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Article Contents

Introduction, purpose of the study, literature search and selection criteria, coding of the studies for exploration of moderators, decisions related to the computation of effect sizes.

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The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis

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Mónica Silva, The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis, Health Education Research , Volume 17, Issue 4, August 2002, Pages 471–481, https://doi.org/10.1093/her/17.4.471

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This review presents the findings from controlled school-based sex education interventions published in the last 15 years in the US. The effects of the interventions in promoting abstinent behavior reported in 12 controlled studies were included in the meta-analysis. The results of the analysis indicated a very small overall effect of the interventions in abstinent behavior. Moderator analysis could only be pursued partially because of limited information in primary research studies. Parental participation in the program, age of the participants, virgin-status of the sample, grade level, percentage of females, scope of the implementation and year of publication of the study were associated with variations in effect sizes for abstinent behavior in univariate tests. However, only parental participation and percentage of females were significant in the weighted least-squares regression analysis. The richness of a meta-analytic approach appears limited by the quality of the primary research. Unfortunately, most of the research does not employ designs to provide conclusive evidence of program effects. Suggestions to address this limitation are provided.

Sexually active teenagers are a matter of serious concern. In the past decades many school-based programs have been designed for the sole purpose of delaying the initiation of sexual activity. There seems to be a growing consensus that schools can play an important role in providing youth with a knowledge base which may allow them to make informed decisions and help them shape a healthy lifestyle ( St Leger, 1999 ). The school is the only institution in regular contact with a sizable proportion of the teenage population ( Zabin and Hirsch, 1988 ), with virtually all youth attending it before they initiate sexual risk-taking behavior ( Kirby and Coyle, 1997 ).

Programs that promote abstinence have become particularly popular with school systems in the US ( Gilbert and Sawyer, 1994 ) and even with the federal government ( Sexual abstinence program has a $250 million price tag, 1997 ). These are referred to in the literature as abstinence-only or value-based programs ( Repucci and Herman, 1991 ). Other programs—designated in the literature as safer-sex, comprehensive, secular or abstinence-plus programs—additionally espouse the goal of increasing usage of effective contraception. Although abstinence-only and safer-sex programs differ in their underlying values and assumptions regarding the aims of sex education, both types of programs strive to foster decision-making and problem-solving skills in the belief that through adequate instruction adolescents will be better equipped to act responsibly in the heat of the moment ( Repucci and Herman, 1991 ). Nowadays most safer-sex programs encourage abstinence as a healthy lifestyle and many abstinence only programs have evolved into `abstinence-oriented' curricula that also include some information on contraception. For most programs currently implemented in the US, a delay in the initiation of sexual activity constitutes a positive and desirable outcome, since the likelihood of responsible sexual behavior increases with age ( Howard and Mitchell, 1993 ).

Even though abstinence is a valued outcome of school-based sex education programs, the effectiveness of such interventions in promoting abstinent behavior is still far from settled. Most of the articles published on the effectiveness of sex education programs follow the literary format of traditional narrative reviews ( Quinn, 1986 ; Kirby, 1989 , 1992 ; Visser and van Bilsen, 1994 ; Jacobs and Wolf, 1995 ; Kirby and Coyle, 1997 ). Two exceptions are the quantitative overviews by Frost and Forrest ( Frost and Forrest, 1995 ) and Franklin et al . ( Franklin et al ., 1997 ).

In the first review ( Frost and Forrest, 1995 ), the authors selected only five rigorously evaluated sex education programs and estimated their impact on delaying sexual initiation. They used non-standardized measures of effect sizes, calculated descriptive statistics to represent the overall effect of these programs and concluded that those selected programs delayed the initiation of sexual activity. In the second review, Franklin et al . conducted a meta-analysis of the published research of community-based and school-based adolescent pregnancy prevention programs and contrary to the conclusions forwarded by Frost and Forrest, these authors reported a non-significant effect of the programs on sexual activity ( Franklin et al ., 1997 ).

The discrepancy between these two quantitative reviews may result from the decision by Franklin et al . to include weak designs, which do not allow for reasonable causal inferences. However, given that recent evidence indicates that weaker designs yield higher estimates of intervention effects ( Guyatt et al ., 2000 ), the inclusion of weak designs should have translated into higher effects for the Franklin et al . review and not smaller. Given the discrepant results forwarded in these two recent quantitative reviews, there is a need to clarify the extent of the impact of school-based sex education in abstinent behavior and explore the specific features of the interventions that are associated to variability in effect sizes.

The present study consisted of a meta-analytic review of the research literature on the effectiveness of school-based sex education programs in the promotion of abstinent behavior implemented in the past 15 years in the US in the wake of the AIDS epidemic. The goals were to: (1) synthesize the effects of controlled school-based sex education interventions on abstinent behavior, (2) examine the variability in effects among studies and (3) explain the variability in effects between studies in terms of selected moderator variables.

The first step was to locate as many studies conducted in the US as possible that dealt with the evaluation of sex education programs and which measured abstinent behavior subsequent to an intervention.

The primary sources for locating studies were four reference database systems: ERIC, PsychLIT, MEDLINE and the Social Science Citation Index. Branching from the bibliographies and reference lists in articles located through the original search provided another source for locating studies.

The process for the selection of studies was guided by four criteria, some of which have been employed by other authors as a way to orient and confine the search to the relevant literature ( Kirby et al ., 1994 ). The criteria to define eligibility of studies were the following.

Interventions had to be geared to normal adolescent populations attending public or private schools in the US and report on some measure of abstinent behavior: delay in the onset of intercourse, reduction in the frequency of intercourse or reduction in the number of sexual partners. Studies that reported on interventions designed for cognitively handicapped, delinquent, school dropouts, emotionally disturbed or institutionalized adolescents were excluded from the present review since they address a different population with different needs and characteristics. Community interventions which recruited participants from clinical or out-of-school populations were also eliminated for the same reasons.

