list of our
families and the codes that composed them, see Fig. 1, which illustrates the process of data
analysis that led to the interpretation presented in the next section, that school culture
impacts the formation of a knower and educator identity in students.
Throughout this coding process, we used memos where we wrote reflections about
emerging interpretations of the data and points of confusion. We used these memos to
grapple with the complexities in the data and with the complexities of figuring out how to
interpret it, bringing the theoretical ideas about identity and school culture discussed above
to bear on our analysis. For instance, the following is an excerpt from a memo we titled
Identity, written during our analysis phase:
kids take up the identity of the people in their lives who have the knowledge and
information to help and educate othersI think school contributes to this identity in a
big wayAnd its not just that the school gave them knowledgebut its that they
made them feel like they had a strong grasp of that knowledge, like they valued that
knowledge, like they were uniquely positioned to help others with that knowledge- it
helped them develop this identity which helped them help others (its not the knowledge
alone, but the perspective on that knowledge espoused and advocated by the school).
As another example, the following excerpt from a memo we titled, How science
learning/school learning factors into decisions/talk about decisions shows how our
reflective writing on our data led us to examine how school culture, not simply the school
classes and curriculum, influenced students perspectives about sexual health decisionmaking; furthermore, this excerpt shows how we came to understand the relationships
between teachers and students to be an integral component of school culture:
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Fig. 1 Process of analysis leading to interpretation that school culture impacts identity formation
The importance of teachers comes up repeatedly in general, and there are numerous
examples of how Mr P is there for them, like a father, is so dedicated, so respected, etc.
Not only is he all those things, but he knows so much, is a nurse, they respect his
knowledge and credentials, etc. The school has created a culture where students are able
to build strong relationships with teachers and get support from them outside the
classroom- this is key to the fact that school influences these kids. Its not just the classes.
Ultimately, through reading and re-reading memos such as these and the lists of quotes
that were associated with each code family, we began to piece together an overall interpretation of the data. Through the writing process, we refined our code families into the
broad themes that form the headings for the next section (also see Fig. 1). We use these
broad themes to build our interpretation of how school culture influences students perspectives about sexual health decision-making by influencing identity formation.
Examining school influence through the lens of identity

For the participants of this study, school had a significant influence on their perspectives about
sexual health decision-making. They responded positively to the curriculum about HIV/AIDS
and sexuality and largely attributed their awareness of, concern for, and choices surrounding
these issues to their school experience. Based on focus groups, interviews, and participant
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observation, we claim that these positive responses to school learning stemmed from three
aspects of school culture: participants relationship with a respected mentor teacher (Mr. P), a
school curriculum that extended beyond the classroom to provide support and resources, and a
prioritization of knowledge and positioning of students as competent future health professionals. We further argue that these features of school culture were influential at least in part
because they contributed to the formation of a particular identity in studentsan identity we
label knower and educator. We describe how participants frequently took on this identity,
speaking as people who see themselves as knowledgeable and who value spreading knowledge
to others. Finally, we discuss tensions and confusions around interpreting students actual
sexual health decisions, as well as students perceptions that science does not influence their
choices. All proper names used in the study are pseudonyms.
Positive response to school curriculum
I think if we have more schools like our school, I think our community would be a lot
more knowledgeable and safer when it comes to having sex and AIDSWil
Across focus groups and interviews, participants were consistently positive about and
grateful for the school education they received around HIV/AIDS and sex education. They
emphasized being lucky enough to be at a health-focused school that prioritized this
learning. They repeatedly set themselves apart from students at other schools who were
not educated about these topics and did not have the same opportunities as we do. For
instance, one participant asserted that, We are lucky that we are at a health school and that
were really learning about this. Causea lot of high schools dont really have a lot of
health classes, medical classes like we do Multiple participants praised the prolonged
time across grade levels that their school spends on these topics, contrasting their program to
how other schools just spend a day on AIDS. They further celebrated their school for the
depth and thoroughness of the biomedical and practical education it provided in contrast to
other places. One participant remarked, Most schools like all high schools they give out
condoms, but who really gives out a condom and actually tells you how to use itNot other
schools; this school actually taught us how to put a condom on. Another student described
HIV/AIDS and sex education as one of the best things we got outta high school.
While students spoke positively about their school as a whole and its prioritizing of
HIV/AIDS and sex education, most of students praise of the school curriculum centered
around their learning from Mr. P. It became clear that their positive response to their school
learning was linked to their relationship with and respect for this teacher, who served as a
professional role model, an advocate, a resource, an advisor, and a confidant. The following sections elaborate on students relationship with Mr. P and its influence on their
response to school learning and on their thinking about decision-making.
Relationship with Mr. P
Author:
Kasandra:
What makes you remember Mr. Ps class?

