As of December 31, 1991, the number of acquired immunodeficiency syndrome (AIDS) cases in Italy exceeded 11,500; two thirds occurred among injecting-drug users (IDUs), and 7% occurred through heterosexual contact with persons who were human immunodeficiency virus (HIV)-antibody-positive. In Italy, because the average age at diagnosis among IDUs and heterosexual persons with AIDS has been 28 and 32 years, respectively, many may have contracted HIV infection as adolescents or young adults. To determine parents' attitudes about AIDS, drug, and sex education and parents' role in educating their children about AIDS, Italy's National Institute of Health conducted a survey of parents of high school students in Rome. This report summarizes survey findings and recommendations for the introduction of AIDS, drug, and sex education in Italian schools.

Epidemiologists from 14 of Italy's 21 regions surveyed parents of 725 students from 30 schools chosen by a cluster sample technique of the 292 classical, scientific, and technical high schools in Rome. Staff visited the schools and selected students using a list of random numbers based on the school's size. Each of the selected students was given a letter addressed to the parents explaining the goals of the study and when they would be contacted. The 725 homes were telephoned; 625 (86%) were successfully contacted, and 611 (98%) parents were interviewed. The parent who answered the phone was interviewed; if another family member answered the phone, the interviewer asked for either parent. Most (72%) of the respondents were women. Respondents' average age was 44.3 years (range: 30-72 years), and they had an average of two children (range: 1-9); the average age of respondents' children was 16.3 years (range: 13-22 years). Nearly half (49%) had more than a middle school education; 10% had more than a high school education. Using a close-ended, pretested questionnaire, parents were asked whether they had discussed AIDS, drugs, and sex with their adolescents; respondents were also asked questions regarding their attitudes about the introduction of these topics in school. Parents favoring such education were asked at what age the topic should be introduced, what subject areas should be covered, and who should teach them.

Of the 611 parents interviewed, 583 (95%) had talked about drugs with their adolescents; fewer had talked about AIDS (508 (83%)) and sex (460 (75%)). Most believed these topics should be introduced in school (602 (99%) supported AIDS education; 600 (98%), drug education; and 578 (95%), sex education). In addition, when asked whether parents would allow their adolescents to participate, almost all would allow participation (577 (94%) for AIDS education, 571 (93%) for drug education, and 557 (91%) for sex education).

Parents who supported AIDS, drug, and sex education in school indicated that, on average, AIDS education for children should begin at 11.7 years of age, and drug and sex education should begin at 9.2 and 10.2 years of age, respectively. Respondents also indicated that the course content should be relatively explicit: 573 (95%) indicated that the use of condoms should be discussed as part of AIDS education. The persons indicated as most appropriate to teach AIDS, drug, and sex education in school differed by topic. Parents indicated that physicians (384 (64%)) were the most appropriate persons to teach AIDS education, followed by teachers (122 (20%)), and persons with AIDS (37 (6%)). For drug education, parents indicated that teachers (251 (42%)), physicians (164 (27%)), and former drug users (100 (17%)) were the most appropriate instructors. Parents preferred physicians (301 (52%)), teachers (196 (34%)), and themselves (38 (7%)) to teach their adolescents sex education.

Factors associated with parental opposition to AIDS, drug, and sex education in school varied by topic. Parents whose children attended a scientific or classical high school, parents who were aged greater than 45 years, parents who had more than a middle school education, and parents who had never discussed the topics at home with their children were more likely to oppose introducing these topics in school. However, among these four groups, parental opposition did not exceed 8% (range: 1.4%-7.4%).

