The Effects of Sex Education on
Adolescent Sexual Risk Taking Behavior
May 2008
Mishan Araujo
Public Policy Program
Stanford University
[email protected]
Thesis Advisors:
Professor Margo Horn, History
Professor Mary Sprague, Public Policy
Abstract
Sex education curriculum has historically been a controversial topic in the United States because
for many Americans, sex education is not just an issue of teaching about sexuality but also an
issue of which morals and values our society should promote. Meanwhile, 9 in 10 adolescents
are sexually active by the time they graduate high school and the United States has the highest
teenage pregnancy and sexually transmitted infection rates of any developed nation. This study
examines the effects of specific sex education curricula on adolescent sexual risk taking
behavior. The results indicate that curricula have virtually no impact on the decision to be
sexually active but that self-efficacy and abstinence-only mandates have important relationships
with the decision to use contraception. The results also indicate that demographic and cultural
variables are influential in adolescent sexual decision-making. Therefore the conclusions
recommend that sex education curricula do not include abstinence-only mandates and consider
including self-efficacy components at an early age. Moreover, the recommendation calls for a
sex education policy that is implemented at the state-level rather than the federal-level and
curricula that are tailored to the community in which they are implemented.
Key words: sexuality, teenagers, contraceptive use, pregnancy, sex education policy,
comprehensive sex education, abstinence-only sex education
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Acknowledgments
I would like to thank my thesis advisor, Professor Margo Horn, for her patience and
guidance. She was instrumental in helping me link my quantitative analysis with the qualitative
research on sexuality education in the United States. I greatly enjoyed working with her and
thank her sincerely for all of her help.
I would also like to thank Professor Mary Sprague who was incredibly helpful throughout the
entire process. I especially wish to thank Professor Sprague for her patience through my data
and editing processes. Her advice and wisdom was always refreshing and helpful.
I thank Professor Geoffrey Rothwell for his help in the early stages of this thesis. His
guidance during Junior Honors Seminar and Honors College helped me tremendously as I sifted
through ideas and research questions.
Lastly, I would like to thank the Public Policy Department and my family and friends for
their support over the last four years at Stanford. They always encourage my research and ideas
without which, this thesis would not be possible.
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Table of Contents
1. Introduction………………………………………………………………………………...…4
2. History of Sex Education……………………………………………………………………..8
3. Literature Review
3a. Literature relating to abstinence-only sex education programs…………………….24
3b. Literature relating to comprehensive sex education programs…………………..…39
4. Methodology…………………………………………………………………………………48
4a. Dependent Variables…………………………………………………………………...50
4b. Curriculum Variables…………………………………………………………………53
4c. Control Variables………………………………………………………………………55
5. The Data……………………………………………………………………………………57
6. Sexual Activity Rates……………………………………………………………………….60
7. Consequences of Sexual Activity
7a. Pregnancy Rates……………………………………………………………………….64
7b. Sexually Transmitted Infection (STI) Rates………………………………………….67
8. Prevention Methods
8a. Birth Control Use………………………………………………………………………72
8b. Condom Use……………………………………………………………………………77
9. Conclusion…………………………………………………………………………………...80
10. Appendix A………………………………………………………………………………....88
11. Appendix B……………………………………………………………………...………101
12. References………………………………………………………………………...……….103
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Introduction
The way in which we, as a society, talk to our young people about sex and intimate
relationships can significantly influence the way they see themselves as individuals, as partners,
and as sexual human beings. Sex education can influence adolescents’ perception of the risks
associated with sexual behavior, and the precautions they can and should take to reduce that risk.
Sexual risk taking behaviors among adolescents, and its unfortunate consequences, are major
contemporary policy concerns. Research has shown that many American teenagers are sexually
active and because they do not always make safe choices when it comes to sexual behavior and
they face consequences which result in increased governmental spending and negative social and
health outcomes.
Although rates of teen sexual activity have declined over the past 15 years, nearly two-thirds
of high school youth still report having had sex and more than one in five report having had four
or more sexual partners by the time they graduate high school. One-quarter of sexually active
adolescents nationwide have an STI, and some of these STIs are lifelong viral infections without
any cure (Trenholm et al 2007). Two in three adolescents are sexually active by the age of
eighteen. Currently, in America, thirty-one percent of young women become pregnant at least
once before they reach the age of 20, and 8 in 10 of these pregnancies are unintended. In 2000,
the U.S. rate of teen pregnancy was almost twice that of Great Britain, four times the rate of
France and Germany, and almost ten times the rate of Japan (National Teen Pregnancy
Prevention Campaign, 2006).
My thesis hopes to offer a unique and nuanced perspective on the highly controversial issue
of sex education policy. My final conclusions are based on both my qualitative findings as well
as my quantitative findings. In considering both results, I am able to discuss the most realistic
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and effective ways of reducing adolescent sexual risk taking behavior while simultaneously
helping to shape conversations about sexuality and intimate relationships in a way that will leave
teenagers feeling confident and self-assured.
Sex education is a policy tool, which can reduce the future costs (to the government and to
the individual) of teenage sexual risk-taking behavior and its outcomes, namely pregnancy and
sexually transmitted infections. Teenage mothers are significantly less likely than their peers to
finish high school and only 1.5 percent earns a college degree by the age of 30. Adolescent
mothers are at greater risk for obesity, sexually transmitted infections and hypertension.
Moreover, the children of teens often suffer from chronic health problems, have insufficient
access to health care, and experience poor school performance. Lastly, teen pregnancy costs
Americans billions of dollars each year. Almost 500,000 children are born to teenage mothers
annually and the government spends about $9.1 billion a year to help these families through
social welfare programs. These reasons help explain why many policy experts believe that by
reducing teen pregnancy, the government will be able to improve the educational attainment
levels of Americans and in doing so, minimize poverty, and improve the economy (National
Teen Pregnancy Prevention Campaign, 2006).
There are clear economic, health, education, and safety concerns guiding the need for a
policy that will effectively and efficiently educate the majority of teenagers to help them make
healthy sexual decisions and prevent teenage pregnancy and the spread of sexually transmitted
infections. I argue that American adolescents need an educational curriculum that will teach
them values of self-worth, assertiveness, comfort with their body and their sexuality, and
empowerment. All of these qualities are likely to contribute to healthy intimate relationships.
My results indicate that sex education curriculum does not influence rates of sexual activity
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among adolescents. Given that curriculum does not play a large role in the adolescent’s decision
to have sex, in order to reduce teen pregnancy and STI rates, the curriculum must increase riskaltering behavior. I have found that self-efficacy curriculum is associated with increased
condom use rates while abstinence-only education is associated with decreased birth control use
rates, increased pregnancy rates, and increased STI rates. I also found that factors such as race,
income level, and religious belief are more influential in determining risk-altering behavior,
pregnancy rates, and STI rates than curriculum components. Based on these findings, I
recommend that future policy regarding sex education be considered at a state level so as to
better account for demographic differences and that curriculum include self-efficacy components
and do not include abstinence-only education.
Schools and local community centers are the necessary place to implement these programs.
First, sex education fits very well into the philosophy behind American public schools. In
particular, we believe in “the idea that if young people are given all the facts, they will make the
right decisions [and] the idea that young people are innately good and valuable citizens in the
making and need only the proper environment in which to flourish… (Luker 2006).” Secondly,
schools are an institution in American society regularly attended by most youth. Therefore,
teaching sex education in school is the most effective way of reaching the majority of young
people. Moreover, because the vast majority of teenagers are enrolled in school for several years
before they are sexually active, sex education in school is preventative and can successfully
educate adolescents before they are at risk for teen pregnancy or sexually transmitted infections.
Unfortunately 5 out of every 100 American adolescents dropout of school before they finish high
school and so, in order to reach those populations, programs would need to be implemented in
community and outreach centers as well (Kaufman 2001).
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Sex education is a difficult topic for the United States because there is passionate
disagreement regarding how best to teach adolescents to reduce sexual risk taking behaviors.
Proponents of what I refer to as abstinence-only sex education argue that because adolescents
should not be having sex at all, and because the only way to ensure no teenage pregnancy or
sexually transmitted infections is to abstain from sexual activity, sex education programs should
teach abstinence and nothing more. Proponents of what I refer to as comprehensive sex
education argue that many teenagers are already having sex and engaging in sexual activity
despite any attempt to dissuade them, therefore we need to equip them with the tools necessary
to make healthy and safe decisions. The debate on sex education is about more than programs
and curriculum, it is about the kind of information we give adolescents, the way men and women
should behave, the role of sexuality in human life, and whether or not we teach that the world is
full of clear boundaries or of informed decision making.
My thesis examines data from 2001, 2003 and 2005 that measures sexual risk-taking
behaviors among adolescents in 29 states. I evaluate the efficacy of state sex education policy in
reducing sexual risk taking behaviors among adolescents by measuring contraceptive use, sexual
activity, teenage pregnancy, and sexually transmitted infection (STI) rates. I hope to determine
which types of sex education curricula (self-efficacy, STI education, and abstinence-only) are
most able to reduce teenage pregnancy, teenage sexually transmitted infection rates, rates of
sexual activity, and increase contraceptive use among adolescents who choose to be sexually
active.
In addition to this empirical evaluation of curriculum, I also explore the social value in giving
adolescents the tools necessary to think independently, make informed decisions, and feel
comfortable with their bodies and their sexuality. I understand that this kind of education is not
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limited to teaching the benefits of abstinence, the use of contraception, and the dangers of
sexually transmitted infections. This education also includes lessons in self-efficacy,
assertiveness, resisting peer pressure, exploring and embracing individual identities, and
developing comfort to ask questions and talk about difficult issues with trusted adults.
During the era of the social hygienists sexuality and sex education were discussed openly in
schools, community centers, churches, and living rooms. This was motivated by a desire to
make the lives of adolescents safer and happier. I am interested in exploring how we as a
country might get back to this point with new knowledge and insight and what we will gain if we
can.
History of Sex Education
Beginning in the late twentieth century, Americans began to notice the beginnings of a war
between the proponents of abstinence-only sex education and the proponents of comprehensive
sex education. The battle over sex education is impassioned and complicated because it is not
only a fight about sex, but also a fight about gender, power, human nature, and the relationship
between men and women. However, given the high rates of sexual activity among teenagers and
the dangers of sexually transmitted infections and teenage pregnancy, in the next few years our
country will be forced to make decisions as to how we will resolve this debate.
Sex education was first developed in the United States in the Progressive Era between 1880
and 1920. After months of planning, in New York socialite Grace Hoadley Dodge’s Fifth
Avenue apartment, a group of well-known and respected individuals who were concerned with
the high rates of prostitution and venereal diseases formed the American Social Hygiene
Association (ASHA). ASHA became the first organization in the United States to develop and
support sex education curriculum.
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By using the term “social hygiene” as a euphemism for sex, ASHA was able to remain within
the socially appropriate parameters of the time while promoting sex education and talking about
issues that were considered private or taboo. The issue of sexual education was so important to
these individuals that the first president of ASHA, Charles Eliot, left his position as president of
Harvard University and declined an ambassadorial appointment from President Wilson to begin
managing ASHA. Because of ASHA’s prestigious founders and the popularity of their goals,
they were able to secure funding from social figures like John Rockefeller Jr. and Julius
Rosenwald. ASHA garnered significant support very early in its existence because many people
at the time shared the striking belief that, “teaching people about sex was the surest and best way
to make American society better in regard to a wide range of problems (Luker 2006).”
The formation of ASHA came after many years of brainstorming and planning on the part of
individuals and other organizations. In 1905, Dr. Prince A. Morrow hoped to form a society
dedicated to the war against venereal disease. He was convinced that prostitution, promiscuity,
and venereal disease were far more prominent than anyone suspected and that as physicians, he
and his colleagues had an obligation to act against what he deemed to be major public health
concerns. When Dr. Morrow spoke to the Academy of Medicine in August 1905, he focused on
the ways in which individual sexual behavior was inextricably linked with public health issues.
In doing so, he linked adolescent sexuality to public health concerns and suggested that
prevention could be achieved through social reform and education. For the first time, physicians
began to see value in educating adolescents about sexuality, and understood they could prevent
adolescents from contracting and spreading venereal diseases (Moran 2002). Later that year,
Morrow founded the American Society for Sanitary and Moral Prophylaxis (ASSMP) in order to
lobby for sex instruction that was to be segregated by sex and taught by teachers who were the
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same sex as their students in public schools (Brandt 1987). Shortly after Morrow’s death in
1913, his American Federation for Sex Hygiene and ASSMP merged with another similar group
called the American Vigilance Association to become ASHA, which then became the center of
efforts to eradicate venereal disease and prostitution (Moran 2002).
ASHA distributed informational pamphlets and gave free public lectures in order to educate
the general public about venereal diseases. While these lectures were often well attended and the
literature well received, by 1917 the social hygienists began to believe, as Dr. Morrow had, that
educating adults about the severe consequences of promiscuity and prostitution did little good
because these adults were already so accustomed to dangerous sexual health practices and it was
very difficult to change them. ASHA began to believe that if they could educate the youth,
before they were sexually active, they would be more successful in preventing the spread of
venereal diseases (Moran 2002). ASHA’s activists continued with Dr. Morrow’s lobbying
efforts and by 1919 the U.S. Public Health Service had begun to endorse sex education in
schools. The Public Health Service stated, “As in many other instances, the school must take up
the burden neglected by others (Brandt 1987).”
At this point, public high schools were changing in ways that would make them well suited
for sex education instruction. “Most obvious was the explosion in attendance and its
consequences. In 1871, 80,000 pupils attended public high schools; in 1913 that number would
increase exponentially.” Because the population of the schools increased, educators were
automatically provided access to an increased population of students and for the first time could
put their theories to work. Also, teachers were better prepared to interact with students in
subjects such as sexual health since they began to receive new professional training, including
some training in child psychology (Moran 2002).
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These ventures were not without controversy however. The major concern, among
opponents of teaching sex education in public schools, was the balance between teaching young
people truthful and helpful information about sex before they form dangerous patterns of
behavior that are uneasily broken, while simultaneously avoiding a situation where sex education
encourages increased sexual behavior. In response to these concerns, sex educators argued that
keeping silent about sex did nothing to preserve the purity of young people. The alarming rates
of prostitution and venereal diseases were proof that silence was not stopping these problems.
Furthermore, sex educators relied on the scientific nature of the proposed sex education curricula
to validate their claims. G. Stanley Hall’s early 20th century work in developing “stages” of
adolescence made it easier for sex educators to describe their scientific work as precise and
necessary (Moran 2002). Social hygienists now knew exactly which types of information were
appropriate for which adolescents depending on what stage of development they were in. Also,
sex educators argued that science was “too pure to be suggestive” since it eliminated the erotic
elements of sex. Lastly, they argued that scientific sex education was too boring to be suggestive
in any kind of impure way (Moran 2002). Significantly, although the sex educators trained by
ASHA did focus a considerable amount on science they did not use moral arguments when
trying to dissuade students from engaging in dangerous sexual behavior. Instead they often
invoked fear by discussing the dread of infection and gruesome details of many venereal diseases
(Brandt 1987). ASHA argued that the combination of science and fear would not encourage
increased sexual behavior and would in fact produce lower rates of venereal diseases and
prostitution amongst future generations.
Despite their arguments, ASHA activists, unlike proponents of sex education today, had no
real evidence that sex education would in fact reduce the rates of venereal diseases and
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prostitution, without encouraging young people to engage in sexual activities too early. ASHA
needed a public school district that was supportive of their ideas and willing to implement their
curricula in order to determine its effectiveness. The social hygienists found a receptive
audience in Ella Flagg Young, the superintendent of the Chicago school district in the early
twentieth century. Although she was in her mid 60s and generally considered conservative
regarding sexual issues, she believed strongly that public education should equip students with
the necessary information to survive and exist in a more productive way than the previous
generation. Given that venereal diseases and prostitution were wide spread, Ms. Young believed
she had an obligation to help her students avoid these problems. In this spirit, Young proposed a
course of three lectures which would be given by outside physicians regarding physiology,
“personal sexual hygiene,” “problems of sexual instincts,” and basic facts about venereal
diseases. Recognizing that the majority of students, in Chicago and at this time, did not reach
high school, Young also implemented a “personal purity” course given to middle school and
upper elementary grades where male physicians spoke to boys, female physicians spoke to girls,
and parents could elect to not include their children in these lectures if they desired. These
programs were very well received among the students. The pupils expressed appreciation for the
courses and an interest in more plain facts and “advice regarding the attitude of one sex toward
another (Moran 2002).”
Despite the positive feedback, the Chicago experiment lasted only one year because
conservative school board members, Catholic leaders, and upset parents came together in
opposition to what they called “smut courses” which they claimed were inappropriate and drew
special attention to sex and sexual acts (Moran 2002). ASHA took these concerns into account
and after the Chicago experiment they developed a new method of sex education which they
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hoped would be less controversial. Rather than giving special courses on sexual hygiene, which
some people argued aroused curiosity and gave unnecessary attention to the subject, they would
instead implant the information in other courses such as biology and general health. Not only
did this not give special attention to the topics but it would also attract less attention from the
parents. This method ultimately did not become very popular in many school districts because
they were reluctant to change existing curricula. The school districts that did take on this
approach did not do so for long, mostly for lack of properly trained staff.
The end of World War I brought sex education to the forefront of American politics as a
result of a large anti-venereal diseases campaign for American soldiers, as well as a considerable
cultural shift regarding gender relations and education levels. Following the war, American
youth began demanding more sex education. The requests at Northwestern University for
younger and more candid faculty to teach sex hygiene, as well as interest from students at
Barnard College for a revised biology curriculum which would include lessons on the
reproductive functions of sex organs, inspired high school and even some junior high school
students to begin demanding instruction regarding menstruation and puberty (Moran 2002).