Its Mr. P. (laughs)
When asked about their memories of learning about HIV/AIDS, students immediately
brought up school learning, focusing on what they learned from Mr. P. In talking about
aspects of the curriculum, or knowledge acquired, Mr. P figured centrally. One student said
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that she did not know much about HIV/AIDS until high school, claiming, Mr. P, he was
basically the one that taught me. Others, when asked about a vivid memory of learning
about HIV/AIDS, simply answered, Mr. P. Yet another explained that We pretty much
learned it all from Mr. P. One girl emphasized that the thorough learning they did about
HIV/AIDS was impactful because of how Mr. P taught: I mean the way he did it, he made
it fun. Thus, Mr. P as a person was prominent in their discussions of the curriculum.
Across focus groups, when asked what specifically made Mr. P a good teacher, what
made students remember and value his classes, a consistent image emerged of someone
who was clear, direct, honest, and made them feel comfortable asking questions. Students
spoke about how even when learning challenging new terms or ideas, he would break it
down into words that you understand. They admired his direct, matter-of-fact approach,
and his willingness to discuss anything, for being very open about it and not being shy
about anything. They spoke of how He gave it to us straight, He tells it like it is, and
He got straight to the point. One girl appreciated that he addressed her questions about
pregnancy and AIDS like a typical math problem, which made her want to approach him
with further questions. Many students praised him for his willingness to answer any
question, without censor. One girl asserted:
I think that one of the reasons why a lot of kids get infected with HIV is because they
dont feel likeopening up to talk to a certain adult about it so theyre not educated
about it. But the way Mr. P spoke about it, he was like a really open up person and if
you had any questions you would ask him
It was not just that Mr. P was willing to answer questions, but that he made students
comfortable asking and discussing these issues: you would feel comfortable talking to
him. He spoke honestly with students, without being condescending; one boy explained:
the thing that I always liked about Mr. P, he never treated me like a kid In fact, Mr.
Ps intentions echoed students responses. He spoke of speaking to his students the same
way I would want anybody to deal with my own child, and how he want[s] to give them
honest answers, but at a level they can understand.
Furthermore, students emphasized that they did not feel judged by Mr. P; they did not
feel that he was criticizing their actions, or trying to prevent them from having sex. Instead,
he gives you both sides, positive and negative, and then its your choice This
approach made them more willing to speak openly with him and consider his advice.
Members of the extended focus group attributed this nonjudgmental attitude to his direct
influence on their decisions:
Kasandra:
Author:
Kasandra:
Illisha:
Kasandra:
Hana:
Kasandra:
Illisha:
without Mr. P, some of us would be havin AIDS right now, literally