Studies had to be either experimental or quasi-experimental in nature, excluding three designs that do not permit strong tests of causal hypothesis: the one group post-test-only design, the post-test-only design with non-equivalent groups and the one group pre-test–post-test design ( Cook and Campbell, 1979 ). The presence of an independent and comparable `no intervention' control group—in demographic variables and measures of sexual activity in the baseline—was required for a study to be included in this review.

Studies had to be published between January 1985 and July 2000. A time period restriction was imposed because of cultural changes that occur in society—such as the AIDS epidemic—which might significantly impact the adolescent cohort and alter patterns of behavior and consequently the effects of sex education interventions.

Five pairs of publications were detected which may have used the same database (or two databases which were likely to contain non-independent cases) ( Levy et al ., 1995 / Weeks et al ., 1995 ; Barth et al ., 1992 / Kirby et al ., 1991 /Christoper and Roosa, 1990/ Roosa and Christopher, 1990 and Jorgensen, 1991 / Jorgensen et al ., 1993 ). Only one effect size from each pair of articles was included to avoid the possibility of data dependence.

The exploration of study characteristics or features that may be related to variations in the magnitude of effect sizes across studies is referred to as moderator analysis. A moderator variable is one that informs about the circumstances under which the magnitude of effect sizes vary ( Miller and Pollock, 1994 ). The information retrieved from the articles for its potential inclusion as moderators in the data analysis was categorized in two domains: demographic characteristics of the participants in the sex education interventions and characteristics of the program.

Demographic characteristics included the following variables: the percentages of females, the percentage of whites, the virginity status of participants, mean (or median) age and a categorization of the predominant socioeconomic status of participating subjects (low or middle class) as reported by the authors of the primary study.

In terms of the characteristics of the programs, the features coded were: the type of program (whether the intervention was comprehensive/safer-sex or abstinence-oriented), the type of monitor who delivered the intervention (teacher/adult monitor or peer), the length of the program in hours, the scope of the implementation (large-scale versus small-scale trial), the time elapsed between the intervention and the post-intervention outcome measure (expressed as number of days), and whether parental participation (beyond consent) was a component of the intervention.

The type of sex education intervention was defined as abstinence-oriented if the explicit aim was to encourage abstinence as the primary method of protection against sexually transmitted diseases and pregnancy, either totally excluding units on contraceptive methods or, if including contraception, portraying it as a less effective method than abstinence. An intervention was defined as comprehensive or safer-sex if it included a strong component on the benefits of use of contraceptives as a legitimate alternative method to abstinence for avoiding pregnancy and sexually transmitted diseases.

A study was considered to be a large-scale trial if the intervention group consisted of more than 500 students.

Finally, year of publication was also analyzed to assess whether changes in the effectiveness of programs across time had occurred.

The decision to record information on all the above-mentioned variables for their potential role as moderators of effect sizes was based in part on theoretical considerations and in part on the empirical evidence of the relevance of such variables in explaining the effectiveness of educational interventions. A limitation to the coding of these and of other potentially relevant and interesting moderator variables was the scantiness of information provided by the authors of primary research. Not all studies described the features of interest for this meta-analysis. For parental participation, no missing values were present because a decision was made to code all interventions which did not specifically report that parents had participated—either through parent–youth sessions or homework assignments—as non-participation. However, for the rest of the variables, no similar assumptions seemed appropriate, and therefore if no pertinent data were reported for a given variable, it was coded as missing (see Table I ).

Once the pool of studies which met the inclusion criteria was located, studies were examined in an attempt to retrieve the size of the effect associated with each intervention. Since most of the studies did not report any effect size, it had to be estimated based on the significance level and inferential statistics with formulae provided by Rosenthal ( Rosenthal, 1991 ) and Holmes ( Holmes; 1984 ). When provided, the exact value for the test statistic or the exact probability was used in the calculation of the effect size.

Alternative methods to deal with non-independent effect sizes were not employed since these are more complex and require estimates of the covariance structure among the correlated effect sizes. According to Matt and Cook such estimates may be difficult—if not impossible—to obtain due to missing information in primary studies ( Matt and Cook, 1994 ).

Analyses of the effect sizes were conducted utilizing the D-STAT software ( Johnson, 1989 ). The sample sizes used for the overall effect size analysis corresponded to the actual number used to estimate the effects of interest, which was often less than the total sample of the study. Occasionally the actual sample sizes were not provided by the authors of primary research, but could be estimated from the degrees of freedom reported for the statistical tests.

The effect sizes were calculated from means and pooled standard deviations, t -tests, χ 2 , significance levels or from proportions, depending on the nature of the information reported by the authors of primary research. As recommended by Rosenthal, if results were reported simply as being `non-significant' a conservative estimate of the effect size was included, assuming P = 0.50, which corresponds to an effect size of zero ( Rosenthal, 1991 ). The overall measure of effect size reported was the corrected d statistic ( Hedges and Olkin, 1985 ). These authors recommend this measure since it does not overestimate the population effect size, especially in the case when sample sizes are small.

The homogeneity of effect sizes was examined to determine whether the studies shared a common effect size. Testing for homogeneity required the calculation of a homogeneity statistic, Q . If all studies share the same population effect size, Q follows an asymptotic χ 2 distribution with k – 1 degrees of freedom, where k is the number of effect sizes. For the purposes of this review the probability level chosen for significance testing was 0.10, due to the fact that the relatively small number of effect sizes available for the analysis limits the power to detect actual departures from homogeneity. Rejection of the hypothesis of homogeneity signals that the group of effect sizes is more variable than one would expect based on sampling variation and that one or more moderator variables may be present ( Hall et al ., 1994 ).