Most of these requests went unnoticed and for the next 40 years sex education was sparse
throughout the United States due to both a lack of funding, which demonstrates the
unwillingness of politicians to implement sex education curriculum, as well as to a lack of
trained professionals to teach sexual education courses.
Sex education came to the forefront again in the 1960s because the major cultural shifts of
the 1960s, the availability of birth control, and the increased rates of premarital sex forever
changed American society and in many ways created a divide between sexual conservatives and
sexual liberals. This divide is in large part the cause of contemporary debate surrounding sex
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education policy. These social changes, particularly the change in how men and women relate to
each other, brought about considerable cultural shifts in what was considered appropriate sexual
behavior by the general population, thereby affecting all discussions of sex education curricula.
This so called “sexual revolution” changed the way in which Americans think about sex, their
sexual partners, gender roles, and parenting. All of these concepts shape how contemporary
policy makers and activists frame the sex education debate.
One of the major cultural shifts in attitudes toward sex education was caused by the
development and availability of birth control. Birth control dramatically changed the way many
women looked at sex and sexual relationships because “sex became possible for millions of
women in the way it had always been possible for men, as something you did when you wanted
to, because you wanted to, for its own sake (Irvine 2004).” Highly effective, readily available
and relatively affordable contraception made sex for pleasure an option for women. This change,
coupled with the legalization of abortion in 1973, made pregnancy a choice for many rather than
a fate. Therefore, “the traditional understanding between men and women about what sex and
marriage mean” underwent a radical shift.” Just as the social changes of the 1910s helped foster
the idea of separating sex from procreation, the availability of birth control and the social
changes of the 1960s, formalized this concept. For many sexual conservatives, pregnancy is
what kept men responsible for their relationships with women, and after the landmark Supreme
Court decision of Roe v. Wade, men could no longer be held “accountable” in the same way.
This invoked a greater fear about premarital sex and changed the way many people, in particular
women, felt about sex education and whether or not it would protect or endanger their children.
Another major cultural shift was the new attitude toward premarital sex. Following the
sexual revolution, premarital sex became much more common among all races and
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socioeconomic backgrounds (Luker 2006). Moreover, young people were more willing to
discuss premarital sex and were not concerned with the perceived social ramifications of not
being a virgin before marriage. One college student was quoted in a 1964 issue of Newsweek
magazine as saying, “If two people have established a meaningful relationship they have the
moral right to sleep together.” The 60s also increased the fear in parents of sexual rebellion and
its consequences. Many parents, who had previously thought sex education was unnecessary,
began to believe that sex education might be the proper response to the rebellion they saw among
the youth. Roper and Gallup polls during the 60s consistently found that over 55 percent of
parents believed sex education in high schools was appropriate and in 1968, 71 percent of
parents believed it was very important (Irvine 2004).
The increased interest in sex education in public schools resulted in increased federal funding
for sex education programs. Some historians attribute this increase to the cultural shift that
resulted from the sexual revolution, while others maintain that parental fear of the consequences
of cultural events such as the Woodstock music festival propelled them to create programs that
would educate their children about the health concerns related to sexual relationships. The
American Medical Association, the National Education Association, and the American
Association of School Administrators all created training programs, new sex education programs
and they amplified the programs that were already in existence. There were also new federal
grants available from the U.S. Office of Education to help encourage efforts to teach about
sexuality in the public schools (Irvine 2004).
The cultural changes brought on by the sexual revolution also inspired new organizations;
one of the most influential was the Sex Information and Education Council of the United States
(SIECUS). Mary Calderone resigned as the medical director of Planned Parenthood to start and
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manage the SIECUS organization in 1964. Calderone believed sex education was the best form
of preventive medicine for the potential negative consequences of sexual relations (Moran 2002).
SIECUS sought to redefine sex and broaden discussions about sex to encompass what we now
refer to as sexuality. They hoped that sex would be defined as more than intercourse. SIECUS
activists tried to normalize and legitimize pre-marital sexual relations. But in many ways
SIECUS, at least during its first years, did not do things in an “ultra-liberal” or radical way.
They supported sex for pleasure but only within the context of marriage and they always stressed
the responsibility that comes with sexual relationships. Their actions, compared with those of
the New York League for Sexual Freedom, which was also founded in 1964, can hardly be
considered radical. The New York League for Sexual Freedom “demanded decriminalization of
oral and anal intercourse, interracial marriage, and bestiality and called for reformation of a
range of restrictive laws against censorship, public nudity, divorce, contraception, abortion and
statutory rape laws.” SIECUS, in contrast, was trying to define sexuality as a health issue and
scientific inquiry was their preferred tool to evaluate anything sexual (Irvine 2004). In the
current debate, proponents of comprehensive sex education refer back to this concept and often
argue that teaching about safe sex is a health necessity and that sex education gives students tools
(based on scientific information as opposed to religious) they will use and need throughout their
entire lifetimes. The problem with this argument is that for many people, sex is purely religious
and cannot be discussed in a scientific, health-focused manner. Religious people argue that sex
is something between a man, a woman, and their G-d in the context of a heterosexual marriage,
and they believe there is no need for any other discussion.
As part of their work, SIECUS helped school districts set up sex education curricula and
often trained teachers to ensure its proper implementation. It was during the late 1960s that
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California first became a strong proponent of sex education and with SIECUS’s help began
implementing sex education programs across the state. San Diego had had a sex education
curriculum in place since World War II and their model was used to help the rest of the state
catch-up. SIECUS helped set up a K-12 Family and Life Sex Education program which covered
anatomy, sexual appropriateness, and sexual health. As a result of this program’s
implementation in the San Francisco school district as well as the Los Angeles school district,
the country became acquainted with what would become the “New Right’s” opposition to sex
education and promotion of what they refer to as “family values.” Moran calls this opposition,
“the embodiment of a new middle-class sexual ethos that was closely related to the sexual
revolution.” That is, the parents who reacted negatively to the ideas of the sexual revolution and
feared these ideas would be replicated in the next generation began to fear that sex education
programs would encourage rebellion and premarital sex in their children’s generation.
It was at this time that the sexual conservatives began to run for political office, particularly
on school boards, in order to reverse the sex education curricula decisions (Moran 2002). By
1968, it was obvious to everyone involved in sexual politics that sex education would play a very
important role in the emerging New Right, or Christian Right’s social agenda (Irvine 2004). By
the 1980s the New Right, or as D’Emilio refers to them, the “purity crusaders,” had made a lot of
political progress getting elected to school boards and reversing many of the decisions regarding
new sex education policy. The New Right used the sexuality of youth as the motivation behind
all their campaigns, whether they were against, abortion, the Equal Rights Amendment, gay
rights, pornography, the lyrics of rock music, or sex education (D’Emilio 1997).
Although during its early development, sex education was seen as preparation for marriage,
an attempt to discourage premarital sex, and training for “responsible parenthood,” as the
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twentieth century progressed, sex education “became increasingly all encompassing, expanding
to cover almost everything under the rubric of personal and family living (Luker 2006).” This
change caused even more controversy regarding sex education policy because parents began to
feel that their children were being taught moral values and in some instances, parents believed
they were the wrong moral values. This disagreement eventually led to the development of our
current policy debate. The New Right and sexual conservatives began arguing that sex education
in public schools should be “abstinence-only” sex education, which should promote abstinence
until marriage. The New Right argues that abstinence until marriage is completely realistic in
part because they expect marriage to occur in a person’s mid to late 20s. According to Kristin
Luker, “in general, abstinence education teaches that heterosexual marriage is the only
acceptable place for sex, that contraception can and often does fail, and that abortions can and do
leave lasting emotional effects on people (Luker 2006).”
Conversely, sexual liberals and supporters of organizations like SIECUS continued to lobby
for “comprehensive” sex education. Comprehensive sex education teaches abstinence as the best
method of preventing pregnancy and sexually transmitted infections, but it also teaches that
condoms and other forms of contraception, including birth control, reduce the risks of
unintended pregnancy (when used properly) and, in the case of condoms, sexually transmitted
infections, including HIV/AIDS when they are used properly. Comprehensive sex education
does not promote abstinence until marriage, in large part because proponents of comprehensive
sex education do not anticipate marriage until later in life, often after a career. These differing
opinions, and the passion with which they held are expressed, caused the late twentieth century
to become a war between proponents of abstinence-only sex education and comprehensive sex
education.
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By 1979, 47 percent of all 17-year-olds had had some form of sex education and the concern
about sexually transmitted infections such as HIV/AIDS was growing rapidly. “By the early
1990s, more than 70 percent of teenage women had had more than one [sexual] partner and 20
percent had had six or more (Luker 2006).” Proponents of abstinence-only, as well as
proponents of comprehensive, sex education agreed that something should be done to curb the
growing rates of teenage pregnancy and sexually transmitted infections, especially given the
prevalence of HIV/AIDS. However, they disagreed on the best method of doing so. By the very
late twentieth century and the beginning of the twenty-first century it was clear that, at least in
terms of federal and state funding, abstinence-only education was “winning the war.”
In 1988 only 2 percent of teachers taught abstinence as the only way to prevent pregnancy
and disease but, by 1999, 23 percent did. In the first few years of the twenty-first century,
“comprehensive” became a word that meant abstinence was stressed but contraception was
discussed. This was instead of the original meaning developed by SIECUS which included
discussions of healthy sexual relationships, discussions of physiology, and an openness about
exploring personal sexuality. Meanwhile, as the conservatives began to gain more political
power and the “family values” of the Christian right became more popular, abstinence-only sex
education curricula were becoming more prominent with little public debate. These years also
marked a widespread erosion of what could be said about sexuality to young people in
classrooms. For example, in North Carolina, three chapters covering contraception were taken
out of the ninth-grade textbooks in one district and in another several pages of the Advanced
Placement biology textbook were taken out because they discussed abortion as a part of family
planning. In California, schools stopped showing videos about developing into adolescents after
parental complaints regarding the references to masturbation. (Irvine 2004).
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By the late 1990s there were three major federal sources of funding for abstinence-only sex
education curricula. The Adolescent Family Life Act, Title V of the Social Security Act, and the
Maternal and Child Health Bureau, provided a combine $50 million per year for five years
starting in 1998. Additionally, states that accepted these funds were required to match every four
federal dollars with three state dollars (Irvine 2004).
This was all done in contrast to what seemed to be overwhelming public support for
comprehensive sex education that discussed everything from condoms to birth control to
masturbation to HIV/AIDS. By 2000, Planned Parenthood affiliates employed over seven
hundred staff educators and trainers who taught 1.5 million people each year and polls
consistently showed that a majority of the public believed sex education should expand beyond
the abstinence-only messages (Irvine 2004).
In today’s debate about sex education, proponents of abstinence-only sex education often
argue that teaching students about contraceptives and giving adolescents the tools to make their
own sexual decisions will inevitably lead to higher rates of sexual activity among teenagers.
Although multiple studies have refuted this claim, our current debate, focuses more on the
questioning of what information teenagers should have and what they might do with that
information. Our current debate is similar to the one in the late 19th century and early 20th
century in so far as proponents of comprehensive sex education argue that science is not impure,
that knowledge is a powerful and important tool, that silence is not working as evidenced by
rates of teenage pregnancy and sexually transmitted infections, and that teenagers will make
safer choices if they’re given all the correct and truthful information. The current debate is
different, however, in that this debate is also about the power of information. Who should
dispense this information, where, how, and why, are questions that are considered in churches,
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21
school board meetings, and legislative assemblies across the nation. Our debate has moved
beyond only questioning the effectiveness of sex education and into a more philosophical realm,
which may help explain why it has become so complicated.
Although sex education has traditionally been the domain of local school boards and state
legislatures, since 2000, the federal government has become increasingly involved in funding
these programs. In 1997, 10 million dollars was spent on federally funded abstinence-only sex
education. During President George W. Bush’s first term, spending on abstinence-only sex
education rose from nearly 80 million dollars in 2001 to 137 million dollars in 2004. The budget
for abstinence-only sex education in 2007 was $204 million and in late July 2007 the House of
Representatives passed a bill that would extend the abstinence-only education program by 2
years. Although U.S. health professionals including clinicians, doctors, nurses, researchers,
academics, as well as surveyed parents, broadly support comprehensive sex education,
abstinence-only sex education is becoming more and more prevalent.
Proponents of abstinence-only education often argue that the problems of teenage pregnancy
and teenage sexually transmitted infections, currently plaguing our society, are a result of young
people having too much information about sex and sexual relationships. They argue that
marriage is the place to learn about sex and that when it is taught in schools it encourages
immoral behavior and intrudes on the parent-child relationship. Sex, for many of these
conservatives, is something sacred and the only morally acceptable sex is between a
heterosexual, married couple (Luker 2006).
Proponents of comprehensive sex education believe that these same problems of teenage
pregnancy and sexually transmitted infections are the result of young people not having enough
information about sex. Many of the parents that Kristin Luker interviewed in her sociological
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22
study who were supportive of comprehensive sex education, expressed a “sense of pain and
betrayal…about having the older generation withhold information from them” and they did not
want their children to feel the same betrayal. These parents believe that sex is natural and that
moral sex does not have to fit within the confines of a heterosexual marriage but rather, needs to
be between two consenting people neither of whom are physically or emotionally taken
advantage of. These parents believe that in teaching their children about sex, healthy
relationships, and how to protect themselves against unwanted pregnancy and sexually
transmitted infections, they are enabling “the kinds of decision-making that will permit their
children to become complete adults (Luker 2006).” Luker concludes her study by noting that,
“the fight about sex education is not only about sex but about the value and place of information,
about how men and women are to comport themselves, about the role of sexuality in human life,
and about whether the world is or should be a place of firm lines and boundaries or of
interconnections and informed decisions (Luker 2006).”
The policy disagreements about sex education are understandable and in many ways
expected. Battles over sex education are complicated and difficult in large part because fights
about sex are also fights about gender, power, trust, human nature, and what sex means for us as
human beings. These are all very complicated issues. They force people to think about how
each individual weighs obligations to ourselves and to other human beings. The battles over sex
education have forced Americans to debate whether sex is in the words of Kristen Luker,
“something for individuals to enjoy as they will, as long as they take proper precautions, or is it a
powerful and unruly force that can be entered into only when it has been safely channeled into
marriage (Luker 2006).”
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The debate between abstinence-only and comprehensive sex education programs is clearly
about more than which curricula is most effective in reducing teenage pregnancy and teenage
STI rates. As demonstrated in the following literature review, the research confirms that
comprehensive sex education programs are better at reducing measurable consequences of
teenage sexual risk taking behavior than abstinence-only programs and there is clearly still work
to be done in determining which specific aspects of different programs are most effective and
how these programs should be implemented (state level, federal level, community level, etc.).
However, it is clear that this argument is also about the value and place of information and
honest dialogue. As Luker so eloquently explained, the fight about sex education is about the
role of sexuality in human life, it is about gender, and it is about whether the world should be a
place of clear boundaries or of informed decision-making. As such, any policy regarding sex
education must consider all of these issues and must address the concerns on both sides of the
debate. In addition to deciding how we as a society will prevent teenage pregnancy, teenage STI
rates, and thereby improve the lives of adolescents in our country; we must also decide how we
wish future generations to view sexuality, gender, and their decision making ability.
Policy Questions
The history of sex education in the United States and the current state of the debate between
abstinence-only curriculum and comprehensive curriculum, complicates any understanding of
sex education policy. Effective and politically feasible state-level or federal-level policy
concerning sex education must consider the nuances of the debate and furthermore must be
guided by an understanding of why Americans are so passionately divided on this issue.
That said, effective policy must also consider quantitative evidence regarding which types of
curriculum actually do reduce sexual risk taking behaviors among adolescents. Those involved
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in the debate over sexuality education disagree on what type of curriculum is best for American
children, but they agree that something must be done to reduce rates of teen pregnancy and
sexually transmitted infections.
The previous section of this paper focuses on a qualitative analysis of the history of sex
education, the changing views of sexuality in our country, the way women and men relate to one
another in intimate relationships, the major differences between abstinence-only and
comprehensive sex education, and why our country is so torn about how to address sex education
with our youth. In contrast, the following sections examine, from a quantitative perspective,
which types of curriculum are most effective in reducing sexual risk taking among adolescents.
My final conclusions and policy recommendation are based on both my qualitative findings
as well as my quantitative findings. In considering both findings, my thesis hopes to offer a
unique and nuanced perspective on a highly divisive issue in American politics. This nuanced
approach affords me the opportunity to discuss how realistically and effectively to address the
controversy regarding sex education in public schools, how to shape the conversations about
sexuality and safe sexual practices in our country, how to improve state mandated sex education
programs, and finally the effectiveness of each piece of the curriculum tested.
Literature Review
Abstinence-Only Sex Education
Defining abstinence can be difficult because for many individuals, programs and curricula,
being abstinent can mean a variety of things. For some it is abstaining from any sexual activity
including touching, kissing, mutual masturbation, oral sex and anal sex. For others it is defined
as postponing sex until marriage and sex is left as a somewhat vague and undefined term. Still
others say abstinence is waiting to have vaginal sex until marriage. As a result of these varying
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definitions it is difficult to determine what is meant by an “abstinence-only” curriculum or an
“abstinence-plus” curriculum. To avoid any ambiguity, the federal government defined
abstinence education as a program of education that adheres to the eight criteria below (Santelli
et al 2006).