Why?
Because, even though he didnt tell us directly dont have sex, dont do this,
no he didnt, he just gave us the ups and the downs
He gave you advice basically like on how to go through certain situations, he
never said oncedont do this because youre young, its like, make the
mistakes for yourselfand then learn from them
Exactly
He didnt make you feel bad about it
He didnt make you feel bad for certain things
Yeah, never
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Hana:
Kasandra:
He made you feel good, like, even if you did do it and it was a mistake, he
helped you understand why it was a mistake and why you should better
yourself the next time you do, anything
Exactly
Some also contrasted this balanced approach taken by Mr. P with family members who
commonly emphasized only the negative consequences of having sex and warned students
to stay away from it. In fact, students felt that Mr. Ps approach was more effective at
influencing their choices. Kasandra reiterated her perception of Mr. Ps strong influence: I
think actually Mr. P is the reason why people hold back from certain things.
Finally, students spoke repeatedly of Mr. Ps dedication to them and their close
relationships with him. They saw him as genuinely concerned for their learning and wellbeing. As one girl put it: Hell dedicate his time to know that you have a clear understanding of what youre learning. She also described how she felt his commitment influenced her and her classmates: Mr. P put a lot of time into us. I think thats why we are the
way we are like were aware of everything. Another participant praised his accessibility:
hes so willinghes here mad early for anybody, hes always here whenever you wanna
talk to him Students comments often indicated a close connection and intense appreciation for Mr. P. Multiple students even referred to him as a father or grandfather
figure. He held a unique status for them; as one girl explained, theres never gonna be
another one of Mr. P. Another said, I love him to death Whats good about him?
Everything.
Resources and support outside the classroom
its not only about being in class. I could be walkin down the hallway, all of a
sudden I think of something, I run to Mr. P.Kasandra
Students relationships with Mr. P extended beyond the classroom. In general, the school
prioritized providing students with access to resources and one-on-one support outside of
the classroom about issues related to sexuality. Through Mr. P and the schools three social
workers and guidance counselors, students were given not only information and answers to
questions but also access to confidential clinics and condoms. Participants spoke often of
their conversations with Mr. P about matters related to sexual health outside the classroom.
One participant praised how his attitude towards giving out condoms was you want em,
you got em. Another described how she went to Mr. P to discuss having contracted an STI
and how supportive and helpful he was. She spoke of her trust of Mr. P:
I could have a question about the most personal thing on earthLiterally, I will go to
Mr. P, I will stop him in the hallway, be like Mr. P, I gotta talk to you. I wouldnt
mind to tell him anythinganything that I wouldnt even tell my best friend, I
wouldnt mind telling Mr. P.
Multiple sources of data indicated that this kind of one-on-one support was a central,
conscious component of this schools curriculum. For instance, consistent with the participants assessment of their access to support and resources, we observed Mr. P explain
multiple times to his ninth grade HIV/AIDS and sex education class that he and the other
social workers were available outside of class for one-on-one support. While he encouraged them to communicate with their parents, he explained that he could help students
confidentially find places to get tested or receive medical advice.
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In informal conversations as well as during our interview with Mr. P, he highlighted the
centrality to the schools sex education program of providing students with support and
access to information and confidential services. He said the most successful part of the
program has been that students will reach out to talk to us at all different times to ask
questions and get information, which he described as the heart of why we [designed the
sex education program] in the first place, so that kids would come for information. He
further explained during a planning meeting the first author attended for the curriculum that
when they first implemented the ninth grade program, they had made the conscious choice
to involve the schools social workers and guidance counselors, who were present and
sometimes co-taught curriculum lessons, so that students would have a place to go and to
follow up on their learning in class. He described the program as a way for them to get to
know all their students. He further revealed the frequency of students coming to talk to him
outside of class about sexual health matters, saying it is really unusual since Ive been
here that a week has gone by without somebody asking me some question about sexuality.
In addition to being critical to the HIV/AIDS and sex education program, prioritizing
building relationships with students seemed to be a general feature of the school culture in
this setting. Students and teachers brought up this aspect of the school during interviews
and saw it as a feature that set their school apart from other schools. One girl described
how the teachers know you, and another called the teachers approachable and praised
how they actually showed that they cared for us, and you dont see that in other schools.
In describing the strengths of the school, Mr. P explained:
I think its a very caring place. I mean, I think that teachers here, theres a culture
spoken and unspoken that we go the extra mile to support the kids who are here.
Whether itskeeping our rooms open at lunch time and sitting with them to answer
questions, or just providing a place for them to be, or helping them with social and
emotional issues that come up, orhomework packets or things we can doto
support them academically and sociallyits really a family kinda deal here. I think
that makes it a little bit different than most high schools.
Ms. L, the biology teacher also spoke of how students at their school get individual
attention, more than they would at a big school, and Ms. A, the 12th grade health
teacher, described that one of the schools strengths is that we find many ways to support
our students.
Prioritizing knowledge and positioning as health professionals
Whats good about Mr. P is that he knows so muchI dont understand how he
keeps alla that in his one brainevery time we have classwe learn something
new.Illisha
Beyond being a supportive advisor and resource, also contributing to the impact Mr. P
had on students was the fact that they viewed him as a role model because of his medical
background. More specifically, they praised him for his high level of knowledge. Among
the many positive qualities they attributed to Mr. P, participants repeatedly referenced the
fact that hes a nurse so he really knows what hes doing in terms of health education.
They included among the necessary qualities of a teacher of HIV/AIDS and sexual health
topics that he or she knows their stuff or knows what theyre talkin about. Participants repeatedly referenced the level of depth and detail of their HIV/AIDS and sex
education from Mr. P, reiterating many times how they gained more knowledge than
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they had previously and how they learned a lot in his classes. Indeed, field note
observations of Mr. Ps 9th and 12th grade classes support this assessment of his curriculum as knowledge-centered, particularly focused on biomedical information, often consisting of Mr. P directly providing detailed information about particular topics.
It seemed that over the course of their 4 years, largely through their experiences
learning from and emulating Mr. P, students grew to prioritize knowledge, and to view
learning as acquiring new content knowledge. In addition to the above comments about
valuing knowledge, students responses to Ms. As 12th grade health class provided
another illustration of the importance they placed on knowledge acquisition. In contrast to
Mr. Ps classes, Ms. As (whose primary job was as an English teacher) 12th grade health
class did not focus on biomedical knowledge about HIV/AIDS and sexuality; instead, it
emphasized aspects of sex and relationships such as abuse, communication, and infidelity.
Lessons were usually conducted as group discussions, often heated, with students sharing
ideas and in some instances strong opinions on various issues. Students described their
learning in this class as nothing new and things we already knew. One student
described how in her class we dont learn about it we just talk about it. Another offered
as an indication that they did not learn anything new was that instead of Ms. A teaching
them things, everything we said she put on the board. Discussing and interacting with
peers was not viewed as learning, particularly in Ms. As class where they did not have
deep respect for the knowledge of the teacher, as they did in Mr. Ps classes.
In addition to Mr. Ps classes, teaching style, and position as a highly knowledgeable
role model, aspects of the schools health-focused school culture seemed to also influence
this prioritization of knowledge and knowing. Consistent with the schools mission to
prepare the student body for health professions, students were treated like future health
professionals, via features such as medical uniforms and required hospital internships. In
addition, reinforcing these structures, our participants were strongly positioned as future
medical professionals by Mr. P. A year of field notes from observing Mr. Ps 12th grade
medicine class contained numerous instances where Mr. P spoke to the class as a group of
future healthcare providers, addressing them as future medical professionals, giving
them advice about things like doctor-patient relationships or patient diagnosis, or including
them in the medical community through questions like, what do we do to treat hypertension? Furthermore, he repeatedly praised them for their achievements. On one occasion, he described his future professionals to a visiting group of younger students as
seniors at the highest level. He often referenced his high expectations of these students and highlighted that they were part of an advanced or honors level course.
In sum, we argue that participating in this positively viewed, knowledge-centered sexual
health curriculum; being positioned as future medical professionals by a health-focused
school culture and their highly respected mentor teacher, Mr. P; and having access to
support and resources inside and outside of the classroom all contributed to the formation
of an identity that many students in this setting took on, which we have called knower and
educator. In focus groups and interviews, students spoke frequently as people who viewed
themselves as having knowledge and using that knowledge to educate others. We argue
that in many ways, the school culture, mostly channeled through Mr. P, modeled this
identity for students and gave them the confidence, skills, and resources with which to
claim knowledge and an ability to educate others in their lives. Further, the schools
influence on students perspectives about sexual health decision-making was tied to its
influence on the formation of this identity. In the next section, we illustrate how students
took on this knower and educator identity.
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Taking on knower and educator identities