To examine the relationship between the study characteristics included as potential moderators and the magnitude of effect sizes, both categorical and continuous univariate tests were run. Categorical tests assess differences in effect sizes between subgroups established by dividing studies into classes based on study characteristics. Hedges and Olkin presented an extension of the Q statistic to test for homogeneity of effect sizes between classes ( Q B ) and within classes ( Q W ) ( Hedges and Olkin, 1985 ). The relationship between the effect sizes and continuous predictors was assessed using a procedure described by Rosenthal and Rubin which tests for linearity between effect sizes and predictors ( Rosenthal and Rubin, 1982 ).

Q E provides the test for model specification, when the number of studies is larger than the number of predictors. Under those conditions, Q E follows an approximate χ 2 distribution with k – p – 1 degrees of freedom, where k is the number of effect sizes and p is the number of regressors ( Hedges and Olkin, 1985 ).

The search for school-based sex education interventions resulted in 12 research studies that complied with the criteria to be included in the review and for which effect sizes could be estimated.

The overall effect size ( d +) estimated from these studies was 0.05 and the 95% confidence interval about the mean included a lower bound of 0.01 to a high bound of 0.09, indicating a very minimal overall effect size. Table II presents the effect size of each study ( d i ) along with its 95% confidence interval and the overall estimate of the effect size. Homogeneity testing indicated the presence of variability among effect sizes ( Q (11) = 35.56; P = 0.000).

An assessment of interaction effects among significant moderators could not be explored since it would have required partitioning of the studies according to a first variable and testing of the second within the partitioned categories. The limited number of effect sizes precluded such analysis.

Parental participation appeared to moderate the effects of sex education on abstinence as indicated by the significant Q test between groups ( Q B(1) = 5.06; P = 0.025), as shown in Table III . Although small in magnitude ( d = 0.24), the point estimate for the mean weighted effect size associated with programs with parental participation appears substantially larger than the mean associated with those where parents did not participate ( d = 0.04). The confidence interval for parent participation does not include zero, thus indicating a small but positive effect. Controlling for parental participation appears to translate into homogeneous classes of effect sizes for programs that include parents, but not for those where parents did not participate ( Q W(9) = 28.94; P = 0.001) meaning that the effect sizes were not homogeneous within this class.

Virginity status of the sample was also a significant predictor of the variability among effect sizes ( Q B(1) = 3.47 ; P = 0.06). The average effect size calculated for virgins-only was larger than the one calculated for virgins and non-virgins ( d = 0.09 and d = 0.01, respectively). Controlling for virginity status translated into homogeneous classes for virgins and non-virgins although not for the virgins-only class ( Q W(5) = 27.09; P = 0.000).

The scope of the implementation also appeared to moderate the effects of the interventions on abstinent behavior. The average effect size calculated for small-scale intervention was significantly higher than that for large-scale interventions ( d = 0.26 and d = 0.01, respectively). The effects corresponding to the large-scale category were homogeneous but this was not the case for the small-scale class, where heterogeneity was detected ( Q W(4) = 14.71; P = 0.01)

For all three significant categorical predictors, deletion of one outlier ( Howard and McCabe, 1990 ) resulted in homogeneity among the effect sizes within classes.

Univariate tests of continuous predictors showed significant results in the case of percentage of females in the sample ( z = 2.11; P = 0.04), age of participants ( z = –1.67; P = 0.09), grade ( z = –1.80; P = 0.07) and year of publication ( z = –2.76; P = 0.006).

All significant predictors in the univariate analysis—with the exception of grade which had a very high correlation with age ( r = 0.97; P = 0.000)—were entered into a weighted least-squares regression analysis. In general, the remaining set of predictors had a moderate degree of intercorrelation, although none of the coefficients were statistically significant.

In the weighted least-squares regression analysis, only parental participation and the percentage of females in the study were significant. The two-predictor model explained 28% of the variance in effect sizes. The test of model specification yielded a significant Q E statistic suggesting that the two-predictor model cannot be regarded as correctly specified (see Table IV ).

This review synthesized the findings from controlled sex education interventions reporting on abstinent behavior. The overall mean effect size for abstinent behavior was very small, close to zero. No significant effect was associated to the type of intervention: whether the program was abstinence-oriented or comprehensive—the source of a major controversy in sex education—was not found to be associated to abstinent behavior. Only two moderators—parental participation and percentage of females—appeared to be significant in both univariate tests and the multivariable model.

Although parental participation in interventions appeared to be associated with higher effect sizes in abstinent behavior, the link should be explored further since it is based on a very small number of studies. To date, too few studies have reported success in involving parents in sex education programs. Furthermore, the primary articles reported very limited information about the characteristics of the parents who took part in the programs. Parents who were willing to participate might differ in important demographic or lifestyle characteristics from those who did not participate. For instance, it is possible that the studies that reported success in achieving parental involvement may have been dealing with a larger percentage of intact families or with parents that espoused conservative sexual values. Therefore, at this point it is not possible to affirm that parental participation per se exerts a direct influence in the outcomes of sex education programs, although clearly this is a variable that merits further study.

Interventions appeared to be more effective when geared to groups composed of younger students, predominantly females and those who had not yet initiated sexual activity. The association between gender and effect sizes—which appeared significant both in the univariate and multivariable analyses—should be explored to understand why females seem to be more receptive to the abstinence messages of sex education interventions.

Smaller-scale interventions appeared to be more effective than large-scale programs. The larger effects associated to small-scale trials seems worth exploring. It may be the case that in large-scale studies it becomes harder to control for confounding variables that may have an adverse impact on the outcomes. For example, large-scale studies often require external agencies or contractors to deliver the program and the quality of the delivery of the contents may turn out to be less than optimal ( Cagampang et al ., 1997 ).