Under Section 510, abstinence education is defined as an educational or motivational program
that:
(A) has as its exclusive purpose, teaching the social, psychological, and health gains to be
realized by abstaining from sexual activity
(B) teaches abstinence from sexual activity outside marriage as the expected standard for all
school-age children
(C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock
pregnancy, sexually transmitted diseases, and other associated health problems
(D) teaches that a mutually faithful monogamous relationship in the context of marriage
(between a man and a woman) is the expected standard of human sexual activity
(E) teaches that sexual activity outside of the context of marriage (between a man and a woman)
is likely to have harmful psychological and physical effects
(F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the
child, the child’s parents, and society
(G) teaches young people how to reject sexual advances and how alcohol and drug use increases
vulnerability to sexual advances
(H) teaches the importance of attaining self-sufficiency before engaging in sexual activity
The federal government began seriously supporting abstinence education in 1981 through the
Adolescent Family Life Act (AFLA). Currently, AFLA guarantees $13 million in funding for
abstinence-only based curricula (United States House of Representatives Committee on
Government Reform 2004). Since 1981, the federal support for abstinence programs has
expanded through Title V, Section 510 of the Social Security Act of 1996 and through the
Community-Based Abstinence Education (CBAE) programs that were created in 2000. Section
510 of the Social Security Act originally provided $250 million over five years for programs
whose exclusive purpose was to promote abstinence and it required a state to match $3 for every
$4 from the federal government. As of June 2004, the law has been extended and funding has
increased by $50 million per year. When state contributions are taken into account, Title V
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programs receive approximately $87.5 million dollars annually (Trenholm et al 2007). CBAE
guarantees its money for abstinence-only education through the Special Programs of Regional
and National Significance (SPRANS). SPRANS is the largest and fastest growing source of
abstinence-only education. In its first year of funding in 2001, 33 SPRANS grantees received
$20 million in grants. By 2004, the program had over 100 grantees with a budget of $75 million.
In 2005, the budget was increased to $104 million (United States House of Representatives
Committee on Government Reform 2004). Section 510 of the Social Security Act as well as the
CBAE guidelines prohibit disseminating information on contraceptive services, sexual
orientation, gender identity, and other aspects of human sexuality. Furthermore, programs
funded under CBAE must teach all eight components of the federal definition of abstinence
education, they must target 12-18 year olds, and they cannot use any funds (including their own
private funds) to dispense information about safe sex practices (Santelli 2006). As a result of
this increase in federal funding, there has been an increase in the number of abstinence based sex
education programs that are implemented throughout the country. Based on the criteria for
abstinence-only education, it is clear that this type of sex education curriculum does more than
discuss the biology of sexual intimacy. It also teaches a code of morality that defines parameters
for intimate partnerships and sexual relationships. Through my research I question and explore
the validity of these lessons and the place of education in dictating the types of morally
permissible relationships.
Lindberg, Santelli, and Signh document the changes in formal sex education from 1995 to
2002, in their 2006 paper, using data from the 1995 National Survey of Adolescent Males, the
1995 National Survey of Family Growth, and the 2002 National Survey of Family Growth.
Their study finds that both females and males first received abstinence education at younger ages
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in 2002 than in 1995 and females also learned of birth control at later ages on average. From
1995 to 2002 there was an increase in the share of adolescents who had received abstinence
education before first intercourse, but a decrease in the proportion of sexually experienced males
and females who received instruction on birth control before their first intercourse. In 2002 only
one out of three sexually experienced black males and fewer than one in two sexually
experienced black females received instruction about birth control methods prior to first
intercourse. This is compared to the two-thirds of their white peers who received instruction
about birth control methods prior to first intercourse.
For each gender, the proportion of adolescents who received any formal instruction about
methods of birth control declined significantly. For males, the proportion decreased from 81
percent to 66 percent, and for females they decreased from 87 percent to 70 percent. The
proportion of adolescents who received instruction in “how to say no to sex” increased among
males (74 percent to 83 percent) between 1995 and 2002 but declined among females (92 percent
to 86 percent). Furthermore, the likelihood those adolescents received abstinence education
alone, without any other sex education, increased from 9 percent to 24 percent among males and
from 8 percent to 21 percent among females.
The study finds that the decline in instruction about birth control methods, combined with
increased abstinence education, has resulted in a lower proportion of teenagers receiving
instruction in both birth control methods as well as in abstinence (Lindberg et al 2006).
Landry conducted another study with similar results in 1999. In the Landry study, 69 percent
of the public school districts (the sample consisted of 825 school districts) surveyed taught some
form of sexuality education but only 14 percent used a comprehensive policy that treats
abstinence “as one option for adolescents in a broader sexuality education program” while 35
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percent taught “abstinence as the only option outside of marriage, with discussion of
contraception either prohibited entirely or permitted only to emphasize its shortcomings.” The
31 percent of school districts who did not have a policy to teach sex education left the decision to
individual schools and/or teachers (Landry 1999).
The survey results demonstrated that when all school districts in the country are accounted
for, only 10 percent of the country’s school districts teach a comprehensive sex education
curriculum while 34 percent have an abstinence-plus (abstinence is stressed) and 23 percent have
an abstinence-only policy. Moreover, 33 percent of school districts have no policy at all (Landry
1999).
Given this increase in the prevalence of abstinence based programs, it is somewhat surprising
that there have been very few studies which evaluate the effectiveness of abstinence-only and
abstinence-plus sex education programs and curricula. In particular, the programs funded by
CBAE, which receive the majority of federal funding for abstinence education programs, have
no formal review process. The few research studies that have evaluated abstinence programs
have demonstrated mixed results.
Bennett and Assefi give a systematic review of school-based teenage pregnancy prevention
programs. They analyze the effectiveness of “abstinence-only” and “abstinence-plus” programs.
“Abstinence-plus” is defined as any program that discusses the effectiveness of contraception in
preventing pregnancy and sexually transmitted infections along with teaching abstinence.
The authors recommend that to reduce the rates of teen pregnancy, programs should work to
improve teenage contraceptive behaviors and reduce teens’ sexual activity. Given that the
abstinence-plus programs improve teenage contraceptive knowledge, the authors claim they have
a greater chance of improving use of contraception. Because there is no evidence that
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abstinence-only programs increase the age of sexual initiation or the frequency of sexual activity,
the authors recommend abstinence-plus curricula as a means of curbing teenage pregnancy rates.
To evaluate these programs the researchers assess five basic outcomes. They look at changes
in: sexual behavior (including the delay in initiation of first sexual intercourse), frequency of sex,
number of partners, contraceptive behavior (including contraceptive knowledge, reported use,
and condom use), and pregnancy rates. This is similar to my model but I choose to also include
STI rates.
To analyze sexual behavior the study measures self-reported age of first sexual intercourse,
frequency of sexual activity, and number of partners. The authors find a statistically significant
delay in sexual initiation among teens that are part of an abstinence-plus curriculum. The
abstinence-only curriculum is effective in delaying sexual initiation for up to three months, but at
the 6 or 12-month follow-up interviews, the abstinence-only curriculum was ineffective in
delaying sexual initiation. However, teens who report sexual experiences before any sex
education program and are assigned to the abstinence-plus intervention reported less frequent
sexual intercourse than sexually experienced teens exposed to the abstinence-only program at the
6-month follow-up.
Contraceptive use and knowledge are measured by self-reported outcomes examining
contraceptive use in general and condom use specifically. Four of the five abstinence-plus
programs that evaluate students’ knowledge of contraceptives find improvement in the
intervention group compared with the control group at the follow-up. None of the abstinenceonly programs asks about contraceptive use. Therefore it is difficult to assess the effects of the
program. However, students who participated in the abstinence-only program scored lower on a
six-point test assessing contraceptive knowledge (knowledge of the different types of
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contraceptives and their effectiveness) then student who participated in an abstinence-plus
program. More than 80 percent of abstinence-plus programs measuring contraceptive knowledge
showed an increase at follow-up (Bennet et al 2005). These findings indicate that abstinenceonly programs do not prepare adolescents to make healthy sexual decisions once they do become
sexually active. This is problematic given that the majority of teenagers decide to have
intercourse before the age of 18.
Borawski et al studied the effects of an abstinence-only program called “For Keeps” which
was created for middle school teenagers. “For Keeps” is a 5-day (40 minutes each day)
classroom based curriculum that stresses abstinence until marriage (as defined between a man
and a woman) and focuses on the physical, emotional, and economic consequences of early
sexual activity. The curriculum presents virginity as “a gift that should be protected” and
emphasizes the need for and development of resistance skills. Contraception is discussed, but
only in terms of its failures, and the curriculum emphasizes that contraception cannot protect you
from the emotional and economic consequences of early sexual activity (Borawski et al 2005).
At the 5-month follow-up of the implementation of this curriculum, students who were
exposed to the curriculum demonstrated an increase in HIV/STI knowledge, a stronger belief in
being abstinent, and a decline in their intention to have sex in the next 3 months. However, these
students showed no difference in confidence resisting sexual advances and they demonstrated a
decline in their intentions to use a condom in the future. This decline in intent to use a condom
once they do become sexually active is particularly troubling given that condoms are highly
successful in preventing pregnancy and the transmission of many STIs, including HIV/AIDS
(Borawski et al 2005).
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Barnett and Hurst evaluated an abstinence-only curriculum entitled the Life’s Walk program.
They evaluated the efficacy of this curriculum as it was implemented in northwest Missouri. The
curriculum was designed to give a clear and consistent message to wait until marriage to have
sex. The only mention of birth control and condoms is to discuss their failure rates. The
program’s goals were to “improve adolescent-parent communication about sex, increase factual
knowledge about sex, and increase student understanding about the realities of teen parenthood,
and foster the belief that abstinence is the best way to avoid negative consequences of early
sexual activity (Barnett et al 2003).
The study found a significant increase in parent-adolescent communication about sex but no
overall change in students’ attitudes about sex or their levels of self-esteem. When asked which
method the students would use to avoid pregnancy and STIs there was an increase in the number
of students who chose abstinence and a decrease in the number who chose condoms. The study
also found a statistically significant increase in sexual behavior. This finding is particularly
troublesome since the majority of students claimed to use abstinence as their preferred method of
avoiding pregnancy and STIs, yet an increasing number of students were becoming sexually
active. Barnett et al recommend that if this statistically significant increase is replicated, it is
crucial that more of an emphasis be placed on condom and birth control use so that these
adolescents have effective methods of birth control and STI protection available to them (Barnett
et al 2003).
Opponents of abstinence-only sex education curricula often site the lack of evidence
supporting the effectiveness of abstinence-only curricula as a main reason of opposition. The
mixed results of the few studies that have evaluated the curricula’s effects do reassure to the
opponents that abstinence-only curricula can be effective in reducing teen pregnancy and teen
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sexually transmitted infection rates. Aside from this reason, opponents also express a concern
regarding the validity and scientific truth of the materials used in the abstinence-only curricula as
well as a concern about the moral obligation the United States has to give adolescents all the
tools necessary to make healthy, informed, and safe decisions about their reproductive health.
Finally, many opponents question whether or not abstinence-based curricula promote realistic
and health life choices.
California Representative Henry Waxman asked that a report be done by the Committee on
Government Reform to evaluate the content of “the most popular abstinence-only curricula used
by grantees of the largest federal abstinence initiative, SPRANS (Special Programs of Regional
and National Significance Community-Based Abstinence Education).” The Department of
Health and Human Services provides grants to community organizations that teach abstinenceonly curricula through SPRANS, however, the curricula used by these programs is not reviewed
for accuracy by the federal government (United States House of Representatives Committee on
Government Reform 2004).
The report evaluated thirteen of the most popular curricula that are used by over 150
grantees. These 13 curricula constitute two-thirds of the curricula used by SPRANS grantees in
2003. The report found that 80 percent (11 out of 13) of the abstinence-only curricula reviewed
contain false, misleading, or distorted information about reproductive health. These
“problematic” curricula are used in 25 states by 69 grantees including state health departments,
school districts, hospitals, religious organizations, and pro-life organizations (United States
House of Representatives Committee on Government Reform 2004).
None of the thirteen curricula evaluated provides information on how to select a birth control
method and use it effectively, however many of the curricula exaggerate condom failure rates in
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preventing pregnancy. Much of this exaggeration comes from the curricula’s use of the “typical
use” failure rates rather than the “perfect use” failure rates without explaining the differences.
“Typical use” failure rates include people who use the method incorrectly or only sometimes
while “perfect use” failure rates include people who use a condom every time they have
intercourse and always use the condom correctly. Condoms have a “typical use” failure rate of
about fifteen percent and a “perfect use” failure rate of two percent. According to the World
Health Organization, the difference between typical and perfect use “is due primarily to
inconsistent and incorrect use, not condom failure. Condom failure – the device breaking or
slipping off during intercourse – is uncommon (United States House of Representatives
Committee on Government Reform 2004).”
Despite the CDC’s assurance that, “Latex condoms, when used consistently and correctly,
are highly effective in preventing the transmission of HIV, the virus that causes AIDS,” and that
“latex condoms provide an essentially impermeable barrier to particles the size of STD
pathogen,” some abstinence-only curricula teach that the pathogens of HIV are small enough to
“pass through condoms” and therefore argue that condoms are not effective in preventing the
transmission of HIV (United States House of Representatives Committee on Government
Reform 2004).
Some of the curricula also dispense false information regarding the causes of pregnancy and
STI infections such as HIV/AIDS. One of the curricula erroneously states that just “touching
another person’s genitals can result in pregnancy.” Another curriculum erroneously includes
“tears” and “sweat in a column titled “At risk” for HIV transmission (United States House of
Representatives Committee on Government Reform 2004).
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Many of the curricula use misleading information about the physical and psychological
effects of legal abortion. For example, one curriculum states, “Sterility: Studies show that five to
ten percent of women will never again be pregnant after having a legal abortion.” While
obstetrics textbooks teach that, “fertility is not altered by an elective abortion (United States
House of Representatives Committee on Government Reform 2004).”
Despite receiving significant, and sometimes exclusively, federal funding, many of the
curricula blur religion and science and thereby do not respect the principle of separating church
and state. In particular, the discussion of marriage heavily depends on religion since it defines
marriage only as the union between a man and a woman and considers marriage the only
“socially acceptable” place for intercourse. Also, in discussions of abortion some of the
curricula refer to early fetuses as babies or people and give inaccurate descriptions of their
developmental state (United States House of Representatives Committee on Government Reform
2004).
The report found that some of the curricula treat stereotypes about girls and boys as scientific
fact. For example, one curriculum instructs: “Women gauge their happiness and judge their
success by their relationships. Men’s happiness and success hinge on their accomplishments.”
Another curriculum lists “Financial Support” as one of the “5 Major Needs of Women” and
“Domestic Support” as one of the “5 Major Needs of Men” (United States House of
Representatives Committee on Government Reform 2004).
Finally, the curricula sometimes inappropriately use statistics to convey the wrong facts. For
example, the CDC found that 41 percent of female teens who reported having HIV reportedly
acquired it through heterosexual contact. But the curriculum using this data suggests that 41
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percent of heterosexual females have HIV (United States House of Representatives Committee
on Government Reform 2004).
The problems associated with the curricula evaluated in this study demonstrated the need for
further assessment. If the United States hopes to help adolescents develop into tolerant, kind,
and responsible individuals, the federal government should not be spending millions of dollars
on curriculum that promotes homophobia, gives false information under the guise of science, and
perpetuates gender stereotypes in which women are seen as inferior and submissive partners.
Following the passage of the Balanced Budget Act of 1997, “Congress authorized a scientific
evaluation of the Title V, Section 510 Abstinence Education Program (Trenholm et al 2007).”
This report evaluated four abstinence-only curricula that receive funding through Title V. The
curricula were implemented in Virginia, Mississippi, Florida, and Wisconsin. The curriculum in
Virginia was a non-elective class taught during the school day to students starting in grade eight
and lasting three years. These students came from rural, mainly middle and working-class, twoparent, white households. The curriculum in Florida was a year-long elective class taught
during the school day to students in grades six through eight. These students were mainly from
urban, poor, single-parent, African American and Hispanic families. The program in Wisconsin
was an after-school elective program with voluntary attendance which was taught to students in
grades three through eight daily for two and one-half hours after school for up to four years.
These students came from mainly urban, poor, single-parent, African American families. Lastly,
the program in Mississippi was a non-elective class taught during the school day over two years
to students beginning in grade five. These students came from mainly rural, poor, single-parent,
African American families (Trenholm et al 2007).
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The evaluation looked at rates of sexual abstinence, rates of unprotected sex, number of
sexual partners, expectations to abstain, and reported rates of pregnancy, births and STDs as
demonstrated in surveys taken four to six years after the students began participating in the
study. They also evaluated knowledge and perceptions risks associated with teen sexual activity.
The findings indicate that youth in the programs were no more likely than control groups of their
peers to have abstained from sex. Among those who reported having had sex, they had similar
numbers of sexual partners and had initiated sex at the same mean age. Program and control
group students did not differ in their rates of unprotected sex at first intercourse or over the last
12 months. The program participants did demonstrate a slightly better ability to identify STDs
correctly but less likely to perceive condoms as effective in preventing a range of STDs
(Trenholm et al 2007).