you could tell other people, like friends, people that dont know much about [HIV/
AIDS]. You could be like, Listen, I know about this, and you could tell them, Ive
been in a health class and theyve told me all of this.Luisa
In taking on knower and educator identities, students spoke confidently about the
biomedical knowledge they have obtained at school and detailed numerous ways in which
they support friends and family, such as taking them to clinics or teaching them about the
biology of HIV/AIDS. Many students took on this identity, and aspects of it came up in
every focus group discussion.
Both during focus groups and interviews as well as during class, students highlighted
the knowledge they possessed about HIV/AIDS and sexual health. For example, as mentioned above, they repeatedly spoke about how they already knew about these issues
when they were brought up in classes at later points in their high school years. For instance,
one girl commented about her 11th grade biology class that most of the things that we
learned about the reproductive system, we already knew, and another said that by 12th
grade, we already know everything about like HIV. In a similar example, during their
medicine class presentation about the immune system that included some discussion of
HIV/AIDS, one participant said to the class about this topic, we all know about that.
During focus groups, it seemed to be important to the participants to present themselves
as having thorough and accurate knowledge about HIV and AIDS. In one group, participants engaged in tense debates over content knowledge, like in one example going back
and forth about the likelihood of transmitting HIV from a pregnant mother to her child.
When a resolution to the conversation was reached, one girl asserted of her initially
criticized claimsWhat I said was right. In the same group, two participants mocked
anothers offering of erroneous medical information, laughing at her for confusing dialysis
as a treatment for HIV. They assured her that theyre not gonna use your real name, so
dont worry, a quote that points to the value this group in particular seemed to place on
being known as people who were knowledgeable about biomedical information.
In addition to these examples, in some groups participants used their position of
knowledge to criticize others choices, such as in the following critique of an acquaintances excuses for not using condoms: She had an excuse for everything. Oh, Im
allergic to condoms; Oh, this happenedShe didnt describe a rash, what she described
was basically irritation probably because she didnt use lubrication. This kind of critical
tone where knowledge was used to critique others incomplete understanding was another
illustration of taking on an identity of knower.
In addition to taking on the knower and educator identity in the context of their classes
and our focus groups and interviews, participants talk indicated that they likely took on
this identity in peer and family relationships. They brought up numerous ways in which
they used their status as knowledgeable people about health issues to educate and support
others in their lives. Participants across groups frequently offered specific stories of how
they provided friends and family with information, access to resources, and advice. For
instance, one girl claimed that, I told cousins, uncles, everybody in my family I see
around Do you know what really happens when you have HIV? And I just tell them
what happens, adding how she explained that HIV mainly attacks your immune system. In a similar example, another girl described frequently teaching her not well
educated girlfriend about the biology of HIV:
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I always sit down with my girlfriend and talk about it. Im like this is how HIV and
AIDS spreadsand she was like, What you mean by they lower your immune
system? and Im likeif HIV/AIDS hits your body, then your immune system is
gonna get lower and lower until it eventually dies it out. So, I always make comparisons to make things easier for herAnd shell learn something and then Ill learn
something that she didnt know, so, Ill be able to educate her more about other things.
This position of educator extended in many cases from providing information, to giving
advice based on knowledge, such as urging younger cousins and friends to use condoms or
to get tested, and trying to convince friends that birth controls not a hundred percent
effective. Additionally, participants relayed numerous stories of how they took friends to
clinics and valued the opportunity to do so. For instance, one girl explained:
I really enjoy thatwhen my friendcome to me, shell say, Tiffany, I think Im
pregnant, or Tiffany, I think Im gonna catch something.I know at least four
people or maybe five people that Ive brought to the clinic; they never been in a
clinic before, but they become a member of that clinic, and they start goin andit
makes me really happy to know that my friends are stayin safe
She further described taking an active role in asking friends if they were using condoms:
I just let people know, I always ask them you and your boyfriendare yall protecting
yourself? Another participant similarly detailed her role in actively assisting reluctant
friends, describing one situation where she dragged a pregnant friend by her two
pigtails cause she didnt wanna go to a clinic, and another instance where she convinced
a friend to get a pregnancy test at a clinic that does it free, adding, if you dont want
your parents to know I will take you.
In addition to explaining how they used their knowledge to teach and support friends
and family, participants also expressed a desire to educate younger students in their school
as well as others in their community about these issues. Peer education was a frequent
curricular suggestion, with participants speaking about the value of offering the knowledge that we have to younger students and teach[ing] them what we know. Participants
claimed it would be more effective to learn from people in the same age range as
them, and described these younger, more nave students as being like sponges who are
just ready to absorb knowledge. In addition, participants spoke of the desire to spread
education to their community. One student suggested that they do this by trying to
influence other high schools, middle schools, letting them know what is AIDS, maybe they
dont know, so how can they protect themselves against a thing they dont know what it
is, adding, thats how I startedbeing more aware of what I do
Influencing decisions
Having that kind of education about it and being more aware, it makes a person
more aggressive when making their decisions.Raven
Some of us know better but we still do the opposite.Vanessa
The above sections aim to illustrate that three salient aspects of school culture strong
teacher-student relationships, a curriculum that extended beyond the classroom walls, and
a prioritization of knowledge and becoming health professionalshad a strong influence
on students perspectives about sexual health decision-making. Moreover, the influence of
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school culture was so powerful because it contributed to the formation of knower and
educator identities in studentsidentities which made students receptive and responsive to
their school learning about HIV/AIDS and sexuality because it tapped into their emerging
views of themselves as people and as future health care providers.
However, the schools influence on students actual decisions was more challenging to
discern, in part because, for ethical and methodological reasons, this study focused not on
students behaviors but on their talk about decision-making. Despite this, there were references made to actual choices as well as instances where students behaviors were clearly
revealedinstances which begin to illustrate complexities in decision-making and how it
is influenced in actual situations. In many ways, students comments indicated that what
they learned in school had clear and concrete impacts on their behavior. For instance, one
student claimed, thats why I choose wisely who I have sex with because of Mr. P and
what he taught me Others spoke generally of their class: Since were educated
about it, so we think twice and we make sure we doin like the right thing, or like the best
thing that we could possibly do and protect ourselves. Similarly, another girl asserted that
because of Mr. Ps effective teaching, what we learned there it stood in our heads, and it
would actually make us think before we actually do something. Others described school
as motivating them to speak to their partners:
I still remember [Mr. P] said something about when you have a sexual partner, if you
guys are gonna have sex, talk about STDs and go get tested. If you cant speak to the
person about havin sex, I mean about getting tested, why you having sex with them.
Like that I remember, forever. And its always in my mind
A small number of students said that learning about these topics in school made them
want to abstain from sex, saying things like the more I learn about it more it makes me
want to stay away from it. Finally, one clear way in which the school influenced students
behavior is that it prompted them to educate others about these issues, as discussed in the
previous section. Some directly acknowledged this influence; as one girl stated, I think
thats something that the school helped me with a lot too. Like the knowledge to actually
tell others about it.
However, it seemed that the schools influence on students decisions evolved over time.
Many spoke of being immature or not deeply listening to what they were learning in ninth
grade, but gradually coming to understand its significance and relevance to their lives over
time. For instance, Hana described how in ninth grade sex education she listened, but
didnt really process it, because she felt like it doesnt have nothing to do with me In
contrast, she claimed that she began to be impacted by school learning about these topics in
11th grade when they started talkin about babies. She gave the following reasoning:
Cause I wanna be a neonatal nurse. And a lotta the times a lotta the babies are premature.
And its cause a lotta the females theyre young. So the baby have some kinda defect
cause youre so young havin a baby andithappens causeyou were having sex,
unprotected sex youre so young and your bodys not fully developed.
Hanas response to school sex education changed over time, as it began to tap into her
identity as a future neonatal nurse with an interest in premature babies. Hana continued to
explain how learning from her mother (who cared for foster children that suffered from
disabilities as a result of premature birth to young mothers), Mr. P, and her experience in
hospital internships, that pregnancy at a young age can lead to having a premature baby really
made me pay attention. She also described that she understood more learning about
pregnancy in 11th grade, and realized, Oh, thats what [Mr. Ps] talking about, which was
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not the case in ninth grade. Therefore, the fact that students participated in a 4-year curriculum
that addressed HIV/AIDS and sexuality at different points inside and outside of the classroom
was significant in influencing their responses and behavior over time. As one girl put it: I
think the amount of time we spent on the topic is what really influences us.
However, in addition to these examples that indicated a likely influence of school
learning on students actual decisions over time, there were other examples indicating that,
despite students valuing of the knowledge they gained, they did not always act upon it. For
instance, one girl who strongly took on a knower and educator identity claimed, I give
knowledge about stuff like this and sometimes I make my own mistakes and not do the
same thing Im tellin people. This girl explained acting against her own advice in this
way because of wanting to try to feel it or pleasure in addition to the fact that just
that one person just make you end up doin the same mistake again and again. She further
spoke of how she and others think about the fear of contracting STIs afterwards, not
before they make sexual choices such as not using condoms; she described in extreme
terms how she often is petrified later and wonders after the fact if she would commit
suicide if she learned that she had something. She then reasoned, knowingly, You
should avoid all that commotion [of worrying if you have an STI], just protect yourself.
This comment illustrates the tension in some cases between what students know and
what they do. Other participants similarly spoke of abandoning their beliefs about what the
right or responsible choices were. One girl commented, you dontgo by whats
right, you go by your feelings, what you feel.
Another participant revealed that she did in fact contract an STI after she stopped using
condoms with her partner, a decision that was complicated and which she struggled to
explain. While she revealed that she did not worry about pregnancy, although I was
supposed to, she did consider her safety from STIs in that she spoke to her partner about
getting tested. He had lied and told her that he had been tested. This participant spoke
regrettably about the fact that, I actually trusted him. But she struggled to explain the
choice completely in terms of trust, speaking of a previous partner whose request not to use
condoms she adamantly rejected, despite the fact that she trusted this prior partner more
than the one with whom she had not used condoms. She frequently described how the
choice came down to the fact that things happen in the moment. This seemed to be the
only way she could find to explain an action that she regretted immensely. She did not
fully understand her decision, which felt unfamiliar to her sense of who she was. She said:
I couldnt believe myself, and called herself stupid and nave.
This participant further marveled at how she could have made this mistake when
weve been talking about this since ninth grade. She thought she was the one that
actually got the most out of everything that [was] spoke[n] about [in health class]. Later
she said that although she thought about what she learned in school in relation to her own
choices at first, eventually it kind of wears off. This example illustrates the complexity of sexual decision-making. In some cases, even when students believed in the
advice and knowledge of their school learning, and identified themselves as people who
knew and were aware of the choices they wanted to make, they did not always make those
choices in actual sexual situations.
Influence of science
I dont think they would actually go in depth about sex and stuff because thats a
whole different topic, a whole different lesson, a whole different course.Kasandra
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Although students repeatedly recognized the influence of school learning on their