Reported by: A Consorte, MD, G Di Paolo, MD, AR Iannetti, MD, G Marani Toro, MD, Abruzzi; C Vedovelli, MD, Alto-Adige; LR Curia, MD, A Porcaro, MD, Calabria; F Molese, MD, G Nasti, MD, Campania; MP Corradi, MD, S De Giorgi, MD, M Greci, MD, N Manzoni, MD, Emilia-Romagna; V Accurso, MD, S Brusaferro, MD, R Tominz, MD, Friuli-Venezia-Giulia; MG Agresti, MD, B Alliegro, MD, A Gabbuti, MD, PM Montiroli, MD, P Napoli, MD, P Gallo, DPsych, C Saitto, MD, G Scuderi, DBiol, B Suligoi, MD, Latium; A Matteelli, MD, Lombardy; S Amico, MD, Molise; ED Aquilino, MD, L Vassallo, MD, Sicily; V Lazzeri, MD, M Meli, MD, E Virgone, MD, Tuscany; P Delle Foglie, MD, Trentino; L Sapori, MD, Umbria; G Moro, MD, Veneto; AE Tozzi, MD, S Salmaso, DBiol, FP Gianzi, MD, L Bertinato, MD, National Institute of Health, Rome, Italy. International Br, Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: In Italy, the Ministry of Health and the Ministry of Public Instruction developed a series of guidelines (1) similar to those in the United States (2) to assist schools with AIDS education. Several attempts have been initiated to increase the role of schools in education about HIV-infection prevention; however, educators were concerned about possible parental opposition to the introduction of AIDS, drug, and sex education in the classroom.

A study conducted in 1989 among high school students in Rome demonstrated a high percentage of students were not correctly informed about the ways HIV can be transmitted (3). One fourth of these students were sexually active; however, most of these students did not consistently use condoms. Other surveys of high school students in Rome have indicated a substantial lack of knowledge about sexual physiology and methods of contraception (S. Donati, National Institute of Health, Italy, unpublished data, 1992); 33% of the adolescents aged 17-20 years did not know when in the menstrual cycle a woman was most likely to become pregnant, and 10% believed that "the pill," diaphragm, or intrauterine device were better than condoms for the prevention of sexually transmitted diseases.

Findings from the survey reported here suggest that the concerns of school authorities about parental opposition to AIDS, drug, and sex education in Rome schools may be unfounded. Furthermore, many of the parents had discussed AIDS, drugs, and sex with their children. Based on a comparison of these findings with a recent U.S. survey, Italian parents may discuss AIDS with their children more often than do U.S. parents (84% versus 62%) (4).

Because of the unexpectedly low number of respondents in the sample who opposed the introduction of AIDS, drug, and sex education in schools, this study was unable to identify statistically significant characteristic differences that predicted opposition among parents. Parental opposition may be linked to their belief that they had adequately educated their children in the home or that their children were not at risk for AIDS, drug use, or early initiation of sexual activity.

Parents in Rome overwhelmingly supported AIDS, drug, and sex education and indicated that instruction should begin for children before the age when risk behaviors usually begin. The study also revealed that a high number of parents favored explicit information, specifically about condom use. Condoms had not been explicitly mentioned through electronic media until Italy's 1991 national AIDS television campaign, and the findings in this report suggest a greater openness to deal with such topics among parents of high school students in Rome.

The results of this survey were provided to school administrators and public health practitioners to assist in planning and operating successful AIDS, drug, and sex education programs. In addition, some epidemiologists involved in this survey intend to repeat the survey in their separate regions to assist in the development of appropriate teaching materials and curricula throughout Italy.

References

1. Mixed Working Group of the Ministry of Health/the Ministry of Public Instruction. School guidelines for educational programs in health and the prevention of HIV infection (Italian). Rome: National Institute of Health, Italy, 1992. (ISSN 0391-1675).

2. CDC. Guidelines for effective school health education to prevent the spread of AIDS. MMWR 1988;37(no. S-2).

3. CDC. AIDS-related knowledge and behaviors among teenagers -- Italy, 1990. MMWR 1991;40:214-5,221.

4. CDC. Characteristics of parents who discuss AIDS with their children -- United States, 1989. MMWR 1991;40:789-91.

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