Comprehensive Sex Education
By: J. Williams
Adolescents go through a normative process of sexuality development as they explore how to become healthy sexual adults (Tolman & McClelland, 2011). During this developmental process, however, adolescents are more likely than older age groups to engage in unprotected sexual intercourse (Meschke, Bartholomae, & Zentall, 2000). With over 80% of teen pregnancies occurring unintentionally and individuals between the ages of 15-24 years accounting for nearly 50% of new cases of STIs (Kirby & Laris, 2009), the risks accompanying unprotected sex among adolescents are high. Therefore, it is important for adolescents to understand how to protect themselves against those risks. When communities implement comprehensive sex education programming, they empower adolescents to make informed decisions about their sexuality development and equip them with the skills to avoid unintended pregnancies and STIs.
Many communities have relied on abstinence-only sex education programs to help protect adolescents from the risks associated with unprotected sexual activity (Kohler, Manhart, & Lafferty, 2008). Abstinence-only programs teach adolescents two main points: (1) youth should not engage in sexual intercourse until they are married, and (2) abstinence is the only way to ensure adolescents do not become pregnant or contract a STI (Kohler et al., 2008). Abstinence-only sex education programs generally do not discuss contraceptives except to state that they are ineffective (Kohler et al., 2008). While the idea of abstaining from sexual activity until married may fit with many families’ values, research reveals that abstinence-only programs are not effective. Kohler, Manhart, and Lafferty (2008) found that abstinence-only sex education programs did not significantly reduce the mean age at which adolescents’ first engaged in sexual intercourse, reduce adolescents’ risk of unintended pregnancies, or reduce adolescents’ risk of contracting STIs. Thus, empowering adolescents to make the healthiest choices possible as they develop into healthy sexual adults requires providing them more information than simply to remain abstinent until marriage. It requires providing them complete and accurate information about the risk factors associated with unprotected sexual activity and the information and skills to protect themselves against those risk factors.
Comprehensive sex education programs provide adolescents the information and skills necessary to enable them to make healthy decisions about their sexuality development. Similar to abstinence-only sex education programs, comprehensive sex education programs teach adolescents about postponing the initiation of sexual intercourse; however, comprehensive sex education programs also teach adolescents about condom and contraceptive use as a means to protect against unintended pregnancies and STIs (Kohler et al., 2008). Research indicates that communities can reduce unprotected sexual intercourse among adolescents by implementing comprehensive sex education programming (Kirby & Laris, 2009). Communities can implement programming in school settings or other clinic or community settings (Kirby & Laris, 2009). While some community members may fear that adolescents will engage in more sexual activity if abstinence-only sex education programs are replaced with comprehensive sex education programs, research indicates that comprehensive programs have not led to an increase in sexual activity among adolescents (Kohler et al., 2008).
Becoming a Responsible Teen is one example of a community-based comprehensive sex education program that has proven successful among adolescents (Kirby & Laris, 2009). The program is designed to increase adolescents’ knowledge about sexual risk factors and their ability to make healthy choices when encountering those risk factors (Polacek et al., 2008). The program is comprised of eight weekly sessions that each last between 1.5 to 2 hours (Polacek et al., 2008). During the sessions, adolescents engage in activities that provide them knowledge about the risks associated with sexual activity (Polacek et al., 2008). In addition, adolescents engage in activities that help them build skills in the following critical areas: refusal, assertive communication, risk recognition, condom use, self-management, and problem solving (Butts & Hartman, 2002). The program provides adolescents opportunities to practice the skills they learn in a safe environment among their peers (Polacek et al., 2008). The curriculum strives to turn the learned behaviors into normative behavior among the adolescents (Polacek et al., 2008).
Kirby and Laris (2009) found that Becoming a Responsible Teen positively impacted adolescent sexual behavior. The program reduced unprotected sexual intercourse and increased condom use among adolescents (Kirby & Laris, 2009). In addition, the program increased abstinence and lowered adolescents’ number of intimate partners (Kirby & Laris, 2009). The Centers for Disease Control and Prevention with ETR Associates published an adaptation kit to guide community leaders in making adaptations to Becoming a Responsible Teen when implementing the program into their community (Rolleri et al., 2011).