decision-making and lives, they acknowledged primarily the impact of knowledge learned
in health class, and largely did not perceive learning about HIV/AIDS and sexuality in
science class to be influential to their lives and choices. In contrast to their immediate
discussion of all they learned in health classes, most participants did not attribute their
learning about HIV/AIDS and sexuality to their 11th grade biology course, despite the fact
that it covered both HIV/AIDS and the reproductive system. Some did not remember these
units of study at all, or spoke of them only after we triggered their memories with
descriptions of the lessons. In one focus group, when asked if their 11th grade biology class
influenced them in any way, the group described how it did not, explaining that biology is
more like a matter of fact type of thing, its like whether you know it or you dont
Kasandra even asked if biology was supposed to influence their actual lives and sexual
health decisions, genuinely wondering whether it could do this at all. She described
science as different from sex education, as being a whole different topic, a whole different
lesson, a whole different course. Whereas their biology teacher, Ms. L surrounded
[learning about sex, reproduction, and HIV/AIDS] more around science and how [HIV/
AIDS] affected your cells, in health classes they learned about your system, and how
you look physically. One girl added, Youre lookin at the cells and you like, oh, thats
not gonna happen to me.
As another example, Illisha on many occasions strongly separated health and science,
articulating an intense distaste for the subject matter of science (based largely on a past
experience disliking science class because of an ineffective teacher) but a love of health
and medicine; in fact, she has plans to become a surgical nurse. When asked if what she
learns in Mr. Ps classes has to do with science, she responded, To me, noMaybe cause
I try to push the two apart. She responded similarly about a presentation she gave in
health class about the respiratory system: I dont think it really had anything to do about
science. To me. Thats what I believe. When pushed to explain what made it not about
science, she claimed, I dont know cause it was just explaining how we breathe, then
lightheartedly added, Oh god, I feel like we are going into science, which triggered a
laugh. Despite the clear relationship between health and science, students in general
identified much more with health learning, likely in part because of their identities as
people entering health professions, supported through the school culture and relationship
with Mr. P, as discussed above.
Influencing students decisions: implications for sex education and science education
In contrast to most of the literature on HIV/AIDS and sex education, this study describes a
situation in which high school students not only appreciate and value their school learning
about these topics, but they perceive it to influence their sexual health decisions, in many
cases. As discussed, we attribute this positive response to aspects of school culture that
include the salience of strong teacher-student relationships, a curriculum that consciously
supports students inside and outside of the classroom over time, and a positioning of
students as knowledgeable future health professionalsall of which are important and
influential at least in part because they contribute to the formation of students identities as
knowers and educators, who value and want to share and use their knowledge about HIV/
AIDS and sexual health. These findings have numerous implications for HIV/AIDS and
sex education, fields in which science learning plays an integral part, as well as for science
education in general.
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First, this study suggests that in addition to thinking about the design of effective
classroom curriculum, attention should be paid to how aspects of school culture that extend
beyond particular classrooms and lessons, such as teacher-student relationships, impact
what students take away from curricular learning. For instance, in relation to HIV/AIDS
and sex education, this study illustrates the potential value of attending to students
individual needs for services and advice through providing resources and support outside
the classroom that supplement and complement classroom learning. In the setting
described in this study, this feature was consciously incorporated into the HIV/AIDS and
sex education program, which spanned 4 years, and thus became a significant part of the
cultural fabric of the school.
This study further identifies at least one critical component of providing these support
services within and beyond the classroomthat those delivering them are respected and
trusted by students. Students in this study took advantage of Mr. P and the social work
staffs effort as resources and advisors in large part because they respect Mr. P personally
and professionally, they see him as an advocate for them, and they feel comfortable
discussing sensitive topics with him. Furthermore, students respond to his willingness to
answer any of their questions openly and directly, and to the fact that they do not feel him
as judging their actions or preaching to them about how they should behave. Students in
fact cite this approach as influencing their choices, as opposed to the moralizing discourses
they encounter from families and religious groups that attempt to actively steer them away
from sexual activity in a way similar to much of the abstinence-focused HIV/AIDS and sex
education in the United States (Fine and McClelland 2006).
Other educators might learn from these specific qualities of HIV/AIDS and sex educators that students in this study identified as effective. It would also be informative to
accumulate more knowledge about what specific qualities of teachers resonate with students through research in different settings. This would be useful information to incorporate into professional development and teacher education that typically focuses more on
curriculum content and delivery than on how to build relationships with and interact with
students in ways that gain their trust and respector how to form a school culture that
supports the development of these relationships.
As a starting point, as shown here, other research also supports the importance of care,
support, and provision of services and information in the context of HIV/AIDS and sex
education. For instance, in one ethnographic study also done with New York City students,
Michelle Fine and Sara McClelland (2006) echo the findings of the present study in
reporting that, The critical role of caring and supportive adults, for conversation and
information, was repeated across schools, across gender, across race, ethnic, and class
lines (p. 315). These ideas are also reinforced by theories of social networks and social
support in the field of health behavior and health education, which provide a theoretical
framework for considering the impact of social relationships on health behavior in general
(Heaney and Israel 2002). These theories identify four types of social support: emotional,
which involves the provision of empathy, love, trust, and caring; instrumental, which
involves providing direct services to help people; informational, which involves giving
advice, suggestions, and information that a person can use to address problems; and
appraisal, which helps people evaluate their own actions through things like constructive
feedback and affirmation (p. 186). Mr. P in fact provided these different kinds of social
support to his students.
Of course, this caring, supportive, personal approach in many ways challenges typical
notions of the boundaries between teachers and students and feeds into the significant
controversies surrounding sex education for young people in the United States. For
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example, Janice Irvine (2002) traces a history of heated moral, religious, and political
debate in the US around whether sex education should focus on abstinence only or should
include more comprehensive information about contraception, relationships, and sexuality.
Irvine further describes teachers frequent legal fears of raising the unauthorized in the
