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What Works In Schools : Sexual Health Education

CDC’s  What Works In Schools  Program improves the health and well-being of middle and high school students by:

• Improving health education,
• Connecting young people to the health services they need, and
• Making school environments safer and more supportive.

What is sexual health education?

Quality provides students with the knowledge and skills to help them be healthy and avoid human immunodeficiency virus (HIV), sexually transmitted infections (STI) and unintended pregnancy.

A quality sexual health education curriculum includes medically accurate, developmentally appropriate, and culturally relevant content and skills that target key behavioral outcomes and promote healthy sexual development. 1

The curriculum is age-appropriate and planned across grade levels to provide information about health risk behaviors and experiences.

Sexual health education should be consistent with scientific research and best practices; reflect the diversity of student experiences and identities; and align with school, family, and community priorities.

Quality sexual health education programs share many characteristics. 2-4 These programs:

• Are taught by well-qualified and highly-trained teachers and school staff
• Use strategies that are relevant and engaging for all students
• Address the health needs of all students, including the students identifying as lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ)
• Connect students to sexual health and other health services at school or in the community
• Engage parents, families, and community partners in school programs
• Foster positive relationships between adolescents and important adults.

How can schools deliver sexual health education?

A school health education program that includes a quality sexual health education curriculum targets the development of functional knowledge and skills needed to promote healthy behaviors and avoid risks. It is important that sexual health education explicitly incorporate and reinforce skill development.

Giving students time to practice, assess, and reflect on skills taught in the curriculum helps move them toward independence, critical thinking, and problem solving to avoid STIs, HIV, and unintended pregnancy. 5

Quality sexual health education programs teach students how to: 1

• Analyze family, peer, and media influences that impact health
• Access valid and reliable health information, products, and services (e.g., STI/HIV testing)
• Communicate with family, peers, and teachers about issues that affect health
• Make informed and thoughtful decisions about their health
• Take responsibility for themselves and others to improve their health.

What are the benefits of delivering sexual health education to students?

Promoting and implementing well-designed sexual health education positively impacts student health in a variety of ways. Students who participate in these programs are more likely to: 6-11

• Delay initiation of sexual intercourse
• Have fewer sex partners
• Have fewer experiences of unprotected sex
• Increase their use of protection, specifically condoms
• Improve their academic performance.

In addition to providing knowledge and skills to address sexual behavior , quality sexual health education can be tailored to include information on high-risk substance use * , suicide prevention, and how to keep students from committing or being victims of violence—behaviors and experiences that place youth at risk for poor physical and mental health and poor academic outcomes.

*High-risk substance use is any use by adolescents of substances with a high risk of adverse outcomes (i.e., injury, criminal justice involvement, school dropout, loss of life). This includes misuse of prescription drugs, use of illicit drugs (i.e., cocaine, heroin, methamphetamines, inhalants, hallucinogens, or ecstasy), and use of injection drugs (i.e., drugs that have a high risk of infection of blood-borne diseases such as HIV and hepatitis).

What does delivering sexual health education look like in action?

To successfully put quality sexual health education into practice, schools need supportive policies, appropriate content, trained staff, and engaged parents and communities.

Schools can put these four elements in place to support sex ed.

• Implement policies that foster supportive environments for sexual health education.
• Use health content that is medically accurate, developmentally appropriate, culturally inclusive, and grounded in science.
• Equip staff with the knowledge and skills needed to deliver sexual health education.
• Engage parents and community partners.

Include enough time during professional development and training for teachers to practice and reflect on what they learned (essential knowledge and skills) to support their sexual health education instruction.

By law, if your school district or school is receiving federal HIV prevention funding, you will need an HIV Materials Review Panel (HIV MRP) to review all HIV-related educational and informational materials.

This review panel can include members from your School Health Advisory Councils, as shared expertise can strengthen material review and decision making.

For More Information

Learn more about delivering quality sexual health education in the Program Guidance .

Check out CDC’s tools and resources below to develop, select, or revise SHE curricula.

• Health Education Curriculum Analysis Tool (HECAT), Module 6: Sexual Health [PDF – 70 pages] . This module within CDC’s HECAT includes the knowledge, skills, and health behavior outcomes specifically aligned to sexual health education. School and community leaders can use this module to develop, select, or revise SHE curricula and instruction.
• Developing a Scope and Sequence for Sexual Health Education [PDF – 17 pages] .This resource provides an 11-step process to help schools outline the key sexual health topics and concepts (scope), and the logical progression of essential health knowledge, skills, and behaviors to be addressed at each grade level (sequence) from pre-kindergarten through the 12th grade. A developmental scope and sequence is essential to developing, selecting, or revising SHE curricula.
• Centers for Disease Control and Prevention. Health Education Curriculum Analysis Tool, 2021 , Atlanta: CDC; 2021.
• Goldfarb, E. S., & Lieberman, L. D. (2021). Three decades of research: The case for comprehensive sex education. Journal of Adolescent Health, 68(1), 13-27.
• Centers for Disease Control and Prevention (2016). Characteristics of an Effective Health Education Curriculum .
• Pampati, S., Johns, M. M., Szucs, L. E., Bishop, M. D., Mallory, A. B., Barrios, L. C., & Russell, S. T. (2021). Sexual and gender minority youth and sexual health education: A systematic mapping review of the literature.  Journal of Adolescent Health ,  68 (6), 1040-1052.
• Szucs, L. E., Demissie, Z., Steiner, R. J., Brener, N. D., Lindberg, L., Young, E., & Rasberry, C. N. (2023). Trends in the teaching of sexual and reproductive health topics and skills in required courses in secondary schools, in 38 US states between 2008 and 2018.  Health Education Research ,  38 (1), 84-94.
• Coyle, K., Anderson, P., Laris, B. A., Barrett, M., Unti, T., & Baumler, E. (2021). A group randomized trial evaluating high school FLASH, a comprehensive sexual health curriculum.  Journal of Adolescent Health ,  68 (4), 686-695.
• Marseille, E., Mirzazadeh, A., Biggs, M. A., Miller, A. P., Horvath, H., Lightfoot, M.,& Kahn, J. G. (2018). Effectiveness of school-based teen pregnancy prevention programs in the USA: A systematic review and meta-analysis. Prevention Science, 19(4), 468-489.
• Denford, S., Abraham, C., Campbell, R., & Busse, H. (2017). A comprehensive review of reviews of school-based interventions to improve sexual-health. Health psychology review, 11(1), 33-52.
• Chin HB, Sipe TA, Elder R. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. Am J Prev Med 2012;42(3):272–94.
• Mavedzenge SN, Luecke E, Ross DA. Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: A systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014;66:S154–69.

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Summary State Policies on Sex Education in Schools

Why is sexual education taught in schools.

A 2017 Centers for Disease Control and Prevention (CDC)  survey  indicates that nearly 40 percent of all high school students report they have had sex, and 9.7 percent of high school students have had sex with four or more partners during their lifetime. Among students who had sex in the three months prior to the survey, 54 percent reported condom use and 30 percent reported using birth control pills, an intrauterine device (IUD), implant, shot or ring during their last sexual encounter.

The birth rate for women aged 15-19 years was  18.8 per 1,000 women  in 2017, a drop of 7 percent from 2016. According to CDC, reasons for the decline are not entirely clear, but evidence points to a higher number of teens abstaining from sexual activity and an increased use of birth control in teens who are sexually active. Though the teen birth rate has declined to its lowest levels since data collection began, the United States still has the highest teen birth rate in the industrialized world.

Certain social and economic costs can result from teen pregnancy. Teenage mothers are less likely to finish high school and are more likely than their peers to live in poverty, depend on public assistance, and be in poor health. Their children are more likely to suffer health and cognitive disadvantages, come in contact with the child welfare and correctional systems, live in poverty, drop out of high school and become teen parents themselves. These costs add up, according to The National Campaign to Prevent Teen and Unplanned Pregnancy, which estimates that teen childbearing costs taxpayers at least $9.4 billion annually. Between 1991 and 2015, the teen birth rate dropped 64%, resulting in approximately  $4.4 billion  in public savings in one year alone.

Sexually transmitted infections (STIs) disproportionately affect adolescents due to a variety of behavioral, biological and cultural reasons. Young people ages 15 to 24 represent  25 percent  of the sexually active population, but acquire half of all new STIs, or about 10 million new cases a year. Though many cases of STIs continue to go  undiagnosed and unreported , one in four sexually-active adolescent females is reported to have an STI.

Human papillomavirus  is the most common STI and some estimates find that up to 35 percent of teens ages 14 to 19 have HPV. The rate of reported cases of chlamydia, gonorrhea, and primary and secondary syphilis increased among those aged 15-24 years old between 2017-2018. Rates of reported chlamydia cases are consistently highest among women aged 15-24 years, and rates of reported gonorrhea cases are consistently highest among men aged 15-24 years. A CDC analysis reveals the annual number of new STIs is roughly equal among young women and young men. However, women are more likely to experience long-term health complications from untreated STIs and adolescent females may have increased susceptibility to infection due to biological reasons.

The estimated direct medical costs for treating people with STIs are nearly $16 billion annually, with costs associated with HIV infection accounting for more than 81% of the total cost. In 2017, approximately  21 percent  of new HIV diagnoses were among young people ages 13 to 24 years.

Sex Education and States

All states are somehow involved in sex education for public schoolchildren.

As of October 1, 2020:

• Thirty states and the District of Columbia require public schools teach sex education, 28 of which mandate both sex education and HIV education.
• Thirty-nine states and the District of Columbia require students receive instruction about HIV.
• Twenty-two states require that if provided, sex and/or HIV education must be medically, factually or technically accurate. State definitions of “medically accurate" vary, from requiring that the department of health review curriculum for accuracy, to mandating that curriculum be based on information from “published authorities upon which medical professionals rely.” (See table on medically accuracy laws.)

Many states define parents’ rights concerning sexual education:

• Twenty-five states and the District of Columbia require school districts to notify parents that sexual or HIV education will be provided.
• Five states require parental consent before a child can receive instruction.
• Thirty-six states and the District of Columbia allow parents to opt-out on behalf of their children.

*Medical accuracy is not specifically outlined in state statue, rather it is required by the New Jersey Department of Education, Comprehensive Health and Physical Education Student Learning Standards.

** Medical accuracy requirement is pursuant to rule R277-474 of the Utah Administrative Code.

***Medical accuracy is not outlined in state statute, rather it is included in the Virginia Department of Education Standards of Learning Document for Family Life Resources.

Source: NCSL, 2019; Guttmacher Institute, 2019; Powered by StateNet

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What does age-appropriate, comprehensive sex ed actually look like?

Lee V. Gaines

Elizabeth Miller

With abortion access changing in many states, advocates for sex education say it's more important than ever.

The case for starting sex ed in kindergarten (hula hoops recommended)

Lee Gaines is from member station WFYI, and Elizabeth Miller is from member station OPB.

Copyright © 2022 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

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The Sex Ed. Battleground Heats Up (Again). Here’s What’s Actually in New Standards

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When Judy LoBianco first started teaching health education decades ago, she leaned into what she called the “shock value.”

LoBianco, now the supervisor of health and physical education for the Livingston public schools in New Jersey, remembers showing students videos of childbirth and the movie “Super Size Me,” a 2004 documentary about the negative health effects of fast food.

Over the past couple of decades, though, best practice has shifted, LoBianco said—away from trying to scare kids off behavior that carries any risk and toward an approach that emphasizes decisionmaking, risk management, and self-advocacy.

“It’s about building skills and giving them practice,” LoBianco said. “Because when kids feel confident in their skills, they’ll act in more healthy ways.”

But two states that have updated their standards to reflect this research-based shift are now facing pushback from a vocal group of critics.

In Illinois and New Jersey , where changes to health and sex education standards are rolling out this school year, the revisions have sparked outbreaks of fierce, pointed controversy—a backlash that sex education experts say targets LGBTQ youth and deliberately mischaracterizes the standards and their aims.

At school board meetings in New Jersey districts, opponents of the new standards have claimed that they show young children “sexually explicit” material and are “indocrinating” kids into “woke ideology.” In May, several members of the state board of education called for the standards to be reevaluated , a request that the full board and the acting education commissioner denied.

In Illinois, where districts are not required to provide comprehensive sex education, many school systems have chosen not to adopt the new standards.

Over the past year, the outcry has become a talking point for Republican politicians in these states and a headline issue for national conservative media outlets, which have denounced the standards’ gender inclusivity, contending that they introduce children to age-inappropriate material.