Safer Choices is an example of an effective school-based comprehensive sex education program (Kirby et al., 2004). Safer Choices is a two-year program implemented in high schools to reduce unprotected sexual intercourse among adolescents by delaying the initiation of sexual intercourse and increasing the use of condoms (Coyle et al., 1999). Additionally, the program aims to increase adolescents’ knowledge about HIV and STIs and their belief in their ability to refuse unprotected sexual intercourse and to use condoms (Coyle et al., 1999). Kirby and Laris (2009) found that Safer Choices delayed first sexual experiences among Hispanic adolescents. In addition, the program increased the use of contraceptives and condoms in both genders across all races and ethnicities (Kirby & Laris, 2009).
Safer Choices consists of 20 total classroom sessions; teachers provide the first 10 lessons to students when they are in the 9th grade, and teachers provide the final 10 lessons to the students when they are in the 10th grade (Coyle et al., 1999). In addition to the curriculum, the program includes a school organization consisting of teachers, administrators, students, parents, and members of the community (Coyle et al., 1999). Each school also has a peer team in which students meet with adult coordinators to host activities aimed at altering the culture of the school, and teens share their personal stories of positive sexual behaviors with the student body (Coyle et al., 1999). To facilitate parent-adolescent communication, the program provides three parent newsletters each school year that includes tips to help parents talk with adolescents about sexuality development and provides parent-adolescent homework activities (Coyle et al., 1999). The final component of the program focuses on the school-community link (Coyle et al., 1999). The program includes activities that help adolescents become familiar with resources and support services available in their community and also includes HIV-positive guest speakers from the community during the 10-grade curriculum (Coyle et al., 1999). This multicomponent design incorporates the family, school, and community context into sex education (Coyle et al., 1999).
As these programs demonstrate, communities have the opportunity to create environments that support positive, healthy choices among adolescents as they develop into sexually mature young adults. Community youth development efforts bring adults and youth together as partners to work on projects that are important to adolescents and that make the community a more positive environment for adolescent development. With the community youth development approach, adults and adolescents in the community can work together to develop and implement a comprehensive sex education program. Adolescents can contribute not only in designing the program but can also serve as key participants in the delivery of the program.
Communities have the opportunity to obtain a first-hand look into the minds of adolescents by partnering with them in designing a comprehensive sex education program. In determining the content for the program, a community should consult adolescents on how much they already know and understand about the risks of unprotected sexual activity. Many adolescents understand that engaging in unprotected sexual activity can result in an STI or unintended pregnancy (Trenholm et al., 2007). However, adolescents do not always understand the negative health consequences that accompany STIs, and they often are not aware of the various types of STIs (Trenholm, et al., 2007). Adolescents may also not be fully aware of the challenges of teen parenting. In addition, some adolescents are unfamiliar with where to obtain condoms and contraceptives. Other adolescents may attempt to use condoms or other forms of contraceptives, but they often are unsure how to properly use them (Kirby & Laris, 2009). Adolescents can also help community leaders understand the peer pressures youth face so that the program design can include activities to build adolescents’ skills for responding to peer pressures. By becoming more familiar with the questions adolescents have about sexual development and the pressures they face, community leaders can develop a comprehensive sex education program that provides complete and accurate information for adolescents in the community.
Following the community youth development approach, community leaders should also include adolescents in the delivery of the sex education programming. Comprehensive sex education programs often include role-playing exercises and group discussions to help adolescents learn and practice assertive communication, problem solving, risk recognition, and refusal skills (Butts & Hartman, 2002). With the help of community leaders, adolescents can help create the scenarios for the role-plays and can further help facilitate the role-playing exercises. In addition, adolescents can help adult leaders draft discussion questions and lead the group discussions. Guest speakers are also commonly a part of comprehensive sex education programming (Butts & Hartman, 2002). Adolescents can serve as guest speakers to discuss their personal experiences related to sexuality development (Coyle et al., 1999). As guest speakers, adolescents can share their stories of times they made a positive choice about their sexuality development (Coyle et al., 1999). Pregnant and parenting adolescents can also share their stories to help their peers understand the challenges that accompany early parenting. In these ways, adolescents could be not only learners but also leaders in a comprehensive sex education program in their community.
In summary, communities can empower adolescents to make positive choices about their sexuality development by implementing comprehensive sex education programming. Limiting sex education to abstinence-only programs is not sufficient to empower youth to make healthy decisions about their sexuality development (Kohler et al., 2008). To develop into healthy sexual adults, adolescents need complete and accurate information about the risk factors that accompany sexuality development, including unintended pregnancy and STIs, as well as information and skills training on how to avoid those risk factors (Kirby & Laris, 2009). Therefore, communities should partner with adolescents to create a comprehensive sex education program and enable adolescents to help facilitate the delivery of the program.