classroom, leading to a curriculum that typically emphasizes less controversial topics (p.
188). Acknowledging these challenges, Fine and McClelland (2007) argue for needed
policy-level and legislative changes that support comprehensive sex education in order to
allow adults to play supportive roles in students lives around issues related to sexuality
without legal and other fears. In terms of the discomforts teachers themselves might face
addressing these issues, other schools might learn from the collaboration between teachers
and social workers in the HIV/AIDS and sex education curriculum in this study.
In relation to science education about controversial science topics more generally, this
study suggests that, in addition to thinking about classroom curriculum design and enactment, as argued in relation to sex education, it would behoove schools to focus more broadly
on the significance of school culture in influencing students identities and decisions. Science
education researchers might also more directly investigate the influence of broader aspects of
school culture, such as the quality of teacher-student relationships, on decision-making,
instead of focusing narrowly on the impact of the classroom science curriculum. For
instance, it would be worth investigating the extent to which school-wide and relational
factors impact students identities, decisions, and responses to classroom teaching and
learning, in other settings and in relation to other controversial science topics. We have
suggested elsewhere (Brotman and Moore 2008) that the field of science education would
benefit from a more explicit focus on issues of school culture and school-wide structures that
potentially impact science learning, and the current study further supports this claim.
This study also raises important questions about the potential for science education to
influence students choices about controversial science topics including and beyond HIV/
AIDS and sexual health. For the students in this study, science was in fact influential to their
thinking about decision-making, when it came up in the context of health class and health
issues that resonated with their identities. To a certain extent, this finding contrasts prior
literature discussed earlier showing that students infrequently factor scientific knowledge and
evidence into their personal decisions (Sadler 2004). However, while students viewed health
classes (which included a significant amount of science content) as influential to their
decisions, they largely did not perceive science classes to influence their choices, some
struggling to understand how this would even be possible. Some students went as far as
refusing to acknowledge that they were using science at all in their lives, separating science
distinctly from their use of health knowledge, despite the fact that the health content they
spoke of as valuable has a clear relationship to science. This is consistent with the pattern in
the literature on controversial science topics showing that students tend in particular to
isolate school science learning from their thinking about decision-making.
There seem to be multiple reasons for students perceptions that science class was not
able to influence their choices. We argue that these perceptions stem in part from a lack of
synergy between what students consider science and their identities in the context of
health and medicine. As discussed above, students viewed science as a whole different
topic, a whole different lesson, a whole different course from sex education. Science was
seen as matter of fact and a place where they learned about the impact of HIV/AIDS on
cells, abstract and removed from their experience; whereas, in health class, they learned
about its impact on their bodies, on how you look physically. Although not discussed in
this paper, during the 11th grade biology units on HIV/AIDS and the reproductive system,
we similarly observed that both students and the teacher separated what was appropriate
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for discussion in science as opposed to sex education. Students even censored each
other during these classes, calling certain comments and questions inappropriate for science class, yet discussing them privately at their tables.
These findings indicate that in this setting, the isolation of science as a completely
separate topic, with goals and parameters different from those that are fair game in
health or sex education classes, hindered its ability to influence students choiceseven
though it addressed content areas such as HIV/AIDS and reproduction, clearly relevant to
sexual health decision-making. It seems likely that making more explicit connections
between health and science learning in this setting in particular, where health was heavily
tied to students identities, would have been one way to enhance the potential of science
class to be influential. Others have similarly argued for the potential of these kinds of
often-overlooked connections between science and health learning (Harrison 2005).
Another suggestion might be to explicitly discuss the idea that science is not simply an
isolated body of information but in fact has the potential to be applied to everyday decisions in various ways, among many other important factors. These recommendations are
consistent with increasingly frequent calls in the science education literature to consider
students scientific identity formation (Brickhouse and Potter 2001) as well as to incorporate explicit curriculum around the Nature of Science (NOS) in order to broaden students ideas of what science entails (Zeidler, Sadler, Simmons, and Howes 2005).
However, there were two significant obstacles to highlighting the relationship between
science, health, and decision-making in this setting, and likely others as well. First, the
11th grade biology course was Regents-based, and the teacher felt tremendous pressure to
prepare students for this content-focused standardized exam. Therefore, the purpose of
passing the Regents was paramount and subsumed other potential goals, such as conveying
to students the applicability of scientific understandings to their choices. Second, the
teacher, trained in science not sex education, was uncomfortable addressing the more
personal aspects related to sexual health decision-making. As would be expected, she was
more comfortable sticking to biological concepts and avoided student questions that delved
into more abstract, personal territory.
Thus, addressing issues of policy, teacher professional development, and teacher education are critical if the goals of science education are to be expanded to incorporate the
potential for it to influence decision-making. In fact, the broader literature on controversial
science topics also highlights the challenges science teachers face addressing controversial
science topics, particularly in relation to teachers discomfort in bringing ethics and values
into science (Sadler, Amirschokoohi, Kazempour, and Allspaw 2006). Teaching HIV/
AIDS and sexuality in the context of science, a frequent occurrence in many US schools,
presents additional challenges because of the personal, sensitive nature of the topic
combined with heightened legal fears stemming from the controversial political and
societal climate surrounding sexuality and HIV/AIDS in the US, discussed above (Irvine
2002). Investigating how to address these complex challenges through pre-service and inservice science teacher education would therefore be a fruitful direction for further
research.
Finally, this study raises questions about what it means for school to influence students
around issues of HIV/AIDS and sexual health and other controversial science topics. First,
the study reinforces the complexity of decision-making and efforts to directly influence the
choices students make around sexual health, even when these efforts influence their perspectives, beliefs, and intentions around decision-making. While some students spoke of a
clear trajectory from their learning to their actions, others identified contradictions and
confusions about their actual choices that they struggle to resolve. These findings argue
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against overly simplistic models of decision-making that portray it as a singular,