This is a moral panic that comes whenever society moves away from this patriarchal, Christian, white supremacist view of the way the world should be.

In a sense, this is a familiar story. Pitched debate about the scope of health classes isn’t a new phenomenon, said Nora Gelperin, the director of sex education and training at Advocates for Youth, a group that works for adolescent sexual and reproductive health.

Gelperin was one of the writers of the National Sex Education Standards , which Illinois has adopted. The national standards also influenced New Jersey’s guidelines.

But now, the focus of this pushback has shifted more forcefully toward anti-LGBTQ rhetoric, she said.

Sex education advocates linked this resistance to the anti-LGBTQ legislation that at least 15 states have considered or passed this legislative session . The most well-known of these laws, Florida’s, prevents teachers from instructing K-3 students about gender or sexuality. Other proposed legislation would limit how teachers can use students’ pronouns, restrict use of materials featuring LGBTQ characters or themes, or regulate clubs for LGBTQ students.

And the outrage about sex education has once again put a spotlight on schools’ instructional choices, a situation that some advocates fear could make educators hesitant to address certain topics altogether.

“I have no problem with someone deciding for their own child, but when you get out there and start hijacking the narrative for everyone else’s kid, that’s dangerous,” said LoBianco.

A shift from risk prevention to a more proactive approach

The changes in Illinois and New Jersey are part of an evolution in the field of sex education, said Eva Goldfarb, a professor of public health at Montclair State University. Goldfarb contributed to the most recent version of the National Sex Education Standards, published in 2020.

The guidelines were developed by the Future of Sex Education Initiative, a partnership between three groups that support comprehensive sex education: Advocates for Youth, Answer, and SIECUS: Sex Ed for Social Change. This version is an update from the 2011 edition, which 41 percent of school districts said they’d adopted as of 2016 .

In the 1980s and early ‘90s, the big debate in schools was whether teachers should take an abstinence-only approach or whether they should provide information about how to avoid pregnancy and sexually transmitted infections, Goldfarb said.

In response to the HIV/AIDS epidemic, sex education advocates pushed for and won state-level mandates for prevention education, Goldfarb said.

Still, abstinence-only education has a strong foothold in U.S. schools. The federal government has offered funding for abstinence-only sex education since the 1990s , and funding levels increased during the Trump administration.

But research shows that when schools broaden the scope of sex education classes beyond abstinence or risk prevention—to discuss gender roles and identity, normalize sexual diversity, and focus on social and emotional skills—students can see better outcomes. A research review by Goldfarb and her colleague Lisa Lieberman of 30 years of studies found that this kind of approach—now generally known as comprehensive sex education—can lower anti-LGBTQ bullying, improve the skills that support healthy relationships, and reduce intimate partner violence.

“The goal is helping people to have the important, functional knowledge and skills and attitudes to make healthy decisions for themselves, to appreciate and enjoy their own bodies and sexuality, and to appreciate and respect the bodies of others as well,” Goldfarb said.

What does that mean in practice? Take a few examples from the National Sex Education Standards.

The standards still require schools to provide information about how to mitigate risk. By the end of 8th grade, for example, students should be able to identify different forms of contraception and STI prevention as well as develop a plan for eliminating or reducing the risks of sexual activity.

But the standards also aim to teach students how to seek out information and how to develop their own values. Eighth graders are expected to know how to find medically reliable sources on these topics and to identify factors that are important in deciding whether and when to engage in sexual behaviors.

A classroom assignment might ask students to practice research skills that they’ve learned, said LoBianco . For example, she said, she might divide students into groups and assign each to research a different sexually transmitted infection. As they conduct their research, students would have to evaluate the reliability of the sources they find.

The national standards spiral, covering topics like consent and healthy relationships, anatomy and physiology, gender identity and expression, and sexual health throughout successive grade levels. But that doesn’t mean that topics like STIs, sexual identity, and sexual violence are introduced right away.

Instead, the standards aim to build knowledge and skills sequentially. In 2nd grade, for instance, the national standards require that students can list medically accurate names for the body parts, including genitals, and that students can define “bodily autonomy” and personal boundaries.

The standards are learning goals—what students should know and be able to do. Districts and schools select, create, or purchase the curriculum and lessons they use to convey them.

Anti-LGBTQ groups spread ‘hysteria’ about gender identity

Most parents have historically supported sex education that covers these kinds of topics.

In a 2017 survey of Democrats and Republicans , about 90 percent of parents supported classes that cover healthy relationships, STIs, birth control, and abstinence in high school; 78 percent of parents supported these subjects covered in middle school.

Parents in a 2012 study were less sure about elementary sex education but still mostly positive: About 90 percent were in favor of instruction on communication skills, about 65 percent supported anatomy instruction, and about 52 percent supported instruction about gender and sexual identity.

Now, a vocal group of parent activists and commentators has commandeered the national conversation. They claim that schools are “grooming” young children by discussing LGBTQ identity and providing information about sexual health.

The term “grooming” refers to the behavior of sexual predators, who develop inappropriately close relationships with child victims in order to isolate them and reduce the chance that they will report incidents. But as Education Week reported earlier this year , some conservative commentators have weaponized the word to falsely equate discussions about LGBTQ identity with sexual abuse, a development sociologists and others warn is dangerous.

In a recent C-SPAN interview , Tina Descovich, the co-founder of the right-wing group Moms for Liberty, said that the biggest concern reported from local chapters was “the oversexualization of children.”

“The National Sex Education Standards right now, they actually say in K-3 that they want to teach gender ideology, that children … by the time they reach 7 years old, should be able to understand completely that they could be a boy, or a girl, they could be neither or both. And a lot of parents just don’t want that discussed with their youngest children,” Descovich said.

But experts stressed that this is a misreading and that conversations about gender aren’t inherently sexual in nature.

Kids have 24/7, 365 access to information about their sexual health, and if no adult is intervening or providing info, they’re going to seek out information.

The national standards say that 2nd graders should be able to “define gender, gender identity, and gender-role stereotypes,” as well as discuss how people express their gender and how stereotypes might limit behavior. In 5th grade, students are expected to “demonstrate ways to promote dignity and respect for all people.”

What this means in practice, said Goldfarb, is that teachers might explain to the youngest children that there aren’t “girl toys” or “boy toys” and that however kids want to express themselves is OK. The message, she said, is “we all get to feel good about ourselves and our bodies as we are.”

She attributes the “hysteria” she says activists are creating around gender identity to deeper fears about changing social mores and expansions of rights. “This is a moral panic that comes whenever society moves away from this patriarchal, Christian, white supremacist view of the way the world should be,” Goldfarb said.

Parents also regularly cite concerns about language and definitions, said Advocates for Youth’s Gelperin. For example, the national standards require that by 2nd grade, students know the medically correct terms for their genitals. By 8th grade, students should be able to define vaginal, oral, and anal sex.

“I think there’s this worry that if we say the words like ‘penis’ and ‘vulva’ and ‘anus,’ that’s going to be damaging for kids. And that’s just not the case,” Gelperin said. In fact, research suggests that teaching students accurate terms can help prevent child sexual abuse.

And standards for older students, on defining vaginal, oral, and anal sex, aren’t about providing a how-to guide, said LoBianco. Rather, the idea is to give students accurate information from a trusted source so that they’re not relying on Google searches and social media.

“Kids have 24/7, 365 access to information about their sexual health, and if no adult is intervening or providing info, they’re going to seek out information,” LoBianco said.

How some schools are approaching these changes

In LoBianco’s state of New Jersey, only a handful of districts have publicly opposed the standards. Sex education is mandatory, and department of education officials have said that they will penalize districts that don’t teach a curriculum that aligns to the new standards.

But some districts have put in place workarounds.

The East Hanover school district said that it plans to include some new lessons to meet the standards—but they’ll all be taught on the last day of school, according to local news reports .

And while all districts in the state must let parents opt students out of any sex education lessons, the Middletown Township school system is planning to require parents to opt in.

Considering all the controversy “swirling around,” the district wanted to be as transparent as possible with parents, said Kate Farley, the curriculum committee chair on the Middletown board of education.

In April, New Jersey state Sen. Holly Schepisi, a Republican, posted some sample materials on Facebook, saying that “some go so far as unnecessarily sexualizing children further.” The post ignited a media firestorm and brought fresh pushback from GOP state lawmakers.

It illustrated the confusion between standards and curriculum: The lesson plans Schepisi posted aren’t mandatory.

And in Middletown, parents and community members thought that some of the lessons they’d seen would be required. Or, Farley said, they had heard that there was a specific “gender lesson” in 2nd grade or that the district was planning to teach kindergartners about sex. None of that is true, said Farley.

So, the district selected a set of materials for K-5 and posted all of them online for parents to review. “What you see is exactly what you get,” Farley said. “There’s just no room for any sort of question about what their child will be exposed to.”

Given this intense scrutiny and social-media misinformation, Gelperin suggested that schools take a similar approach to transparency, and make information about what curriculum they’ll be using readily available.

Schools can also hold family nights when parents can come in to look at materials and ask questions, she said.

Teachers and school leaders can always come back to the “why,” said LoBianco—that schools are giving students information and skills that they can use to protect themselves and feel confident in their identities.

“When you explain this to the most reasonable of parents, then they start to understand,” LoBianco said. “If there’s one thing that parents want their children to be, it’s healthy and safe.”

A version of this article appeared in the September 07, 2022 edition of Education Week as The Sex Ed. Battleground Heats Up (Again). Here’s What’s Actually in New Standards

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The Importance of Access to Comprehensive Sex Education

Comprehensive sex education is a critical component of sexual and reproductive health care.

Developing a healthy sexuality is a core developmental milestone for child and adolescent health.

Youth need developmentally appropriate information about their sexuality and how it relates to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

AAP supports broad access to comprehensive sex education, wherein all children and adolescents have access to developmentally appropriate, evidence-based education that provides the knowledge they need to:

• Develop a safe and positive view of sexuality.
• Build healthy relationships.
• Make informed, safe, positive choices about their sexuality and sexual health.

Comprehensive sex education involves teaching about all aspects of human sexuality, including:

• Cyber solicitation/bullying.
• Healthy sexual development.
• Body image.
• Sexual orientation.
• Gender identity.
• Pleasure from sex.
• Sexual abuse.
• Sexual behavior.
• Sexual reproduction.
• Sexually transmitted infections (STIs).
• Abstinence.
• Contraception.
• Interpersonal relationships.
• Reproductive coercion.
• Reproductive rights.
• Reproductive responsibilities.

Comprehensive sex education programs have several common elements:

• Utilize evidence-based, medically accurate curriculum that can be adapted for youth with disabilities.
• Employ developmentally appropriate information, learning strategies, teaching methods, and materials.
• Human development , including anatomy, puberty, body image, sexual orientation, and gender identity.
• Relationships , including families, peers, dating, marriage, and raising children.
• Personal skills , including values, decision making, communication, assertiveness, negotiation, and help-seeking.
• Sexual behavior , including abstinence, masturbation, shared sexual behavior, pleasure from esx, and sexual dysfunction across the lifespan.
• Sexual health , including contraception, pregnancy, prenatal care, abortion, STIs, HIV and AIDS, sexual abuse, assault, and violence.
• Society and culture , including gender roles, diversity, and the intersection of sexuality and the law, religion, media, and the arts.
• Create an opportunity for youth to question, explore, and assess both personal and societal attitudes around gender and sexuality.
• Focus on personal practices, skills, and behaviors for healthy relationships, including an explicit focus on communication, consent, refusal skills/accepting rejection, violence prevention, personal safety, decision making, and bystander intervention.
• Help youth exercise responsibility in sexual relationships.
• Include information on how to come forward if a student is being sexually abused.
• Address education from a trauma-informed, culturally responsive approach that bridges mental, emotional, and relational health.

Comprehensive sex education should occur across the developmental spectrum, beginning at early ages and continuing throughout childhood and adolescence :

• Sex education is most effective when it begins before the initiation of sexual activity.
• Young children can understand concepts related to bodies, gender, and relationships.
• Sex education programs should build an early foundation and scaffold learning with developmentally appropriate content across grade levels.
• AAP Policy outlines considerations for providing developmentally appropriate sex education throughout early childhood, middle childhood, adolescence, and young adulthood.