Overall, the study finds that the curricula funded by Title V demonstrate no impacts on rates
of sexual abstinence, the average age at first sexual intercourse, the number of sexual partners, or
rates of unprotected sex. While the programs did show some improvements in knowledge of
STDs, the program participants were less likely to perceive condoms as effective at preventing
STDs. Notably, the study demonstrated a clear lack of knowledge of the consequences of STDs
among both the program and control groups. Since the control groups received little to no
instruction on sex education, the evaluation cannot say whether comprehensive sex education
curricula would have been more effective in changing sexual behaviors or knowledge (Trenholm
et al 2007). It is alarming that the United States spends millions of dollars a year on education
curricula that does not reduce sexual activity or increase safer sexual choices.
Santelli and Dailard make the case that in funding abstinence-only sex education and
promoting abstinence until marriage as the only option for preventing teen pregnancy and teen
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sexually transmitted infections, we are doing a disservice to teenagers and perhaps even violating
the ethical obligation to protect them from disease and offer all available health options.
Santelli claims that, “there is broad support for abstinence as a necessary and appropriate part
of sexuality education. Controversy arises when abstinence is provided to adolescents as a sole
choice and where health information on other choices is restricted or misrepresented (Santelli et
al 2006).” He argues that promoting abstinence until marriage is not very realistic considering
that few Americans remain abstinent until marriage, many do not or cannot marry and most
American initiate sexual intercourse during adolescents.
The median age at first intercourse for women as of 2002 was 17.4 years and the median age
for first marriage was 25.3 years. For men the median age of first intercourse was 17.7 years and
the age at first marriage was 27.1 years. Given that most Americans initiate intercourse before
marriage, there seems to be a justifiable need to educate teenagers on how to best prevent
pregnancy and sexually transmitted infections before they become sexually active so that once
they initiate intercourse, they are fully prepared to take all necessary health precautions.
“Sexually experienced teens need access to complete and accurate information about
contraception, legal rights to health care, and ways to access reproductive health services, none
of which are provided in abstinence-only programs (Santelli et al 2006).”
President Bush has described abstinence as “the surest way, and the only completely
effective way to prevent unwanted pregnancies and sexually transmitted disease.” However, this
definition depends on a “perfect use” failure rate and several studies have shown that abstinence
users (people who intentionally abstain from sexual activity as a method of birth control and STI
protection) generally do not have a “perfect use” failure rate. A study presented at the 2003
meeting of the American Psychological Society found that “over 60 percent of college students
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who had pledged virginity during their middle or high school years had broken their vow to
remain abstinent until marriage (Dailard 2003).
Researchers have never measured the “typical use” failure rate of abstinence, as they have
with the birth control pill and condoms. It is important that students understand these differences
when statistics are used that discuss the failure of certain contraceptives. Dailard argues that if
curricula are going to promote abstinence they should discuss what happens when abstinence
fails, when people do become sexually active. Not doing so, she argues, is dangerous (Dailard
2003).
Furthermore, Santelli argues that abstinence-only education programs, as defined by the
government funding restrictions, are morally problematic because they withhold information,
promote questionable and inaccurate opinions, and alienate certain populations. For example,
the requirements to receive federal funding force curricula to exclude many people, namely
homosexuals, children raised in single-parent households without the involvement of a second
parent, teenagers who have already engaged in sexual activity and anyone who has sex before
marriage. As a result of condemning homosexual relationships and alienating children from
single-parent households as well as adolescents who are already sexually active, abstinence-only
sex education may have profoundly negative impacts on the well-being many youth, particularly
youth affiliated with the LGBT (lesbian, gay, bisexual, transgender) community (Santelli et al
2006). Moreover, because “access to complete and accurate HIV/AIDS and sexual health
information has been recognized as a basic human right and essential to realizing the human
right to the highest attainable standard of health” according the UN, Santelli believes the
government has an obligation to provide information to its citizens and avoid the provision of
misinformation. This right has been explicitly granted to children through the UN Committee on
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the Rights of the Child, which explicitly states that health professionals have ethical obligations
to provide accurate health information (Santelli 2006).
The research clearly indicates that abstinence-only programs are not effective in reducing
teenage pregnancy, teenage STI rates, or teenage sexual activity (in the long term). This failure
is largely because despite sex education, teenagers still engage in sexual risk taking behaviors,
and since abstinence-only education does not provide them with the necessary tools to reduce
risk, they are vulnerable to dangerous consequences. This research confirms that spending on
abstinence-only education is inefficient as it does not produce the necessary results to justify
such levels of funding. More than that, reports of the quality and content of abstinenceprograms, such as Representative Waxman’s requested report, is startling and disturbing because
they confirm the notion that abstinence-programs perpetuate and legitimize gender stereotypes,
homophobia, and dishonest information about sex. As a country that prides itself on equality,
tolerance, and justice, it is shocking that we allow these falsehoods to be spread through our
education system.
Comprehensive Sex Education
Recognizing that teenage sexual activity and its consequences, namely sexually transmitted
infections, teenage pregnancy, lower educational attainment levels and higher levels of poverty,
are undesirable in our society, we should have a policy that seeks to reduce sexual activity and
sexual risk taking behaviors among teenagers. Moreover, recognizing that despite a recent
decrease in the number of adolescents engaging in sexual activity, about two-thirds of all
students have sex before graduating from high school, it is clear that policy is necessary in the
immediate future as the majority of adolescents in this country are at risk (Kirby 2001).
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It is largely acknowledged by medical professionals, academic professionals, researchers,
and many parents, that comprehensive sex education is in part, the answer to these problems. In
contrast to abstinence-only sex education, comprehensive sex education programs and curricula
focus on giving teenagers the tools necessary to make healthy sexual decisions. Comprehensive
sex education teaches abstinence as the only way to completely prevent unwanted pregnancy and
STIs, but it also teaches about contraceptive use and other risk reducing behaviors such as
reducing the number of partners. Comprehensive sex education often includes lessons in
avoiding peer pressure, gender equality, and the importance of discussing serious and difficult
decisions with trusted adults.
Since the antecedents to teen pregnancy and teen sexually transmitted infection rates are both
sexual and non-sexual, there should be curricula and programs which focus on preventing risky
sexual behavior with methods that address both types of antecedents (Kirby 2001). With that in
mind, Kirby and the National Institute to Prevent Teenage and Unwanted Pregnancy developed
the following characteristics of a comprehensive sex education program:
10 Characteristics of Effective Sex and HIV Education Programs
The curricula of the most effective sex and HIV education programs share ten common
characteristics. These programs:
1. Focus on reducing one or more sexual behaviors that lead to unintended pregnancy or
HIV/STI infection.
2. Are based on theoretical approaches that have been demonstrated to influence other healthrelated behavior and identify specific important sexual antecedents to be targeted.
3. Deliver and consistently reinforce a clear message about abstaining from sexual activity
and/or using condoms or other forms of contraception. This appears to be one of the most
important characteristics that distinguish effective from ineffective programs.
4. Provide basic, accurate information about the risks of teen sexual activity and about ways to
avoid intercourse or use methods of protection against pregnancy and STIs.
5. Include activities that address social pressures that influence sexual behavior.
6. Provide examples of and practice with communication, negotiation, and refusal skills.
7. Employ teaching methods designed to involve participants and have them personalize the
information.
8. Incorporate behavioral goals, teaching methods, and materials which are appropriate to the
age, sexual experience, and culture of the students.
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9. Last a sufficient length of time (i.e., more than a few hours).
10. Select teachers or peer leaders who believe in the program and then provide them with
adequate training.
Generally speaking, short-term curricula – whether abstinence-only or sexuality education
programs – do not have measurable impact on the behavior of teens.
I argue that it is important to implement programs like the ones described above, both
because of the potential reduction in teenage pregnancy and sexually transmitted infections, but
also because programs such as these will teach future generations values such as self-worth, selfesteem, assertiveness, and comfort with their body and sexuality. These values are arguably an
important part of any education.
The case for comprehensive sex education is made from many sectors of the population.
“National organizations such as the American Medical Association, the American Academy of
Pediatrics and the National Academy of Sciences have recommended that schools implement
comprehensive sex education strategies” because they believe that comprehensive sex education
programs provide students with the information and skills they need to reduce their number of
partners and to use contraceptive and disease prevention methods effectively when they choose
to become sexually active (Landry et al 2003). As early as 1943, a Gallup Poll found that 68
percent of adults approved of sex education in schools and by 1985 that support had increased to
85 percent. Furthermore, the adults explicitly stated they wanted the instruction to include both
abstinence and condoms and other methods of contraception (Kirby 2006). More recently,
Bleakley et al found in their 2006 paper, about half of American adults actually oppose
abstinence-only programs and more than half believe it is not an effective way to prevent
unintended teen pregnancy (Kirby 2006).
The research confirms the effectiveness of comprehensive sex education programs.
Comprehensive sex education programs have been evaluated more than 50 times and have
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consistently been found effective. “Some of these programs have been demonstrated to delay
sex, reduce the frequency of sex, and reduce the number of sexual partners, increase condom use,
or increase contraceptive use more generally. Some reduce sexual risk, both by delaying sex and
increasing condom and overall contraceptive use. A few even have evidence that they reduce
teen pregnancy or sexually transmitted disease (STD) rates. Notably the evidence is very strong
that these programs do not increase sexual behavior, even when they do encourage condom or
other contraceptive use (Kirby 2006).” Despite this evidence, by the end of 2006 the federal
government, including mandatory matching grants from the states, spent roughly a billion dollars
on abstinence-only programs (Kirby 2006).
Kirby argues that once 10 to 20 percent of the students are beginning to have sex, they have
the right to accurate and balanced information about abstinence, condoms, and other forms of
contraception. He argues that from a public health standpoint, adolescents should be given such
information, as well as the skills and access to condoms and contraception so that they are more
likely to use protection if they do have sex (Kirby 2006). He states that, “Until we have strong
evidence that particular abstinence-only programs are effective, we certainly should relax the
funding restrictions and fund programs (including comprehensive programs) that effectively
delay sex among young people (Kirby 2006).”
The literature has confirmed Kirby’s work and assertions and has revealed some interesting
insights into how to develop programs that effectively reduce sexual risk taking without
necessarily talking about intercourse, sexual activity, or contraception.
One study in 1995 conducted by Frost evaluated five comprehensive sex education programs.
“Postponing Sexual Involvement” is a school-based curriculum in Atlanta, Georgia that is
administered to eighth grader students and is based on social influence and social inoculation
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theories. The goal of the program is to teach youth to abstain from sex but the curriculum
includes lessons on abstinence, life skills, sex education, contraceptive education and
contraceptive access. Older teenagers who assist the students in developing skills to resist any
pressure to have sex teach the curriculum. A total of 10 classes are held over a three-month
period. “Reducing the Risk” is a school-based curriculum which targets primarily 10th grade
students in California. The curriculum attempts to teach skills necessary to resist pressures to
engage in risky behavior, not limited to sexual behavior, and they teach students to avoid
unprotected intercourse either by not having sex or by using contraceptives. The curriculum is
taught in 15 sessions presented over a three-week period by specially trained high school
teachers. “School/Community Program” is a community-based program that was implemented
in a rural community in South Carolina. District teachers, administrators, and special service
personnel attended graduate-level courses covering issues related to sexuality education and
adolescent decision-making, self-esteem, communication, and influences on sexual behavior. As
a community, they created an ongoing sex education curriculum (which included contraceptive
distribution) for all grade levels and they recruited clergy, church leaders, and parents to attend
mini-courses and used newspapers and radios to spread its messages. “Self Center” is a schoolbased sexuality and reproductive health education and counseling with the provision of medical
services at a nearby clinic. The program was implemented in Baltimore, Maryland and was
taught by a team consisting of a social worker and nurse practitioner. The classes included
informal individual counseling, small-group sessions, and appointments with to obtain
contraceptive and reproductive health care services at a nearby clinic. Lastly, “Teen Talk” is a
curriculum implemented in Texas and California. The program taught abstinence, life skills, sex
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education, contraceptive education and contraceptive access. The curriculum was taught over 6
sessions throughout 2-3 weeks in both rural and urban settings (Frost et al 1995).
In this study, Frost compared the behavior of participating adolescents known as the
“treatment group” and the behavior of similar adolescents not exposed to the curriculum, the
control group for each of the five programs. There were follow-up interviews to measure
changes in behavior and consistency of behavior one to two years following the participation (or
non-participation) in each program (Frost et al 1995).
The “Postponing Sexual Involvement” curriculum demonstrated that before participation in
the program, 25 percent of the treatment group participants were sexually active while 23 percent
of the control group participants reported being sexually active. After the program, the number
of sexually active teenagers in the treatment group rose by 18 percent while the number of
sexually active teenagers in the control group rose by 25 percent. Therefore a lower percentage
of treatment group teenagers engaged in sexual behavior when compared with the control group.
Similar results were found with “Reducing the Risk” and “Self Center” while, “Teen Talk”
found no significant results. Overall these findings indicate a value in early intervention and
indicate that comprehensive sex education programs do not lead to increased sexual behavior
which many critics claim is an adverse effect (Frost et al 1995).
“Postponing Sexual Involvement”, “Reducing the Risk”, and “Self Center” demonstrated an
ability to delay the initiation of sexual activity among participant as well as increase the
proportion of sexually active teenagers using contraceptives. However, only “Self Center” was
able to demonstrate a significant impact on teenage pregnancy rates. This did not surprise Frost
et al because “Self Center” was also the program most active in arranging for contraceptive care
for sexually active students.
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“School/Community Program” saw the most dramatic results in reducing sexual activity and
increasing contraceptive use rates. Frost attributes this to their focus on including as many
members of the community as possible in the program as well as the fact that many of the
students knew their teachers and educators and there was already a sense of trust between
students and program leaders (Frost et al 1995).
Kirby has demonstrated in many studies that risks of teen pregnancy increase under
conditions such as: “community disadvantage; family structure and economic disadvantage;
family, peer, and partner attitudes and behavior; and characteristics of teens themselves,
including biology, detachment from school, other behaviors that put young people at risk,
emotional distress, and sexual beliefs, attitudes, and skills (Kirby 2001).”
His most recent research suggests that students who are doing well in school and have
educational and career plans for the future are less likely to become pregnant or cause a
pregnancy. Therefore, it would be beneficial to develop programs which help young people
develop skills and confidence, teach them to focus on their education, and take advantage of job
opportunities. This can include service learning, vocational education and employment
programs, and broadly defined youth development programs (Kirby 2001). Service learning
programs often include voluntary service within the community and structured time for
preparation and reflection before, during, and after the service. “Service learning programs may
have the strongest evidence of any intervention that they reduce actual teen pregnancy rates
while the youth are participating in the program.” These programs help teens develop
relationships with adults, give them a sense of autonomy, help them feel empowered, and reduce
the opportunities teens have to engage in risky behavior, including sex (Kirby 2001). The clear
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political advantage to these programs is that they do not require any discussion of sexuality or
sexual behavior that can often lead to opposition from sexual conservatives.
There has been some research that seeks to determine how effective self-esteem building and
resistance to peer pressure is in preventing sexual risk taking behaviors among teenagers and in
essence test Kirby’s budding hypothesis. Lieberman et al evaluated an abstinence-based
(meaning focused on abstinence, but not abstinence-only), small-group pregnancy prevention
program that took place in three New York City schools. This particular curriculum focuses
more on self-esteem than knowledge about sexual health. It focuses on “relationships and
communication, skills-building and positive mental health, as well as providing up-to-date and
accurate information about sexuality and about pregnancy and disease prevention.” Several
studies have indicated that, “poor self-concept is associated with earlier onset of sexual activity
for both male and female adolescents.” Therefore, the curriculum wished to focus on raising
self-esteem and confidence in order to mitigate the risks of pregnancy.
The curriculum studied is called The Project IMPPACT and it is taught in groups of 8-12
students that meet 12-14 times throughout a semester and are taught by sexual health teachers
who have been trained to teach this particular curriculum. The groups are single-sex or
coeducational depending on the maturity level of the participants and the ability to recruit an
equal number of participants from each sex.
The students who participated in the curriculum were considered “at-risk” for teenage
pregnancy and sexually transmitted infections as “nearly two-thirds of the intervention group and
one-half of the comparison group reported that a few, most, or all of their friends had had sex.
One-third of the males and 44 percent of the females reported having at least one friend who had
been pregnant or who had caused a pregnancy (Lieberman et al 2000).”
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The study found no short-term differences between groups in terms of attitudes about
teenagers having sex or about their own intention to have sex. There were also no significant
differences in the long term regarding depression, self-esteem, intention to have sex, attitudes
about teen pregnancy or the age of initiation of sexual activity. The results of the study did
however demonstrate the need for sex education specific to contraceptive use and STI
prevention, since many of the students reported being sexually active or knowing someone who
is sexually active (Lieberman et al 2000).
Denny and Young studied the implementation and effectiveness of a different abstinence
based curriculum called “Sex Can Wait.” This curriculum is designed to include lesson plans for
elementary, middle, and high school students. Previous published studies demonstrated positive
behavior effects of this curriculum and Denny and Young were interested in evaluating these
effects after an 18-month period (Denny et al 2006).
The curriculum designed for elementary school students is called “Knowing Myself” and it
focuses on self-esteem, reproductive anatomy and physiology, changes associated with puberty,
values and decision-making skills. The middle school curriculum is called “Relating to Others”
and it focuses on the development and enhancement of communication skills. Finally, the high
school curriculum, called “Planning My Future” focuses on goal setting and life planning. There
are no lessons dealing with contraceptives and teachers are instructed to only answer questions
on topics discussed in the curricula (Denny et al 2006).