Interestingly there was a significant change in effect sizes across time, with effect sizes appearing to wane across the years. It is not likely that this represents a decline in the quality of sex education interventions. A possible explanation for this trend may be the expansion of mandatory sex education in the US which makes it increasingly difficult to find comparison groups that are relatively unexposed to sex education. Another possible line of explanation refers to changes in cultural mores regarding sexuality that may have occurred in the past decades—characterized by an increasing acceptance of premarital sexual intercourse, a proliferation of sexualized messages from the media and increasing opportunities for sexual contact in adolescence—which may be eroding the attainment of the goal of abstinence sought by educational interventions.

In terms of the design and implementation of sex education interventions, it is worth noting that the length of the programs was unrelated to the magnitude in effect sizes for the range of 4.5–30 h represented in these studies. Program length—which has been singled out as a potential explanation for the absence of significant behavioral effects in a large-scale evaluation of a sex education program ( Kirby et al ., 1997a )—does not appear to be consistently associated with abstinent behavior. The impact of lengthening currently existing programs should be evaluated in future studies.

As it has been stated, the exploration of moderator variables could be performed only partially due to lack of information on the primary research literature. This has been a problem too for other reviewers in the field ( Franklin et al ., 1997 ). The authors of primary research did not appear to control for nor report on the potentially confounding influence of numerous variables that have been indicated in the literature as influencing sexual decision making or being associated with the initiation of sexual activity in adolescence such as academic performance, career orientation, religious affiliation, romantic involvement, number of friends who are currently having sex, peer norms about sexual activity and drinking habits, among others ( Herold and Goodwin, 1981 ; Christopher and Cate, 1984 ; Billy and Udry, 1985 ; Roche, 1986 ; Coker et al ., 1994 ; Kinsman et al ., 1998 ; Holder et al ., 2000 ; Thomas et al ., 2000 ). Even though randomization should take care of differences in these and other potentially confounding variables, given that studies can rarely assign students to conditions and instead assign classrooms or schools to conditions, it is advisable that more information on baseline characteristics of the sample be utilized to establish and substantiate the equivalence between the intervention and control groups in relevant demographic and lifestyle characteristics.

In terms of the communication of research findings, the richness of a meta-analytic approach will always be limited by the quality of the primary research. Unfortunately, most of the research in the area of sex education do not employ experimental or quasi-experimental designs and thus fall short of providing conclusive evidence of program effects. The limitations in the quality of research in sex education have been highlighted by several authors in the past two decades ( Kirby and Baxter, 1981 ; Card and Reagan, 1989 ; Kirby, 1989 ; Peersman et al ., 1996 ). Due to these deficits in the quality of research—which resulted in a reduced number of studies that met the criteria for inclusion and the limitations that ensued for conducting a thorough analysis of moderators—the findings of the present synthesis have to be considered merely tentative. Substantial variability in effect sizes remained unexplained by the present synthesis, indicating the need to include more information on a variety of potential moderating conditions that might affect the outcomes of sex education interventions.

Finally, although it is rarely the case that a meta-analysis will constitute an endpoint or final step in the investigation of a research topic, by indicating the weaknesses as well as the strengths of the existing research a meta-analysis can be a helpful aid for channeling future primary research in a direction that might improve the quality of empirical evidence and expand the theoretical understanding in a given field ( Eagly and Wood, 1994 ). Research in sex education could be greatly improved if more efforts were directed to test interventions utilizing randomized controlled trials, measuring intervening variables and by a more careful and detailed reporting of the results. Unless efforts are made to improve on the quality of the research that is being conducted, decisions about future interventions will continue to be based on a common sense and intuitive approach as to `what might work' rather than on solid empirical evidence.

References marked with an asterisk indicate studies included in the meta-analysis.

Description of moderator variables

Effect sizes of studies

Tests of categorical moderators for abstinence

Weighted least-squares regression and test of model specification

Barth, R., Fetro, J., Leland, N. and Volkan, K. ( 1992 ) Preventing adolescent pregnancy with social and cognitive skills. Journal of Adolescent Research , 7 , 208 –232.

Billy, J. and Udry, R. ( 1985 ) Patterns of adolescent friendship and effects on sexual behavior. Social Psychology Quarterly , 48 , 27 –41.

Brown, L., Barone, V., Fritz, G., Cebollero, P. and Nassau, J. ( 1991 ) AIDS education: the Rhode Island experience. Health Education Quarterly , 18 , 195 –206.*

Cagampang, H., Barth, R., Korpi, M. and Kirby, D. ( 1997 ) Education Now And Babies Later (ENABL): life history of a campaign to postpone sexual involvement. Family Planning Perspectives , 29 , 109 –114.

Card, J. and Reagan, R. ( 1989 ) Strategies for evaluating adolescent pregnancy programs. Family Planning Perspectives , 21 , 210 –220.

Christopher, F. and Roosa, M. ( 1990 ) An evaluation of an adolescent pregnancy prevention program: is `just say no' enough? Family relations , 39 , 68 –72.

Christopher, S. and Cate, R. ( 1984 ). Factors involved in premarital sexual decision-making. Journal of Sex Research , 20 , 363 –376.

Coker, A., Richter, D., Valois, R., McKeown, R., Garrison, C. and Vincent, M. ( 1994 ) Correlates and consequences of early initiation of sexual intercourse. Journal of School Health , 64 , 372 –377.

Cook, T. and Campbell, D. (1979) Quasi-experimentation: Design and Analysis Issues for Field Settings . Houghton Mifflin, Boston.

Denny, G., Young, M. and Spear, C. ( 1999 ) An evaluation of the Sex Can Wait abstinence education curriculum series. American Journal of Health Behavior , 23 , 134 –143.*

Dunkin, M. ( 1996 ) Types of errors in synthesizing research in education. Review of Educational Research , 66 , 87 –97.