Most adolescents report receiving some type of formal sex education before age 18. While sex education is typically associated with schools, comprehensive sex education can be delivered in several complementary settings:

• Schools can implement comprehensive sex education curriculum across all grade levels
• The Sexuality Information and Education Council of the United States (SIECUS) provides guidelines for providing developmentally appropriate comprehensive sex education across grades K-12.
• Pediatric health clinicians and other health care providers are uniquely positioned to provide longitudinal sex education to children, adolescents, and young adults.
• Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents outlines clinical considerations for providing comprehensive sex education at all developmental stages, as a part of preventive health care.
• Research suggests that community-based organizations should be included as a source for comprehensive sexual health promotion.
• Faith-based communities have developed sex education curricula for their congregations or local chapters that emphasize the moral and ethical aspects of sexuality and decision-making.
• Parents and caregivers can serve as the primary sex educators for their children, by teaching fundamental lessons about bodies, development, gender, and relationships.
• Many factors impact the sex education that youth receive at home, including parent/caregiver knowledge, skills, comfort, culture, beliefs, and social norms.
• Virtual sex education can take away feelings of embarrassment or stigma and can allow for more youth to access high quality sex education.

Comprehensive sex education provides children and adolescents with the information that they need to:

• Understand their body, gender identity, and sexuality.
• Build and maintain healthy and safe relationships.
• Engage in healthy communication and decision-making around sex.
• Practice healthy sexual behavior.
• Understand and access care to support their sexual and reproductive health.

Comprehensive sex education programs have demonstrated success in reducing rates of sexual activity, sexual risk behaviors, STIs, and adolescent pregnancy and delaying sexual activity. Many systematic reviews of the literature have indicated that comprehensive sex education promotes healthy sexual behaviors:

• Reduced sexual activity.
• Reduced number of sexual partners.
• Reduced frequency of unprotected sex.
• Increased condom use.
• Increased contraceptive use.

However, comprehensive sex education curriculum goes beyond risk-reduction, by covering a broader range of content that has been shown to support social-emotional learning, positive communication skills, and development of healthy relationships.

A 2021 review of the literature found that comprehensive sex education programs that use a positive, affirming, and inclusive approach to human sexuality are associated with concrete benefits across 5 key domains:

Benefits of comprehensive sex education programs 

When children and adolescents lack access to comprehensive sex education, they do not get the information they need to make informed, healthy decisions about their lives, relationships, and behaviors.

Several trends in sexual health in the US highlight the need for comprehensive sex education for all youth.

Education about condom and contraceptive use is needed:

• 55% of US high school students report having sexual intercourse by age 18 .
• Self-reported condom use has decreased significantly among high school students.
• Only 9% of sexually active high school students report using both a condom for STI-prevention and a more effective form of birth control to prevent pregnancy .

STI prevention is needed:

• Adolescents and young adults are disproportionately impacted by STIs.
• Cases of chlamydia, gonorrhea, and syphilis are rising rapidly among young people.
• When left untreated , these infections can lead to infertility, adverse pregnancy and birth outcomes, and increased risk of acquiring new STIs.
• Youth need comprehensive, unbiased information about STI prevention, including human papillomavirus (HPV) .

Continued prevention of unintended pregnancy is needed:

• Overall US birth rates among adolescent mothers have declined over the last 3 decades.
• There are significant geographic disparities in adolescent pregnancy rates, with higher rates of pregnancy in rural counties and in southern and southwestern states.
• Social drivers of health and systemic inequities have caused racial and ethnic disparities in adolescent pregnancy rates.
• Eliminating disparities in adolescent pregnancy and birth rates can increase health equity, improve health and life outcomes, and reduce the economic impact of adolescent parenting.

Misinformation about sexual health is easily available online:

• Internet use is nearly universal among US children and adolescents.
• Adolescents report seeking sexual health information online .
• Sexual health websites that adolescents visit can contain inaccurate information .

Prevention of sex abuse, dating violence, and unhealthy relationships is needed:

• Child sexual abuse is common: 25% of girls and 8% of boys experience sexual abuse during childhood .
• Youth who experience sexual abuse have long-term impacts on their physical, mental, and behavioral health.
• 1 in 11 female and 1 in 14 male students report physical DV in the last year .
• 1 in 8 female and 1 in 26 male students report sexual DV in the last year .
• Youth who experience DV have higher rates of anxiety, depression, substance use, antisocial behaviors, and suicide risk.

The quality and content of sex education in US schools varies widely.

There is significant variation in the quality of sex education taught in US schools, leading to disparities in attitudes, health information, and outcomes. The majority of sex education programs in the US tend to focus on public health goals of decreasing unintended pregnancies and preventing STIs, via individual behavior change.

There are three primary categories of sex educational programs taught in the US :

• Abstinence-only education , which teaches that abstinence is expected until marriage and typically excludes information around the utility of contraception or condoms to prevent pregnancy and STIs.
• Abstinence-plus education , which promotes abstinence but includes information on contraception and condoms.
• Comprehensive sex education , which provides medically accurate, age-appropriate information around development, sexual behavior (including abstinence), healthy relationships, life and communication skills, sexual orientation, and gender identity.

State laws impact the curriculum covered in sex education programs. According to a report from the Guttmacher Institute :

• 26 US states and Washington DC mandate sex education and HIV education.
• 18 states require that sex education content be medically accurate.
• 39 states require that sex education programs provide information on abstinence.
• 20 states require that sex education programs provide information on contraception.

US states have varying requirements on sex education content related to sexual orientation :

• 10 states require sex education curriculum to include affirming content on LGBTQ2S+ identities or discussion of sexual health for youth who are LGBTQ2S+.
• 7 states have sex education curricular requirements that discriminate against individuals who are LGBTQ2S+.Youth who live in these states may face additional barriers to accessing sexual health information.

Abstinence-only sex education programs do not meet the needs of children and adolescents.

While abstinence is 100% effective in preventing pregnancy and STIs, research has conclusively shown that abstinence-only sex education programs do not support healthy sexual development in youth.

Abstinence-only programs are ineffective in reaching their stated goals, as evidenced by the data below:

• Abstinence-only programs are unsuccessful in delaying sex until marriage .
• Abstinence-only sex education programs do not impact the rates of pregnancy, STIs, or HIV in adolescents .
• Youth who take a “virginity pledge” as part of abstinence-only education programs have the same rates of premarital sex as their peers who do not take pledges, but are less likely to use contraceptives .
• US states that emphasize abstinence-only education have higher rates of adolescent pregnancy and birth .

Abstinence-only programs can harm the healthy sexual and mental development of youth by:

• Withholding information or providing inaccurate information about sexuality and sexual behavior .
• Contributing to fear, shame, and stigma around sexual behaviors .
• Not sharing information on contraception and barrier protection or overstating the risks of contraception .
• Utilizing heteronormative framing and stigma or discrimination against students who are LGBTQ2S+ .
• Reinforcing harmful gender stereotypes .
• Ignoring the needs of youth who are already sexually active by withholding education around contraception and STI prevention.

Abstinence-plus sex education programs focus solely on decreasing unintended pregnancy and STIs.

Abstinence-plus sex education programs promote abstinence until marriage. However, these programs also provide information on contraception and condom use to prevent unintended pregnancy and STIs.

Research has demonstrated that abstinence-plus programs have an impact on sexual behavior and safety, including:

• HIV prevention.
• Increase in condom use .
• Reduction in number of sexual partners .
• Delay in initiation of sexual behavior .

While these programs add another layer of education, they do not address the broader spectrum of sexuality, gender identity, and relationship skills, thus withholding critical information and skill-building that can impact healthy sexual development.

AAP and other national medical and public health associations support comprehensive sex education for youth.

Given the evidence outlined above, AAP and other national medical organizations oppose abstinence-only education and endorse comprehensive sex education that includes both abstinence promotion and provision of accurate information about contraception, STIs, and sexuality.

National medical and public health organizations supporting comprehensive sex education include:

• American Academy of Pediatrics .
• American Academy of Family Physicians.
• American College of Obstetricians and Gynecologists .
• American Medical Association .
• American Public Health Association .
• Society for Adolescent Health and Medicine .

Pediatric clinics provide a unique opportunity for comprehensive sex education.

Pediatric health clinicians typically have longitudinal care relationships with their patients and families, and thus have unique opportunities to address comprehensive sex education across all stages of development.

The clinical visit can serve as a useful adjunct to support comprehensive sex education provided in schools, or to fill gaps in knowledge for youth who are exposed to abstinence-only or abstinence-plus curricula.

AAP policy and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents provide recommendations for comprehensive sex education in clinical settings, including:

• Encouraging parent-child discussions on sexuality, contraception, and internet/media use.
• Understanding diverse experiences and beliefs related to sexuality and sex education and meeting the unique needs of individual patients and families.
• Including discussions around healthy relationships, dating violence, and intimate partner violence in clinical care.
• Discussing methods of contraception and STI/HPV prevention prior to onset of sexual intercourse.
• Providing proactive and developmentally appropriate sex education to all youth, including children and adolescents with special health care needs.

Perspective

Karen Torres, Youth activist

There were two cardboard bears, and a person explained that one bear wears a bikini to the beach and the other bear wears shorts – that is the closest thing I ever got to sex ed throughout my entire K-12 education. I often think about that bear lesson because it was the day our institutions failed to teach me anything about my body, relationships, consent, and self-advocacy, which became even more evident after I was sexually assaulted at 16 years old. My story is not unique, I know that many young people have been through similar traumas, but many of us were also subjected to days, months, and years of silence and embarrassment because we were never given the knowledge to know how to spot abuse or the language to ask for help. Comprehensive sex ed is so much more than people make it out to be, it teaches about sex but also about different types of experiences, how to respect one another, how to communicate in uncomfortable situations, how to ask for help and an insurmountable amount of other valuable lessons.

From these lessons, people become well-rounded, people become more empathetic to other experiences, and people become better. I believe comprehensive sex ed is vital to all people and would eventually work as a part to build more compassionate communities.

Many US children and adolescents do not receive comprehensive sex education; and rates of formal sex education have declined significantly in recent decades.

Barriers to accessing comprehensive sex education include:

Misinformation, stigma, and fear of negative reactions:

• Misinformation and stigma about the content of sex education curriculum has been the primary barrier to equitable access to comprehensive sex education in schools for decades .
• Despite widespread parental support for sex education in schools, fears of negative public/parent reactions have led school administrators to limit youth access to the information they need to make healthy decisions about their sexuality for nearly a half-century.
• In recent years, misinformation campaigns have spread false information about the framing and content of comprehensive sex education programs, causing debates and polarization at school board meetings .
• Nearly half of sex education teachers report that concerns about parent, student, or administrator responses are a barrier to provision of comprehensive sex education.
• Opponents of comprehensive sex education often express concern that this education will lead youth to have sex; however, research has demonstrated that this is not the case . Instead, comprehensive sex ed is associated with delays in initiation of sexual behavior, reduced frequency of sexual intercourse, a reduction in number of partners, and an increase in condom use.
• Some populations of youth lack access to comprehensive sex education due to a societal belief that they are asexual, in need of protection, or don’t need to learn about sex. This barrier particularly impacts youth with disabilities or special health care needs .
• Sex ed curricula in some schools perpetuate gender/sex stereotypes, which could contribute to negative gender stereotypes and negative attitudes towards sex .

Inconsistencies in school-based sex education:

• There is significant variation in the content of sex education taught in schools in the US, and many programs that carry the same label (eg, “abstinence-plus”) vary widely in curriculum.
• While decisions about sex education curriculum are made at the state level, the federal government has provided funding to support abstinence-only education for decades , which incentivizes schools to use these programs.
• Since 1996, more than $2 billion in federal funds have been spent to support abstinence-only sex education in schools.
• 34 US states require schools to use abstinence-only curriculum or emphasize abstinence as the main way to avoid pregnancy and STIs.
• Only 16 US states require instruction on condoms or contraception.
• It is not standard to include information on how to come forward if a student is being sexually abused, and many schools do not have a process for disclosures made.
• Because of this, abstinence-only programs are commonly used in US schools, despite overwhelming evidence that they are ineffective in delaying sexual behavior until marriage, and withhold critical information that youth need for healthy sexual and relationship development.

Need for resources and training:

• Integration of comprehensive sex education into school curriculum requires financial resources to strengthen and expand evidence-based programs.
• Successful implementation of comprehensive sex education requires a trained workforce of teachers who can address the curriculum in age-appropriate ways for students in all grade-levels.
• Education, training, and technical assistance are needed to support pediatric health clinicians in addressing comprehensive sex education in clinical settings, as a complement to school-based education.