References
Butts, J. B., & Hartman, S. (2002). Project BART: Effectiveness of a behavioral intervention to reduce HIV risk in adolescents. The American Journal of Maternal/Child Nursing, 27, 163-169.
Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Harrist, R., . . . Weil, M. (1999). Short-term impact of Safer Choices: A multicomponent, school-based HIV, other STD, and pregnancy prevention program. Journal of School Health, 69, 181-188.
Kirby, D., & Laris, B. A. (2009). Effective curriculum-based sex and STD/HIV education
programs for adolescents. Child Development Perspectives, 3, 21-29.
Kirby, D. B., Baumler, E., Coyle, K. K., Basen-Engquist, K., Parcel, G. S., Harrist, R., & Banspach, S. W. (2004). The “Safer Choices” intervention: Its impact on the sexual behaviors of different subgroups of high school students. Journal of Adolescent Health, 35, 442-452. doi:10.1016/j.jadohealth.2004.02.006
Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42, 344-351. doi:10.1016/j.jadohealth.2007.08.026
Meschke, L. L., Bartholomae, S., & Zentall, S. R. (2000). Adolescent sexuality and parent-adolescent processes: Promoting healthy teen choices. Family Relations, 49, 143-154. doi:10.1016/S1054-139X(02)00499-8
Polacek, G. N. L. J., Coker, J., Lewis, K. L., Minter, M., Villela-Perez, V., & Scott, A. A. (2008). BART to HIVEd: Adapting an HIV education prevention program. Health Promotion Practice, 9, 45-58. doi:10.1177/1524839907306405
Rolleri, L. A., Lezin, N., Taylor, J., Moore, C., Wilson, M. M., Fuller, T. R., . . . St. Lawrence, J. S. (2011). Tools and resources for making informed adaptations to Becoming a Responsible Teen. Retrieved November 8, 2012, from http://recapp.etr.org/recapp/documents/programs/BART_Adaptation_Kit.pdf
Tolman, D. L., & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review. Journal of Research on Adolescence, 21, 242-255. doi:10.1111/j.1532-7795.2010.00726.x
Trenholm, C., Devaney, B., Fortson, K., Quay, L., Wheeler, J., & Clark, M. (2007). Impacts of four Title V, Section 510 abstinence education programs. Princeton, NJ: Mathematica Policy Research.
Many communities have relied on abstinence-only sex education programs to help protect adolescents from the risks associated with unprotected sexual activity (Kohler, Manhart, & Lafferty, 2008). Abstinence-only programs teach adolescents two main points: (1) youth should not engage in sexual intercourse until they are married, and (2) abstinence is the only way to ensure adolescents do not become pregnant or contract a STI (Kohler et al., 2008). Abstinence-only sex education programs generally do not discuss contraceptives except to state that they are ineffective (Kohler et al., 2008). While the idea of abstaining from sexual activity until married may fit with many families’ values, research reveals that abstinence-only programs are not effective. Kohler, Manhart, and Lafferty (2008) found that abstinence-only sex education programs did not significantly reduce the mean age at which adolescents’ first engaged in sexual intercourse, reduce adolescents’ risk of unintended pregnancies, or reduce adolescents’ risk of contracting STIs. Thus, empowering adolescents to make the healthiest choices possible as they develop into healthy sexual adults requires providing them more information than simply to remain abstinent until marriage. It requires providing them complete and accurate information about the risk factors associated with unprotected sexual activity and the information and skills to protect themselves against those risk factors.
Comprehensive sex education programs provide adolescents the information and skills necessary to enable them to make healthy decisions about their sexuality development. Similar to abstinence-only sex education programs, comprehensive sex education programs teach adolescents about postponing the initiation of sexual intercourse; however, comprehensive sex education programs also teach adolescents about condom and contraceptive use as a means to protect against unintended pregnancies and STIs (Kohler et al., 2008). Research indicates that communities can reduce unprotected sexual intercourse among adolescents by implementing comprehensive sex education programming (Kirby & Laris, 2009). Communities can implement programming in school settings or other clinic or community settings (Kirby & Laris, 2009). While some community members may fear that adolescents will engage in more sexual activity if abstinence-only sex education programs are replaced with comprehensive sex education programs, research indicates that comprehensive programs have not led to an increase in sexual activity among adolescents (Kohler et al., 2008).
Becoming a Responsible Teen is one example of a community-based comprehensive sex education program that has proven successful among adolescents (Kirby & Laris, 2009). The program is designed to increase adolescents’ knowledge about sexual risk factors and their ability to make healthy choices when encountering those risk factors (Polacek et al., 2008). The program is comprised of eight weekly sessions that each last between 1.5 to 2 hours (Polacek et al., 2008). During the sessions, adolescents engage in activities that provide them knowledge about the risks associated with sexual activity (Polacek et al., 2008). In addition, adolescents engage in activities that help them build skills in the following critical areas: refusal, assertive communication, risk recognition, condom use, self-management, and problem solving (Butts & Hartman, 2002). The program provides adolescents opportunities to practice the skills they learn in a safe environment among their peers (Polacek et al., 2008). The curriculum strives to turn the learned behaviors into normative behavior among the adolescents (Polacek et al., 2008).
Kirby and Laris (2009) found that Becoming a Responsible Teen positively impacted adolescent sexual behavior. The program reduced unprotected sexual intercourse and increased condom use among adolescents (Kirby & Laris, 2009). In addition, the program increased abstinence and lowered adolescents’ number of intimate partners (Kirby & Laris, 2009). The Centers for Disease Control and Prevention with ETR Associates published an adaptation kit to guide community leaders in making adaptations to Becoming a Responsible Teen when implementing the program into their community (Rolleri et al., 2011).
Safer Choices is an example of an effective school-based comprehensive sex education program (Kirby et al., 2004). Safer Choices is a two-year program implemented in high schools to reduce unprotected sexual intercourse among adolescents by delaying the initiation of sexual intercourse and increasing the use of condoms (Coyle et al., 1999). Additionally, the program aims to increase adolescents’ knowledge about HIV and STIs and their belief in their ability to refuse unprotected sexual intercourse and to use condoms (Coyle et al., 1999). Kirby and Laris (2009) found that Safer Choices delayed first sexual experiences among Hispanic adolescents. In addition, the program increased the use of contraceptives and condoms in both genders across all races and ethnicities (Kirby & Laris, 2009).
Safer Choices consists of 20 total classroom sessions; teachers provide the first 10 lessons to students when they are in the 9th grade, and teachers provide the final 10 lessons to the students when they are in the 10th grade (Coyle et al., 1999). In addition to the curriculum, the program includes a school organization consisting of teachers, administrators, students, parents, and members of the community (Coyle et al., 1999). Each school also has a peer team in which students meet with adult coordinators to host activities aimed at altering the culture of the school, and teens share their personal stories of positive sexual behaviors with the student body (Coyle et al., 1999). To facilitate parent-adolescent communication, the program provides three parent newsletters each school year that includes tips to help parents talk with adolescents about sexuality development and provides parent-adolescent homework activities (Coyle et al., 1999). The final component of the program focuses on the school-community link (Coyle et al., 1999). The program includes activities that help adolescents become familiar with resources and support services available in their community and also includes HIV-positive guest speakers from the community during the 10-grade curriculum (Coyle et al., 1999). This multicomponent design incorporates the family, school, and community context into sex education (Coyle et al., 1999).
As these programs demonstrate, communities have the opportunity to create environments that support positive, healthy choices among adolescents as they develop into sexually mature young adults. Community youth development efforts bring adults and youth together as partners to work on projects that are important to adolescents and that make the community a more positive environment for adolescent development. With the community youth development approach, adults and adolescents in the community can work together to develop and implement a comprehensive sex education program. Adolescents can contribute not only in designing the program but can also serve as key participants in the delivery of the program.
Communities have the opportunity to obtain a first-hand look into the minds of adolescents by partnering with them in designing a comprehensive sex education program. In determining the content for the program, a community should consult adolescents on how much they already know and understand about the risks of unprotected sexual activity. Many adolescents understand that engaging in unprotected sexual activity can result in an STI or unintended pregnancy (Trenholm et al., 2007). However, adolescents do not always understand the negative health consequences that accompany STIs, and they often are not aware of the various types of STIs (Trenholm, et al., 2007). Adolescents may also not be fully aware of the challenges of teen parenting. In addition, some adolescents are unfamiliar with where to obtain condoms and contraceptives. Other adolescents may attempt to use condoms or other forms of contraceptives, but they often are unsure how to properly use them (Kirby & Laris, 2009). Adolescents can also help community leaders understand the peer pressures youth face so that the program design can include activities to build adolescents’ skills for responding to peer pressures. By becoming more familiar with the questions adolescents have about sexual development and the pressures they face, community leaders can develop a comprehensive sex education program that provides complete and accurate information for adolescents in the community.
Following the community youth development approach, community leaders should also include adolescents in the delivery of the sex education programming. Comprehensive sex education programs often include role-playing exercises and group discussions to help adolescents learn and practice assertive communication, problem solving, risk recognition, and refusal skills (Butts & Hartman, 2002). With the help of community leaders, adolescents can help create the scenarios for the role-plays and can further help facilitate the role-playing exercises. In addition, adolescents can help adult leaders draft discussion questions and lead the group discussions. Guest speakers are also commonly a part of comprehensive sex education programming (Butts & Hartman, 2002). Adolescents can serve as guest speakers to discuss their personal experiences related to sexuality development (Coyle et al., 1999). As guest speakers, adolescents can share their stories of times they made a positive choice about their sexuality development (Coyle et al., 1999). Pregnant and parenting adolescents can also share their stories to help their peers understand the challenges that accompany early parenting. In these ways, adolescents could be not only learners but also leaders in a comprehensive sex education program in their community.
In summary, communities can empower adolescents to make positive choices about their sexuality development by implementing comprehensive sex education programming. Limiting sex education to abstinence-only programs is not sufficient to empower youth to make healthy decisions about their sexuality development (Kohler et al., 2008). To develop into healthy sexual adults, adolescents need complete and accurate information about the risk factors that accompany sexuality development, including unintended pregnancy and STIs, as well as information and skills training on how to avoid those risk factors (Kirby & Laris, 2009). Therefore, communities should partner with adolescents to create a comprehensive sex education program and enable adolescents to help facilitate the delivery of the program.
References
Butts, J. B., & Hartman, S. (2002). Project BART: Effectiveness of a behavioral intervention to reduce HIV risk in adolescents. The American Journal of Maternal/Child Nursing, 27, 163-169.
Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Harrist, R., . . . Weil, M. (1999). Short-term impact of Safer Choices: A multicomponent, school-based HIV, other STD, and pregnancy prevention program. Journal of School Health, 69, 181-188.
Kirby, D., & Laris, B. A. (2009). Effective curriculum-based sex and STD/HIV education
programs for adolescents. Child Development Perspectives, 3, 21-29.
Kirby, D. B., Baumler, E., Coyle, K. K., Basen-Engquist, K., Parcel, G. S., Harrist, R., & Banspach, S. W. (2004). The “Safer Choices” intervention: Its impact on the sexual behaviors of different subgroups of high school students. Journal of Adolescent Health, 35, 442-452. doi:10.1016/j.jadohealth.2004.02.006
Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42, 344-351. doi:10.1016/j.jadohealth.2007.08.026
Meschke, L. L., Bartholomae, S., & Zentall, S. R. (2000). Adolescent sexuality and parent-adolescent processes: Promoting healthy teen choices. Family Relations, 49, 143-154. doi:10.1016/S1054-139X(02)00499-8
Polacek, G. N. L. J., Coker, J., Lewis, K. L., Minter, M., Villela-Perez, V., & Scott, A. A. (2008). BART to HIVEd: Adapting an HIV education prevention program. Health Promotion Practice, 9, 45-58. doi:10.1177/1524839907306405
Rolleri, L. A., Lezin, N., Taylor, J., Moore, C., Wilson, M. M., Fuller, T. R., . . . St. Lawrence, J. S. (2011). Tools and resources for making informed adaptations to Becoming a Responsible Teen. Retrieved November 8, 2012, from http://recapp.etr.org/recapp/documents/programs/BART_Adaptation_Kit.pdf
Tolman, D. L., & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review. Journal of Research on Adolescence, 21, 242-255. doi:10.1111/j.1532-7795.2010.00726.x
Trenholm, C., Devaney, B., Fortson, K., Quay, L., Wheeler, J., & Clark, M. (2007). Impacts of four Title V, Section 510 abstinence education programs. Princeton, NJ: Mathematica Policy Research.