Chapter 2, Section 2: Sexuality Education

Comprehensive sexuality and HIV education programs that directly address sexual antecedents have shown great promise in preventing adolescent pregnancy and childbearing (Kirby, 2001). A number of curricular programs have been rigorously evaluated and shown to be successful in prevention efforts. In fact, 44 percent of youth ages 13–18 identify sex education courses as an important resource for sexual health issues (Henry J. Kaiser Family Foundation, 2000). When comprehensive sexuality education is included in a broader youth development program there is greater potential for success.

Recent data tell us that most young people are getting some kind of education relating to sexuality, but the content of programs varies widely (Henry J. Kaiser Family Foundation, 2000; Kirby, 2001). Decisions of which components to include in an adolescent pregnancy program need to be made by each agency with consideration to the specific population in which it serves. In this section, the focus will be on comprehensive approaches and what can be learned from successful programs. Recently, some people have referred to comprehensive sexuality programs as “Abstinence-Plus” programs, in order to emphasize that abstinence is also an important component of comprehensive programs.

Sexuality education has been widely debated in the United States for the last few decades. One argument against it is that providing comprehensive sexuality education “will encourage young people to have sex.” On the contrary, research shows that these programs do not increase sexual activity, the number of partners, the frequency of sex, or hasten the onset of sexual activity in teens (Kirby, 2001). In fact, some programs delay onset of sexual activity and reduce frequency, as well as the number of sexual partners among teenagers. Some programs also found increases in use of condoms and other contraceptives among groups of sexually active youth (Kirby, 2001).

Douglas Kirby, Ph.D., has rigorously evaluated and critiqued existing research on sexuality education and HIV education programs, and has determined that there are ten characteristics that were found to be consistent in all of the successful curricular programs. These characteristics are discussed later in this document (page 13). He has identified five programs that have shown strong evidence of success and the Centers for Disease Control and Prevention (CDC) has identified these same five sex and HIV education programs as effective.

Sexuality and HIV education programs might address an array of topics, such as anatomy and the body; reproduction: puberty and sexual development; sexual decision-making and limit setting; peer and partner pressure; abstinence; information about condoms and other contraceptive methods; gender; sexual orientation; sexually transmitted infections (STIs) including HIV; risk reduction; healthy relationships; reproductive health and rights; healthy sexuality over the lifespan; and other topics. Information about pregnancy prevention and the development of necessary skills is put in the larger context of healthy sexuality. Many programs offer opportunities for young people to ask embarrassing or difficult questions anonymously.

Research Demonstrates

The following are important components of comprehensive sexuality and peer education programs based on the work of Dr. Douglas Kirby and the National Campaign to Prevent Teen Pregnancy. While many types of programs may be able to show an increase in knowledge, the following characteristics are important in order to actually reduce sexual risk-taking, which is far more challenging. Interestingly, these characteristics are similar to those of educational programs that have been found to reduce substance abuse (Dusenbury & Falco, 1995).