Eagly, A. and Wood, W. (1994) Using research synthesis to plan future research. In Cooper, H. and Hedges, L. (eds), The Handbook of Research Synthesis. Russell Sage Foundation, New York, pp. 485–500.

Franklin, C., Grant, D., Corcoran, J., Miller, P. and Bultman, L. ( 1997 ) Effectiveness of prevention programs for adolescent pregnancy: a meta-analysis. Journal of Marriage and the Family , 59 , 551 –567.

Frost, J. and Forrest, J. ( 1995 ) Understanding the impact of effective teenage pregnancy prevention programs. Family Planning Perspectives , 27 , 188 –195.

Gilbert, G. and Sawyer, R. (1994) Health Education: Creating Strategies for School and Community Health. Jones & Bartlett, Boston, MA.

Guyatt, G., Di Censo, A., Farewell, V., Willan, A. and Griffith, L. ( 2000 ) Randomized trials versus observational studies in adolescent pregnancy prevention. Journal of Clinical Epidemiology , 53 , 167 –174.

Hall, J., Rosenthal, R., Tickle-Deignen, L. and Mosteller, F. (1994) Hypotheses and problems in research synthesis. In Cooper, H. and Hedges, L. (eds), The Handbook of Research Synthesis. Russell Sage Foundation, New York, pp. 457–483.

Hedges, L. and Olkin, I. (1985) Statistical Methods for Meta-Analysis. Academic Press, San Diego, CA.

Herold, E. and Goodwin, S. ( 1981 ) Adamant virgins, potential non-virgins and non-virgins. Journal of Sex Research , 17 , 97 –113.

Holder, D., Durant, R., Harris, T., Daniel, J., Obeidallah, D. and Goodman, E. ( 2000 ) The association between adolescent spirituality and voluntary sexual activity. Journal of Adolescent Health , 26 , 295 –302.

Holmes, C. ( 1984 ) Effect size estimation in meta-analysis. Journal of Experimental Education , 52 , 106 –109.

Howard, M. and McCabe, J. ( 1990 ) Helping teenagers postpone sexual involvement. Family Planning Perspectives , 22 , 21 –26.*

Howard, M. and Mitchell, M. ( 1993 ) Preventing teenage pregnancy: some questions to be answered and some answers to be questioned. Pediatric Annals , 22 , 109 –118.

Hunter, J. ( 1997 ) Needed: a ban on the significance test. Psychological Science , 8 , 3 –7.

Jacobs, C. and Wolf, E. ( 1995 ) School sexuality education and adolescent risk-taking behavior. Journal of School Health , 65 , 91 –95.

Johnson, B. (1989) DSTAT: Software for the Meta-Analytic Review of Research Literatures . Lawrence Erlbaum, Hillsdale, NJ.

Jorgensen, S. ( 1991 ) Project taking-charge: An evaluation of an adolescent pregnancy prevention program. Family Relations , 40 , 373 –380.*

Jorgensen, S, Potts, V. and Camp, B. ( 1993 ) Project Taking Charge: six month follow-up of a pregnancy prevention program for early adolescents. Family Relations , 42 , 401 –406

Kinsman, S., Romer, D., Furstenberg, F. and Schwarz, D. ( 1998 ) Early sexual initiation: the role of peer norms. Pediatrics , 102 , 1185 –1192.

Kirby, D. ( 1989 ) Research on effectiveness of sex education programs. Theory and Practice , 28 , 165 –171.

Kirby, D. ( 1992 ) School-based programs to reduce sexual risk-taking behaviors. Journal of School Health , 62 , 280 –287.

Kirby, D. and Baxter, S. ( 1981 ) Evaluating sexuality education programs. Independent School , 41 , 105 –114.

Kirby, D. and Coyle, K. ( 1997 ) School-based programs to reduce sexual risk-taking behavior. Children and Youth Services Review , 19 , 415 –436.

Kirby, D., Barth, R., Leland, N. and Fetro, J. ( 1991 ) Reducing the risk: impact of a new curriculum on sexual risk-taking. Family Planning Perspectives , 23 , 253 –263.*

Kirby, D., Short, L., Collins, J., Rugg, D., Kolbe, L., Howard, M., Miller, B., Sonenstein, F. and Zabin, L. ( 1994 ) School-based programs to reduce sexual-risk behaviors: a review of effectiveness. Public Health Reports , 109 , 339 –360.

Kirby, D., Korpi, M., Barth, R. and Cagampang, H. ( 1997 ) The impact of Postponing Sexual Involvement curriculum among youths in California. Family Planning Perspectives , 29 , 100 –108.*

Kirby, D., Korpi, M., Adivi, C. and Weissman, J. ( 1997 ) An impact evaluation of Project Snapp: an AIDS and pregnancy prevention middle school program. AIDS Education and Prevention , 9 (A), 44 –61.*

Levy, S., Perhats, C., Weeks, K., Handler, S., Zhu, C. and Flay, B. ( 1995 ) Impact of a school-based AIDS prevention program on risk and protective behavior for newly sexually active students. Journal of School Health , 65 , 145 –151.

Main, D., Iverson, D., McGloin, J., Banspach, S., Collins, J., Rugg, D. and Kolbe, L. ( 1994 ) Preventing HIV infection among adolescents: evaluation of a school-based education program. Preventive Medicine , 23 , 409 –417.*

Matt, G. and Cook, T. (1994) Threats to the validity of research synthesis. In Cooper, H. and Hedges, L. (eds), The Handbook of Research Synthesis. Russell Sage Foundation, New York, pp. 503–520.