Lack of diversity and cultural awareness in curricula:

• A history of systemic racism, discrimination, and long-standing health, social and systemic inequities have created racial and ethnic disparities in access to sexual health services and representation in sex education materials. The legacy of intergenerational trauma in the medical system should be acknowledged in sex education curricula.
• Sex education curriculum is often centered on a white audience, and does not address or reflect the role of systemic racism in sexuality and development .
• Traditional abstinence-focused sex education programs have a heteronormative focus and do not address the unique needs of youth who are LGBTQ2S+ .
• Sex education programs often do not address reproductive body diversity, the needs of those with differences in sex development, and those who identify as intersex .
• Sex education programs often do not reflect the unique needs of youth with disabilities or special health care needs .
• Sex education programs are often not tailored to meet the religious considerations of faith communities.
• There is a need for sex education programs designed to help youth navigate sexual health and development in the context of their own culture and community .

Disparities in access to comprehensive sex education.

The barriers listed above limit access to comprehensive sex education in schools and communities. While these barriers impact youth across the US, there are some populations who are less likely to have access to comprehensive to sex education.

Youth who are LGBTQ2S+:

• Only 8% of students who are LGBTQ2S+ report having received sexual education that was inclusive .
• Students who are LGBTQ2S+ are 50% more likely than their peers who are heterosexual to report that sex education in their schools was not useful to them .
• Only 13% of youth who are bisexual+ and 10% of youth who are transgender and gender expansive report receiving sex education in schools that felt personally relevant.
• Only 20% of youth who are Black and LGBTQ2S+ and 13% of youth who are Latinx and LGBTQ2S+ report receiving sex education in schools that felt personally relevant.
• Only 10 US states require affirming content on LGBTQ2S+ relationships in sex education curriculum.

Youth with disabilities or special health care needs:

• Youth with disabilities or special health care needs have a particular need for comprehensive sex education, as these youth are less likely to learn about sex or sexuality form their parents , healthcare providers , or peer groups .
• In a national survey, only half of youth with disabilities report that they have participated in sex education .
• Typical sex education may not be sufficient for youth with Autism Spectrum Disorder, and special methods and curricula are necessary to match their needs .
• Lack the desire or maturity for romantic or sexual relationships.
• Are not subject to sexual abuse.
• Do not need sex education.
• Only 3 states explicitly include youth with disabilities within their sex education requirements.

Youth from historically underserved communities:

• Students who are Black in the US are more likely than students who are white to receive abstinence-only sex education , despite significant support from parents and students who are Black for comprehensive sex education.
• Youth who are Black and female are less likely than peers who are white to receive education about where to obtain birth control prior to initiating sexual activity.
• Youth who are Black and male and Hispanic are less likely than their peers who are white to receive formal education on STI prevention or contraception prior to initiating sexual activity.
• Youth who are Hispanic and female are less likely to receive instruction about waiting to have sex than youth of other ethnicities.
• Tribal health educators report challenges in identifying culturally relevant sex education curriculum for youth who are American Indian/Alaska Native.
• In a 2019 study, youth who were LGBTQ2S+ and Black, Latinx, or Asian reported receiving inadequate sex education due to feeling unrepresented, unsupported, stigmatized, or bullied.
• In survey research, many young adults who are Asian American report that they received inadequate sex education in school.

Youth from rural communities:

• Adolescents who live in rural communities have faced disproportionate declines in formal sex education over the past two decades, compared with peers in urban/suburban areas.
• Students who live in rural communities report that the sex education curriculum in their schools does not serve their needs .

Youth from communities and schools that are low-income:

• Data has shown an association between schools that are low-resource and lower adolescent sexual health knowledge, due to a combination of fewer school resources and higher poverty rates/associated unmet health needs in the student body.
• Youth with family incomes above 200% of the federal poverty line are more likely to receive education about STI prevention, contraception, and “saying no to sex,” than their peers below 200% of the poverty line.

Youth who receive sex education in some religious settings:

• Most adolescents who identify as female and who attended church-based sex education programs report instructions on waiting until marriage for sex, while few report receiving education about birth control.
• Young people who received sex education in religious schools report that education focused on the risks of sexual behavior (STIs, pregnancy) and religious guilt; leading to them feeling under-equipped to make informed decisions about sex and sexuality later in life.
• Youth and teachers from religious schools have identified a need for comprehensive sex education curriculum that is tailored to the needs of faith communities .

Youth who live in states that limit the topics that can be covered in sex education:

• Students who live in the 34 states that require sex education programs to stress abstinence are less likely to have access to critical information on STI prevention and contraception.
• Prohibitions on addressing abortion in sex education or mandates that sex education curricula include medically inaccurate information on abortion designed to dissuade youth from terminating a pregnancy.
• Limitations on the types of contraception that can be covered in sex education curricula.
• Requirements that sex education teachers promote heterosexual, monogamous marriage in sex education.
• Lack of requirements to address healthy relationships and communication skills.
• Lack of requirements for teacher training or certification.

Comprehensive sex education has significant benefits for children and adolescents.

Youth who are exposed to comprehensive sex education programs in school demonstrate healthier sexual behaviors:

• Increased rates of contraception and condom use.
• Fewer unplanned pregnancies.
• Lower rates of STIs and HIV.
• Delayed initiation of sexual behavior.

More broadly, comprehensive sexual education impacts overall social-emotional health , including:

• Enhanced understanding of gender and sexuality.
• Lower rates of homophobia and related bullying.
• Lower rates of dating violence, intimate partner violence, sexual assault, and child sexual abuse.
• Healthier relationships and communication skills.
• Understanding of reproductive rights and responsibilities.
• Improved social-emotional learning, media literacy, and academic achievement.

Comprehensive sex education curriculum goes beyond risk reduction, to ensure that youth are supported in understanding their identity and sexuality and making informed decisions about their relationships, behaviors, and future. These benefits are critical to healthy sexual development.

Impacts of a lack of access to comprehensive sex education.

When youth are denied access to comprehensive sex education, they do not get the information and skill-building required for healthy sexual development. As such, they face unnecessary barriers to understanding their gender and sexuality, building positive interpersonal relationships, and making informed decisions about their sexual behavior and sexual health.

Impacts of a lack of comprehensive sex education for all youth can include :

• Less use of condoms, leading to higher risk of STIs, including HIV.
• Less use of contraception, leading to higher risk of unplanned pregnancy.
• Less understanding and increased stigma and shame around the spectrum of gender and sexual identity.
• Perpetuated stigma and embarrassment related to sex and sexual identity.
• Perpetuated gender stereotypes and traditional gender roles.
• Higher rates of youth turning to unreliable sources for information about sex, including the internet, the media, and informal learning from peer networks.
• Challenges in interpersonal communication.
• Challenges in building, maintaining, and recognizing safe, healthy peer and romantic relationships.
• Lower understanding of the importance of obtaining and giving enthusiastic consent prior to sexual activity.
• Less awareness of appropriate/inappropriate touch and lower reporting of child sexual abuse.
• Higher rates of dating violence and intimate partner violence, and less intervention from bystanders.
• Higher rates of homophobia and homophobic bullying.
• Unsafe school environments.
• Lower rates of media literacy.
• Lower rates of social-emotional learning.
• Lower recognition of gender equity, rights, and social justice.

In addition, the lack of access to comprehensive sex education can exacerbate existing health disparities, with disproportionate impacts on specific populations of youth.

Youth who identify as women, youth from communities of color, youth with disabilities, and youth who are LGBTQ2S+ are particularly impacted by inequitable access to comprehensive sex education, as this lack of education can impact their health, safety, and self-identity. Examples of these impacts are outlined below.

A lack of comprehensive sex education can harm young women.

• Female bodies are more prone to STI infection and more likely to experience complications of STI infection than male bodies.
• Female bodies are disproportionately impacted by long-term health consequences of STIs , including pelvic inflammatory disease, infertility, and ectopic pregnancy.
• Female bodies are less likely to have or recognize symptoms of certain STI infections .
• Human papillomavirus (HPV) is the most common STI in young women , and can cause long-term health consequences such as genital warts and cervical cancer.
• Women bear the health and economic effects of unplanned pregnancy.
• Comprehensive sex education addresses these issues by providing medically-accurate, evidence based information on effective strategies to prevent STI infections and unplanned pregnancy.
• Students who identify as female are more likely to experience sexual or physical dating violence than their peers who identify as male. Some of this may be attributed to underreporting by males due to stigma.
• Students who identify as female are bullied on school property more often than students who identify as male.
• Young women ages 16-19 are at higher risk of rape, attempted rape, or sexual assault than the general population.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful gender norms, and building the skills required for respectful, equitable relationships.

A lack of comprehensive sex education can harm youth from communities of color.

• Youth of color benefit from seeing themselves represented in sex education curriculum.
• Sex education programs that use a framing of diversity, equity, rights, and social justice , informed by an understanding of systemic racism and discrimination, have been found to increase positive attitudes around reproductive rights in all students.
• There is a critical need for sex education programs that reflect youth’s cultural values and community .
• Comprehensive sex education can address these needs by developing curriculum that is inclusive of diverse communities, relationships, and cultures, so that youth see themselves represented in their education.
• Racial and ethnic disparities in STI and HIV infection.
• Racial and ethnic disparities in unplanned pregnancy and births among adolescents.
• Nearly half of youth who are Black ages 13-21 report having been pressured into sexual activity .
• Adolescent experience with dating violence is most prevalent among youth who are American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial.
• Adolescents who are Latinx are more likely than their peers who are non-Latinx to report physical dating violence .
• Youth who are Black and Latinx and who experience bullying are more likely to suffer negative impacts on academic performance than their white peers.
• Students who are Asian American and Pacific Islander report bullying and harassment due to race, ethnicity, and language.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful stereotypes, and building the skills required for respectful, equitable relationships.
• Young people of color—specifically those from Black , Asian-American , and Latinx communities– are often hyper-sexualized in popular media, leading to societal perceptions that youth are “older” or more sexually experienced than their white peers.
• Young men of color—specifically those from Black and Latinx communities—are often portrayed as aggressive or criminal in popular media, leading to societal perceptions that youth are dangerous or more sexually aggressive or experienced than white peers.
• These media portrayals can lead to disparities in public perceptions of youth behavior , which can impact school discipline, lost mentorship and leadership opportunities, less access to educational opportunities afforded to white peers, and greater involvement in the juvenile justice system.
• Comprehensive sex education addresses these issues by including positive representations of diverse youth in curriculum, challenging harmful stereotypes, and building the skills required for respectful relationships.

A lack of comprehensive sex education can harm youth with disabilities or special health care needs.

• Youth with disabilities need inclusive, developmentally-appropriate, representative sex education to support their health, identity, and development .
• Youth with special health care needs often initiate romantic relationships and sexual behavior during adolescence, similar to their peers.
• Youth with disabilities and special health care needs benefit from seeing themselves represented in sex education to access the information and skills to build healthy identities and relationships.
• Comprehensive sex education addresses this need by including positive representation of youth with disabilities and special health care needs in curriculum and providing developmentally-appropriate sex education to all youth.
• When youth with disabilities and special health care needs do not get access to the comprehensive sex education that they need, they are at increased risk of sexual abuse or being viewed as a sexual offender.
• Youth with disabilities and special health care needs are more likely than peers without disabilities to report coercive sex, exploitation, and sexual abuse.
• Youth with disabilities and special health care needs report more sexualized behavior and victimization online than their peers without disabilities.
• Youth with disabilities are at greater risk of bullying and have fewer friend relationships than their peers.
• Comprehensive sex education addresses these issues by providing education on healthy relationships, consent, communication, and bodily autonomy.

A lack of comprehensive sex education can harm youth who are LGBTQ2S+.

