question is no longer should sex education be
taught, but rather how should it be taught.
Over 93% of all public high schools currently
offer courses on sexuality or HIV.(1) More than
510 junior or senior high schools have school-linked
The question now is are
these programs effective, and if not,
how can we make them better?
do youth need sex education?
need the right information to help protect themselves.
The US has more than double the teenage pregnancy
rate of any western industrialized country,
with more than a million teenagers becoming
pregnant each year.(2) Teenagers have the highest
rates of sexually transmitted diseases (STDs)
of any age group, with one in four young people
contracting an STD by the age of 21.(3) STDs,
including HIV, can damage teenagers' health
and reproductive ability. And there is still
no cure for AIDS.
infection is increasing most rapidly among young
people. One in four new infections in the US
occurs in people younger than 22.(4) In 1994,
417 new AIDS cases were diagnosed among 13-19
year olds, and 2,684 new cases among 20-24 year
olds.(5) Since infection may occur up to 10
years before an AIDS diagnosis, most of those
people were infected with HIV either as adolescents
has sex education failed to help our children?
alone is not enough to change behaviors.(6)
Programs that rely mainly on conveying information
about sex or moral precepts-how the body's sexual
system functions, what teens should and shouldn't
do-have failed. However, programs that focus
on helping teenagers to change their behavior-using
role playing, games, and exercises that strengthen
social skills-have shown signs of success.(7)
the US, controversy over what message should
be given to children has hampered sex education
programs in schools. Too often statements of
values ("my children should not have sex
outside of marriage") come wrapped up in
misstatements of fact ("sex education doesn't
work anyway"). Should we do everything
possible to suppress teenage sexual behavior,
or should we acknowledge that many teens are
sexually active, and prepare them against the
negative consequences? Emotional arguments can
get in the way of an unbiased assessment of
the effects of sex education.(8)
countries have been much more successful than
the US in addressing the problem of teen pregnancies.
Age at first intercourse is similar in the US
and five other countries: Canada, England, France,
the Netherlands, and Sweden, yet all those countries
have teen pregnancy rates that are at least
less than half the US rate.(9) Sex education
in these other countries is based on the following
components: a policy explicitly favoring sex
education; openness about sex; consistent messages
throughout society; and access to contraception.
sex education curricula begin in high school,
after many students have already begun experimenting
sexually. Studies have shown that sex education
begun before youth are sexually active helps
young people stay abstinent and use protection
when they do become sexually active.(10) The
sooner sex education begins, the better, even
as early as elementary school.
kinds of programs work best?
the Risk, a program for high school students
in urban and rural areas in California, used
behavior theory-based activities to reduce unprotected
intercourse, either by helping teens avoid sex
or use protection. Ninth and 10th graders attended
15 sessions as part of their regular health
education classes and participated in role playing
and experimental activities to build skills
and self-efficacy. As a result, a greater proportion
of students who were abstinent before the program
successfully remained abstinent, and unprotected
intercourse was significantly reduced for those
students who became sexually active.(11)
Sexual Involvement, a program for African-American
8th graders in Atlanta, GA, used peers (11th
and 12th graders) to help youth understand social
and peer pressures to have sex, and to develop
and apply resistance skills. A unit of the program
also taught about human sexuality, decision-making,
and contraceptives. This program successfully
reduced the number of abstinent students who
initiated intercourse after the program, and
increased contraceptive use among sexually experienced
Oakland Teens (HOT) targets all 7th graders
attending a junior high school in Oakland, CA.
Health educators teach basic sex and drug education,
and 9th grade peer educators lead interactive
exercises on values, decision-making, communication,
and condom-use skills. After one year, students
in the program were much less likely to initiate
sexual activities such as deep kissing, genital
touching, and sexual intercourse.(13)
Prevention for Adolescents in School, a program
for 9th and 11th graders in schools in New York
City, NY, focused on correcting facts about
AIDS, teaching cognitive skills to appraise
risks of transmission, increasing knowledge
of AIDS-prevention resources, clarifying personal
values, understanding external influences, and
teaching skills to delay intercourse and/or
consistently use condoms. All sexually experienced
students reported increased condom use after
review of 23 studies found that effective sex
education programs share the following characteristics:(10)
1. Narrow focus on reducing sexual risk-taking
behaviors that may lead to HIV/STD infection
or unintended pregnancy.
2. Social learning theories as a foundation
for program development, focusing on recognizing
social influences, changing individual values,
changing group norms, and building social skills.
3. Experimental activities designed to personalize
basic, accurate information about the risks
of unprotected intercourse and methods of avoiding
4. Activities that address social or media influences
on sexual behaviors.
5. Reinforcing clear and appropriate values
to strengthen individual values and group norms
against unprotected sex.
6. Modeling and practice in communication, negotiation,
and refusal skills.
still needs to be done?
sex education programs in schools have been
around for many years, most programs have not
been nearly as effective as hoped. Schools across
the country need to take a rigorous look at
their programs, and begin to implement more
innovative programs that have been proven effective.
Educators, parents, and policy-makers should
avoid emotional misconceptions about sex education;
based on the rates of unwanted pregnancies and
STDs including HIV among teenagers, we can no
longer ignore the need for both education on
how to postpone sexual involvement, and how
to protect oneself when sexually active. A comprehensive
risk prevention strategy uses multiple elements
to protect as many of those at risk of pregnancy
and STD/HIV infection as possible. Our children
deserve the best education they can get.