Miller, N. and Pollock, V. (1994) Meta-analytic synthesis for theory development. In Cooper, H. and Hedges, L. (eds), The Handbook of Research Synthesis. Russell Sage Foundation, New York, pp. 457–483.

O'Donnell, L., Stueve, A., Sandoval, A., Duran, R., Haber, D., Atnafou, R., Johnson, N., Grant, U., Murray, H., Juhn, G., Tang, J. and Piessens, P. ( 1999 ) The effectiveness of the Reach for Health Community Youth Service Learning Program in reducing early and unprotected sex among urban middle school students. American Journal of Public Health , 89 , 176 –181.*

Peersman, G., Oakley, A., Oliver, S. and Thomas, J. (1996) Review of Effectiveness of Sexual Health Promotion Interventions for Young People . EPI Centre Report, London.

Quinn, J. ( 1986 ) Rooted in research: effective adolescent pregnancy prevention programs. Journal of Social Work and Human Sexuality , 5 , 99 –110.

Repucci, N. and Herman, J. ( 1991 ) Sexuality education and child abuse: prevention programs in the schools. Review of Research in Education , 17 , 127 –166.

Roche, J. ( 1986 ) Premarital sex: attitudes and behavior by dating stage. Adolescence , 21 , 107 –121.

Roosa, M. and Christopher, F. ( 1990 ) Evaluation of an abstinence-only adolescent pregnancy prevention program: a replication. Family Relations , 39 , 363 –367.*

Rosenthal, R. (1991) Meta-analytic Procedures for Social Research. Sage, Newbury Park, CA.

Rosenthal, R. and Rubin, D. ( 1982 ) Comparing effect sizes of independent studies. Psychological Bulletin , 92 , 500 –504.

Sexual abstinence program has a $250 million price tag (1997) The Herald Times , Bloomington, Indiana, March 5, p. A3.

St Leger, L. ( 1999 ) The opportunities and effectiveness of the health promoting primary school in improving child health—a review of the claims and evidence. Health Education Research , 14 , 51 –69.

Thomas, G., Reifman, A., Barnes, G. and Farrell, M. ( 2000 ) Delayed onset of drunkenness as a protective factor for adolescent alcohol misuse and sexual risk taking: a longitudinal study. Deviant Behavior , 21 , 181 –210.

Visser, A. and Van Bilsen, P. ( 1994 ) Effectiveness of sex education provided to adolescents. Patient Education and Counseling , 23 , 147 –160.

Walter, H. and Vaughan, R. ( 1993 ) AIDS risk reduction among multiethnic sample of urban high school students. Journal of the American Medical Association , 270 , 725 –730.*

Weeks, K., Levy, S., Chenggang, Z., Perhats, C., Handler, A. and Flay, B. ( 1995 ) Impact of a school-based AIDS prevention program on young adolescents self-efficacy skills. Health Education Research , 10 , 329 –344.*

Zabin, L. and Hirsch, M. (1988) Evaluation of Pregnancy Prevention Programs in the School Context . Lexington Books, Lexington, MA.

• least-squares analysis
• sex education

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Effectiveness of Sex Education Interventions in Adolescents: An Overview

Affiliations.

• 1 Equity-in-Health Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
• 2 School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
• 3 School of Human Sciences, Universidad Nacional de Colombia, Bogotá, Colombia.
• PMID: 32048888
• DOI: 10.1080/24694193.2020.1713251

The objective of this overview was to identify and evaluate the effectiveness of sex education interventions aimed at reducing sexual risk behaviors in adolescents. A search was conducted of systematic reviews in English, Spanish and Portuguese from 1946 until July 2018 in the following databases: MEDLINE (Ovid), EMBASE, Scopus, PsyArticles, Cochrane Central Register of Controlled Trials, LILACS and additional resources. The extraction and analysis of data was synthesized in a narrative mode describing intervention, population, and key outcomes such as decreased risky sexual behavior, decreases in sexually transmitted infections, and adolescent pregnancy. There were 2289 potentially relevant studies, of which 31 systematic reviews related to adolescent interventions were included. It was demonstrated that interventions involve parents and the community as participants, are based on audiovisual media and school workshops, and their emphasis is on information and training in school. Different reviews framed in methods of psychosocial intervention based on community groups and the home as a fundamental axis were reported. Finally, a large amount of scientific evidence related to the subject was identified. New directions are presented for interventions in sexual education for adolescents based on the combination of actions and techniques, the implementation of digital technology, and socio-cultural and contextual adaptations.

Keywords: Sexual health; adolescent; school health services; sex education; sexuality.

Publication types

• Systematic Review
• Adolescent Behavior / psychology*
• Risk-Taking
• Sex Education / methods
• Sex Education / standards*
• Sex Education / statistics & numerical data

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• 01 May 2024

Why it’s essential to study sex and gender, even as tensions rise

You have full access to this article via your institution.

In 2023, students protested against a new policy in Texas, where parents would be notified if their child asks to be identified as transgender. Credit: Brett Coomer/Houston Chronicle/Getty

This week, Nature is launching a collection of opinion articles on sex and gender in research. Further articles will be published in the coming months. The series will highlight the necessity and challenges of studying a topic that is both hugely under-researched and, increasingly, the focus of arguments worldwide — many of which are neither healthy nor constructive.

Some scientists have been warned off studying sex differences by colleagues. Others, who are already working on sex or gender-related topics, are hesitant to publish their views. Such a climate of fear and reticence serves no one. To find a way forward we need more knowledge, not less.

Collection: Sex and gender in science

Nearly 20 researchers from diverse fields, including neuroscience, psychology, immunology and cancer, have contributed to the series, which provides a snapshot of where scholars studying sex and gender are aligned — and where they are not. In time, we hope this collection will help to shape research, and provide a reference point for moderating often-intemperate debates.

