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
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
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
“Abstinence-only”
requirements
a) Health gains of abstinence
b) Abstinence outside of marriage is the
expected standard
c) Only certain way to avoid pregnancy,
STIs and other health problems
d) Mutually faithful monogamous
marriage is the expected standard for
sexual activity
“Abstinence-only”
requirements
e) Sex outside of marriage is likely to
have harmful psychological, physical
effects
f) Out-of-wedlock childbearing is
harmful to child, parents and society
g) How to reject sexual advances, role
of alcohol and drug use
h) Importance of attaining selfsufficiency before engaging in sex
Comprehensive Sexuality
Education
• Abstinence, AND
• Prevention of pregnancy and sexually
transmitted infections (STIs)
Healthy
• And more…..
Media
Anatomy
Relationships
Adoption Sexual violence,
dating violence
DecisionPuberty
making
Abortion
Sexual
Interpersonal
orientation
communication
Comprehensive Sexuality
Education
• “Medically accurate”
• Based on scientific evidence, not
ideology
• “Age-appropriate”
Other approaches
• “Abstinence-based,” “Abstinence-plus”
• Focus on abstinence, with some
prevention messages
• Poorly defined, very common
• Other abstinence
• Does not adhere to “abstinence-untilmarriage” guidelines
• Increase in abstinence-only messages
over time
Review of scientific research
• Effective sexuality education programs
• What parents want for school-based
sexuality education
• Teachers’ experiences with sexuality
education
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
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
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
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
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
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
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
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
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
Effective sex education
• Conclusions
• Several effective comprehensive
programs
• Abstinence-only-until-marriage
programs, not effective for behavior
change
• Some promising abstinence programs
Review of scientific research
• Effective sexuality education programs
• What parents want for school-based
sexuality education
• Teachers’ experiences with sexuality
education
Parents on sex ed….
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
What parents want
• Overall views on sexuality education
• 12 specific sexuality education
topics
• Earliest grade level
• Demographic/personal
characteristics
What parents want
Characteristics of the sample, n=1605
What parents want
Thinking about sex education classes, do you think teenagers
should be taught…
What parents want
Sex education should include information about abstinence and
prevention of pregnancy and STDs
What parents want
What parents want
Should this topic be taught? What is the earliest grade level?
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
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”
Review of scientific research
• Effective sexuality education programs
• What parents want for school-based
sexuality education
• Teachers’ experiences with sexuality
education
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
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?
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.
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.
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
Teachers’ experiences
• Additional content to teach
• Healthy relationships
• The emotional component of sexual
relationship
• STI and pregnancy prevention
• Sexual orientation and sexual identity
• Media
Teachers’ experiences
• Conclusions
• Teachers want to teach more content…
• … but face numerous barriers
• More research to come…..
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