Knowledge about Sex Education in Adolescence: A Cross-Sectional Study

Round 1

Reviewer 1 Report

The subject of the study is suitable for the purpose and scope of the journal. It is also a subject that is needed in the literature. The study abstract is presented in a clear, understandable and good structure. Although the introduction is in a good structure, a literature review can be added with current sources covering the last 2-3 years. Thus, it can be understood more clearly that the problem persists.

The method part of the study is presented in detail. However, the reader will understand it more easily if it is presented under sub-headings such as research design, participants, data collection tools, procedure, and data analysis.

For example, the Sociodemographic characterization of the sample table can be presented in the participant's section.

The analyzes made in the Results section are appropriate but not adequately interpreted. A more detailed interpretation can be made; for example, the results part should not end with the table.

The discussion section is presented in a good structure. The results were compared and supported with other research results.

In conclusion part, the limitations of the study can be presented.

Author Response

Dear Author

Please find the response in the attached file. 

Best Regards

The Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for the opportunity to review this manuscript. The constructs of investigation are of strong interest to the readers of this journal.

1.    Given that your sampling methods were non-probalistic convenience sampling yet your study’s aims call for a wider sample, I am curious about your rationale to use quantitative methods. Specifically, given that your research aims included the goal to… “identify areas that require targeted educational actions…” (p. 2), qualitative methods may have helped to build theory about this understudied and important construct. Please provide further rationale within the manuscript about your study’s design.

2.    Your authorship team references “Portuguese adolescents,” but the adolescents only came from one city. How many secondary schools participated? What grades were each of these students? Also, several demographic variables (e.g., race, sexual orientation, ability statis, etc.) are not included in Table 1. As one’s sexuality is inextricably linked from social location and positionality, please explain the rationale to not report such information.

3.    On p. 6, you write that, “…results suggest that age and gender are crucial factors associated with the level of knowledge about adolescents.” This is not new knowledge. I also wonder if it’s possible for you to generalize this knowledge to all adolescents based on your sample from once city in Portugal. Is there a possibility that there were geographic and/or cultural factors that impacted these data? Please thoroughly revise the presentation of the findings in order to build upon existing literature.

Thank-you for the opportunity to review this manuscript.

Author Response

Dear Author

Please find the response in the attached file. 

Best Regards

The Authors

Author Response File: Author Response.pdf

Reviewer 3 Report

Dear Authors,

I hope this message finds you in good health.

I have recently had the pleasure of reviewing your submitted manuscript, “Knowledge about Sex Education in Adolescence: a cross-sectional Study,” for the Adolescents Journal. The subject of your study is indeed significant, and your commitment to it is appreciated.

Upon thorough evaluation, several points need further clarification or development to bolster the manuscript's overall coherence, quality, and academic rigor. I have listed these recommendations below:

The manuscript would benefit from a more explicit definition of its central contribution and the existing knowledge gap it aims to fill. Including this in the introduction and re-emphasizing in the discussion could help explain your study's significance.

In Table 1, it is not clear why averages are applied to qualitative variables, which are typically nominal or categorical. Could you elucidate your rationale for this decision?

Also, in Table 1, the term 'Country in Cohabitation' is ambiguous. More detailed clarification would be useful.

The categorization of test scores as high or low needs clearer delineation. Providing specific criteria or a benchmark for this classification will enhance understanding and reproducibility.

The method of correlating qualitative demographic variables with numerical or ordinal variables (scales) is not clearly explained. Could you clarify if you've used point biserial or tetrachoric correlations?

I had difficulty finding the citation validating your questionnaire - “Neves AS, Pereira M, Carvalho J, Diniz JA. Validation of the questionnaire on sexual knowledge among Portuguese adolescents. J Sex Res. 2016; 53(7):871-880.” If this reference is not available, it's critical to seek an alternative, valid source to substantiate the questionnaire's credibility.