Among the elementary school participants, the 18-month follow up demonstrated a higher
level of knowledge and a lower rate of participation in sexual intercourse in the last month
compared with the control group of elementary age children. Among middle school participants,
the 18-month follow up did not demonstrate any significant differences between the control and
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the intervention groups in terms of knowledge about sex and sexually transmitted infections, but
it did demonstrate that participants were less likely to report participation in sexual intercourse.
A reduced rate of sexual activity is an admirable achievement for a sex education curriculum
because by not having sex, or having less sex, adolescents are reducing or eliminating their risk.
The Sex Can Wait group of high school students demonstrated a higher score on knowledge
about sex and sexually transmitted infections and indicated a greater desire to remain abstinent
than the non-treatment group. It is important to note that the knowledge test did not cover
knowledge about contraception use or effectiveness (Denny et al 2006). This study indicates that
there may be effective methods of reducing sexual activity, thereby reducing all sexual risk
taking behavior, which do not explicitly deal with contraceptive use but focus more on selfesteem and relationship building. If the battle between abstinence-only and comprehensive sex
education continues without resolution, this may be a necessary route to appease both sides of
the argument. If the self-efficacy elements of sex education were effective, it would be possible
to reduce sexual risk-taking behaviors among adolescents without raising the controversial issues
of condom use, birth control use, and abstinence-only education. This would not necessarily
alleviate the controversy surrounding the promotion of gender equality through sexual education
however.
With these studies in mind, I developed a methodology that could quantitatively measure the
ability of state mandated sex education policies to reduce sexual risk-taking behaviors among
adolescents.
Methodology
To determine which aspects of sex education curriculum are most effective in reducing
sexual risk taking behavior among teenagers, I will asses the effect of state sex education polices
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on five variables related to risky sexual behavior. As discussed in the literature review, several
researchers have previously compared various sex education programs and discussed their ability
to reduce sexual activity, and thereby reduce unwanted pregnancy and sexually transmitted
infection rates, among teenagers. Most of these studies focus on how various programs work to
reduce sexual activity among adolescents, and while some look at teen pregnancy and teen STI
rates most focus only on sexual activity. Therefore, my thesis contributes to the literature by
focusing on several different measures of sexual risk taking behavior among adolescents. Also,
unlike most of the literature, which focuses on teenagers across the country in small
communities, where the data is on an individual level, my thesis examines state level rates of
teen pregnancy and teen sexually transmitted infection rates, condom use and birth control use
rates, and sexual activity rates. Moreover, there have been no studies that focus on individual
states and their sex education mandates. Lastly, there has been little to no research comparing
specific elements of sex education curriculum in order to determine how a state policy can affect
risky sexual behaviors through mandated sex education curriculum. In particular, the notion that
self-efficacy components of sex education curriculum could reduce sexual risk taking behavior
among adolescents, particularly females, is a new and developing hypothesis that has been
thoroughly examined in only one other study. In comparing the effects on sexual risk taking
behavior of policies of 29 different states, my research will bring a new level of understanding to
adolescent sexual behavior and help inform future policy by specifying which components of sex
education curriculum are most effective in reducing sexual risk taking behavior among
adolescents.
My goal is to determine which aspects of each state’s different sex education policies are
most effective in reducing risky sexual behavior among 15-19 year olds in their state. To this
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end, I plan to measure the impact of three aspects of the mandated curriculum on sexual
behaviors and the risks associated with them. More specifically I will measure how abstinenceonly mandates, self-esteem building exercises, and specific STI education, aside from HIV/AIDS
education, affect rates of pregnancy, sexually transmitted infections, condom use, birth control
pill use, and sexual activity among 15-19 year olds.
Using OLS regression, I evaluate the effect of mandated sex education policies on five
separate dependent variables related to sexual risk taking behavior. My dependent variables are
rates of pregnancy, sexual activity, sexually transmitted infection, and contraception use (birth
control pill use and condom use) among 15-19 year olds. These 29 states vary greatly in their
rates of unwanted pregnancy and sexually transmitted infections among adolescents. For the
purpose of my thesis, I define adolescent sexual risk-taking behavior as sexual activity in the last
year, unprotected sex, teenage pregnancy, and rates of sexually transmitted infections.
While I gathered data from 2001, 2003, and 2005, I was never able to collect information on
more than 28 states for a particular year. I was able to collect data for 16, 25, and 28 states in
2001, 2003, and 2005, respectively. In total, 29 different states are represented in the data set. In
an effort to maximize the number of observations, I combined observations across the three
years, which gave me a total of 69 state-year observations.
Variables
Sexual Risk-Taking Behaviors (Dependent Variables)
It can be argued that any sexual behavior among adolescents is risk taking because at their
young age, with little knowledge or experience, they are likely to make mistakes, have
unprotected sex, and potentially be emotionally hurt. That said, for the purpose of my thesis, I
define sexual risk taking behavior as sexual activity, unprotected sex, teenage pregnancy, and
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rates of sexually transmitted infections. These dependent variables were chosen because they are
each important determinants of the success of sex education curriculum. The goal of any sex
education program is to reduce sexual activity among adolescents. If a curriculum is unable to
do so, than the program should work to reduce rates of pregnancy and STI infection. One
method of doing so would be to increase rates of contraceptive use among adolescents. Each of
my dependent variables measures the curriculum’s success in one component of this process.
I view changes in risk-taking behavior as either potentially risk-eliminating or risk altering.
Depending on the decision of the adolescent, they can eliminate their risk, reduce their risk, or
increase their risk. For example, if an adolescent chooses to be sexually active they are exposing
themselves to risk but if they also choose to use a condom, they are altering that exposure to risk.
Oettinger first wrote about this concept of risk-altering and risk-reducing behaviors in
adolescents in his 1999 paper published in the Journal of Political Economy. I adapted the
model he used in his paper to measure sexual risk taking behavior. I use five dependent
variables: rates of sexual activity, pregnancy, sexually transmitted infection, birth control use,
and condom use.
•
Risk Eliminating Behaviors
o Decreased rates of sexual activity: reducing sexual activity, or choosing not to
engage in sexual activity at all is a risk eliminating behavior because it
eliminates or reduces exposure to risk.
•
Risk Altering Behaviors
o Rates of sexually transmitted infection (STI): lowering STI rates is risk
altering because it indicates that some action is being taken to make sex safer
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and less risky. Lower STI rates could potentially also be risk eliminating
since it may indicate a decrease in sexual activity.
o Rates of pregnancy: lowering pregnancy rates is a risk-altering behavior
because although the adolescents are still having sex, they are having safer
sex, thereby altering their risk. Again, lower rates of pregnancy could be
associated with risk eliminating behavior since it may indicate a lower rate of
sexual activity.
o Rates of contraceptive use (as measured by condom use and birth control pill
use): increasing contraceptive use rates is also risk-altering because it does not
reduce the exposure to risk, but it signifies an altered risk associated with
intercourse.
I chose to use rates of currently sexually active adolescents because I believe it is these
adolescents who would be most impacted by the risk-eliminating and risk-altering factors
associated with sex education curriculum. Since they are currently making sexual decisions,
they have an important opportunity to reduce their risk.
I chose to use rates of pregnancy and sexually transmitted infections because the ability to
reduce these rates demonstrates a change in adolescent risk-taking behavior and while the goals
of various sex education programs may vary, they all consistently strive to reduce rates of teen
pregnancy and sexually transmitted infections.
I also want to measure the impact of sex education policy on contraception use because if
adolescents are not going to change their rates of sexual activity, the best way to alter their risk is
to teach them to use contraception. I decided to use both condom use rates and birth control pill
use rates because I think they each demonstrate a different risk-altering motivation. For
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example, birth control pills only prevent pregnancy and not STIs. Therefore, users of only birth
control pills are primarily concerned with altering the risk to pregnancy. This may indicate that
they are in a monogamous relationship and are having sex frequently; it also indicates a greater
effort to alter risk since an annual examination by a doctor or nurse practitioner is necessary in
order to receive a prescription and the prescription must be filled on a regular basis. Condom
use, on the other hand, indicates a desire to alter pregnancy risk and STI risk. It also implies
users are not necessarily in monogamous relationships and since condoms are easier to obtain, it
requires less effort.
Curriculum Variables (Independent Variables)
My independent variables of primary interest are the components of each state’s sexual
education program. To categorize their programs, I use the following three policy determinants:
abstinence-only sex education, self-efficacy exercises, and specific STI education, not including
education about HIV/AIDS. The abstinence-only sex education is a risk-eliminating component
of curricula because it is intended to reduce or eliminate sexual activity among adolescents,
thereby reducing their exposure to risk. Specific STI education is risk-altering education because
although it may slightly reduce sexual activity, its goal is to encourage safer sex to alter the risk.
Self-efficacy components of curricula can be considered both risk-eliminating and risk-altering
because these components encourage students to resist the peer pressure to engage in sexual
relations at all, leading to risk reduction, but they also work to empower adolescents to feel
comfortable talking to their partners about contraceptive options which is risk-altering.
My first variable is whether abstinence-only sex educated is mandated by the state. In my
regression analysis, I use a binary variable for abstinence-only sex education where 1 indicates a
mandate of abstinence-only education and 0 indicates no mandate. Abstinence-only sex
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education curricula do not include any information about sexual intercourse or sexual
relationships, such as contraception and sexuality. This type of curriculum explains that
abstaining from sexual activity is the only moral and safe decision. Abstinence-only curricula
and studies measuring their effectiveness are explained thoroughly in the literature review. My
hypotheses regarding the effects on risk taking behavior of this and the other two pieces of sex
education curriculum are explained later when I discuss my analysis for each of the 5 risk taking
behaviors separately.
The next aspect of the curriculum I examined was specific instruction regarding sexually
transmitted infections, excluding education regarding HIV/AIDS. Again, I used a binary
variable in the regression where 1 indicated the curriculum mandated specific instruction and 0
indicated that it did not mandate. Some sex education curriculum focuses only on HIV/AIDS
and fails to address other prevalent STIs such as Chlamydia and Gonorrhea. This is problematic
because discussions of HIV/AIDS do not necessarily have to discuss sex or what it means to
practice safe-sex. Unfortunately, many sex education curriculums do not have medically
accurate information regarding how HIV/AIDS is transmitted and some focus primarily on “the
homosexual lifestyle” when discussing the risks associated with HIV/AIDS (United States House
of Representatives Committee on Government Reform 2004). If there is no education that
teaches concrete ways to prevent prevalent STIs, the adolescents may perceive less risk than
actually exists and therefore may not take proper steps to protect themselves.
The last determinant is whether the curriculum included teaching about self-efficacy. Again,
I used a binary variable in my OLS regression where 1 indicated a mandated self-efficacy piece
of the curriculum and a 0 indicated no mandate. Self-efficacy pieces of curriculum include
teaching self-esteem, strategies for avoiding peer pressure, tactics for saying no to sexual
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advances, and discussions about self-worth. Based on the literature, these are potential ways of
influencing sexual behaviors that do not necessarily deal with instruction on disease and
pregnancy. Self-efficacy lessons are a suggested way of decreasing sexual activity, thereby
decreasing teenage pregnancy rates and teenage sexually transmitted infection rates.
As shown in Table 1 and Table 2 of the appendix, there is correlation between several of the
independent variables. In particular, self-efficacy and abstinence are highly negatively
correlated (-0.616). This could be problematic since it may limit the regression equation’s ability
to explain variance. However, I anticipate being able to reconcile this by including and
excluding certain variables. Similarly, abstinence and STI education are negatively correlated (0.260). Self-efficacy and STI education are positively correlated (0.620) indicating that states
which choose to teach self-efficacy also see value in teaching specific STI education apart from
HIV/AIDS.
Demographic Variables (Control Variables)
In my regression analysis I use three control variables: race, religion, and income. These
demographic factors were chosen because, according to the literature, they often impact sexual
risk taking behaviors among teenagers through cultural identity as well as through access to
information and contraceptive services (Kirby 2001). My hypotheses regarding their effects on
risk-taking behaviors will be discussed for each of the five dependent variables in the analysis
section.
There is very little correlation between the control variables (Table 2) with the exception of
non-religious and below poverty line, which are negatively correlated (-0.411). Importantly,
there is correlation between several of the control variables and the independent curriculum
variables. For example, abstinence is positively correlated with non white and below poverty
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line (0.243 and 0.482) but negatively correlated with non religious (-0.371). If my results
indicate that abstinence is associated with higher rates of teen pregnancy and teen STI rates,
these correlations would indicate that non white and low income communities are associated
with this type of curriculum more often while non religious communities are not associated as
often with abstinence-only curriculum. Similarly, self-efficacy is positively correlated with non
religious and negatively correlated with below poverty line (0.404 and -0.429) which could raise
equity issues if it is demonstrated that self-efficacy is associated with lower rates of teen
pregnancy and this correlation demonstrates that low income teenagers are less likely to receive
this kind of curriculum. These correlations are shown extensively in Table 2 of the Appendix.
Regression Equation
With these considerations in mind, I created the following equation to measure each
curriculum components effect on the dependent variables measuring sexual risk taking behavior.
Risk Taking Behavior = α + β1ABSit + β2SEit +β3STIEDit + β4NWit +β5NRit + β6BPLit + ε
where:
Dependent Variables
•
Risk Taking Behavior = one of the five dependent variables measured
o Sexual activity rate (SAR): percent of 15-19 year olds who have had
sexual intercourse at least once in the last 12 months
o Pregnancy rate (PR): percent of 15-19 year olds who have been
pregnant at least once
o Sexually transmitted infection rate (STIR): percent of 15-19 year
olds who have contracted either gonorrhea, syphilis, or chlamydia at
least once
o Birth control pill use rate (BCU): percent of 15-19 year olds who
have had intercourse in the last 3 months and used birth control pills
before their last sexual intercourse
o Condom use rate (CU): percent of 15-19 year olds who have had
intercourse in the last 3 months and used a condom during their last
sexual intercourse
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Curriculum Variables
•
•
•
ABS (abstinence only) = 1 when the state mandates abstinence-only sex
education curriculum, zero otherwise
SE (self-efficacy) = 1 when the state mandates a self-efficacy or self-esteem
building component of sex education curriculum, zero otherwise
STIED (STI education) = 1 when the state mandates specific STI education
(aside from HIV/AIDS education), zero otherwise
Control Variables
•
•
•
NW (non white) = percent of state population that identifies as non-white
NR (non religious) = percent of the state population that identifies as nonreligious
BPL (below poverty line) = percent of state that lives below the national
poverty line
ε = an error term
The Data
The Sexuality Information and Education Council of the United States (SIECUS) compiles
information on state level mandates concerning sexuality education. Using the information
gathered by SIECUS, I determined which states mandate sexuality education, and of those that
do mandate sexuality education, what types of sex education curriculum they mandate. Using
this information, I began to create my data set.
The CDC conducts a National Youth Risk Behaviors Survey annually and participants are
chosen from across the country. They then give states the option of conducting the survey
themselves to get a better sense of the risk behaviors of youth in each specific state. I have taken
the data collected by the states that choose to conduct the survey themselves and used it for the
purposes of my thesis. For California, I have chosen to use data from the California Youth
Behavior Survey because California does not participate in the CDC survey. The California
Youth Behavior Survey asks almost identical questions as the CDC survey, but is conducted
every two years.
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I also only used states used that have a policy mandate to teach sex education in public
schools. Since my ultimate goal in this data analysis is to determine what effect various parts of
sex education curriculum have on adolescent risk taking behaviors, I need to know that the
majority of adolescents in the state receive the same sex education, particularly because I do not
have individual level data. The mandates for sex education curriculum do not need to be for any
particular kind of curriculum, that is, they could be comprehensive, HIV/AIDS only, or
abstinence-only. As explained earlier, I used information compiled by SIECUS to determine
which components of sex education are taught in each state. By excluding states that do not
mandate some form of sex education, I reduced the likelihood that the adolescent risk taking
behaviors are independent of any sex education curriculum. As a result, states did not qualify for
my data set if they chose not to participate in any youth risk behavior survey or if the state is not
required to teach any kind of sex education. There were some instances (California, for
example) where I kept a state in the data set even though the state did not specifically mandate
that sexuality education be taught. However, I only did this if I was assured that the vast
majority (over 85%) of students in the state received sex education by the state’s health
department.
It is important to acknowledge that even though a state mandates a certain type of sex
education, it does not ensure that other types of sex education are not also taught. For example,
if a state mandates abstinence-only education and does not mandate self-efficacy components of
curriculum, a school district could still choose to teach self-efficacy lessons. I do not anticipate
this to be problematic because the data is state-level and so an added curriculum piece in one
school district should not have a detrimental impact on the data.
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I measured the curriculum’s effect on risk taking behaviors and risk outcomes, namely
pregnancy, rates of sexually transmitted infections, condom use, birth control use, and rates of
sexual activity. To determine the teen pregnancy rates in each state, I used the Guttmacher
Institute’s data on the number of pregnancies among 15-19 year olds in each state in 2001 and
2003, this data was not available for 2005 so it was not included. For the number of sexually
transmitted infections reported among 15-19 year olds I relied on data collected by each state’s
health department. This information was available online at the state’s public health department
website. These websites are listed in Appendix B. The rates of sexually activity, condom use,
and birth control pill use were determined using the CDC surveys that were implemented in each
participating state and the California Youth Behavior survey.
