School Sexuality Education and Adolescent Risk-Taking Behavior
Jacobs, Cecilia Dine, Wolf, Eve M., Journal of School Health
Costs and negative consequences associated with teen pregnancy and the spread of sexually transmitted diseases (STDs) among adolescents spurred interest in studying and developing methods to prevent these problems. School sexuality education provides one possible means of prevention that health care professionals and scientists have recommended and studied.[1-9] This review examines studies measuring effects of school sexuality education on adolescent sexual risk-taking behavior. The term "sexuality education" refers to formal, comprehensive school courses that deal with human sexuality in the broadest sense, as opposed to courses which last only a few days and deal with one or two topics. The term "sexual risk-taking behavior" refers to any sexual behavior that puts health or well-being at risk by inducing unwanted pregnancy or contraction of an STD. Methodological problems common in this body of research are addressed and several studies which measured effects of school sexuality education are examined. Finally, conclusions are drawn and suggestions for future research are made.
Studies measuring effects of school sexuality education focused on effects on student knowledge, attitudes, and behavior. An examination of the literature reveals inconsistent findings in all of these areas. This result may be due to methodological problems inherent in this area of research, or to lack of real treatment effects. Perhaps the most striking problem in the study of sexuality education involves the inadequate and inconsistent definition of terms. Programs with different goals, structures, lengths, delivery agents, and theoretical underpinnings often are referred to as sexuality education. For example, abstinence-oriented programs, AIDS prevention programs, programs that emphasize contraception, and programs that only cover physiological topics all are considered "sexuality education" courses. Programs of various lengths and levels of comprehensiveness also are referred collectively to as sexuality education.
Another common problem, particularly when behaviors are being measured, involves the use of self-report, retrospective data. For example, one method used to measure effects of sexuality education has subjects complete surveys asking whether or not they participated in sexuality education courses or asking about the content or comprehensiveness of a particular course they completed. These data are compared with self-report data on knowledge, attitudes, and behavior. Caution is warranted when interpreting results obtained in this manner. Subjects' perceptions of what constitutes sexuality education may vary substantially. Subjects also may be cautious or forgetful when asked to reveal information about their sexual attitudes and behavior.
Drawing conclusions about effects of school sexuality education often proves difficult because a range of variables can influence an adolescent's sexual knowledge, attitudes, and behavior. For example, research has shown that, in addition to school sexuality education courses, other important variables affect sexual knowledge, attitudes, and behavior including peer attitudes and behavior, family of origin values, self-efficacy, locus of control, choice of partner, relationship with partner, and media exposure.[11-14] Controlling for all of these variables proves extremely difficult. Minimally, a study measuring effects of school sexuality education needs a comparison group of students not exposed to the independent variable. Once this procedure is achieved, another level of control can be initiated by matching subjects according to other variables such as those mentioned above. Studies from the sexuality education literature, however, often lack the minimum requirement of a control or comparison group. Without such control measures, it is difficult to determine whether sexuality education is associated with changes in knowledge, attitudes, and behavior or whether other variables such as peer group or maturation is responsible. …