• Most sex education curriculum is not inclusive or representative of LGBTQ2S+ identities and experiences.
• Because school-based sex education often does not meet their needs, youth who are LGBTQ2S+ are more likely to seek sexual health information online , and thus are more likely to come across misinformation.
• The majority of parents support discussion of sexual orientation in sex education classes.
• Comprehensive sex education addresses these issues by including positive representation of LGBTQ2S+ individuals, romantic relationships, and families.
• Sex education curriculum that overlooks or stigmatizes youth who are LGBTQ2S+ contributes to hostile school environments and harms the healthy sexual and mental development .
• Youth who are LGBTQ2S+ face high levels of discrimination at school and are more likely to miss school because of bullying or victimization .
• Ongoing experiences with stigma, exclusion, and harassment negatively impact the mental health of youth who are LGBTQ2S+.
• Comprehensive sex education provides inclusive curriculum and has been shown to improve understanding of gender diversity, lower rates of homophobia, and reduce homophobic bullying in schools.
• Youth who are LGBTQ2S+ are more likely than their heterosexual peers to report not learning about HIV/STIs in school .
• Lack of education on STI prevention leaves LGBTQ2S+ youth without the information they need to make informed decisions, leading to discrepancies in condom use between LGBTQ2S+ and heterosexual youth.
• Some LGBTQ2S+ populations carry a disproportionate burden of HIV and other STIs: these disparities begin in adolescence , when youth who are LGBTQ2S+ do not receive sex education that is relevant to them.
• Comprehensive sex education provides the knowledge and skills needed to make safe decisions about sexual behavior , including condom use and other forms of STI and HIV prevention.
• Youth who are LBGTQ2S+ or are questioning their sexual identity report higher rates of dating violence than their heterosexual peers.
• Youth who are LGBTQ2S+ or are questioning their sexual identity face higher prevalence of bullying than their heterosexual peers.
• Comprehensive sex education teaches youth healthy relationship and communication skills and is associated with decreases in dating violence and increases in bystander interventions .

A lack of comprehensive sex education can harm youth who are in foster care.

• More than 70% of children in foster care have a documented history of child abuse and or neglect.
• More than 80% of children in foster care have been exposed to significant levels of violence, including domestic violence.
• Youth in foster care are racially diverse, with 23% of youth identifying as Black and 21% of identifying as Latinx, who will have similar experiences as those highlighted in earlier sections of this report.
• Removal is emotionally traumatizing for almost all children. Lack of consistent/stable placement with a responsive, nurturing caregiver can result in poor emotional regulation, impulsivity, and attachment problems.
• Comprehensive sex education addresses these issues by providing evidence-based, culturally appropriate information on healthy relationships, consent, communication, and bodily autonomy.

Sex education is often the first experience that youth have with understanding and discussing their gender and sexual health.

Youth deserve to a strong foundation of developmentally appropriate information about gender and sexuality, and how these things relate to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

Decades of data have demonstrated that comprehensive sex education programs are  effective  in reducing risk of STIs and unplanned pregnancy. These benefits are critical to public health. However, comprehensive sex education goes even further, by instilling youth with a broad range of knowledge and skills that are  proven  to support social-emotional learning, positive communication skills, and development of healthy relationships.

Last Updated

American Academy of Pediatrics

Experts: Sex Education Should Begin in Kindergarten

First-of-its-kind research shows sex education yields positive outcomes beyond STD and pregnancy prevention

Posted in: Education , Graduate School , Health , Research

Sex education is much more than “the birds and the bees” – and it impacts children in ways that have never been fully quantified.

That is, until now.

A new study by Montclair State University professors Eva Goldfarb and Lisa Lieberman – the first of its kind in the field – shows comprehensive sex education can prevent child sex abuse and intimate partner violence, increase appreciation for sexual diversity and improve environments for LGBTQ students, among other benefits.

The research is the most extensive body of work to date that shows comprehensive sex education should begin as early as kindergarten.

“This landmark study establishes once and for all that quality sex education that begins early, is developmentally appropriate and builds sequentially through middle and high school can improve young people’s physical, mental and emotional well-being,” says Goldfarb, a professor of Public Health at Montclair State. “While many people think of sex education only in terms of pregnancy and STD prevention, these findings speak to the broader impact of quality sex education.”

No Different Than Math

Goldfarb and Lieberman analyzed 30 years of published research on school-based programs around the world, and their respective outcomes.

The results show that sex education, like any other subject, is most effective when it builds –  creating an early foundation and advancing with developmentally appropriate content and teaching.

Children as young as preschool age not only comprehend, but can openly discuss subjects as varied as gender diversity, gender nonconformity and gender-based oppression, making it the ideal time to begin creating a foundation for lifelong sexual health.

“Waiting until eighth grade algebra to first introduce the subject of math would be absurd. The same is true for sex education,” says Goldfarb.“Basic foundational concepts such as personal boundaries, different family structures, healthy friendships, treating others with respect, and social-emotional skills need to be introduced early in elementary school. These become the building blocks for more sophisticated discussions in later grades.”

Creating Safer Environments and Healthier Outcomes

Programming implemented in earlier grade levels has helped to prevent child sex abuse. It has also led to improved self-protective skills, improved knowledge of appropriate/inappropriate touching, increased parent-child communication and increased disclosure of abuse.

At the higher grade levels, comprehensive sex education within schools has also resulted in decreased intimate partner violence, as well as an increase in bystander interventions and other positive bystander behaviors.

The same can be said for the environments created by quality sex education. Goldfarb and Lieberman’s research found that LGBTQ-supportive classes across the curriculum, and within sex education in particular, resulted in a more positive school climate, including increased feelings of safety and lower levels of homophobia and bullying for all students – specifically decreased homophobic bullying.

Likewise, LGBTQ-inclusive sex education resulted in better mental health among LGBTQ students including lower reports of suicidal thoughts, as well as decreased use of drugs or alcohol before sex, and increased school attendance among that student population.

“If students are able to avoid early pregnancy, STIs, sexual abuse, and interpersonal violence

and harassment, while feeling safe and supported within their school environment, they are more likely to experience academic success,” says Lieberman, who is chair of Montclair State’s Department of Public Health. “This is particularly important for LGBTQ students who regularly face more hostility in schools and are more likely to drop out.”

Additional Outcomes

Their research also yielded important findings  as to the benefits of comprehensive sex education including: improved body image, better overall interpersonal relationships (not just intimate ones), and improved media literacy – including an increased understanding of how media can impact a person’s sense of self and the perceptions of teen “norms.”

Putting It All Together

To date, fewer than half of school districts nationwide have adopted the National Sex Education Standards for comprehensive sex education.

Research shows that the majority of parents and communities already support comprehensive sex education. Goldfarb and Lieberman hope their research will encourage more school districts across the country to implement this programming as early as possible.

“Hopefully, this research will help the public to recognize that quality sex education, beginning in the earliest grades, can improve the wellbeing of young people in ways that will serve them well throughout their lives,” says Lieberman.

US Adolescents’ Receipt of Formal Sex Education

Reproductive rights are under attack. Will you help us fight back with facts?

Sex education is vital to adolescents’ healthy sexual development, and young people have the right to information that is medically accurate, inclusive, and age- and culturally appropriate in order to make informed decisions about their sexual behavior, relationships and reproductive choices. 1–4 Numerous health organizations recommend comprehensive sex education that addresses a range of topics, 2–4 and support for this type of instruction is reflected in national public health goals. 5

Formal sex education for adolescents consists of instruction that generally takes place in a structured setting, such as a school, community center or church. The US Department of Health and Human Services’ Healthy People 2030 initiative includes objectives for formal sex education for adolescents based on a minimal set of topics that focus on delaying sex, using birth control methods and preventing STIs (including HIV). 6 However, not all states require sex education and any required content varies widely; there is further variation at both the district and school levels. 7,8 Understanding differences in the receipt of formal instruction is the first step toward ensuring that the needs of all youth are met.

The data in this fact sheet come from multiple rounds of the National Center for Health Statistics’ National Survey of Family Growth and apply to female and male respondents aged 15–19 at the time of the survey interview. (Self-reported gender at time of interview may differ from respondents’ gender assigned at birth.)

• Young people are not getting the sex education they need: About half of adolescents (53% of females and 54% of males) reported in 2015–2019 that they had received sex education that meets the minimum standard articulated in Healthy People 2030; among teens reporting penile-vaginal intercourse, fewer than half (43% of females and 47% of males) received this instruction before they first had sex. 9
• In 2015–2019, more adolescents reported that they had received instruction about saying no to sex (81% of females and 79% of males) or waiting until marriage (67% and 58%, respectively) than about where to obtain birth control (48% of females and 45% of males) or how to use a condom (55% and 60%, respectively). 9

that they had received instruction on where to get birth control before they had sex for the first time. 9

• More than 90% of adolescents reported receiving instruction on STIs, including HIV. 9
• Adolescents reported in 2015–2019 that they first received instruction about birth control methods, where to get birth control and how to use a condom primarily in grades nine and above. 9

Changes in receipt of sex education

Adolescents were less likely to report receiving sex education on key topics in 2015–2019 than they were in 1995. 9

• In 1995, 81% of adolescent males and 87% of adolescent females reported that they had received instruction on birth control methods, while in 2015–2019, 63% of males and 64% of females reported receiving instruction on this topic. 9
• Although the proportion of adolescent males reporting instruction on saying no to sex increased between 1995 and 2015–2019 (74% vs. 79%), this proportion decreased for adolescent females during the same time period (92% vs. 81%). 9

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Disparities in sex education received

Disparities in the receipt and timing of formal sex education by gender, race and ethnicity, and sexual orientation leave some young people without critical information for their sexual health and well-being, particularly when this instruction does not occur before they first have sex.

• In 2015–2019, adolescent females were more likely than males to report receipt of instruction on waiting until marriage to have sex (67% vs. 58%), while males were more likely to report instruction about condoms (60% vs. 55%). 9
• Adolescent males were more likely than females to report that, before they had sex for the first time, they had received condom instruction (64% vs. 50%), instruction about birth control methods (61% vs. 54%) and instruction on STIs or HIV (78% vs. 69%). 9

Race and ethnicity

• In 2015–2019, non-Hispanic Black adolescents were more likely than their peers of other races and ethnicities to report having received instruction about condoms (males, 67% vs. 58–62% and females, 65% vs. 50–56%). 9
• Non-Hispanic Black males and Hispanic males were less likely than non-Hispanic White males to report having received instruction on a range of topics before they first had sex: prevention of STIs or HIV (70% and 72%, respectively, vs. 84%), methods of birth control (41% and 54% vs. 75%) and where to get birth control (36% and 42% vs. 56%). 9
• In 2015–2019, 30% of non-Hispanic Black females reported that they had learned about where to get birth control before having sex for the first time; this was true for 45% of non-Hispanic White females and 49% of Hispanic females. 9

Sexual orientation

• Males who reported that they were homosexual, gay or something else were less likely than straight males to report in 2015–2019 that they had received instruction about STIs or HIV (83% vs. 93%) or where to get birth control (31% vs. 46%). 9

Sources of formal instruction

Young people receive sex education from multiple sources. Religious institutions were commonly reported in 2015–2019 as a source of sex education, but they rarely offered comprehensive information.

• In 2015–2019, adolescents who attended religious services at least once a week were more likely than their peers who attended services less frequently or not at all to report having received instruction about delaying sex until marriage and less likely to report having received instruction about birth control methods. 9
• Among adolescent females who reported in 2015–2019 that they had received instruction about waiting until marriage to have sex, 56% received this instruction in church; more than half (53%) received this instruction in school and 13% in a community setting. Among males, 49% reported that they received this instruction in church, 59% in school and 11% in a community setting. 9 (Some respondents received instruction in multiple locations.)
• Among adolescents who reported in 2015–2019 that they had received instruction about birth control methods, 92% of females and 98% of males received it in school. Only 2% and 3%, respectively, reported receiving instruction about birth control methods at church, and 14% and 4% reported receiving instruction in another community setting. 9

1. Santelli JS et al., Abstinence-only-until-marriage: an updated review of U.S. policies and programs and their impact, Journal of Adolescent Health , 2017, 61(3):273–280, doi:10.1016/j.jadohealth.2017.05.031.

2. Breuner CC et al., Sexuality education for children and adolescents, Pediatrics , 2016, 138(2):e20161348, doi:10.1542/peds.2016-1348.

3. American College of Obstetricians and Gynecologists, Comprehensive sexuality education, Committee Opinion No. 678, Obstetrics & Gynecology , 2016, 128(5):e227–e230, doi:10.1097/AOG.0000000000001769.

4. Society for Adolescent Health and Medicine, Abstinence-only-until-marriage policies and programs: an updated position paper of the Society for Adolescent Health and Medicine, Journal of Adolescent Health , 2017, 61(3):400–403, doi:10.1016/j.jadohealth.2017.06.001.

5. Office of Disease Prevention and Health Promotion (ODPHP), US Department of Health and Human Services (HHS), Healthy People 2030: Adolescents, no date, https://health.gov/healthypeople/objectives-and-data/browse-objectives/… .

6. ODPHP, HHS, Increase the proportion of adolescents who get formal sex education before age 18 years—FP‑08, no date, https://health.gov/healthypeople/objectives-and-data/browse-objectives/… .

7. Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, School Health Policies and Practices Study, Trends Over Time: 2000–2016 , 2019, https://www.cdc.gov/healthyyouth/data/shpps/results.htm .

8. Guttmacher Institute, Sex and HIV education, State Laws and Policies (as of January 1, 2022) , 2022, https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education .

9. Lindberg LD and Kantor L, Adolescents’ receipt of sex education in a nationally representative sample, 2011–2019, Journal of Adolescent Health , 2022, 70(2):290–297, doi:10.1016/j.jadohealth.2021.08.027.

Figure sources:

1995 and 2002: Lindberg LD et al., Changes in formal sex education: 1995–2002, Perspectives on Sexual and Reproductive Health , 2006, 38(4):182–189. 2006–2010: Lindberg LD et al., Changes in adolescents’ receipt of sex education, 2006–2013, Journal of Adolescent Health , 2016, 58(6):621–627. 2011–2015 and 2015–2019 : reference 9.

Federally Funded Abstinence-Only Programs: Harmful and Ineffective

Federally funded sex education: strengthening and expanding evidence-based programs, sex and hiv education, adolescents deserve better: what the biden-harris administration and congress can do to bolster young people’s sexual and reproductive health, united states.

• Northern America : United States

The State of Sex Education

• Posted December 4, 2018
• By Jill Anderson

With the rise of #MeToo, consent — what it means, how to recognize when it is or isn't being given, how to effectively voice it — has been one of the most talked about topics of the year. And with it has come the question of how and when to educate children about consent, and how consent fits (or should fit) into traditional sex education programs .

It's a hard question, since even traditional sex ed is not yet universal in schools in the United States. In fact, according to a report released this year by the Center for American Progress (CAP), only 24 states and the District of Columbia mandate sex education in public schools. Even fewer states include consent.

"According to state laws and education standards, only 10 states and the District of Columbia mention the terms 'healthy relationships,' 'sexual assault,' or 'consent' in their sex education programs," the CAP report states. "This means that the majority of U.S. public school students do not receive instruction through their state’s sex education program on how to identify healthy and unhealthy relationship behaviors."

“Sex ed is often scattershot and many students don’t have access to sex ed at all,” says Catherine Brown, the vice president of education policy at CAP, who coauthored the report, in an interview recorded for the  Harvard EdCast . “And when they do, it is often fear-based and [about] all the things that can go wrong.”

Sex education in America is still often taught as abstinence-only, despite decades of research showing that this approach results in higher teen pregnancy rates and STDs. Absent a more complete sex education — or any at all — children often learn from peers, siblings, or the internet, Brown tells EdCast, opening the way for misinformation and a lack of understanding of what is and isn’t appropriate when it comes to respect in sexual relationships. Students need to be prepared for the world we live in and become part of a broader conversation about “communication, intimacy, desire, and healthy relationships,” Brown says. 

Although the federal government has moved to reduce access to intervention tools such as sex education, there's also some good news: Many states, fueled by the #MeToo movement, are taking initiative to make change, Brown says. “#MeToo is the catalyst for better consent and sex ed in schools and states around the country,” she says, citing Georgia, Illinois, Missouri, and Maryland as states that have updated laws to include consent.

Part of a special series about preventing sexual harassment at school.  Read the whole series .

Illustration by Wilhelmina Peragine

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State Profiles

Access the SIECUS State Education Profiles: A living document of real-time updates on U.S. state policies for sex education. Our color-coded, state-by-state analysis evaluates existing laws and legislative activities, providing a detailed view of regional educational policies. These profiles serve as a crucial tool for advancing informed, comprehensive sex education, reflecting our ongoing commitment to shape policy that supports equitable and effective teaching standards.

State Profile Highlights

• 30 states and the District of Columbia require sex education, either explicitly by law or by proxy via enforced state standards.
• 39 states and the District of Columbia specifically require instruction on HIV/AIDS in schools.
• 35 states require schools to emphasize the importance of abstinence when sex education or HIV/STI instruction is provided.
• 17 states provide abstinence-only sex education
• 21 states require instruction on condoms or contraception when sex education or HIV/STI instruction is provided.
• 12 states do not require sex education or HIV/STI instruction to be any of the following, by law: age-appropriate, medically accurate, culturally responsive, or evidence-based/evidence-informed.
• 12 states require sex education or HIV/STI instruction to include information on consent.
• 10 states have policies that include affirming sexual orientation instruction on LGBTQ identities or discussion of sexual health for LGBTQ youth.
• 4 states explicitly require instruction that discriminates against LGBTQ people
• 3 states (CA, OR, WA) require comprehensive sex education to be taught in all schools
• 2 states (CO and IL) require sex education curriculum to be comprehensive, IF it is taught in schools.

The provided highlights are not a comprehensive view of how sex education is implemented in each state; rather, it only represents the policies and laws in place that influence the kind of sex education that might exist in your local jurisdiction. . As a result, these highlights do not reflect the realities of how sex education looks like in classrooms across the United States due to the intricacies of local control at the school district and individual school level. For more detailed inquiries regarding these statistics, please contact Alison Macklin, Director of Policy and Advocacy, [email protected]

For a detailed look at sex ed policies that impact you based on where you live, click on your state in the map above.

About the SIECUS State Profiles

The SIECUS State Profiles provides an in-depth and up-to-date look at the state of sex education in all 50 states, the District of Columbia, Puerto Rico, and the outer United States territories and associated states, pursuant to data available.

The profiles include an overview of each state’s current sex education laws, policies, and guidelines, newly introduced legislation, and relevant action that advocates have taken to advance or defend sex education in their communities. This report also incorporates the Centers for Disease Control and Prevention’s School Health Profiles data to help paint a comprehensive picture of what sexual health education topics are, or are not, being taught to young people in the classroom.

The SIECUS State Profiles serves as an evolving guide and will be regularly updated as new legislation and related activity becomes available.

This resource is intended to be used by advocates, educators, policymakers, health care providers, parents, and youth to aid in efforts to advance sex education in every community across the country. To request older editions of the SIECUS State Profiles (2003 – 2015), please email [email protected] .

Other State Profile Editions (Archive)

Review the 2022 Sex Ed State Profiles

Review the 2021 Sex Ed State Profiles

Review the 2020 Sex Ed State Profiles

Older Archives (2016-2018)

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Sex Education in School, are Gender and Sexual Minority Youth Included?: A Decade in Review

Affiliation.

• 1 University of Missouri Sinclair School of Nursing, Columbia, Missouri, Saint Xavier University, Chicago, Illinois.
• PMID: 33762901
• PMCID: PMC7986966
• DOI: 10.1080/15546128.2020.1832009

Comprehensive sexual health education increases sexual health knowledge and decreases adverse health outcomes and high-risk behaviors in heterosexual youth but lacks information relevant to gender and sexual minority youth. Universal access to comprehensive sexual health education that includes information relevant to gender and sexual minority individuals is lacking in the United States, leading to poor health outcomes for gender and sexual minority youth. The purpose of this review was to examine sexual health education programs in schools in the United States for the inclusion of information on gender identity and sexual orientation. The review provides information on current programs offered in schools and suggestions to make them more inclusive to gender and sexual minority youth.

Keywords: LGBTQ+; gender minority; sex education; sexual health; sexual minority.

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The effects of school poverty on adolescents’ sexual health knowledge

Robert atkins.

Rutgers University-Camden Center for Children, 325 Cooper Street, Camden, NJ 08102

Michael J. Sulik

Arizona State University Department of Psychology Tempe, AZ

Daniel Hart

Rutgers University-Camden Center for Children, Camden, NJ

Cynthia Ayres

Rutgers, The State University of New Jersey Rutgers University-Newark College of Nursing, Newark, NJ

Nichole Read

Rutgers University-Camden Center for Children, Camden, NJ 08102

Using National Longitudinal Study of Adolescent Health data, hierarchical linear modeling was conducted to estimate the association of school poverty concentration to the sexual health knowledge of 6,718 adolescents. Controlling for individual socio-economic status, school poverty had modest negative effects on sexual health knowledge. Although not directly associated with sexual health knowledge, after controlling for demographic characteristics, school poverty interactions showed that sexual health knowledge was associated with higher grade point average (GPA) and age. The combination of low GPA and high-levels of school poverty was especially detrimental for students’ sexual health knowledge. There are differences in the sexual health knowledge of adolescents attending low poverty and high poverty schools that can be attributed to the school environment.

The purpose of this study was to investigate whether a specific school characterstic—the school poverty concentration —influences the sexual health knowedge of high school students. Whether high school characteristics are associated with effectiveness of sexual health education efforts is important for at least two reasons. First, adolescence is a critical developmental period for public health education efforts because many adolescents are starting to engage in risky sexual behaviors known to lead to unplanned pregnancy and sexually transmitted infections ( Mueller, Gavin, & Kulkarni, 2008 ). Second, although there are many informal sources of sexual health information (e.g., parents, peers, media) schools are one place where formal sexual health education takes place ( Blum, McNeely, Rinehart, 2002 ; Flay, 2002 ). Sexual health education refers to instruction relating to sex and sexualilty including anatomy, reproduction, development, and behavior. Beginning in grades five or six almost all students in the United States begin to receive some form of sexual health education ( Landry, Singh, & Darroch, 2000 ).

Although most children and adolescents receive sexual education in school, there is strong evidence that the effectiveness of school-based sexual health education varies across schools. This disparity is important to address because effective school-based health education curricula have been linked to reductions in the risky sexual behaviors that lead to sexually transmitted infection and unplanned pregnancy ( Mueller et al., 2008 ). For example, Mueller and colleagues (2008) found an association between sex education and the delay of first sexual intercourse among adolescents. Additionally, Muller et al. found sex education was particularly important for populations that are historically at increased risk for early initiation of sex and for becoming infected with sexually transmitted disease at first intercourse (e.g., Black males and females living in urban areas).

Researchers and policymakers have become increasingly interested in understanding the risk taking and health damaging factors that contribute to health disparities. Although most of the findings on health disparities relate to adults, a growing number of researchers have focused on understanding how an individual’s health during childhood and adolescence influences the development of health disparities ( Cheng & Jenkins, 2009 ; Flores & Tomany-Korman, 2008 ). Evidence suggests that individuals who experience poor health during childhood are at increased risk of poor health during adulthood ( Reilly, 2007 ). In addition, the behaviors associated with morbidity and mortality during adulthood, such as unhealthy dietary practices, are established during childhood and adolescence ( Reilly, 2007 ; Story, Neumark-Sztainer & French, 2002 ). Of course, children and adolescents do not establish health behaviors on their own: they are greatly influenced by those they interact with in their household and neighborhood environments—family members, neighbors, peers, and schools ( Dowd, Zajacova, & Aiello, 2009 ; Newacheck, Hung, Park, Brindis, & Irwin, Jr., 2003 ). Thus, understanding how social and contexutal factors may contribute to health disparities is important.

Epidemiological Sociology

One theoretical approach commonly used to explore how social factors such as household, school, and neighborhood environments influence health disparities comes from epidemiological sociology, which posits that health disparities across socioeconomic levels and along racial lines are deepened when a society develops the capacity to promote, maintain, or restore health ( Phelan & Link, 2005 ). Proponents of this approach point out that populations living in industrialized countries are expected to live healthier and longer than previous generations as the medical treatments and technology available to promote, maintain, and restore health far surpasses what was available to previous generations. Epidemiological sociologists acknowledge that given these two trends, it is tempting to believe that there exists a causal relationship between health innovations and improved health ( Link, 2008 ). Although the availability of improved technology and treatments is essential to improved population health, Link (2008) pointed out that these technologies are not sufficient causes because a host of social factors determine the “uptake” of new technology and treatments. For example, although beta-blockers for the treatment of heart attacks have been an available treatment since the mid-1980s, the uptake of this life-saving treatment across the United States has been slow and uneven, with a far greater use in certain regions of the country (e.g., Northeastern United States) than in others (e.g., Arkansas; Link). Whenever there is public knowledge about disease prevention, health-relevant lifestyles, or the uptake of health-enhancing technical innovations, “groups who are less likely to be exposed to discrimination and who have greater access to knowledge, money, power, prestige, and beneficial social connections” are the first to benefit from the advancement ( Link, 2008 , p. 374; Phelan & Link, 2005 ).This process is referred to as the “social shaping of disease” and is a process that sustains health disparities. One of our aims in the study was to consider how schools, through the neighborhoods they serve and the resources available to them, contribute to health disparities through the social shaping of disease.