• Focus on reducing one or more sexual behaviors that lead to unintended pregnancy (Kirby, 2001). It is critical to have a singular focus when addressing the reduction of sexual behaviors. If a program takes on too much by utilizing a broad prevention message aimed at reducing numerous sexual behaviors, the take home message becomes too large and is therefore less likely to be digested by the target audience.
• Provide basic, accurate information about the risks of teen sexual activity and methods of avoiding unprotected intercourse (Kirby, 2001). Youth need to have information presented in a simple way in order to help them assess risks and avoid risky behaviors like unprotected sex. The importance of providing honest answers to young people’s questions based on factual evidence cannot be overemphasized.
• Convey and repeatedly reinforce a clear message about abstinence and/or condom use or other forms of contraception. Effective programs give a clear and consistent message about behavior, such as delaying sexual intercourse or messages about condom and contraceptive use and continually reinforce that message through activities and discussion (Kirby, 2001). Educators should present a clear value towards abstinence, and proper and consistent condom and contraceptive use as the most beneficial choices young people can make. Programs that try to affect the group norms of young people through group activities show the most promising success (Kirby, 2001).
• Build skills through modeling and practice. Research suggests that skills training greatly increases the effectiveness of sexuality education (Kirby, 2001). Effective programs provide information about skills, demonstrate effective use of those skills, and then provide some sort of skill rehearsal and practice (Kirby, 2001). Reinforcing the messages of the program with skills building exercises that model communication, negotiation, and refusal skills, will assist young people in putting their beliefs into practice. In one national survey, students who had any type of sexuality education said they wanted more time spent on practical skills, such as how to talk to a partner about STIs or other sexual health issues, where to get tested for HIV or other STIs, or where to get birth control and how to use it (Henry J. Kaiser Family Foundation, 2000). It is important to provide as many opportunities as possible for young people to actively work on their skills.
• Address social pressures related to sexual behavior. A survey by the Henry J. Kaiser Family Foundation and YM Magazine (1998) showed that 36 percent of teens felt pressure to do something sexual or had actually done something sexual that they were not ready to do. More often, girls had these experiences. This underlines the importance of proactively addressing very real and complex pressures young people experience. Youth feel pressure from peers, partners, media and other sources; and boys and girls may experience different kinds of pressures, or attach different meaning to the social pressures they receive. Effective programs include activities that discuss situations that might lead to sex, address peer norms about having sex or using condoms, and address ubiquitous media influences and messages that are often unrealistic (Kirby, 2001).
• Use a variety of teaching methods that involve the participants and help them personalize information (Kirby, 2001; National Campaign to Prevent Teen Pregnancy, 1999). Engage students in the learning process by asking them what they want to learn and involving them in the planning and evaluating of the program. View the curriculum as flexible, depending on emerging student needs and current events. Avoid using a purely didactic approach to teaching by using experiential exercises, small group activities, discussions, and role-play. Have the staff serve as a facilitator, guide, resource, and co-learner (Hedgepeth & Helmich, 1996).
• Incorporate behavior goals, teaching methods, and materials that are appropriate to the age, sexual experience, and culture of the participants. Postrado and Nicholson (1992) suggest designing programs for different age groups. They indicate that younger, non-sexually active youth may be more easily influenced by abstinence approaches than adolescents who are sexually active. Similarly, programs must differ to reflect the differences in youth in regards to sexuality, that is, their gender, sexual orientation, sexual values and attitudes, sexual health, sexual experience, and relationships. It is important to remember that such differences not only appear within groups but within individuals themselves (Hedgepath & Helmich, 1996). A great deal of cultural diversity exists in our society. When designing prevention programs, staff must consider the fact that our communities consist of individuals from many racial, religious, and cultural backgrounds, with diverse beliefs, values, and practices and create programs accordingly (Hedgepath & Helmich, 1996).
• Programs should be based on theoretical approaches that have been demonstrated to be effective in influencing other health-related risk behaviors (Kirby, 2001). There should be a theoretical background for sexuality education programs in order to go beyond a cognitive level and affect social norms, behavior, and individual values, and to build personal skills. Programs might use social learning theories or theories of behavior change in order to reach youth in meaningful ways.
• Provide ongoing education that lasts long enough to allow participants to complete important activities. It takes time to fully process activities and information, and to have a behavioral impact on youth. One or two sessions are not sufficient to address the myriad issues and questions adolescents have about sexuality. It is important to provide enough structured time to meet program objectives. Kirby (2001) found that programs with effective outcomes fell into two categories in terms of duration. The first were those that lasted 14 or more hours and the second were those that lasted a smaller number of hours, but worked with youth in small group settings who had voluntarily joined the program. The second type also had the benefit of smaller, more intensive group experiences, which could have a greater impact in some respects.
• Use teachers or peers who believe in the approach and have been trained to deliver the program (Kirby, 2001; National Campaign to Prevent Teen Pregnancy, 1999). Careful selection of teachers and peer leaders is essential. Not everyone is cut out for teaching about sexuality and pregnancy, and it is important to identify those who are comfortable with sexuality in general, and with your program objectives and messages, in particular. Leading effective role-plays is tricky and it requires a great deal of skill to successfully process activities. It is vitally important that all teachers and peer leaders receive training, which may range from a few hours to a few days, and which should include multiple opportunities to practice leading exercises and discussing sensitive topics.

Implementation Tips

• Identify a specific behavior that you would like your youth to adopt or avoid (e.g., using condoms, avoiding risky situations, not making sexual
  decisions while using drugs or alcohol) and target your messages specifically to that behavior.
• Include lots of opportunities for participants to practice the skills associated
  with the topics discussed. This may include role-plays, condom relays,
  research activities, or homework.
• Have students fill out anonymous cards that ask for real-life sexual situations that they or their friends have faced. Use these cards for practice exercises and role-plays.
• Ask students regularly, “Would this happen this way in real life?” If not, ask them what would work or how the situation might turn out better.
• Provide ongoing training and support to the people delivering the program.

Sexuality Education Program Assessment .pdf

To download a free copy of the Adobe Acrobat Reader, which you can use to view .pdf documents, select (click on) the Acrobat Reader icon.