A large body of evidence supports the implementation of comprehensive sexuality education as one solution to this problem. Evidence suggests that abstinence-only approaches do not lead to behavioral changes and result in critical health information being inappropriately withheld. Abstinence Only Education Policies: Young women and youth from racial and ethnic minority backgrounds are at particular risk, as indicated by the data below.
Eliminating such health disparities is a priority for APHA. In , an estimated 12, young people 13—24 years of age were newly infected with HIV representing In , Blacks accounted for Young men who have sex with men are also disproportionately affected, with For example, in , the gonorrhea rate among young Black women 15—19 years of age was 2, Similarly, the gonorrhea rate among young Black men 15—19 years old 1, For women, the second highest age-specific rates of reported chlamydia in were among to year-olds 3, In , the pregnancy rate among young women 15—19 years of age was Pregnancy rates were greater among Black There were also differences in birth rates with rates of Forced sex was reported by Some of these factors are largely individual or personal, such as knowledge, skills, and intent.
Others, including class, race, and access to services, are related to social context. For example, in a literature review of research on the influence of socioeconomic status SES on teen births, the authors concluded that a number of factors associated with low SES, including underemployment, low income, low education levels, neighborhood disadvantage, and neighborhood-level income inequality, were associated with teen births.
Some studies point to the link between depression and sexual behavior among adolescents, including a greater likelihood of multiple partners. In addition to operating independently, gender norms intersect with other aspects of social contexts such as poverty and racial inequality. The majority of policies associated with teenage pregnancy and STI infection are determined at the state and local levels.
Current statutes related to sexuality education represent a patchwork of policies across the country. For example, only 22 states and the District of Columbia mandate sexuality education, and 33 states and the District of Columbia mandate HIV education.
Additional states have requirements related to the content and delivery of sexuality education. For example, 13 states require that curricula be medically accurate, and 26 states and the District of Columbia require that information be age appropriate.
Twenty-two states and the District of Columbia require that schools notify parents before instruction begins, giving parents the opportunity to opt their children out of such instruction; in contrast, three states require parents to proactively opt their children into sexuality education instruction.
Of particular importance, given the evidence base described below, only 18 states require that information on contraception be included in sexuality education, as compared with 25 states that require instructors to stress abstinence and 19 that limit discussions of sexual activity to the context of marriage. The federal government first began funding replication of evidence-based programs for teen pregnancy prevention in In addition, federal funding streams have provided vital support for the evaluation of innovative approaches to teen pregnancy prevention as a means of expanding the evidence base for programs that focus on addressing the negative health outcomes described above.
In addition, federal agencies have not set any content standards related to evidence-based curricula. They should provide adolescents with developmentally appropriate information regarding a broad range of topics related to sexuality, including puberty, reproductive health, interpersonal relationships, body image, harassment, stigma and discrimination, intimate partner violence, gender norms, gender identity, and sexual orientation.
Furthermore, CSE programs provide opportunities for students to develop communication, decision-making, and other interpersonal skills. Ideally, these programs would start in kindergarten and continue through the 12th grade, provide age-appropriate content, and be taught by teachers who have received proper training.
CSE programs generally allow parents to exercise the option of taking their children out of opting out of such classes if they do not wish their children to be exposed to this information. Experts in the fields of adolescent development, health, and education recommend that sexuality education programs, as part of a comprehensive health education program, provide young people with accurate information necessary to protect their sexual health; foster equality, rights, and respect; assist youth in developing a positive view of themselves and their sexuality; and help them acquire skills to communicate effectively, make informed decisions, and stay safe.
In the past decade, numerous narrative reviews, meta-analyses, and systematic reviews of adolescent behavior change interventions broadly, or sex and HIV education specifically, have concluded that such programs are generally effective.
Evidence indicates that teaching methods and connections to parents and schools may contribute to program impact. Specifically, the conclusion from a number of reviews is that skill building and interactive activities that help students personalize information are prevalent among effective programs. Sexuality education, by engaging students in topics that are meaningful to them and by substantively contributing to school-wide efforts to create safe and welcoming environments, can foster school connectedness.
Students who feel connected to their school are also more likely to have better academic achievement, including higher grades and test scores, have better school attendance, and stay in school longer. These organizations represent a broad constituency of education advocates and professionals, health care professionals, religious leaders, child and health advocates, and policy organizations. Indeed, evaluations consistently show that comprehensive sexuality education does not lead to earlier sexual initiation or greater frequency of sexual activity.
