Sex education is such a highly charged topic that evidence of effectiveness often gets lost in battles over ideology.
A new website based on an academic research review aims to help users navigate the maze of programs and claims by listing information about programs backed by rigorous research evidence. This evidence focuses on whether or not programs help curtail sexual activity, decrease teen-age pregnancy rates, foster the use of contraceptives and/or reduce rates of sexually transmitted infections.
The Office of Adolescent Health in the U.S. Department of Health and Human Services sponsors the website. Much of the information it contains is based on a research review, published online February 11, that is scheduled to appear in a forthcoming issue of the peer-refereed Journal of Adolescent Health. A total of 88 of the 1,900 citations considered met the reviewers' standards for quality (e.g. they were experimental or quasi-experimental) and relevance, in the sense that they took place in the United States and targeted adolescents under the age of 20. All of the studies were published between 1989 and 2011. The 88 studies considered 31 different sex-education programs.
The review findings suggest that effective sex-education programs take many different forms. The 31 approaches identified included abstinence-based and comprehensive sex education offered in schools, as well as individualized programs run out of clinics and residential treatment centers.
"One main takeaway just for school board members or policymakers looking to implement a teen pregnancy program with some evidence behind it is they have a lot more choices today than they did 20 or 25 years ago," said Brian Goesling, a senior researcher and associate director of human services research at Mathematica Policy Research, headquartered in Princeton, NJ.
Public debates about sex education in schools often focus on religiously and morally based concerns about sending a strong message of abstinence. The Journal of Adolescent Health review focused on issues of evidence rather than abstinence. But the Health and Human Services website permits users to search for programs with different types of approaches, including whether or not a program focuses on abstinence. A quick search of the site reveals that abstinence is the focus of three of the 31 programs described in the Journal of Adolescent Health study. Heritage Keepers Abstinence Education is a middle school or high school curriculum backed by "moderate" evidence. Making a Difference! is an after-school or community-based curriculum for students 13 and younger. The evidence backing the program was rated "high" by researchers. Promoting Health Among Teens- Abstinence Only is also an after-school or community-based program for children under age 14 with an evidence rating of "high." The available evidence suggests that all three programs reduce sexual activity. The programs either failed to impact other outcomes or lacked rigorous evidence on their impact on teen-age pregnancy, contraceptive use, and sexually transmitted diseases.
Goesling and his co-authors found just one program with evidence of affecting all four outcomes. SiHLE-Sisters, Informing, Healing, Living, Empowering is a health clinic-based program that targets African-American teen-age girls at risk of contracting HIV. Its evidence level was rated "high."
For the remaining 30 programs, past research had either not considered at least one outcome, the evidence related to that outcome was too weak to be included in the review or the program had failed to impact at least one outcome of interest. The most frequently examined outcome was sexual activity. All but three reviewed programs were backed by research that considered whether or not particpants ended up engaging in less sexual activity. Just six programs failed to reduce sexual activity.
The least frequently studied outcomes were sexually transmitted diseases and teen pregnancy or birth rates. Given that reducing teen pregnancy is the ultimate goal of most of these programs, this seemed odd. Goesling explained that many of the programs targeted younger students, meaning that long-term (and more expensive and complicated) research designs were required to determine whether the approach ended up reducing pregnancy rates.
Another weakness in the literature was that most programs were backed by only one or maybe two high-quality studies.
"It's nice to have that initial study that may show some strong positive effects but to get to the point that we really have confidence that that program works and can be called up with different populations, you'd really like to see more than one study on the program," Goesling said.
A final weakness was the shortage of high-quality studies of programs targeting Hispanic teens. Goesling and his co-authors noted that this was particularly problematic because Hispanics have the highest teen-age birthrate of any major racial or ethnic group in the United States. According to the most recent data available from the Centers for Disease Control and Prevention, the 2011 Hispanic teen-age birthrate was 49.4 per 1,000 15- to 19-year-olds, as compared to the national average of 31.3 per 1,000 teens. However, both Hispanic and overall birthrates have steeply declined by about 50 percent since 1991.