Schools and Health Disparities

Although schools have received less attention than individual and family-level processes as a contributor to the health behaviors of youth ( Wight, Botticello, & Aneshensel, 2006 ), they are one of the most important institutional influences on the health behaviors that are established in school age youth in the United States and Europe ( Stewart-Brown, 2006 ). Schools influence health in multiple ways. For example, most public schools promote health by requiring students to participate in physical education classes, and many schools offer students opportunties to engage in extracurricular recreational activities. In addition, for some children the most nutritious meal of the day is eaten at school. Finally, many schools have personnel such as school nurses who provide first aid and health surveillance and health education teachers who provide instruction on health education topics such as sexual education ( Satcher, 2001 ).

Schools and Health Education

There is a growing body of evidence to suggest that schools differ in the amount of health education they provide to students. For example, through an analysis of a national survey of school health education policies and practices conducted by the Centers for Disease Control (CDC), Brener, Jones, Kann, and McManus(2003) found that students in poor and urban school districts received less health education than their counterparts in more affluent school districts. Although in our review of the literature we found no studies of the health knowledge of students in schools with high concentrations of low income students, there is a relationship between what students are taught in school and their knowledge. Indeed, students from urban schools with high concentrations of low-income students from minority backgrounds have lower levels of academic achievement than their peers ( Bradley & Corwyn, 2002 ; McLoyd, 1998 ). The diminished learning outcomes of students from high-poverty, urban schools have been attributed to an accumulation of factors (e.g, poverty itself, English as a second language, health and safety problems), which disrupt the educational process ( Bradley & Corwyn, 2002 ; Lippman et al., 1996 ).

School Effects on Health Knowledge

Although a growing number of researchers have sought to understand the role schools play in the health knowledge of students attending high-poverty, urban schools—most of whom are racial and ethnic minorities—there is a need for more of this type of research. For example, although students attending high poverty schools are more likely to disengage from school through absenteeism or dropout than their peers at low poverty schools, it is not known how this influences health knowledge ( Swenson et al., 2010 ). Schools are an important source of health promotion and it may be that students in poor and urban schools either are not receiving or are not absorbing the same amount of health promotion resources as their counterparts in other schools. A gap in school resources may contribute in both ways to health disparities. Although most studies of the association of poor and urban schools with learning outcomes have not been focused on how these characteristics influence student health, there is some evidence that schools do influence health disparities. For example, Sellström and Bremberg (2006) reviewed 17 studies in which multilevel analysis was used to identify whether the social context of schools (e.g., high expectations of students, strong administrative leadership) influenced the health and well-being of students after controlling for the socio-economic background of students. Based on these studies, the authors concluded that the social context of the school environment contributes to health outcomes even after accounting for the differences in socioeconomic backgrounds of the students.

Study Overview

Through secondary analysis of the National Longitudinal Study of Adolescent Health (Add Health; Harris, 2009 ), factors that influence the health and well-being of adolescents in the United States were explored. First, we investigated whether there are sexual health knowledge differences between adolescents from advantaged and disadvantaged environments. Hypothesis 1 was that students from low socio-economic households have lower levels of sexual health knowledge than students from more affluent households. Second, we investigated whether differences in the sexual health knowledge of adolescents could be attributed to the school socioeconomic environment. Hypothesis 2 was that school poverty would be negatively related to sexual health knowledge. Finally, we investigated the extent to which school poverty interacts with student age, verbal intelligence, and academic achievement to moderate the influence of family background on sexual health knowledge. Hypothesis 3 was that school poverty moderates the influence of household and family background variables on sexual health knowledge.

Sample and Setting

The study was approved by the university’s Institutional Review Board. The data used come from Wave I of the Restricted Use Data Add Health, a school-based study of youth originally in grades 7 through 12 (see Harris, 2009 ). All high schools in the United States that included an 11 th grade and at least 30 students were eligible for inclusion in the Add Health study. A sample of 80 eligible high schools was selected. The sample was stratified by region, urbanicity (urban/suburban/rural), school type (public/private/parochial), racial/ethnic mix, and size; schools were selected with probability proportional to size ( Harris, 2009 ).

The analyses reported here use data from the in-home and the school administrator questionnaires which were collected between September 1994 and December 1995. The Add Health study used a stratified, two-stage sampling procedure in which schools were first selected for inclusion in the study and students were subsequently sampled from these schools. Due to the nested design, the ordinary least squares regression assumption of independent observations was violated. Multilevel modeling (SAS 9.2 PROC MIXED) was used to account for similarities among students sampled from the same schools because failing to take the nested nature of the Add Health data into account can result in negatively biased standard errors and a corresponding increase in the nominal alpha rate of statistical tests ( Cohen, Cohen, West, & Aiken, 2003 ).

We had two methodological reasons for not using the sample weights developed for the data. First, the weights were developed for the full sample of adolescent participants. In the analysis discussed in this manuscript we dropped participants who were: not 15 years of age or older; had missing data; or were not the oldest child in their family (applied to participants with siblings in study). Second, Carle (2009) found that the differences between weighted and unweighted multilevel model analyses are minimal and do not lead to different inferential conclusions. So even if using the weights is more accurate in principle (and according to Carle the differences are relatively small), the sample weights would not correspond to the actual data we used.

All Add Health respondents ( n = 20,745) with complete data on the study measures were eligible for inclusion in the analysis; listwise deletion was used to exclude participants with missing data. Moreover, only the oldest child in each family was selected to participate in the study ( n = 17,898) to avoid violating the statistical assumption of independence of observations. By design, participants younger than 15 years old in 1994 were not asked questions regarding sexual health knowledge. This reduced the sample size to 13,454. In addition, participants attending schools for which school free/reduced price lunch data were not available also were excluded from the analysis, reducing the sample size to 10,272. Our analytic sample size, restricted to cases with complete data on all study variables, was 6,718 from 99 different schools. The racial/ethnic composition of the sample was: 61% White, 19% Black, 1% Native American, 6% Asian, and 14% other/multiracial; 18% of the sample was of Hispanic or Latino origin. Nearly half of the sample was female (49%). There were minor differences between the analytic sample and the Add Health sample. For example, the analytic sample was slightly older (16.96), had a larger percentage of Black participants (23%) and a slightly lower GPA (6.14).

Individual socio-demographics

Participants self-reported their birth date, ethnicity (dummy variable: 0 = Non-Hispanic ; 1 = Hispanic ), race (dummy variables: White =0; Black, Asian, Native American, and other/multiracial = 1), and gender (dummy variable: male = 0, female = 1). The highest level of education reported by the mother was used to measure parental educational level. Educational attainment ranged from 1 ( eighth grade or less ) to 9 ( professional training beyond a 4-year college or university ). The annual family income reported by a parent was used to assess the participants’ economic status. Income was highly positively skewed. Therefore, we applied a logarithmic transformation to the variable to improve its distributional properties by first increasing income by a value of one (so that the minimum income value would be one instead of zero; the logarithm of zero is undefined), and subsequently computing the base 10 logarithm of the incomes scores.

School attendance

Two questions were used to assess school attendance: participants were asked to report the number of times that they missed school with an excuse (e.g., sick or out of town) 0–3 (0= never , 3= more than 10 times ) and the number of times that they missed school without an excuse (0 – 99 times).

Academic Achievement

The grades that participants reported they received in their most recent grading period for English, Mathematics, Social Studies, and Science were averaged ( A = 4.0; D or lower = 1.0). The self-reported GPA was slightly higher than the school reported GPA but they were highly correlated ( r = .72). The use of the school reported GPA did not change the results, and over 2,500 participants would have had to be excluded from analyses using the school-reported GPA because it was not reported in the school data.

Intelligence

Intelligence was estimated with an abridged version of the Peabody Picture Vocabulary Test (PPPVT; Halpern, Joyner, Udry, & Suchindran, 2000 ). The test correlates well with other measures of intelligence and is well-suited for use in field surveys ( Halpern et al., 2000 ).

Poverty concentration in school

To assess the poverty concentration in each school the proportion of students eligible for the free lunch program under the National School Lunch Act during the 1993–94 school year was used. The proportion of students eligible for free or reduced school lunch ranged from 0% to 85%. High-poverty schools are defined as public schools where more than 75% of the students are eligible for free or reduced school lunch ( Aud et al., 2010 ).

Sexual health knowledge

The sexual health knowledge of participants was measured with a “Knowledge Quiz” which was part of the in-home Add Health questionnaire in Wave I. The quiz was comprised of 10 true or false questions on various topics about human sexuality, scored as the respondent’s total number of correct answers. For example, students were asked, “The most likely time for a woman to get pregnant is right before her period starts.” Don’t Know was scored as an incorrect answer, whereas scores for participants who refused to answer some of the questions (<1% of all participants) were considered missing. The total score ranged from 0 to 10 (with higher scores indicating greater knowledge).

Analysis Plan

We used a model building approach to analysis ( Singer & Willett, 2003 ), which is conceptually similar to hierarchical regression analysis. We started with a relatively simple model containing level-1 predictors (e.g., age, gender). In the second step, we added level-2 (i.e., school-level) predictors. Finally, in the third step we added interactions among level-1 and level-2 variables. Likelihood ratio tests were used to determine whether adding a set of predictors improved model fit relative to the simple model. To estimate the amount of variance in each outcome accounted for by the set of predictors, the correlation between the model-predicted scores and the actual scores was squared. This pseudo r 2 statistic is analogous to the r 2 statistic in multiple regression and can be interpreted similarly ( Singer & Willett, 2003 ).

Descriptive statistics

Table 1 shows the means, standard deviations, and ranges for sex knowledge, age, intelligence, family income, GPA, school poverty, and school size. Most of the study sample attended schools in or near large metropolitan areas and only a small percentage of schools had high levels of school poverty.

Descriptive Statistics for Participants and Schools

Note. Peabody Picture Vocabulary Test (PPVT).

Model Testing

We first estimated a null model without predictors that partition the sexual health knowledge into within-school and between-school variability ( Snijders & Bosker, 1999 ). In this model, 17.2% of the variance was between schools, whereas 82.8% of the variance was between students within schools. Another interpretation of this statistic, known as the intraclass correlation coefficient (ICC), is that the expected correlation between sexual health knowledge scores of two students randomly drawn from the same school was .17. Although the majority of the variability was between students within schools, rather than between schools, it was considered desirable to predict the between school variability using school characteristics. In addition, although level-2 predictors such as school poverty can only explain level-2 variability, cross-level interactions could potentially explain variability at level-1 and level-2.

In the first substantive model, depicted in column 1 of Table 2 , we investigated whether there were sexual health knowledge differences between adolescents from advantaged and disadvantaged environments, accounting for age and intelligence (Hypothesis 1). Sexual health knowledge increased with age, but this was qualified by a quadratic effect for age, such that the association between sexual health knowledge and age was steepest for younger adolescents and leveled out for older adolescents. There was a similar pattern for intelligence: PPVT scores were more strongly related to sexual knowledge scores for children with lower scores. Sexual health knowledge was higher in females than males. Neither family income nor parental education was associated with sexual health knowledge after accounting for verbal intelligence.

Hierarchical Linear Models Predicting Sexual Health Knowledge.

In Model 2, depicted in column 2 of Table 2 , we included school level concentrations of poverty to test Hypothesis 2 that school level effects would contribute to sexual health knowledge. The main effect of school poverty was unrelated to sexual health knowledge after accounting for the individual-level variables.

To determine whether school factors moderate individual-level factors (Hypothesis 3), several interactions were tested in Model 3. Specifically, we tested the interaction of school poverty with the following variables: excused and unexcused absences from school, PPVT and PPVT 2 , age and age 2 , and GPA. Unexcused absence was a significant predictor of sexual health knowledge (inverse relationship between unexcused absences and sexual health knowledge); however, there was no significant interaction between school poverty and attendance. Consequently, we dropped it from the model. The interactions between school poverty and PPVT were not significant, and therefore were dropped from the final model. Figure 1 shows the simple slope of GPA on sexual health knowledge for adolescents attending schools with varying levels of poverty. To more clearly illustrate the association of poverty with GPA and sexual health knowledge, we chose to show the estimates for schools with no poverty (0%), the sample mean for school poverty (21%), and an estimate for so-called high poverty schools (75%). GPA had less of an effect at low poverty schools than at high poverty schools.