Moreover, several other references in your manuscript are inaccessible. For references 11, 12, 13, and 14, among others, could you provide DOIs or alternative verification methods? This is crucial as unverifiable references can compromise the manuscript's academic integrity and the readers' ability to explore your sources.

Ethical considerations surrounding studies involving minors are paramount. Beyond mentioning approval by a University Committee, more transparency around this aspect will enhance your manuscript's ethical standing.

Lastly, it appears that a significant body of literature has not been included or discussed in your research. Including more relevant publications will solidify your arguments and contextualize your study within the broader academic discourse.

Please understand these comments as constructive feedback aimed at enhancing your work's scientific merit and academic reliability. I appreciate your efforts to contribute to this critical field and eagerly await the manuscript's evolution.

Best Regards,

Author Response

Dear Author

Please find the response in the attached file. 

Best Regards

The Authors

Author Response File: Author Response.pdf

Reviewer 4 Report

1.  When it comes to sex education, this reviewer is concerned about any program in terms of how comprehensive it may be.  What functions do sexual organs have besides their reproductive purposes?  How do you avoid sexual predators when walking or when online?  What mindset is best when dating?  What about online dating education sites (e.g., Marni, your wing-girl)?  What are red flags when dating?  What are good signs?  How do you get out of a relationship that has turned abusive?  If issues like these are avoided, then I would question the comprehensiveness of the program.  I don't know about this program, so it's not a critique, just an issue.

2.  If the students had so many questions and only twenty minutes, I would expect that some did not finish their surveys.  What percent did not finish and what was done with incomplete surveys?

3.  How similar are the parental data to that of parents in Portugal at large?

4.  On page 4, Table 1 the term "Country" is used for living with two parents.  Was that the correct term?

5.  On page 4, Table 1, what does cohabitation with brothers mean?  What about sisters?

6.  When differences between means are discussed it would be useful to also include effect sizes in terms of cohen's d or other measures.  Some of the differences look pretty small in terms of effect sizes.  Standard deviations should be reported along with means. 

7.  What correlations did you use?  Pearson zero-order or Spearman rho's?

8.  Cohabitation and Parents' marital status do not appear to be linear variables but rather nominal variables, which are not appropriate for correlational analyses in most cases.  They should be analyzed with a chi-square test or a oneway analysis of variance, depending on assumptions and objectives.

9.  Line 315.  You could just say "one school" rather than "school X".  No need to identify the school.  Back in the early 1980's, some colleagues did a study on sexuality in one school and when word got out, in athletic competitions, nearby schools mocked the school for having had the sexuality study conducted there.

Author Response

Dear Author

Please find the response in the attached file. 

Best Regards

The Authors

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

With the corrections made, the article is in a quality that can be published. It is thought that it will contribute to the journal and the field.

Author Response

Dear Reviewer

Thank you for your valuable feedback on our article. We appreciate your time and effort in reviewing our work

Reviewer 2 Report

Dear Editors,

thank you for the opportunity to provide feedback on this revised manuscript. I have had the opportunity to review the original manuscript, the feedback from the original reviews, and the revision. The authors have done an outstanding job of attending to the feedback from the review of the original submission, and the manuscript is much improved. 

As I read this revised manuscript, I have two minor edits that should be attended to:

1.     On p. 3, the authors note: “This study underscores the significance of comprehensive sexual education programs in promoting positive outcomes among Portuguese adolescents.” How will your study add to the readers’ understanding of these findings? Add 1-2 sentences about how your study will build upon these findings and what holes it will attempt to fill in the literature.

2. On pp. 5-6, the two levels of the variable "sex" are "masculine" and feminine." Are these not descriptors of gender (not sex)? The authors should address the rationale for use of "mascline" and "feminine" (instead of "male" and "female" and "intersex"). I would recommend commenting on this choice (and its potential implications) in the discussion section. 