In practice, people use sex and gender to mean different things. But researchers studying animals typically use sex to refer to male and female individuals , as defined by various anatomical and other biological features. In studies involving humans, participants are generally asked to identify their own sex and/or gender category. Here, gender usually encompasses social and environmental factors , including gender roles, expectations and identity.

For as long as scientific inquiry has existed, people have mainly studied men or male animals. Even as recently as 2009, only 26% of studies using animals included both female and male individuals, according to a review of 10 fields in the biological sciences 1 . This bias has had serious consequences. Between 1997 and 2000, for instance, eight prescription drugs were removed from the US market, because clinical testing had not revealed women’s greater risk of developing health problems after taking the drugs.

Male–female comparisons are powerful in biomedical research — don’t abandon them

The tide, however, is turning. Many journals, including those in the Nature Portfolio , and funders, such as the US National Institutes of Health, have developed guidelines and mandates to encourage scientists to consider sex and, where appropriate, gender in their work.

These efforts are reaping benefits 2 . Studies, for example, are showing that a person’s sex and/or gender can influence their risk of disease and chances of survival when it comes to many common causes of death — including cardiovascular conditions and cancer.

Despite this, many researchers remain unconvinced that the inclusion of sex and gender information is important in their field. Others, who are already doing so, have told Nature that they’re afraid of how their work is perceived and of how it could be misunderstood, or misused.

Podcast: Sex and gender discussions don't need to be toxic

Because researchers who are exploring the effects of sex and gender come from many disciplines, there will be disagreements. An often-raised and valid concern, for example, is that when researchers compare responses between female and male animals, or between men and women, they exclude those whose sex and/or gender doesn’t fall into a binary categorization scheme. Another is that variability between individuals of the same sex could be more important than that between sexes.

Sometimes sense does seem to get lost in the debates. That the term sex refers to a lot of interacting factors, which are not fully understood, does not invalidate its usefulness as a concept 3 . That some people misinterpret and misuse findings concerning differences between sexes, particularly in relation to the human brain , should not mean denying that any differences exist.

Tempering the debate

Many of the questions being raised, however, are important to ask, especially given concerns about how best to investigate biological differences between groups of humans , and the continued — and, in some regions, worsening — marginalization of people whose sex and/or gender identity doesn’t fall into narrowly defined norms. Often, such questions and concerns can be addressed through research. For example, studies might find that variability between individuals of the same sex in diet, or body weight, say, are more important predictors of how likely they are to develop anaemia than whether they are male or female.

We need more-nuanced approaches to exploring sex and gender in research

The problem, then is not the discussions alone: science exists to examine and interrogate disagreements. Rather, the problem is that debates — and work on sex and gender, in general — are being used to polarize opinions about gender identity. As Arthur Arnold, a biologist at the University of California, Los Angeles, and his colleagues describe in their Comment article , last September, legislation banning gender-affirming medical care for people under 18 years old was introduced in Texas on the basis of claims that everyone belongs to one of two gender groups, and that this reality is settled by science. It isn’t. Scientists are reluctant to study sex and gender, not just because of concerns about the complexity and costs of the research, but also because of current tensions.

But it is crucial that scholars do not refrain from considering the effects of sex and gender if such analyses are relevant to their field. Improved knowledge will help to resolve concerns and allow a scholarly consensus to be reached, where possible. Where disagreements persist, our hope is that Nature ’s collection of opinion articles will equip researchers with the tools needed to help them persuade others that going back to assuming that male individuals represent everyone is no longer an option.

Nature 629 , 7-8 (2024)

doi: https://doi.org/10.1038/d41586-024-01207-0

Beery, A. K. & Zucker, I. Neurosci. Biobehav. Rev. 35 , 565–572 (2011).

Article   PubMed   Google Scholar  

Tannenbaum, C., Ellis, R. P., Eyssel, F., Zou, J. & Schiebinger, L. Nature 575 , 137–146 (2019).

Velocci, B. Cell 187 , 1343–1346 (2024).

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A Case for Sex Education in Schools Research Paper

Introduction, what is sex education, merits of sex education, demerits of sex education.

Sex education for students has emerged as a very important component of quality educational system in recent years. The goal of this education is to prepare the young people for responsible, healthy and productive citizenship by providing them with knowledge on their sexual development, biological and reproductive health, and self management.

While the objectives of sex education are favorable for the entire society, the issue is still controversial with debates being held over the suitability of offering sex education to children and teenagers. Sex education is supposed to help the youth to develop a positive attitude towards their sexuality and gain knowledge and skills that can be used to achieve sexual health.

The controversy over sex education surrounds the issue of who should teach students about sex and the specific way in which this teaching should be accomplished (Hillier and Mitchell, 2008).

While proponents of sex education assert that it will instill factual knowledge about sex to the young hence enabling them to enjoy sexual health in future, opponents contend that it will encourage students to become sexually active at an early age.

This paper will set out to argue that sex education in schools has many significant merits and should therefore be promoted. To reinforce this opinion, this paper will highlight the merits and demerits of sex education in order to demonstrate that the merits far outweigh the perceived demerits.

Goldman (2010) asserts that “Learning about sex is a core part of school life” (p.48). It would therefore be most beneficial if this learning took place in a formal manner through sex education programs.

The sexuality education programmes offered in schools embody a wide range of aspects including sexual development, reproductive health, safety, and interpersonal relationships. Lack of sex education can result in ignorance, and poor decision making by youths in matters concerning sex.

This would result in increased rates of sexually transmitted infections and unwanted pregnancies by many young people. Sex education therefore seeks to empower children by giving them information that can be used to protect their health and well being.

Today’s children are reaching the reproductive maturity of puberty at earlier ages than any of the other previous generations. One half of all girls are having their first periods by age 12 while one half of all boys are having their first erection at about 13 years of age (Goldman, 2010).