As a result of a limited sample size, I combined the data I had collected for states in 2001,
2003, and 2005 to create one larger data set that spans the three years. The data I gathered for
2001 sexual risk taking behaviors includes 16 states: California, Delaware, Florida, Maine,
Massachusetts, Michigan, Missouri, Montana, Nevada, New Jersey, North Dakota, Rhode Island,
South Dakota, Vermont, Wisconsin, and Wyoming. For 2003 sexual risk taking behaviors, I was
able to add Alabama, Alaska, Kentucky, New Hampshire, New York, North Carolina, Ohio,
Oklahoma, Tennessee, and West Virginia in addition to the states used in 2001. The 2005 data,
adds Hawaii, Indiana, Iowa, and Kansas to the 2003 list, but does not include Alaska. In total, 29
states were observed for at least one year, and some for multiple years. My final data set
includes 69 state-year observations (see Table 1 of the Appendix).
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Results and Analysis
Reducing sexual activity rates is the top priority of every sex education program. That said,
given that 2 in 3 adolescents are sexually active before reaching the age of 18, it is important to
also prioritize reducing the risk that sexually active adolescents face.
My analysis first seeks to measure the extent to which curriculum can reduce sexual activity.
If sex education curriculum is able to convince students to have less sex or no sex at all, it will
inevitably reduce the negative consequences of sexual activity, namely pregnancy and STI rates.
If however, the curriculum is unrelated to sexual activity rates, I consider its relationship with
pregnancy and STI rates, in order to determine its ability to reduce these negative outcomes for
sexual active adolescents. Lastly, I examine the curriculum’s influence on condom use and birth
control use because these methods of contraception are the most effective way to reduce risk
assuming no reduction in sexual activity.
Sexual Activity Rates
Reducing rates of sexual activity among adolescents is the goal of almost all sex education
programs. When adolescents choose to not engage in sexual behavior, or to engage less
frequently, they are potentially eliminating or significantly reducing their exposure to risk. As a
result, the ability of a sex education curriculum to reduce sexual activity is important and
significant.
This dependent variable is also important because it is at the center of the controversial
debate over comprehensive and abstinence-only sex education. Proponents of abstinence-only
education argue that comprehensive sex education encourages more sexual activity since it gives
students information about sexual intercourse and teaches them about contraception. As
discussed in the literature review, studies indicate that comprehensive sex education has no effect
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on sexual activity rates except in some instances it has been found to slightly reduce activity
rates. Proponents of comprehensive sex education argue that abstinence-only education does not
decrease sexual activity rates and therefore does not provide the teenagers who are choosing to
have sex with any tools to protect themselves against STIs and pregnancy.
I hypothesize that the abstinence variable will have no effect on sexual activity rates because,
based on the literature, abstinence only curriculum does not seem to reduce the number of
adolescents engaging in sexual intercourse. I believe that self-efficacy components of
curriculum will have a negative relationship with sexual activity because this curriculum could
give students the confidence necessary to reduce sexual advances and peer pressure. I do not
anticipate STI education to have a large impact on sexual activity rates but it should reduce them
slightly since learning about the number of sexually transmitted infections they can be exposed
to should impact students. Viewing pictures of STIs and hearing about their negative
consequences such as itching, burning, and infertility, should give adolescents the idea that STIs
should be avoided and that they should take precautions to avoid them.
I anticipate a negative relationship between non-religious and sexual activity since religious
people may be more likely to postpone sexual activity. Also, since teenage pregnancy rates are
higher among minority and low-income populations, I hypothesize that non-white and below
poverty line will be associated with higher rates of sexual activity.
In Table 3 of Appendix A, I present the correlations for each independent variable with the
dependent variable, sexual activity. Only two variables have a statistically significant correlation
with sexual activity: non-religious (-0.27) and below poverty line (0.24). The signs of these two
correlations are consistent with my hypotheses. The curriculum variables and the other control
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variables (non-white) are not correlated with sexual activity. This is consistent with my
abstinence hypothesis, but not with my other hypotheses.
Similar to the correlations results, the non-religious and below poverty line variables are the
only two variables that have a statistically significant relationship with sexual activity when
entered separately into the regression equation. Their R-squared statistics are very small
however (0.07 and 0.058 respectively). As a result of these initial findings, I ran a regression
which included only non-religious and below poverty line and found that in this equation, the
below poverty line variable was no longer significant. This could be explained by the high
correlation (-0.411) between the non-religious and the below poverty line variable (Table 2).
The adjusted R-squared statistic was also higher when non-religious was the only variable in the
equation, indicating a better fit. The coefficient on the non-religious variable (-0.247) is not very
substantively significant since it represents a less than one percent decrease in sexual activity
rates.
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I am surprised by some of the results of my regression analysis because I anticipated the selfefficacy component to have more of an impact on sexual activity rates. Based on interviews that
Kirby conducted in 2006, young women often report self-esteem and goal-oriented attitudes as
reasoning behind their decision to not have sex. Therefore, I expected to see a negative
relationship between self-efficacy and sexual activity. The insignificance of the self-efficacy
variable in my regression leads me to believe that these goal-oriented attitudes and self-esteem
are not easily taught through self-efficacy curriculum. Perhaps it takes more than self-esteem
building exercises and role-playing activities in class to influence sexual decision-making.
Also, I was not expecting to see that the populations that often have the highest rates of
teenage pregnancy do not have positive relationships with sexual activity rates. This indicates
that the higher rates of pregnancy in these populations are not necessarily a result of higher rates
of intercourse, and may in fact be a result of less access to contraception, which is consistent
with my results for birth control and condom use rates.
These results also indicate that all three components of sex education that I examined do not
appear to play a large role in adolescent sexual decision-making. Consistent with many of the
studies discussed in the literature review and contrary to many proponents of abstinence-only sex
education, my findings indicate that abstinence-only components do not have a strong negative
relationship with sexual activity rates.
None of my variables explained much of the variance in sexual activity rates, the R squared
statistic for my final regression equation was only 0.070. Therefore there are many other factors
that influence a teenager’s decision-making process such as peer pressure, the media, and social
values.
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Given these findings, I assume that the sex education curriculum does not explain an
adolescent’s decision to have sex and therefore is not effective in reducing sexual activity rates.
Going forward, I measure the curriculum’s impact (if any) on teen pregnancy and STI rates
because if the curriculum is unable to reduce exposure to risk through a reduction in sexual
activity, perhaps it is still able to reduce risk outcomes by teaching risk-altering behaviors.
Pregnancy Rates
Teenage pregnancy is a major contemporary policy concern because, as advocates on both
sides of the sex education debate acknowledge, teenage pregnancy and the potential for teenage
mothers have many negative consequences for the teenager and for the broader society. Teenage
mothers are much less likely than their peers to finish high school and go to college and are
much more likely to suffer from obesity, sexually transmitted infections, and poverty. Moreover,
the federal government spends over $9 billion dollars a year on families with teenage mothers to
help support them (National Teen Pregnancy Prevention Campaign, 2006).
Reduced rates of teenage pregnancy indicate that teenagers are either engaging in less sexual
activity or they are having “safer sex” by using condoms and other forms of contraception such
as birth control pills. Either way, this reduction is a positive outcome for activists on both sides
of the debate.
In my particular data set, I was unable to include pregnancy rates in 2005, which means that
my observations were 41 states instead of 69. With fewer observations, the effect of the
independent variables are less likely to be statistically significant, which should be considered
when interpreting my results.
That said, I hypothesize that abstinence will have a positive relationship with pregnancy rates
since abstinence curriculum does not teach risk-altering methods such as contraception use. I do
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not think abstinence-only curriculum will reduce sexual activity rates, and given no reduction in
sexual activity rates and no information about contraception, I anticipate that the abstinence
variable will not significantly influence pregnancy rates. Self-efficacy should have a negative
relationship with pregnancy rates since it is meant to both reduce sexual activity and increase
risk-altering behaviors. I hypothesize that STI education will have an insignificant relationship
with pregnancy rates because it did not have a significant relationship with condom use and a
positive relationship with condom use would be the only predictor of a relationship with
pregnancy rates. If there is a relationship however, I anticipate that it will be negative because
STI education should increase condom usage, which is a risk-altering behavior that should lead
to decreased teenage pregnancy rates.
Previous research and data indicate that minority and low-income populations have higher
rates of teenage pregnancy and therefore I anticipate the non-white and below poverty line
control variables to have positive relationships with the pregnancy rate. Birth control, one of the
most effective methods of pregnancy prevention, can be difficult to access because a prescription
requires a doctor’s appointment and without health insurance can be very expensive. Minority
populations and low income populations are less likely to have access to birth control as a result
of these impediments to access and therefore, I anticipate they will have positive relationships
with pregnancy rates. I do not imagine the non-religious variable to have a significant
relationship with pregnancy rates because I do not anticipate religion will have a significant
impact on sexual activity or contraceptive rates.
My initial regression equations (Table 5), which examined each curriculum variable
separately, indicate that none of the curriculum variables are significant. Abstinence was close
to being significant (p=0.056), so it was not surprising that when I combined the curriculum
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variables abstinence became significant. The other two curriculum variables were still not
significant, and so I decided to drop them from further analysis on teen pregnancy rates.
When the control variables were examined separately only non-white was significant.
However, when all control variables were considered, in Equation 8, they all became significant
and the R squared statistic was 0.69, indicating a good fit.
I then ran a regression, Equation 9, which included abstinence and the control variables, but
found that abstinence was not significant in this case. The adjusted R squared statistic decreased
from 0.665 to 0.660 between Equation 8 and 9 indicating that abstinence does not improve the
fit.
It appears that the curriculum variables do not explain the variance in pregnancy rates, and
that they are better explained by the control variables in Equation 8. The high R-squared statistic
of the three control variables is 0.691 while it is only 0.13 for the three curriculum variables.
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These results are consistent with the correlations presented in Table 3. They indicate that none
of the curriculum variables have a significant relationship with pregnancy rates. They also
indicate that only the non-white variable will have a significant relationship which is interesting
given that non-white and below poverty line are not correlated. This indicates that perhaps lowincome communities are less associated with higher teenage pregnancy rates than I anticipate.
Similarly to sexual activity rates, pregnancy rates were not impacted significantly by sex
education curriculum. If the curriculum is unable to influence rates of sexual activity and rates
of pregnancy, the curriculum will need to increased risk-altering behaviors such as contraceptive
use in order to reach its goals of reducing risk to adolescents.
The fact that the control variables were able to explain much of the variance in pregnancy
rates indicates the importance of considering demographic issues when creating sex education
policy. If low-income communities are less likely to use birth control and therefore have higher
rates of pregnancy, than in these communities, the curriculum should include better access to
contraception and more focused instruction on contraceptive use. These results indicate that
curriculums may need to be tailored to the communities they are implemented in order to be
most effective.
Sexually Transmitted Infection (STI) Rates
Sexually transmitted infections (STI) among adolescents are another unfortunate
consequence of risky sexual behavior. Some STIs are treatable and do not have very severe
consequences while others can lead to infertility and last a lifetime. In my thesis I determined
the STI rate for each state by finding the number of adolescents who were infected with
Chlamydia, Gonorrhea, or Syphilis. I chose these STIs because they are the most commonly
recorded STIs. However, it would have been better if I were able to get rates of infection for the
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human papilloma virus (HPV) since that is the most common sexually transmitted infection, but
I could not access these rates.
It is important to measure STI rates and pregnancy rates separately because different risk
altering behaviors can influence pregnancy and STI rates. Although condom use can reduce both
STI and pregnancy rates, birth control use can only reduce pregnancy rates.
I hypothesize that abstinence-only curriculum will have an insignificant relationship with STI
rates since abstinence-only curriculum does not provide any risk-altering methods, including the
use of condoms, and does not appear to reduce sexual activity, as mentioned earlier. Selfefficacy should have a negative relationship with STI rates since this type of curriculum is meant
to encourage risk-altering behavior, specifically avoiding peer pressure to not use condoms and
creating the confidence necessary to ask a partner to use a condom. STI education should have
the most significant relationship with STI rates since the central goal of STI education is to
reduce STI rates and encourage risk-altering behaviors like condom use that will lead to lower
STI rates.
Similar to teenage pregnancy rates, STI rates have historically been higher among lowincome and minority populations (National Campaign Against Teenage Pregnancy 2006).
Therefore, I predict that both the non-white and below poverty line variables will have positive
relationships with STI rates. I anticipate the non-religious control variable to have a slightly
negative relationship with STI rate since non-religious people might be slightly more likely to
use condoms regularly and therefore reduce their likelihood of contracting an STI. However, I
do not expect this relationship to be strong because I do not anticipate that a teenager’s religious
background plays a large role in their decision to use a condom.
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My regression equations are in Table 6 of Appendix A. The initial equations, which consider
each of the curriculum variables separately, indicate that abstinence and self-efficacy have
significant relationships with STI rates (and they are in line with my predictions) but that STI
education does not have a significant relationship. Also, interestingly, the R-squared statistic is
fairly large in Equation 1, which considers only abstinence, indicating that this curriculum
variable may be explaining a good part of the variance in STI rates. Equations 5 and 6
demonstrate that abstinence remains significant and the coefficient stays positive when
considered with the other curriculum variables while self-efficacy and STI education are not
significant when considered with the abstinence variable. This indicates that the variance in STI
rates is explained more by the abstinence-only curriculum than the other variables. However, in
Equation 6, when abstinence is considered with STI education, STI education is nearly
significant (p-value=0.054) and when all three curriculum variables are considered together, in
Equation 4, abstinence and STI education are significant. Therefore, I will consider abstinence
and STI education in the further regression analyses.
When each of the control variables were considered separately, Equations 7-9, each of the
controls appears significant (as predicted by the descriptive statistics). Notably, the R-squared
statistics in Equations 7 and 8 are very small, while Equation 9 has a much higher R-squared
statistic. This may indicate that the below poverty line variable is explaining the most variance
out of the three control variables. When the three control variables were considered together in
Equation 10, none of them remained statistically significant but the adjusted R-squared statistic
remained relatively strong (0.354), indicating that one or two of the variables may be explaining
variance. In order to determine which of the variables was explaining the most variance, I
examined each potential combination of control variable pairs and found that only below the
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poverty line remained significant in each pair. As a result, I used only below poverty line as a
control variable.
In Equation 14, I examined two curriculum variables, abstinence and STI education, with the
below the poverty line variable as a control. Abstinence and below poverty line were significant,
but STI education was not. Again, STI education was close to significance (p-value=0.066). In
an attempt to find a better fit, I ran the regression including only abstinence and below poverty
line. Equation 15 shows my final regression equation and the R-squared (0.411) led to me to
believe that it is a fairly good fit of explaining the variance in STI rates among adolescents. That
said, the R-squared and adjusted R-squared of Equation 14, which includes STI education, are
higher than those in Equation 15. This indicates that STI education may be an important variable
to consider, despite it not being significant.
The coefficient on abstinence in my final regression, Equation 15, is considerably
substantively significant. The coefficient is 0.499 indicating that abstinence only education is
associated with approximately 0.5 percent higher rates of STIs. Since the mean STI rate among
the states included in the data set is 1.42, this is a very substantively significant effect.
According to my descriptive statistics in Table 2 of Appendix A, abstinence-only education is
also positively correlated with the below poverty line, indicating that students who are below the
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poverty line are more likely to be exposed to abstinence-only education and, given my regression
results, also have a positive relationship with STI rates.
I am surprised that STI education did not have a strong relationship with STI rates, since the
point of the STI education curriculum is to reduce STI rates. Furthermore, given that STI
education was near significant in my final regression equation, it is important to note that the
coefficient was positive. This indicates the exact opposite relationship that educators of STI
education hope to have with STI rates and implies that STI education is not effective in
achieving its main objective, the reduction of STI rates. I was also surprised that self-efficacy
did not have a significant relationship with STI rates, particularly since it is designed to increase
condom use and thereby decrease STI rates. However, similar to my results with sexual activity
rates, this could indicate that in order for self-efficacy to be effective, it must be introduced early
in a child’s life and must be consistently reinforced, rather than mentioned briefly in a one-hour
lesson plan on sex education. I want to reiterate again that these results might be different if I
was able to include HPV rates.
These findings indicate that again, the self-efficacy curriculum variable is not among the
influential factors affecting pregnancy and STI rates, just as it was not impacting sexual activity
rates. However, given the high percentage of adolescents who are sexually active, it is possible
that self-efficacy curriculum could impact contraceptive use rates, and thereby significantly
reduce exposure to risk. With this in mind, I now measure sex education curriculum’s ability to
explain the variance in rates of risk-altering behaviors, namely birth control pill use and condom
use.
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Birth Control Use
Sex education should reduce sexual risk-taking among adolescents by giving them the
necessary information to make healthy sexual decisions. The best way to reduce teen pregnancy
rates, teen STI rates, and sexual risk taking behavior among adolescents is to reduce the number
of adolescents engaging in sexual activity in the first place. This should be the primary goal of
any sex education curriculum. That said, if adolescents are going to engage in sexual activity,
there should be risk-altering aspects of the curricula that empower the individual to alter the
chances of contracting an STI or impregnating someone/becoming pregnant themselves.
The use of birth control pills is an important risk-altering behavior for adolescents who
choose to be sexually active. While birth control pills do not protect against sexually transmitted
infections, they are 99 percent effective in preventing pregnancy when taken as directed. Given
birth control’s high level of effectiveness, using it is an important and influential risk-altering
method. Increasing birth control rates among sexually active adolescents is a significant
accomplishment because it is an effective method of reducing unwanted pregnancy and reducing
the rate of teenage pregnancy. The ability of sex education curriculum to increase birth control
use among adolescents would signify the curriculum’s ability to influence adolescent decisionmaking and encourage risk-reducing behavior.
When considering the effect of sex education on birth control rates, it is important to consider
that birth control pills can be relatively difficult to access, particularly in comparison with
condoms, because they must be prescribed by a physician and without health insurance, they can
be quite expensive. It is also important to consider that, birth control pills require repeated
diligence to be effective. The pills must be taken daily and refilled as often as once a month.