Author Response

Thank you for your feedback on the revised manuscript. We appreciate your attention to detail and helpful suggestions. We have carefully reviewed your comments and have made the following changes to address them:

• On p. 3, we have added an additional sentence to clarify how our study will contribute to the readers' understanding of the findings mentioned. We now state: "Furthermore, our study aims to investigate the specific mechanisms through which comprehensive sexual education programs influence the outcomes of Portuguese adolescents, providing insights into the potential causal pathways and addressing existing gaps in the literature."
• On pp. 5-6, we have revised the terminology used for the variable "sex." Instead of "masculine" and "feminine," we now use "male" and "female" to accurately represent the biological sex of the participants. : We acknowledge the importance of using precise terminology and have addressed this choice and its potential implications in the discussion section. we have changed the terms in the table, and we also had the following statement in the discussion:

"In our study, we utilized the terms 'male' and 'female' as descriptors for the levels of the variable 'sex.' These terms accurately represent the biological sex of the participants in our sample. While we acknowledge that gender is a multifaceted construct influenced by social and cultural factors, our study examined the association between biological sex and the outcomes of interest. By using 'male' and 'female,' we aimed to maintain consistency with established terminology and ensure clarity in our findings regarding the biological sex of the participants. It is important to note that our study does not directly explore the complexities of gender identity or gender-related factors. Future research could further investigate the influence of gender-related factors on the outcomes under investigation by considering a more diverse range of gender identities."

Reviewer 3 Report

Dear Authors,

I trust this message finds you well.

I have recently completed a second review of your manuscript entitled "Knowledge about Sex Education in Adolescence: A Cross-Sectional Study" submitted to the Adolescents Journal.

Firstly, I appreciate your efforts to address the feedback provided during the first review, and your commitment to contributing to our understanding of adolescent sexuality. The topic you are exploring is indeed crucial and deserves rigorous research.

However, after reviewing your revisions, I am sorry to let you know that several of the significant issues noted in the initial review are still. These issues unfortunately affect the overall validity of your study and therefore need urgent attention.

First of all, the precision of your sources still needs improvement. I noticed discrepancies between the data reported, especially in the validation of the questionnaire, and the actual references cited. Such inaccuracies can compromise the integrity of the research and the trustworthiness of your findings.

Secondly, your results require a deeper analysis and discussion. Currently, they seem superficial and do not provide a substantial contribution to the existing body of knowledge on the topic. I encourage you to critically engage with your findings in a way that meaningfully advances our understanding of adolescent sexuality.

Thirdly, the methodological concerns raised in the first review around the sampling method and sample size persist. The sample remains non-probabilistic and small, hindering the ability to derive significant evidence or draw generalizable conclusions from your study.

Lastly, there remain several inaccuracies in your references. There are inconsistencies between the information you have cited and the content of the original sources. Attention to detail is crucial to maintain the credibility and scholarly rigor of your manuscript.

While it is not an easy recommendation to make, given these unresolved issues, I believe that the paper in its current form is not ready for publication in the Adolescents Journal. This does not, however, diminish the importance of your research topic. I strongly encourage you to consider these critiques and take the necessary steps to improve your manuscript for future resubmissions.

Best regards,

Author Response

Dear Reviewer,

Thank you for reviewing our manuscript, "Knowledge about Sex Education in Adolescence: A Cross-Sectional Study", and providing valuable feedback. We appreciate your recognition of our efforts and commitment to contributing to the field of adolescent sexuality.

We apologize for not fully addressing the issues raised in the initial review. We understand the importance of ensuring the validity and reliability of our study, and we are committed to rectifying the identified shortcomings.

We have carefully considered your comments and suggestions and made the possible revisions necessary to enhance the quality of our research. We greatly value your expertise and insights and are committed to incorporating your feedback to ensure a rigorous and robust manuscript. Your guidance will be invaluable in strengthening our research's overall impact and significance.

Once again, we appreciate your time and effort in reviewing our manuscript.

1 - We appreciate your valuable input and the opportunity to address your concerns regarding our results' depth of analysis and discussion.