These lowered ages of reproductive fertility mean that a good number of children will experience signs of pubertal development during their primary school years. Without sex education, the children will have no knowledge of the dramatic changes their bodies are going through.

Goldman (2010) asserts that it is imperative that children be provided with sex education to given them the information need and psychologically prepare them to cope with the dramatic changes before they occur. This will avoid unnecessary anxiety on the part of the children and also minimize the risks that they may be exposed to by a lack of sexual awareness.

It has been observed that sexual activity for men and women all over the world begins in their late teenage years; that is between 15 and 19 years. However, the age of commitment to marriage is from the late 20s to the early 30s.

This gap between sexual activity and marriages demonstrates that “information about sexual behavior is essential… to improve sexual health” (Goldman, 2010, p.48). Sex education helps to maximize responsibility in individuals from an early age. They are therefore able to develop values in their lives that will ensure that they do not engage in risky sexual behavior.

All members of the society acknowledge that sex education is important for young people. However, the topic of sex is not openly discussed in most cultures and families. Juping (2010) confirms that for most parents, the topic of sex is embarrassing and hence not discussed in spite of the fact that parents have the best opportunities to provide this education for their children.

In addition to this, parents who do give sex education to their children shy away from going into details due to factors such as; parental inhibitions, communication misunderstandings, and lack of knowledge on issues such as STIs and their treatments (Juping, 2010).

Sex education provided in schools will ensure that children coming from such backgrounds are not denied of the valuable information on sexual health and relationships.

Schools are more likely to encourage children to develop their own value framework of expression, values and choices as opposed to parents who will seek to influence the choices made by their children based on their own values.

Sex education programmes offered in schools are structured so that they give the youth factual information without trying to instill any moral values or judgment. The youth are in search of sex information that is both non-judgmental and non-prescriptive in nature (Limmer, 2010).

Considering the fact that parents are anxious about their children and generally over protective, it is unlikely that such information will come from them. Schools are therefore best placed to provide the youth with unbiased information that will give them the knowledge and skills needed to make healthy choices in their sexual and reproductive lives.

A major argument against the provision of sex education in school is it leads to the acquisition of too much information of a negative kind by children. Their innocence is therefore destroyed as they are exposed to sexual knowledge at an early age.

This is not an empty claim since sex education aims to provide factual information without any bias to the children and youth. As it is, sex education is provided in a value neutral environment and contents of sex education programs are teachings on safe sex practices, sexual diversity, and abstinence (Hillier & Mitchell, 2008).

This value-neutral environment is detrimental to children and the youth who require guidance so as to make the best decisions on matters such as sex.

A common fear is that sex education provided in school will result in the corruption of student’s moral standings and make them more likely to engage in sex. As a matter of fact, sex education gives the youth intimate knowledge on matters of sex.

Some of this youth may have been uninterested or ignorant of the topic of sex until this exposure. Opponents of sex education in schools therefore state that there is no need for children to be provided with details on sex until they are about to engage in a definitive adult relationship.

Juping (2010) supports this opinion by revealing that sex education provides students with information which may cause some to get sexual ideas and engage in experimentation.

Arguably the most significant demerit of sex education is that the material taught goes against most of the moral and religious beliefs that parents have instilled in their children. Goldman (2010) confirms that sex education programs are structured around a secular basis and moral or religious undertones are not present in the teachings.

The secular nature of sex education is based on the belief that education should be aimed at providing comprehensive education on sex to the children and not instructing children not to have sex.

However, religion and morals play a major role in the lives of most people in the society and they dictate how people approach the issue of sex.

Most religions advocate abstinence for unmarried people which can have a positive impact on sexual attitudes among the youth. Sex education discounts this religious influences and moral values which typically provide guidance for the youth on sexual matters.

This paper set out to discuss the merits and demerits of sex education in school so as to show that it is beneficial for the youth. From the arguments given in this paper, it is clear that there are many valid arguments both for and against the provision of sex education in schools.

Many of the arguments against sex education are based on the wrong assumption that children and the youth will indulge in sexual activity once they are made aware of the sexual possibilities through sex education.

Research overwhelmingly demonstrates that the youth are not predisposed to experimenting with sex as a result of the sex education they receive.

Instead, sex education empowers them to make better decisions regarding sex in future. It can therefore be authoritatively stated that sex education in schools should be encouraged since it have numerous positive benefits for children and the youth.

Goldman, J.D. (2010). The new sexuality education curriculum for Queensland primary schools. Sex Education, 10(1), 47–66.

Hillier, L. & Mitchell, A. (2008). It was as useful as a chocolate kettle’: sex education in the lives of same sex- attracted young people in Australia. Sex Education , 8 (2), 211–224.

Juping, Y. (2010). Sex education beyond school: implications for practice and research. Sex Education , 10(2), 187–199.

Limmer, M. (2010). Young men, masculinities and sex education. Sex Education , 10(4), 349–358.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2019, April 3). A Case for Sex Education in Schools. https://ivypanda.com/essays/a-case-for-sex-education-in-schools/

"A Case for Sex Education in Schools." IvyPanda , 3 Apr. 2019, ivypanda.com/essays/a-case-for-sex-education-in-schools/.

IvyPanda . (2019) 'A Case for Sex Education in Schools'. 3 April.

IvyPanda . 2019. "A Case for Sex Education in Schools." April 3, 2019. https://ivypanda.com/essays/a-case-for-sex-education-in-schools/.

1. IvyPanda . "A Case for Sex Education in Schools." April 3, 2019. https://ivypanda.com/essays/a-case-for-sex-education-in-schools/.

Bibliography

IvyPanda . "A Case for Sex Education in Schools." April 3, 2019. https://ivypanda.com/essays/a-case-for-sex-education-in-schools/.

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