straightforward process of logically weighing pros and cons (Reyna and Farley 2006). We
present further evidence supporting the need to complicate how we think about decisionmaking in the context of science and sex education in an earlier publication (Brotman,
Mensah, and Lesko 2010).
Additionally, while studies of HIV/AIDS and sex education curricula typically measure their success by the extent to which they change particular behaviors, such as
condom use, this study shows that there are also other ways in which curriculum, and the
school culture within which it is embedded, can meaningfully influence students around
these issues. For example, in addition to its potential influence on students specific
sexual health choices and its clear influence on their perspectives about issues such as
contraception and partner communication, another outcome of school learning about
these topics is that it prompts students in this study to affect their communities by
providing knowledge (often scientific) and resources to others in their lives in concrete
ways, through activities such as taking friends to clinics. These students develop a
concern for these issues and a confidence that they can influence their own and others
lives in relation to HIV/AIDS and sexual health. This kind of influence is not noticeable
in the majority of curriculum evaluations, which quantitatively measure a narrow subset
of potential behavioral impacts.
Conclusion: bringing school culture into the conversation

This study provides insight into how a school culture that speaks to students identities can
prompt them to value and use school and science learning in a variety of ways in relation to
sexual health decision-making. While curriculum and curriculum design typically focus
primarily on content, pedagogy, and lesson design within particular classrooms, this study
suggests that perhaps less tangible relational and school-wide factors are also critically
important, and might deserve more direct attention from HIV/AIDS and sex education
researchers and curriculum developers. Science education researchers of other controversial science topics that involve decision-making might also acknowledge and directly
investigate the role of not only the classroom science curriculum, but the broader aspects of
school culture that potentially influence identities, decisions, and students responses to
classroom teaching and learning.
Appendix
Focus group protocols
Questions about learning:
1. When I say HIV/AIDS, what are the first three things that come into your mind (write
down on post-its)?
a. Does anyone want to share either something they wrote or anything else about
what comes to mind when you think about HIV/AIDS?
2. How would you explain HIV/AIDS to someone who has never heard about it?
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3. Tell me about an especially vivid memory you have of learning about HIV/AIDS.
a. Prompt as needed:
i. What do you remember learning (ask for more specifics about situation)?
ii. Why do you think it was so memorable? What was memorable about it?
4. Tell me about the earliest memory you have of learning about HIV/AIDS.
i.
What do you remember learning (ask for more specifics about situation)?
5. What other memories do you have of learning about HIV/AIDS or experiences related
to HIV/AIDS?
a. Prompt as needed for how and what they learn from the examples they bring up.
6. If they have not already come up in discussion, prompt with: What memories do you
have of learning about HIV/AIDS from:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Family?
Friends/peers?
Religion?
Cultural communities?
Media/News?
Popular culture?
Internet?
Advertisements?
Personal experiences?
Other adults?
School? Classes? Social Workers? Teachers?
After school programs?
7. Tell me (more) about learning about HIV/AIDS in school.