Lastly, it is important to remember that the pills are a prevention method that females have
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control over but males have little to no control over. All of these factors mean that birth control
is a risk-altering method that is difficult to access and requires substantial effort. This implies
that if the risk-altering components of curriculum do increase birth control use, they do so
despite obstacles faced by many teenagers.
I hypothesize that the abstinence variable will have an insignificant effect on birth control use
because abstinence-only education does not include any information about birth control and
other contraceptives. I think the self-efficacy variable will have a significant positive impact on
birth control use rates. This is largely because the self-efficacy aspects of curriculum should
encourage the female students to feel confident in taking action that will reduce the risk of sexual
activity. Finally, I hypothesize that learning about sexually transmitted infections (STI) will
have virtually no effect on birth control use rates since birth control pills do not protect against
STIs.
By regressing the curriculum and control variables on birth control use rates, I am able to
better understand the effect of the independent variables on birth control pills and determine
which of the variables best explain the variance in birth control rates. Since many of the
independent variables are highly correlated, it is crucial to be able to determine whether each
independent variable has an independent effect when controlling for the other variables.
The regression results are shown in Table 7 of Appendix A. When considered alone,
abstinence mandates were associated with a decrease in birth control use (-4.63) and self-efficacy
was associated with an increase in birth control use (2.71). Compared to self-efficacy,
abstinence is both more substantively significant (-4.6 vs. 2.7) and statistically significant (0.00
versus 0.06). It also has more explanatory power (R-squared=0.16 vs. 0.06). STI education did
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not have a substantively or statistically significant relationship with birth control use (p=0.36),
and was therefore dropped from future models.
When abstinence and self-efficacy were included in the regression equation together,
abstinence remained substantively and statistically significant while self-efficacy did not. In
addition, as indicated by the adjusted R-squared statistic, the model’s fit was better when
abstinence was the only variable in the equation (0.15 vs. 0.14). Therefore I eliminated selfefficacy from future models of birth control rates.
Abstinence-only mandates having more of an effect than self-efficacy on birth control use is
consistent with my hypothesis. Abstinence-only education does not educate students about the
existence of proper usage of birth control pills. Therefore, students exposed to abstinence
curriculum will have to gather information on birth control use and access to birth control pills
entirely on their own, thereby reducing the likelihood of usage. However, I did expect selfefficacy to have some independent impact on birth control rates, which is not evident in my
results. Perhaps the lack of an effect of self-efficacy is because in order for this type of
curriculum to be effective the adolescents must be exposed at an earlier age and more regularly
than the sex education curriculum allows for.
Two of the three control variables might also have a significant impact on birth control use. I
anticipate that race will have a significant impact on birth control use. Given that minority
populations are more likely to be low income and without health insurance, it is likely that they
do not have easy access to birth control pills. Similarly, I hypothesize that the “below the
poverty line” variable will likely be associated with a decrease in birth control use because the
costs of birth control can be difficult for low-income communities, especially since low-income
individuals are less likely to have health insurance that helps cover the costs of birth control pills.
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Although I expected that religious convictions would prevent some females from using birth
control pills so there would be a positive relationship between “non religious” and birth control
use in the regression analysis, I do not anticipate religion to have a significant influence on
adolescents’ decisions to access birth control pills because adolescents who would not use birth
control pills because of their religious beliefs would most likely not be having sex in the first
place.
When my regression equations contained each of the three control variables separately, they
were each statistically significant: non-white had a negative relationship with birth control use,
non-religious had a positive relationship, and below poverty line had a negative relationship. All
three of these results were in line with my original hypothesis, although I did not expect the
relationship between non-religious and birth control use to be significant.
When I ran a regression that included all three of the control variables, non-white and below
poverty line remained statistically significant while non-religious did not. Both of the significant
variables remained significant when they were included in a regression together. As a result, I
dropped non-religious from future regressions but kept non-white and below poverty line.
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When abstinence was included along with one or both of the two significant control
variables, it remained negatively related to birth control use and statistically significant.
Therefore I included abstinence, non-white, and below poverty line in my final regression model.
My results from this final model indicate that abstinence only mandates are negatively
related to birth control use rates with coefficient -2.003 and both non-white as well as below
poverty line are also negatively associated with birth control use rates. These findings raise
several interesting conclusions and questions.
These results suggest that racial and economic factors may significantly impact teenagers’
decision to use birth control pills, potentially by limiting access to this form of contraceptive.
This further implies that factors other than sex education curricula have a much bigger impact
adolescent risk-altering behavior, which is important to consider because if the objective of an
organization or policy is to increase the number of adolescents using birth control as a method of
contraception, they may need to consider access issues more than education issues. For example,
some programs take teenagers to free health clinics where they can access birth control pills and
others have physicians come to the school to explain procedure for accessing birth control in
order to debunk myths or rumors. The lack of access to birth control pills could potentially
explain the lack of significance that self-efficacy pieces of curriculum had in the regression
equation. Although self-efficacy exercises may encourage young women to protect themselves
by teaching them that their future is worth protecting, if they do not have access to the resources
with which to protect themselves, it will not matter that they wanted to protect themselves in the
first place.
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The objections to abstinence-only mandates stem from a belief that in denying adolescents
information about contraceptive options, sex education curriculums are preventing contraceptive
use among a population of adolescents that is having sexual intercourse and should be protecting
themselves from risk. The results of this regression analysis suggest that these fears may be
validated. In the final model, the coefficient value on abstinence was -2.00. Therefore,
compared to a state with comprehensive sex education, a state with an abstinence-only mandate
15-19 year olds who have had sexual intercourse in the last 3 months are 2 percent less likely to
use birth control. In a state like California, that is a substantial number of teenagers who are not
engaging in risk-altering behavior.
Overall, my results also suggest that the curriculum does play a role in the adolescent’s
choice. However, issues of access play a much more substantial role than education curriculum
in a teenager’s decision to use birth control. Therefore, it is important for policy makers to
consider issues of access just as seriously as they consider issues of education.
Condom Use Rates
Condom use is an effective and inexpensive method of birth control and STI prevention,
however they must be used correctly in order to be effective. Condoms cannot be kept in certain
temperatures, they expire with time, and they must be put on correctly in order to be effective.
Unfortunately, teenagers often use condoms incorrectly, or neglect using condoms at all for lack
of knowledge or because of social norms. It is not uncommon for adolescents, young men in
particular, to report a lack of condom use as a result of a belief that it may make them appear
“less trustworthy (“Most boys who don’t plan…” 2005).”
Comprehensive sex education curriculum teach not only that condom use is an important and
effective method of birth control and STI prevention, but it also gives explicit instructions for
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how to use condoms so they are effective. Proponents of abstinence only education argue that
this type of teaching will only encourage adolescents to engage in more sex, a notion that is not
consistent with the results of my regression analysis on sexual activity.
I hypothesize that abstinence will have an insignificant relationship with condom use since
abstinence-only curriculum does not discuss condom use at all. Conversely, I expect selfefficacy and STI education to have positive relationships with condom use since they both
encourage risk-altering behaviors. Self-efficacy may lead to lower rates of sexual activity by
encouraging students to resist peer pressure, however my analysis (described below) indicates
that this is not the case. Self-efficacy lessons are meant to encourage goal-oriented behavior
because adolescents who have hopes to go to college or who feel responsible to provide for their
families or set a good example for younger siblings are less likely to engage in risky sexual
behavior. Self-efficacy curriculum should give students the confidence to ask their partners to
use condoms and should encourage other risk-altering behaviors like birth control use, by
instilling confidence. STI education explains all the various STIs that teenagers are at risk for
when they engage in sexual intercourse. Since condoms are an effective method of reducing STI
exposure, STI education and condom use should have a positive relationship.
I do not expect any of the control variables to have significant relationships with condom use
since condoms are easily accessible and do not appeal to any particular cultural groups. It could
be that the non-religious variable has a positive relationship with condom use since the Catholic
Church, for example, does not believe in condoms or birth control. However, I do not expect
this to have a large impact on the data.
Mishan Araujo
79
The regression results are presented in Table 8 of Appendix A. Of the curriculum variables,
only self-efficacy even approached statistical significance when the variables were entered
separately. The relationship is positive, which is consistent with my hypothesis.
Of the control variables, non-white was the only statistically significant effect and it has the
most explanatory power of the six variables (R-squared=0.254). Therefore the final regression
equation includes self-efficacy and non-white.
My hypothesis regarding the positive effect of self-efficacy on condom use was correct,
although in the final regression analysis the variable was only statistically significant at p≤0.06
(1.880), substantively this indicates a nearly 2 percent increase in condom use rates which is
significant, particularly for states with large populations such as California. This result is
encouraging because although, as demonstrated in the sexual activity section, self-efficacy may
not reduce sexual activity, it is positively related to condom use. Both the abstinence variable, as
well as the STI education variable, was not statistically significant which did not meet my
expectations. Abstinence-only education does not address contraceptive uses, which led me to
hypothesize that this variable would be associated with lower condom use rates. My hypothesis
Mishan Araujo
80
could be incorrect because abstinence only education does not increase or decrease condom use
and instead plays an insignificant role in the decision to use condoms. However, because the
United States spends millions of dollars on abstinence only education, this result is problematic.
Policy on sex education should lead to risk-reducing results, and in this instance, abstinence-only
curriculum does not. The insignificance of the STI education variable is problematic because
this type of curriculum is created with the sole intention of reducing STI rates. Either reducing
sexual activity rates or increasing condom use rates can accomplish this. However, according to
my regression results, STI education does not successfully do either of these things. Moreover it
appears to have no statistically significant relationship with STI rates. Therefore, this type of
curriculum should probably be re-evaluated to make it more effective.
The below poverty line variable and non-religious variable were not significant, indicating
that religion and income status are not necessarily significant determinants of condom use.
These results are consistent with my hypotheses. It is difficult to understand why non-white is so
positively correlated with condom use. However, it could be a result of the health community’s
increased effort to reduce unwanted pregnancy among non-white populations in recent years.
Although increased contraceptive use can reduce risk associated with sexual intercourse, the
most effective way to reduce adolescent risk is to eliminate or largely reduce the exposure to
risk. By reducing rates of sexual activity, sex education curriculum will thereby reduce the
potential negative consequences of sexual activity such as teenage pregnancy and sexually
transmitted infection.
Conclusion
In this thesis, I have examined the history of sex education and the controversial debate
between proponents of abstinence-only and comprehensive sex education. This was followed by
Mishan Araujo
81
a quantitative analysis to find which elements of sex education curriculum can reduce adolescent
sexual risk taking behavior, and additionally, which elements have no effect or potentially a
negative effect on adolescent decision-making. I believe that my thesis offers a unique
contribution by combining the qualitative analysis of the history of sex education and its current
controversial debate with the results of my quantitative analysis. In using both these results to
inform my policy recommendations, it is my hope that I will bring nuance and a deeper level of
understanding to these issues.
Both my qualitative and quantitative results suggest that sex education policy is a
complicated and difficult subject for many reasons. I have found that sex education does not
play a significant role in the teenager’s decision to have sex, which indicates that other factors
such as family and peer pressure do play a role. With this in mind, sex education policy should
be geared toward giving students information about safe sexual practices so that when they do
decide to have sex, they do so safely. I also found that cultural and demographic factors play a
significant role in some adolescent sexual decisions such as contraceptive use, and therefore can
affect outcomes like pregnancy rates and STI rates. This suggests that sex education curriculum
should be catered to the specific communities it will implemented in and should not necessarily
be a nationally enforced policy since it will not be as effective if it does not take demographic
and cultural considerations into account. I have found that abstinence-only education is not
effective and in many instances is associated with increased risk taking behavior such as lowered
contraceptive use. Lastly, I have found that self-efficacy has the potential to be an effective part
of a sex education curriculum.
My results indicate that the demographic and cultural variables I used explain more variation
than any of the dependent curriculum variables I examined.
Mishan Araujo
82
R-squared statistics of
equation with:
dependent
variable
Sexual
activity
pregnancy
rates
STI rates
birth control
use
condom use
all three
curriculum
variables
all three
demographic
and cultural
variables
0.008
0.081
0.131
0.691
0.415
0.39
0.17
0.76
0.150
0.289
As this table demonstrates the demographic and cultural variables had greater explanatory
power, as measured by the R-squared statistic, than the curriculum variables (with the exception
of STI rates). These results indicate that future sex education policy should be made with
consideration for demographic characteristics such as race and socio-economic status. That said,
the curriculum variables were able to explain some of the variance as well.
Given previous research, it is clear that abstinence-only education does not reduce sexual
activity among adolescents for more than a few months (if at all), and it does little to improve
risk-altering behavior among adolescents. My regression analysis indicates that abstinence-only
education is not significantly related to sexual activity, is negatively related to birth control use
rates, and is positively related to pregnancy and sexually transmitted infection rates. These
outcomes (along with previous research) indicate that abstinence-only curriculum is not the best
method of reducing risky adolescent sexual behavior.
The finding that abstinence-only mandates do not influence sexual activity rates is an
important result in terms of the larger policy debate. Often times, proponents of abstinence-only
Mishan Araujo
83
sex education argue that comprehensive sex education will increase sexual activity rates because
suggesting safe ways of having sex could, in a sense, give permission to the adolescents to
engage in sexual behavior. Conversely, proponents of comprehensive-sex education argue that
sexual activity rates are not influenced by discussions of contraception and self-efficacy and that
adolescents make the decision to have sex independent of learning methods for safer sex. My
results suggest that the proponents of comprehensive sex education are correct.
The research I read on abstinence-only curriculum, and in particular the findings of the report
commissioned by Representative Waxman (D-CA), indicate that this type of curriculum
perpetuates gender stereotypes and at times endorses homophobic ideas. It is important that
young men and women in our country be taught ideas of equality, respect and tolerance,
particularly when discussing intimate relationships, rather than sexist and homophobic ideas in
order to create a society in which individuals are treated with respect and fairness regardless of
gender, race or sexuality. These principles are the same values and ideals that America was
founded on. Based on my findings and the findings of others, it seem that abstinence-only
education does little to protect adolescents from the risk they face in sexual relationships and
may even prevent them from learning skills that will contribute to healthy relationships in the
future. Knowing that 9 in 10 adolescents are sexually active before leaving high school, and
given that my results indicate that sexual activity is not influenced by sex education, it is clear
that the sex education curriculum delivered in classrooms should be one that provides
information about contraceptive use and other preventative measures. Moreover, given the
findings of the report commissioned by Representative Waxman and the findings of the National
Coalition Against Unwanted Pregnancy, it is clear that abstinence-only education sometimes also
teaches false information about contraception, HIV/AIDS, and gender relationships.
Mishan Araujo
84
Adolescents should be given accurate information in schools. Furthermore, if our society hopes
to be one of equality, we cannot allow our young people to be taught that men and women are
not equal in intimate relationships or that homosexuals are somehow deficient human beings.
Additionally, abstinence-only education is based on the idea that students should not be
taught to evaluate the pros and cons of a decision, and using resources, think critically about their
decision-making. This approach teaches that the world is black and white and that there is only
one right choice and one wrong choice in a situation, rather than a nuanced complexity of
choices. This kind of thinking is problematic and will inhibit our country’s ability to teach future
generations how to solve complex and difficult problems. Our young people need to learn how
to take the information provided to them, analyze it and assess the potential outcomes and then
make a decision that is well informed. Without learning this skill, they will not be well prepared
to be leaders or good citizens because in reality, the world is not black and white, and the
problems these students will face as adults will be filled with nuance and complexity.
My second curriculum variable, self-efficacy, is an exciting policy area to explore because if
it is able to reduce risky sexual behavior among adolescents, it would provide a policy option
that does not deal with the controversy associated with discussing sexual relationships and
contraceptive methods in schools. Self-efficacy exercises are meant to increase self-esteem and
help adolescents face peer pressure with greater confidence. Moreover, self-efficacy curriculum
is designed to encourage adolescents to set goals for themselves and to plan their futures so that
they have an invested interest in reducing their exposure to risk. Since this development is a
fairly new idea, there has not been much literature on the topic.
My regression analysis did not indicate that self-efficacy has a strong relationship with any of
the dependent variables I considered, aside from condom use (significant at the p≥0.1 level). I
Mishan Araujo
85
predicted that self-efficacy would have a strong relationship with condom use, but also with birth
control use and rates of sexual activity, which was not the case. It is possible that the goals of
self-efficacy and the hypotheses about its results are valid and important, but in order to see
those results, it is necessary to have more than a few exercises in self-esteem building. The kind
of confidence that is necessary to resist peer pressure, to stand up for oneself, and to believe in
one’s own future, most likely needs to begin at an earlier age and probably needs to be reinforced
by family and social surroundings, not just the hour spent in school on some self-efficacy
exercises.
My last curriculum variable, STI education, did not explain the variance in most of the
dependent variables I examined, with the exception of STI rates. However, the coefficient
associated with STI rates was positive at the p≥0.1 level, which is inconsistent with my
hypothesis and previous research. Knowledge of sexually transmitted infections has traditionally
been seen as a motivator for reducing risk behavior since adolescents better understand the
consequences of STIs. However, my data indicated that this curriculum variable was not able to
explain much variance, and when it was able to explain variation, the explanation was
contradictory to previous research. This is concerning because there is a high prevalence of STIs
among adolescents in the Untied States, and STI education is the most logical way of curbing
these rates, however if it is not working, something else must be done to try and reduce these
rates of infections.