We have carefully considered your comments and significantly improved our manuscript's analysis and discussion sections. We recognize the importance of providing a comprehensive and meaningful contribution to the existing knowledge on adolescent sexuality.

In response to your feedback, we have delved deeper into the analysis of our results, exploring the nuances and implications of the findings. We have critically engaged with the data, highlighting the significance and impact of our findings with the broader understanding of adolescent sexuality.

Through an in-depth discussion, we have expanded upon the potential implications of our results for theory, practice, and future research. We have highlighted the gaps in the existing literature that our study addresses, providing new insights and perspectives. Additionally, we have emphasized the need for further investigation and the importance of our findings in advancing our understanding of adolescent sexuality.

We believe these enhancements have substantially strengthened the depth and contribution of our analysis and discussion. Our revised manuscript now provides a more comprehensive and meaningful exploration of our findings and their implications for the field.

2 - We appreciate your continued attention to the methodological concerns raised in the first review, specifically regarding the sampling method and sample size.

We want to address your concerns regarding the non-probabilistic nature of our sample and the small sample size. Our study was conducted in a specific secondary school in Northern Portugal, and the participants consisted of students aged 15 to 17 years, attending grades 10 through 12. We acknowledge that our sampling method was non-probabilistic, as we recruited participants from a single school. This approach allowed us to focus our research on a specific context and obtain in-depth insights into the knowledge about sexuality among adolescents within that particular school community.

While our sample may not represent the entire adolescent population in Portugal, it is representative of the students attending the selected secondary school. Our research within this school established a meaningful connection with the participants, ensuring their comfort and willingness to participate. This approach provided valuable data to explore the research objectives within the context.

Regarding the sample size, we used a Sample Size Calculator to determine the minimum sample size required to fulfil the desired statistical criteria. We aimed to achieve a 95% confidence level and a precision of ± 5%. Based on these criteria, a minimum sample size of 270 was determined. Although our sample size may be considered small in generalizability to a larger population, it is essential to note that our study focused on the specific context of the selected school. We addressed the limitations of the sample size in the discussion section, acknowledging the potential impact on the generalizability of our findings beyond the school population.

In the discussion section of our manuscript, we have highlighted the need for future research to include a more diverse range of schools and regions to enhance the generalizability of the results. We recognize that the limitations of the sample size should be carefully considered when interpreting the findings and drawing conclusions.

3 - Regarding the inaccuracies in the references we provided, we have thoroughly reviewed and revised them, ensuring they are more up-to-date and consistent with the sources. We have cross-checked all the information and made necessary amendments to ensure accuracy and reliability.

Author Response File: Author Response.docx

Reviewer 4 Report

At line 248 should this not be Table 1?

The word siblings is not spelled correctly in this table

The word Teacher should be capitalized to parallel how other categories are begun with a capital letter.

Author Response

We want to express our sincere gratitude to the reviewers for their valuable feedback and insightful comments on our manuscript. We greatly appreciate the time and effort they dedicated to reviewing our work. We are pleased to inform the reviewers that we have carefully considered their suggestions and made the necessary changes to improve the quality and clarity of the manuscript.

First, as suggested by the reviewer, we have corrected line 248, and the reference should indeed be to Table 1. We apologize for the oversight and appreciate the reviewer's attention to detail.

Furthermore, we have addressed the spelling error in the table by correcting the spelling of the word "siblings" to ensure accuracy and consistency throughout the manuscript.

Additionally, we have capitalized the word "Teacher" in Table 1 to maintain consistency with other categories that begin with a capital letter. This change enhances the overall readability and professionalism of the table.

Once again, we thank the reviewers for their valuable input, which has significantly contributed to improving our manuscript. We believe these changes have strengthened the clarity and accuracy of our research findings.

Round 3

Reviewer 3 Report

Dear Authors,

I congratulate you on the substantial improvements made to the document. Although there are still design flaws, the paper looks more rigorous and with valuable contributions. I will recommend its publication. I wish you every success in your next studies.