i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
123
Tell me about an especially vivid memory you have of learning about

HIV/AIDS in school.
What else stands out about your learning experiences?
What classes/grades have you learned about HIV/AIDS in?
What did you learn? What kinds of things did you do?
What has it been like to learn about HIV/AIDS in school?
Whats an uncomfortable moment you can remember?
A useful moment? Something you liked?
A moment where you learned something?
Something you thought wasnt useful? Something you didnt like?
What do you think people in your class thought about it? Did anyone ever
talk about it outside of class? What did they say?
Probe for specifics about these experiences based on participant observation
429
Questions about decision-making:

1. How do you think high school students decide whether or not to have sex?
2. How do you think high school students decide whether or not to use condoms (/have
safe sex)?
3. How do you think high school students decide whether or not to talk to their partners
about using condoms (/safe sex)?
4. How do you think high school students decide whether or not to get tested for HIV/
AIDS?
5. How do you think high school students decide whether or not to talk to their partners
about getting tested for HIV/AIDS?
6. What other kinds of decisions do high school students have to make about these
issues?
a. For each of the above scenarios, prompt as needed:
i. What do they think about?
ii. What goes through their heads when deciding?
iii. What kinds of things affect their decisions?
iv. What has the biggest affect on their decisions?
7. How do you think school learning influences high school students decisions (at this
school)?
a. Ask specifically about what they took away from 9th, 11th, and 12th health/
science grade classes, if they dont come up.
8. What do you think would make school learning more relevant to your lives and
decisions/more influential?
a. Is there anything you wanted to learn about but didnt in school? What was
missing?
9. Is there anything else youd like to say about this topic?
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Author Biographies
Jennie S. Brotman holds a Ph.D. in Science Education from Teachers College, Columbia University, where
she studied urban high school students talk about HIV/AIDS and sexual health decision-making. Her
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research examines how young people grapple with controversial, science-related issues and how schools and
teachers might influence students decision-making processes. Jennie was previously a middle school
science teacher and has done professional development and curriculum development work in numerous
elementary, middle, and high schools. She has also served as an adjunct instructor for the Barnard College
Education Program and is currently a Senior Educational Consultant for Teaching Matters, Inc. in New York
City.
Felicia Moore Mensah is an Associate Professor of Science Education in the Department of Mathematics,
Science, and Technology at Teachers College, Columbia University, New York, USA. Felicias work
includes research in teacher education and teacher professional development, and her research addresses the
complexity and significance of preparing teachers for urban classrooms and assisting them in developing
empowering practices as science teachers. She uses predominantly qualitative research methods to explore
questions of identity, diversity, equity and social justice in science education.
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Cult Stud of Sci Educ (2013) 8:403431

Urban high school students perspectives about sexual

Linking learning, curriculum, school culture, and identities

Urban high school students perspectives

Research approach: striving to root interpretation in data

Urban high school students perspectives

Urban high school students perspectives

Gathering students perspectives: focus groups and interviews

conversational manner. Students provided positive feedback on the focus groups,

Urban high school students perspectives

Constructivist grounded theory as a tool for systematic data analysis

Urban high school students perspectives

Examining school influence through the lens of identity

What makes you remember Mr. Ps class?

Urban high school students perspectives

without Mr. P, some of us would be havin AIDS right now, literally

Urban high school students perspectives

Urban high school students perspectives

Taking on knower and educator identities

Urban high school students perspectives

Urban high school students perspectives

Although students repeatedly recognized the influence of school learning on their

Urban high school students perspectives

Urban high school students perspectives

against overly simplistic models of decision-making that portray it as a singular,

Conclusion: bringing school culture into the conversation

7. Tell me (more) about learning about HIV/AIDS in school.

Tell me about an especially vivid memory you have of learning about

Urban high school students perspectives

Questions about decision-making:

Urban high school students perspectives

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