My results may be explained by a lack of complete data. The data that was accessible to me
included only Gonorrhea, Syphilis, and Chlamydia rates, but the most common STI among
adolescents is human papilloma virus (HPV), therefore the STI rates in my data set are not
Mishan Araujo
86
entirely complete. If I had access to a more complete data set, my results may or may not have
been different.
As mentioned earlier, the control variables I used in my quantitative analysis had more
explanatory power than many of my curriculum variables. Moreover, my qualitative analysis
suggest that curricula designed with a specific, small community in mind, are more successful
that those designed for mass implementation without considering demographic and cultural
variables.
The three control variables I used in my regression analysis played a large role in explaining
the variance in several of the dependent variables. The percent of non-white population
explained some of the variance in estimating birth control use rates and condom use rates. The
percent of non-religious population was positively correlated with pregnancy rates. Below
poverty line was negatively correlated with birth control rates and positively correlated with both
pregnancy and STI rates. These results are important because they indicate that certain
communities may be more likely to experience certain types of risky sexual behavior and their
consequences. Moreover, my qualitative research suggests that the sex education programs
which are specifically tailored to small communities and are conscious of the demographics of
that community, are the most successful. In addition, the explanatory power of the control
variables indicates that adolescents are potentially influenced by much more than the sex
education curriculum they are exposed to. These results suggest that sex education policy should
be approached from a community perspective and not necessarily at the federal level. In crafting
policy with specific communities in mind, the curriculum will be better able to serve the needs
and concerns of that community. For example, my results indicate that economic concerns and a
lack of access to health care providers may prevent some adolescents from using birth control
Mishan Araujo
87
pills. With this in mind, some sex education programs bring students to local free clinics and
help them make appointments to get prescriptions for heavily subsidized birth control pills.
Teaching about sexual relationships is a controversial topic largely because it forces people
to confront much larger questions. For example, should adolescents be taught gender equality
through sex education? Should teenagers be given information and asked to make decisions
based on that information, or should the world be one of clear boundaries where choices are
presented simply as right versus wrong? These questions are daunting and difficult and people
across the country will have sharply different views about the answers.
Since we know that the majority of teenagers engage in sexual intercourse before leaving
high school, the stakes are high when considering the policy implications of sexual education.
Sex education policy must give adolescents the information and tools necessary to reduce their
risk. Moreover, since we can safely assume that the vast majority of teenagers will eventually be
in intimate relationships, they must learn about gender equity, communication, and tolerance to
be good partners. And they must learn contraceptive methods in order to be safe in their sexual
decisions. The American school system is designed in a way that allows our young citizens to
have access to information, and then to approach the world and make decisions based on their
critical analysis of that information. I do not believe that sex education policy should do any less
and based on my results, there is an opportunity for sex education policy to help teenagers make
safer choices.
Mishan Araujo
88
Appendix A
Mishan Araujo
89
Table 1
state year
Alabama
2003
Alabama
2005
Alaska*
2003
California*
2001
California*
2003
California*
2005
Delaware
2001
Delaware
2003
Delaware
2005
Florida
2001
Florida
2003
Florida
2005
Hawaii
2005
Indiana
2005
Iowa 2005
Kansas
2005
Kentucky
2003
PR
STIR
ABS
SE
STIED SAR
CU
BCU
NW
NR
BPL
9.1
2.5
1
0
1
41.9
61.8
17
35.4
6
16.1
2.9
1
0
1
38
61.8
18
35.3
6
16.1
7.3
2.0
0
0
0
27.6
62.3
24.8
34.2
9.1
1.5
1
1
1
25.6
9.1
1.6
1
1
1
23.1
1.7
1
1
1
9.3
0
1
9.3
0
10
60.7
20
13.2
78.4
60.7
20
13.2
21.4
77.8
60.7
20
13.2
1
39.2
62.2
20.1
33.1
17
9.6
1
1
42.7
62.5
17.9
33.1
17
9.6
0
1
1
39.2
63.7
17.7
33.1
17
9.6
9.7
1.9
1
1
1
36.4
65.1
13.4
44.3
12
11.9
9.7
1.9
1
1
1
36.2
65.5
14
44.3
12
11.9
1.8
1
1
1
36.2
66.8
13
44.3
12
11.9
1.8
1
0
1
24.1
47.6
12.7
14.1
1
0
0
34.6
62.6
1.4
0
1
1
32.8
61.8
1.6
1
0
1
33.3
0
0
0
38.7
7.6
9
17.2
16
11.1
29.8
9.6
13
10.5
67.9
21.2
20.0
15
11.1
61.7
17.5
12.5
13
16.3
Mishan Araujo
Kentucky
2005
Maine
2001
Maine
2003
Maine
2005
Mass.
2001
Mass.
2003
Mass.
2005
Michigan
2001
Michigan
2003
Michigan
2005
Missouri
2001
Missouri
2003
Missouri
2005
Montana
2001
Montana
2003
Montana
2005
Nevada
2001
Nevada
2003
Nevada
2005
New
Hampshire
2003
90
0
0
0
33.5
65.2
18.4
12.5
13
16.3
5.2
0.8
0
1
1
34.6
52.2
36.1
4.5
16
11.5
5.2
0.8
0
1
1
31.2
57.8
36.7
4.5
16
11.5
0.9
0
1
1
33.5
58.6
34.6
4.5
16
11.5
6.0
1.2
0
1
1
32.5
58.1
23.1
22.5
16
9.9
6.0
1.2
0
1
1
29.8
57.4
23.1
22.5
16
9.9
1.2
0
1
1
34.1
65
25
22.5
16
9.9
7.5
2.0
1
0
1
29.9
61
21.7
23.6
15
12.5
7.5
2.0
1
0
1
31.1
62.5
17.1
23.6
15
12.5
2.2
1
0
1
29.4
61.7
18.5
23.6
15
12.5
7.6
1.7
1
1
1
38.8
61.5
21.2
18.8
15
13
7.6
1.8
1
1
1
38.4
67.3
24
18.8
15
13
1.8
1
1
1
33.2
67.2
18
18.8
15
13
6.0
1
0
0
30.7
57.5
23.1
13.7
17
13.6
6.0
1
0
0
29.9
59.6
24.1
13.7
17
13.6
1
0
0
31.2
61.3
23.8
13.7
17
13.6
11.3
1.9
1
0
0
34.6
59.1
17.3
42.5
20
11.1
11.3
1.9
1
0
0
32.6
62
19.9
42.5
20
11.1
2.0
1
0
0
30.8
62.4
16.5
42.5
20
11.1
0.7
0
1
1
31.1
56.4
33.3
5.5
17
6.6
4.7
Mishan Araujo
New
Hampshire
2005
New
Jersey
2001
New York
2003
New York
2005
North
Carolina
2003
North
Carolina
2005
North
Dakota*
2001
North
Dakota*
2003
North
Dakota*
2005
Ohio 2003
Ohio 2005
Oklahoma
2003
Oklahoma
2005
Rhode
Island
2001
Rhode
Island
2003
Rhode
Island
2005
91
0.7
0
1
1
33
64.7
28.5
5.5
17
6.6
0
1
0
36.1
63.7
12.9
64.0
15
8.4
1.0
0
1
1
29.7
70.4
15.2
41.8
13
14.5
0.9
0
1
1
29.2
70.7
13.8
41.8
13
14.5
2.6
1
1
1
37.9
62.1
17.6
35.7
10
13.8
2.7
1
1
1
37.1
62.8
17.6
35.7
10
13.8
4.2
1.2
1
0
0
30.8
59.1
25.7
10.8
3
10.8
4.2
1.2
1
0
0
31.6
66.3
21.6
10.8
3
10.8
1.0
1
0
0
32.4
63.2
25
10.8
3
10.8
7.4
2.7
2.8
1
1
0
0
1
1
29.8
36.4
59.8
61.7
25.9
20
18.3
18.3
15
15
11.7
11.7
8.6
1.4
1
0
0
37.2
64.3
17.7
30.8
14
14
1.4
1
0
0
36.3
61.7
16.4
30.8
14
14
6.9
1.5
0
1
1
36.1
56.1
17.4
23.2
15
11.6
6.6
1.5
0
1
1
31.1
63
21.6
23.2
15
11.6
1.5
0
1
1
36.5
65.8
19.4
23.2
15
11.6
8.0
9.1
9.5
Mishan Araujo
South
Dakota
2001
South
Dakota
2003
South
Dakota
2005
Tennessee
2003
Tennessee
2005
Vermont
2001
Vermont
2003
Vermont
2005
West
Virginia
2003
West
Virginia
2005
Wisconsin
2001
Wisconsin
2003
Wisconsin
2005
Wyoming*
2001
Wyoming*
2003
Wyoming*
2005
92
5.4
1.7
1
0
0
29.4
58.3
18.7
13.3
8
12.9
5.4
1.7
1
0
0
30.2
61.9
24.6
13.3
8
12.9
1.5
1
0
0
31.2
57
19.9
13.3
8
12.9
2.0
1
0
0
35.6
59.4
16.2
25.6
9
15
2.2
1
0
0
38.2
57.5
18.4
25.6
9
15
4.4
0.4
0
1
1
29.1
59.5
30.7
4.4
22
8.7
4.4
0.4
0
1
1
30.6
59.7
31.3
4.4
22
8.7
0.2
0
1
1
30.9
64.7
33.3
4.4
22
8.7
1
0
0
38.8
64.7
24.6
6.3
13
16.2
1
0
0
39.3
61.4
24
6.3
13
16.2
8.9
6.7
5.5
2.2
0
1
1
29.1
59.2
25.6
16.3
14
10.9
5.5
2.2
0
1
1
26.5
65.2
24.8
16.3
14
10.9
2.4
0
1
1
29.5
65.3
23
16.3
14
10.9
7.7
1.0
0
1
0
32.9
61.8
25.7
12.6
20
10.3
7.7
1.0
0
1
0
31.8
64
22.7
12.6
20
10.3
1.0
0
1
0
34.7
64.9
24.9
12.6
20
10.3
Mishan Araujo
93
Table 2
Independent Variable Correlation
Control Variables
Curriculum Variables
ABS
SE
STIED
NW
NR
Pearson
1.000
-0.260* 0.243*
0.616**
0.371**
ABS Correlation
N
69
69
69
69
69
Pearson
1.000 0.620** 0.137 0.404**
Correlation
SE
N
69
69
69
69
Pearson
1.000
0.128
0.199
STIED Correlation
N
69
69
69
Pearson
1.000
0.074
Correlation
NW
N
69
69
Pearson
1.000
Correlation
NR
N
67
Pearson
BPL Correlation
N
**. Correlation is significant at the 0.01 level (2-tailed)
*. Correlation is significant at the 0.05 level (2-tailed).
BPL
0.482**
69
-0.429**
69
-0.249*
69
0.169
69
-0.411**
67
1.000
69
Table 3
Sexual Activity Rates Descriptive Statistics
ABS
SE
STIED
NW
NR
BPL
Pearson
sexual
0.030
-0.030
-0.078
-0.035
-.265* 0.241*
Correlation
activity
rates
N
69
69
69
69
67
69
Pregnancy Rates Descriptive Statistics
ABS
SE
STIED
NW
NR
BPL
Pearson
0.301
-0.020
-0.002 0.772** 0.177
0.300
pregnancy Correlation
rates
N
41
41
41
41
40
41
STI Rates Descriptive Statistics
ABS
SE
STIED
NW
NR
BPL
Pearson
0.574**
0.065 0.424**
0.550**
0.404**
0.359**
STI rates Correlation
N
57
57
57
57
55
57
Birth Control Use Descriptive Statistics
ABS
SE
STIED
NW
NR
BPL
Pearson
Birth
-0.403** 0.236
0.114
0.300*
Correlation
0.758**
0.384**
control
use
N
65
65
65
65
63
65
Condom Use Rates Descriptive Statistics
ABS
SE
STIED
NW
NR
BPL
Pearson
0.053
0.254*
0.126 0.504** 0.104
0.187
condom
Correlation
use
N
68
68
68
68
66
68
**. Correlation is significant at the 0.01 level (2-tailed)
*. Correlation is significant at the 0.05 level (2-tailed).
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Table 4
Sexual Activity
Control Variables
Curriculum
Variables
Variable
E1
E2
0.259
Abstinence
(0.806)
Self-0.255
Efficacy
(0.809)
STI ed
E3
E4
0.344
(0.804)
0.520
(0.760)
-0.693 -0.933
(0.521) (0.513)
E5
E7
-0.010
(0.773)
non white
Non
religious
Below
poverty
line
R squared
adj R
squared
E6
E8
E9
-0.013
(0.750)
-0.247
(0.031)
-0.200 -0.207
(0.117) (0.097)
0.464
0.217
0.196
(0.046) (0.396) (0.429)
0.001
0.001
0.006
0.008
0.001
0.070
0.058
0.081
0.079
-0.014
-0.014
-0.009
-0.038
-0.014
0.056
0.044
0.037
0.050
N=67
p-value in parentheses
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Table 5
Pregnancy Rates
Control Variables
Curriculum
Variables
Variable
E1
E2
1.148
Abstinence
(0.056)
Self-0.079
Efficacy
(0.899)
STI ed
E3
E4
1.740
(0.024)
1.166
(0.227)
-0.009 -0.339
(0.989) (0.675)
E6
E7
0.093
(0.000)
Non white
non
religious
below
poverty
line
R squared
adj R
squared
E5
E8
E9
0.312
(0.500)
0.087
0.085
(0.000) (0.000)
0.095
0.103
(0.034) (0.028)
0.075
(0.275)
0.266
0.277
0.247
(0.057) (0.004) (0.021)
0.091
0.000
0.000
0.131
0.596
0.031
0.090
0.691
0.695
0.067
-0.025
-0.026
0.061
0.585
0.006
0.067
0.665
0.660
N=40
p-value in parentheses
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Table 6
Variable
E1
Curriculum Variables
Abstinence
0.731
(0.000)
Control Variables
STI Rates
Non white
SelfEfficacy
E2
E3
E4
E5
E6
E7
E9
0.597
0.675
0.799
(0.001) (0.000) (0.000)
-0.517
(0.002)
-0.389 -0.090
(0.064) (0.626)
0.089
0.479
(0.633) (0.009)
STI ed
0.300
(0.054)
0.018
(0.001)
non
religious
below
poverty
line
R squared
adj R
squared
E8
-0.048
(0.007)
0.174
(0.000)
0.330
0.163
0.004
0.415
0.333
0.375
0.180
0.129
0.302
0.318
0.148
-0.014
0.381
0.308
0.352
0.165
0.113
0.290
N=55
p-value in parentheses
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Table 6 continued
STI Rates
E10
E11
E12
E13
E14
E15
Curriculum Variables
0.572
0.499
(0.001) (0.003)
Abstinence
Control Variables
Variable
non white
0.10
0.019
0.008
(0.092) (0.000) (0.166)
non
religious
-0.028 -0.051
(0.123) (0.001)
SelfEfficacy
0.272
(0.066)
STI ed
below
poverty
line
R squared
adj R
squared
0.115
(0.30)
-0.015
(0.358)
0.143
0.172
0.102
0.107
(0.001) (0.000) (0.011) (0.009)
0.390
0.331
0.327
0.355
0.448
0.411
0.354
0.305
0.302
0.330
0.417
0.389
N=55
p-value in parentheses
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Table 7
Birth Control Use
Control Variables
Curriculum
Variables
Variable
E1
E2
-4.63
Abstinence
(0.00)
Self2.71
Efficacy
(0.06)
STI ed
E3
E4
E5
-5.20 -5.109
(0.01) (0.006)
-1.05 -0.717
(0.64) (0.692)
1.35
0.46
(0.36) (0.80)
E6
E8
-0.33
(0.00)
non white
non
religious
below
poverty
line
R squared
adj R
squared
E7
0.39
(0.02)
E9
E10
-2.003
(0.039)
-0.327
(0.00)
-0.305
(0.000)
0.139
(0.138)
-0.97
(0.00)
-0.703
(0.00)
-0.541
(0.011)
0.16
0.06
0.01
0.17
0.16
0.58
0.09
0.15
0.76
0.68
0.15
0.04
0.00
0.12
0.14
0.57
0.08
0.13
0.75
0.67
N=55
p-value in parentheses
Mishan Araujo
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Mishan Araujo
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Appendix B
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102
STI Rate Sources
Alabama
Alaska
California
Florida
Hawaii
Iowa
Kansas
Maine
Massachusetts
Michigan
Missouri
Nevada
New
Hampshire
New York
North Carolina
North Dakota
Ohio
Oklahoma
Rhode Island
South Dakota
Tennessee
Vermont
Wisconsin
Wyoming
http://www.adph.org/
http://www.hss.state.ak.us/
http://www.dhs.ca.gov/
http://www.doh.state.fl.us/
http://hawaii.gov/health/
http://www.idph.state.ia.us/
http://www.kdheks.gov/
http://www.maine.gov/dhhs/boh/
http://www.mass.gov/dph/
http://www.michigan.gov/mdch/
http://www.dhss.mo.gov/
http://health2k.state.nv.us/
http://www.dhhs.state.nh.us/DHHS/DHHS_SITE/default.htm
http://www.health.state.ny.us/
http://www.dhhs.state.nc.us/
http://www.health.state.nd.us/
http://www.odh.state.oh.us/
http://www.ok.gov/health/
http://www.health.state.ri.us/
http://doh.sd.gov/
http://health.state.tn.us/
http://healthvermont.gov/
http://www.dhfs.state.wi.us/
http://wdh.state.wy.us/
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