Sexuality Education: Birds, Bees, and Scientific Evidence

1. Sexuality Education: Birds, Bees, and Scientific Evidence Marla Eisenberg, Sc.D., M.P.H. Healthy Youth Development • Prevention Research Center Department of Pediatrics, Division of Adolescent Health and Medicine University of Minnesota

3. Overview • What is school-based sexuality education? • Review of the scientific research • Effectiveness of different programs • Parental support for different programs • Teachers’ views on teaching sex ed

4. Sexuality Education Lingo • Abstinence-only education • Initiated with 1998 Social Security Act, $50 million in annual grants • Recently renewed, $250 million as part of Health Care Reform legislation • 8 requirements • Developed by Heritage Foundation • Designed to clarify what “counts” as abstinence for funding purposes

5. “Abstinence-only” requirements • Health gains of abstinence • Abstinence outside of marriage is the expected standard • Only certain way to avoid pregnancy, STIs and other health problems • Mutually faithful monogamous marriage is the expected standard for sexual activity

6. “Abstinence-only” requirements • Sex outside of marriage is likely to have harmful psychological, physical effects • Out-of-wedlock childbearing is harmful to child, parents and society • How to reject sexual advances, role of alcohol and drug use • Importance of attaining self-sufficiency before engaging in sex

7. Comprehensive Sexuality Education • Abstinence, AND • Prevention of pregnancy and sexually transmitted infections (STIs) • And more….. Healthy Relationships Media Anatomy Sexual violence, dating violence Adoption Decision-making Puberty Abortion Sexual orientation Interpersonal communication

8. Comprehensive Sexuality Education • “Medically accurate” • Based on scientific evidence, not ideology • “Age-appropriate”

9. Other approaches • “Abstinence-based,” “Abstinence-plus” • Focus on abstinence, with some prevention messages • Poorly defined, very common • Other abstinence • Does not adhere to “abstinence-until-marriage” guidelines • Increase in abstinence-only messages over time

11. Review of scientific research • Effective sexuality education programs • What parents want for school-based sexuality education • Teachers’ experiences with sexuality education

12. Effective sex education • What is rigorous scientific research? • Not all studies are created equal • Peer review – the hallmark of scientific studies • Two reviews of sexuality education programs

13. Effective sex education • Emerging Answers; Kirby, 2007 • Conducted in U.S., 1990-2007 • >100 teens ages 12-18 • Impact on behavior and health outcomes • Experimental or quasi-experimental design • Sufficient longitudinal follow-up • Appropriate statistical analysis • Impacts of abstinence-only education programs; Trenholm, et al, 2007

14. Effective sex education • Comprehensive programs (Kirby, 2007) • Improved sex-related factors • Knowledge about risks, consequences • Values, beliefs, attitudes about sex, condoms, contraception • Confidence to say “no,” insist on condoms, use condoms • Intention to avoid sex or unprotected sex • Communication with adults about sex

15. Effective sex education • Comprehensive programs (Kirby, 2007) • Improved sexual behaviors • Delayed sexual initiation • Reduced number of partners, frequency of sex • Increased condom or contraceptive use • Did NOT lead to earlier or more frequent sex • Worked for wide variety of participants, in different settings, communities

16. Effective sex education • Abstinence-only until marriage (Maynard et al, 2005; Trenholm et al, 2007) • Improved sex-related factors • Views of abstinence • Perceptions of adverse consequences • Expectations of abstinence • BUT increased inaccurate information about condoms

17. Effective sex education • Abstinence-only until marriage (Trenholm et al, 2007) • Did not delay sexual initiation • Did not decrease number of partners • But did NOT have negative impacts on condom, contraceptive use

18. Effective sex education • Other abstinence-only programs (Kirby, 2007) • Improved sex-related factors • Values, beliefs, attitudes favoring abstinence • Intentions to abstain from sex • Sexual behaviors • Did not delay sexual initiation • Did not increase secondary abstinence • Did not decrease number of partners • But did NOT have negative impact on condoms, contraceptives

19. Effective sex education • Jemmott et al, 2010 • Scientifically rigorous • Tested abstinence-only program against safer-sex and combined models • Key findings re: abstinence-only program • Reduced sexual initiation • Reduced recent sexual activity • No effect on condom use

20. Effective sex education • Jemmott et al, 2010 • Abstinence content • NOT abstinence-until-marriage • No inaccurate/disparaging information, esp. regarding condoms • Sample • African American students, 12 years old • Volunteer participants • Setting, structure • Not school-based • Weekends, 8-1 ratio, follow-up counseling

21. Effective sex education • Conclusions • Several effective comprehensive programs • Abstinence-only-until-marriage programs, not effective for behavior change • Some promising abstinence programs

22. Review of scientific research • Effective sexuality education programs • What parents want for school-based sexuality education • Teachers’ experiences with sexuality education

24. Parents on sex ed….

25. What parents want • Study of Minnesota parents (Eisenberg et al, 2008) • Telephone survey of parents, 2006 –2007 • Sampling frame stratified by congressional district • Survey based on existing instruments • 2,546 contacts with eligible households • child age 5-18 • English or Spanish speaking parent • 1605 parents, 63% participation rate

26. What parents want • Overall views on sexuality education • 12 specific sexuality education topics • Earliest grade level • Demographic/personal characteristics

27. What parents want Characteristics of the sample, n=1605

28. What parents want Thinking about sex education classes, do you think teenagers should be taught…

29. What parents want Sex education should include information about abstinence and prevention of pregnancy and STDs

30. What parents want

31. What parents want Should this topic be taught? What is the earliest grade level?

33. What parents want • Conclusions • Minnesota parents overwhelmingly support comprehensive sex ed • Consistent support across demographic categories, geographic regions • Variety of topics, mostly by middle-school • Findings are consistent with several other peer-reviewed studies

34. What parents want • Other research shows strong support for abstinence-only education (Zogby Int’l, 2007) • National sample, 1002 parents of 10-16 y.o. • Find strong support for abstinence education • BUT, defined abstinence education as: “permitting an age-appropriate discussion of contraceptives within the context of promoting abstinence as the healthiest choice”

35. Review of scientific research • Effective sexuality education programs • What parents want for school-based sexuality education • Teachers’ experiences with sexuality education

37. Teachers’ experiences • Qualitative study, focus groups • 42 sexuality educators, diverse group • Discussion questions • Supports and barriers in teaching sex ed • What they would like to teach and what prevents them from teaching what they would like

38. Teachers’ experiences • Thinking about the sex education curricula or content you use, what grade would you give it in terms of how well it prepares students to be sexually healthy adults and why?

39. Teachers’ experiences I would give it a C. Just because it is general. And we can’t say, or we are not supposed to talk about gay, lesbian, unless of course somebody asks you can answer, or oral sex…. I don’t think we should have to rely on the kids to have to ask to get a comprehensive education.

40. Teachers’ experiences • If it were totally up to you what would you teach your students? What prevents you from teaching the way you’d like to? We could probably do better if we had more control over what we could present.

41. Teachers’ experiences • Other barriers • Restrictive policies • Time available to teach content • Timing of programming • Poor curricula and lack of resources to purchase/get trained on a new one

42. Teachers’ experiences • Additional content to teach • Healthy relationships • The emotional component of sexual relationship • STI and pregnancy prevention • Sexual orientation and sexual identity • Media

43. Teachers’ experiences • Conclusions • Teachers want to teach more content… • … but face numerous barriers • More research to come…..

44. Some concluding thoughts • Strong alignment • Evidence of effective programs • What parents want • What teachers think students’ need • School-based sexuality education can be part of sexual violence prevention