Another is that only a limited amount of time is devoted to these interventions in the school environment. A third is that a number of factors affect sexual behavior, pregnancy, and STI infection, and only a subset of these determinants are amenable to change through behavioral interventions. However, a large body of research links sexual and reproductive health outcomes to academic achievement, and pregnancy is a leading cause of school dropout among teenage girls. As discussed previously, parents overwhelmingly support school-based sexuality education programs that cover a broad range of topics.
Alternative Strategies The predominant alternative strategy to comprehensive sexuality education is abstinence-only education. Abstinence-only programs—that is, programs that conform to the criteria listed in Section b of Title V of the Social Security Act—focus exclusively on promoting abstinence until marriage.
These programs are required to teach that abstinence from all sexual behavior outside of marriage is the expected standard of human sexual activity and that sexual activity outside of marriage is likely to have harmful psychological and physical effects. Reviews of the evidence from evaluations of these programs show that their overall results are inconclusive or that abstinence-only programs lack efficacy. When strictly adhered to, abstaining from intercourse is, in fact, fully protective against pregnancy and most STIs.
Given the low rates of sexual activity among younger teens, emphasizing abstinence is an age-appropriate strategy for this age group. Indeed, one study showed that a theory-based abstinence-only intervention implemented among year-olds significantly reduced sexual initiation among program participants at the month follow-up point. Additional resources should be devoted to the implementation and evaluation of promising approaches that address current challenges facing young people.
Also, such programs should be required to include information about both abstinence and contraception; address issues related to gender, power, rights, and respect; include parent-child communication components; and teach goal-setting, decision-making, negotiation, and communication skills. Urges all states to require and adequately fund local school districts and schools to plan and implement comprehensive sexuality education as an integral part of comprehensive K—12 school health education.
This education must be scientifically and medically accurate and based on theories and strategies with demonstrated evidence of effectiveness; be consistent with community standards and efforts to foster safe and welcoming schools; be implemented in a nonjudgmental manner that does not impose specific religious viewpoints on students; support positive parent-child communication and guidance; be age, developmentally, and culturally appropriate; and be taught by well-prepared teachers who have received specialized training in the subject matter.
Schools should be required to provide this instruction to all students unless a parent or legal guardian has specifically requested that his or her child be excused from the entirety of the instruction before it begins.
Urges the US Congress to cease funding abstinence-only programs that lack efficacy and inappropriately withhold critical health information. Encourages higher education institutions to prepare prospective teachers in the content and pedagogy of effective comprehensive sexuality education.
Supports the efforts of advocates of comprehensive sexuality education programs to bring this policy to the attention of national, state, and local policymakers so as to ensure that these recommendations are implemented in policies, research, and programs.
Centers for Disease Control and Prevention. HIV infection, testing, and risk behaviors among youths—United States. Accessed December 30, Sexually transmitted diseases among American youth: Perspect Sex Reprod Health.
Sexually transmitted disease surveillance Kost K, Henshaw S. US teenage pregnancies, births, and abortions, Adolescent pregnancy among lesbian, gay, and bisexual teens. International Handbook of Adolescent Pregnancy. Youth risk behavior surveillance—United States, Centers for Disease Control and Prevention; Socioeconomic disadvantage as a social determinant of teen childbearing in the U. Connecting race and place: Am J Public Health.
Income inequality and sexually transmitted in the United States: Predictors of multiple sexual partners from adolescence through young adulthood. Pregnancy coercion, intimate partner violence and unintended pregnancy.
Dating violence and the sexual health of Black adolescent females. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy and suicidality. Perpetration of intimate partner violence associated with sexual risk behaviors among young adult men. State policies in brief: Sex and HIV education programs: The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Am J Prev Med.
Guidelines for comprehensive sexuality education: Future of Sex Education Initiative. National sexuality education standards: Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: Arch Pediatr Adolesc Med. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States.
J Acquir Immune Defic Syndr. Systematic review of abstinence-plus HIV prevention programs in high-income countries. A decade in review: The case for addressing gender and power in sexuality and HIV education: J Appl Res Child. Parent opinion of sexuality education in a state with mandated abstinence education: Support for comprehensive sexuality education: