The publisher's final edited version of this article is available at J Adolesc Health See other articles in PMC that cite the published article. For more than four decades, sex education has been a critically important but contentious public health and policy issue in the United States [ 1 — 5 ].
AOUM was funded within a variety of domestic and foreign aid programs, with 49 of 50 states accepting federal funds to promote AOUM in the classroom [ 7 , 8 ]. Since then, rigorous research has documented both the lack of efficacy of AOUM in delaying sexual initiation, reducing sexual risk behaviors, or improving reproductive health outcomes and the effectiveness of comprehensive sex education in increasing condom and contraceptive use and decreasing pregnancy rates [ 7 — 12 ]. At the federal level, the U.
Other federal funding priorities have moved positively toward more medically accurate and evidence-based programs, including teen pregnancy prevention programs [ 1 , 3 , 12 ]. At the state level, individual states, districts, and school boards determine implementation of federal policies and funds.
Limited in-class time and resources leave schools to prioritize sex education in competition with academic subjects and other important health topics such as substance use, bullying, and suicide [ 4 , 13 , 14 ]. A recent report by the Guttmacher Institute noted that although 37 states require abstinence information be provided 25 that it be stressed , only 33 and 18 require HIV and contraceptive information, respectively [ 1 ].
Without coordinated plans for implementation, credible guidelines, standards, or curricula, appropriate resources, supportive environments, teacher training, and accountability, it is no wonder that state practices are so disparate [ 4 ]. At the societal level, deeply rooted cultural and religious norms around adolescent sexuality have shaped federal and state policies and practices, driving restrictions on comprehensive sexual and reproductive health information, and service delivery in schools and elsewhere [ 12 , 13 ].
These declines continue previous trends from — to —, which included increases in receipt of abstinence information and decreases in receipt of birth control information [ 17 — 19 ]. Moreover, the study highlights several additional new concerns. First, important inequities have emerged, the most significant of which are greater declines among girls than boys, rural-urban disparities, declines concentrated among white girls, and low rates among poor adolescents.
Finally, although receipt of sex education from parents appears to be stable, rates are low, such that parental-provided information cannot be adequately compensating for gaps in formal instruction. Paradoxically, the declines in formal sex education from to have coincided with sizeable declines in adolescent birth rates and improved rates of contraceptive method use in the United States from to [ 20 , 21 ].
These coincident trends suggest that adolescents are receiving information about birth control and condoms elsewhere. Others have commented on the myriad of online sexual and reproductive resources available to adolescents and their increasing use of sites such as Bedsider.
The Future of Sex Education Given the insufficient state of sex education in the United States in , existing gaps are opportunities for more ambitious, forward-thinking strategies that cross-cut levels to translate an expanded evidence base into best practices and policies.
Clearly, digital and social media are already playing critical roles at the societal level and can serve as platforms for disseminating innovative, scientifically and medically sound models of sex education to diverse groups of adolescents, including sexual minority adolescents [ 14 , 22 — 24 ].
Research, program, and policy efforts are urgently needed to identify effective ways to harness media within classroom, clinic, family household, and community contexts to reach the range of key stakeholders [ 13 , 14 , 22 — 24 ].
As adolescents turn increasingly to the Internet for their sex education, perhaps school-based settings can better serve other unmet needs, such as for comprehensive sexual and reproductive health care, including the full range of contraceptive methods and STI testing and treatment services. Whether these priorities will survive an election year and new administration is uncertain.
At the state and local program level, models of sex education that are grounded in a broader interdisciplinary body of evidence are warranted [ 4 , 11 — 14 , 27 — 29 ]. The most exciting studies have found programs with rights-based content, positive, youth-centered messages, and use of interactive, participatory learning and skill building are effective in empowering adolescents with the knowledge and tools required for healthy sexual decision-making and behaviors [ 4 , 11 — 14 , 27 — 29 ].
Modern implementation strategies must use complementary modes of communication and delivery, including peers, digital and social media, and gaming, to fully engage young people [ 14 , 22 , 23 , 27 ].
Ultimately, expanded, integrated, multilevel approaches that reach beyond the classroom and capitalize on cutting-edge, youth-friendly technologies are warranted to shift cultural paradigms of sexual health, advance the state of sex education, and improve sexual and reproductive health outcomes for adolescents in the United States. Sex and HIV education. Department of Health and Human Services, Office of disease prevention and health promotion. Department of Health and Human Services; Abstinence and abstinence-only education: A review of U.
The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. Am J Prev Med.
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