The interaction of GPA and school poverty on sexual health knowledge

Figure 2 shows an analogous figure for the Age × Age × School Poverty interaction. Although students attending low poverty and high poverty schools start and end at similar levels of sexual health knowledge, in mid-adolescence there is a knowledge gap between these students. Specifically, students attending low poverty schools show an early, rapid increase in sexual health knowledge that is delayed in students attending high poverty schools.

The interaction of age and school poverty on sexual health knowledge

The model containing these interactions fit significantly better than the main effects model. Although the increment in r 2 was small, this increase was the change in prediction while controlling for the individual-level predictors.

Adolescence is the period during which risky behaviors leading to social and public health problems such as unplanned pregnancy and sexually transmitted infections start or peak. Consonant with previous studies and our hypothesis, adolescents from lower socio-economic backgrounds had lower levels of sexual health knowledge than their more affluent peers. This is an important finding as there is evidence that disparities in health literacy, such as sexual health knowledge, are associated with sexual risk taking ( Berkman et al., 2011 ).

The key finding in this study is that the school environment exerts an effect, beyond individual socio-economic status, on the sexual health knowledge of adolescents. However, contrary to our hypothesis, school poverty was not directly associated with sexual health knowledge after controlling for individual characteristics. We viewed school poverty as a proxy for overall school resources and expected to see a main effect of school poverty. Instead, school poverty interacted with individual predictors of sexual health knowledge. As we hypothesized, students with poor academic outcomes were especially likely to have low levels of sexual health knowledge in the context of low-income schools. The effect of poor academic achievement on sexual health knowledge was muted in low poverty schools. As shown in Model 3 and Figure 2 , there was a significant interaction between school poverty and age; and as shown in Figure 1 , there was a significant interaction between school poverty and GPA. The interaction plotted in Figure 2 indicates that, compared to their counterparts, adolescents in high-poverty schools take longer to increase their sexual health knowledge. This suggests that during middle adolescence, when many adolescents are beginning to engage in risky sexual behaviors known to lead to unplanned pregnancy and sexually transmitted infections, those in high-poverty schools have less knowledge to guide behavior than their peers in schools with lower levels of poverty. The interaction plotted in Figure 1 shows that the students in high-poverty schools with the lowest GPAs had significantly lower levels of sexual health knowledge than their counterparts in average and low poverty schools. This finding is of concern given that there is strong evidence to suggest an association between academic performance and sexual risk taking ( Halpern et al., 2000 ; Kirby, 2002 ). Although further investigation is required to better understand how schools with a low income student body influence the sexual health knowledge and other health related outcomes of the students who attend those schools, the findings do indicate that interventions to improve the health of adolescents and reduce health disparities should include a focus on resources available in the school environment.

The factors that may explain the association between sexual health knowledge and school environment can be divided into two categories—resources of the school and needs of the students. The resources of schools serving students in high poverty schools –which tend to be urban—do not compare favorably to the resources of affluent schools. For examples, teachers in high poverty schools are less likely to have a master’s degree and regular professional certification than teachers working in low-poverty schools ( Aud et al., 2010 ). In addition, up to 30% of new teachers in large urban schools leave their positions within the first 3 years of teaching indicating high teacher turnover ( Chittooran & Chittooran, 2010 ).

The student factors influencing the sexual health knowledge of students in high poverty schools include the fact that they come to school with a higher level of need than their affluent counterparts in low poverty schools ( Aud et al., 2010 ; Chittooran & Chittooran, 2010 ). Compared to their affluent counterparts, students in high poverty schools are more likely to speak English as a second language, be homeless, and have unmet health care needs. Moreover, they are more likely to live in homes where there is less supervision and in neighborhoods where there are higher rates of crime ( Aud et al., 2010 ; Lippman et al., 1996 ). These environmental characteristics adversely influence the learning environment, as there is an increased likelihood that students will not be able to actively engage with what is being taught in the classroom ( Chittoran & Chittoran, 2010 ).

Our findings extend the understanding of how disadvantages in the lives of children and adolescents influence health disparities. Racial and ethnic minorities are more likely than their White counterparts to live in high poverty urban communities and to experience poorer health than their White counterparts in less distressed communities ( Villaruel, 2004 ). To account for this health disparity most researchers have focused on the differences between these populations in terms of access to healthcare resources and health-related behaviors such as engagement in health-compromising behaviors (e.g., unprotected sexual intercourse, drug use). The results of this study signal that this focus should be broadened to include exploration of how the socio-economic environment of schools influences health ( Ompad, Galea, Caiaffa, & Vlahov, 2007 ). As the findings suggest, this environment plays a role in the social shaping of disease.

Our results support policies that aim to increase the resources of high-poverty schools with increased funding ( Basch, 2010 ). Without increased funding, students in these schools face a double burden due to correlated individual and school level incomes. Moreover, developing policies to improve the outcomes for students attending high-poverty schools will become increasingly important as the number of students attending high-poverty schools is growing. According to the most recent Condition of Education report, one in six students now attends a high-poverty school ( Aud et al., 2010 ).

There are several limitations of this study. First, although as for most researchers, we have used free or reduced school lunch eligibility to understand how school context influences child and adolescent outcomes, there are other school influences on adolescent sexual health knowledge that we did not investigate. Second, very few of the students in our study sample (1.5%) attended schools that would be defined as high-poverty schools (greater than 75% of students eligible for school lunch). Another limitation is that because high school students are likely not to declare their eligibility for free or reduced school lunch ( Gleason, 1995 ) we may have underestimated the extent of school poverty. Future studies using multidimensional tools to quantify school poverty may improve our understanding of how school poverty influences health outcomes.

Conclusions

High school students from low socio-economic communities are less knowledgeable about sexual health than their peers from more affluent communities. This disparity in health information may be associated with future health disparities. If this association proves to be causal, improving the health knowledge of students attending schools with high concentrations of students from low-income households may be an effective means to reduce health disparities.

Acknowledgements

This project was supported through funding by the Robert Wood Johnson Nurse Faculty Scholars Award program. This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 ( ude.cnu@htlaehdda ). No direct support was received from grant P01-HD31921 for this analysis

Contributor Information

Robert Atkins, Rutgers University-Camden Center for Children, 325 Cooper Street, Camden, NJ 08102.

Michael J. Sulik, Arizona State University Department of Psychology Tempe, AZ.

Daniel Hart, Rutgers University-Camden Center for Children, Camden, NJ.

Cynthia Ayres, Rutgers, The State University of New Jersey Rutgers University-Newark College of Nursing, Newark, NJ.

Nichole Read, Rutgers University-Camden Center for Children, Camden, NJ 08102.

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Relationships and sex education (RSE) and health education

Statutory guidance on relationships education, relationships and sex education (RSE) and health education.

Applies to England

Relationships education, relationships and sex education (rse) and health education.

PDF , 622 KB , 50 pages

Foreword by the Secretary of State

About this guidance, introduction to requirements, relationships education (primary), relationships and sex education (rse) (secondary), physical health and mental wellbeing (primary and secondary), delivery and teaching strategies, annex a: regulations for relationships education, relationships and sex education (rse) and health education, annex b: resources for relationships education, relationships and sex education (rse) and health education, annex c: cross government strategies for relationships education, relationships and sex education (rse) and health education, implementation of relationships education, relationships and sex education and health education 2020 to 2021.

This is statutory guidance from the Department for Education (DfE) issued under section 80A of the Education Act 2002 and section 403 of the Education Act 1996.

Schools must have regard to the guidance and, where they depart from those parts of the guidance which state that they should, or should not, do something, they will need to have good reasons for doing so.

This statutory guidance applies to all schools, and is for:

• governing bodies of maintained schools (including schools with a sixth-form) and non-maintained special schools
• trustees or directors of academies and free schools
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• headteachers, principals and senior leadership teams
• diocese and other faith representatives
• relevant local authority staff for reference

To help school leaders follow this statutory guidance, we have published:

• an implementation guide to help you plan and develop your curriculum
• a series of training modules to help train groups of teachers on the topics within the curriculum
• guides to help schools communicate with parents of primary and secondary age pupils

Updates to the page text to make it clear this guidance is now statutory. Updated the drugs and alcohol section of annex B to include a link to the teacher training module on drugs, alcohol and tobacco and to remove the link to the research and briefing papers. We have not made changes to any of the other guidance documents.

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Which states are restricting, or requiring, lessons on race, sex and gender

Since 2017, dozens of states have enacted more than 120 laws and policies reshaping the teaching of race, racism, sexual orientation and gender identity. These new rules now affect how three-fourths of the nation’s students learn about topics ranging from the role of slavery in American history to the lives of nonbinary people.

The Washington Post is tracking state laws, rules and policies that regulate instruction about race, as well as lessons on sex and gender, and will continue to update this page as state leaders take action.

Much of the first wave of curriculum legislation — from the late 2010s to 2021 — focused on how schools can teach about race, racism and the nation’s racial history.

How race education has changed in each state

Mostly blue states have passed expansive laws that do things like require that students learn about Black or Native American history. For example, a 2021 Delaware law says schools must offer K-12 students instruction on Black history including the “central role racism played in the Civil War” and “the significance of enslavement in the development of the American economy.”

Mostly red states, meanwhile, have passed laws that, among other things, outlaw teaching a long list of concepts related to race, including the idea that America is systemically racist or that students should feel guilt, shame or responsibility for historical wrongs due to their race. For example, a 2021 Texas law forbids teaching that “slavery and racism are anything other than deviations from, betrayals of, or failures to live up to, the authentic founding principles of the United States, which include liberty and equality.”

The target of curriculum laws has shifted over time to include determining how teachers can discuss — or whether they can discuss — gender identity and sexual orientation with students.

Changes to sex/gender education in each state

Mostly blue states have passed expansive laws that do things like require teaching about prominent LGBTQ individuals in history. For example, a 2024 Washington state law says school districts must adopt “inclusive curricula” and “diverse, equitable, inclusive” instructional materials that feature the perspectives of historically marginalized groups including LGBTQ people.

But at the same time, mostly red states have passed restrictive laws that would, among other things, outlaw lessons about gender identity and sexual orientation before a certain grade or require parental permission to learn about these topics. In one example, a 2023 Tennessee law says schools must obtain parents’ written consent for a student to receive lessons featuring a “sexual orientation curriculum or gender identity curriculum.”

Who is affected by these restrictions?

The laws cumulatively affect about three-fourths of all Americans aged 5 to 19, The Post found. The restrictive laws alone affect nearly half of all Americans in that age group. The majority of laws apply to K-12 campuses, where First Amendment protections are less potent as compared to the freedoms the courts have afforded to college and university professors.

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LGBTQ+ students may need to seek sex education outside school due to curricula gaps

Doing so could force them to seek inaccurate, potentially dangerous advice elsewhere

Media Information

• Embargo date: June 17, 2024 12:01 AM CT
• Release Date: June 14, 2024

Media Contacts

Kristin Samuelson

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Journal: The Journal of Sex Research

• Addressing negligence could be ‘life-saving,’ argue study authors
• Curricula based on abstinence-only approaches or religious principles, or contained oppressive, suppressive elements marginalized LGBTQ+ youth, survey found
• ‘I wish I was taught about gay sex, sexual orientation, and all the other controversial topics that [are deemed] ‘grooming,’ one survey respondent said

CHICAGO --- Children across the U.S. who identify as LGBTQ+ say the sexual health-education curricula they receive is leaving them without essential information to make informed decisions about their sexual health, which could force them to seek potentially inaccurate or dangerous advice elsewhere.

The results of a new, national, peer-reviewed survey, show these young people — aged 13 to 17 — believe crucial topics surrounding sexual orientation and gender identity are being omitted from sexual health-education programs.

One survey respondent said, “I wish I was taught about gay sex, sexual orientation, and all the other controversial topics that [are deemed] ‘grooming.’ When kids aren’t taught good sex ed, they learn how to do it in an unhealthy way from other sources like the internet or word of mouth. If we teach children about these topics, they’ll be safer when they become teenagers.” (Read more comments below)

Experts who led the study say the addition of key items in the curricula could be “life-saving.”

The study was published June 17 in The Journal of Sex Research .

“LGBTQ+ youth expressed a strong desire to learn more about topics related to their sexual orientation and gender identity, highlighting a critical gap in existing curricula,” said study author Erica Szkody , a postdoctoral research associate at Northwestern University Feinberg School of Medicine who led the data collection for the study.

“Despite the well-known benefits of comprehensive sexual health education, the majority of school sexual health-education curricula in the U.S. is non-comprehensive and excludes LGBTQ+ students. Our analyses underscore the extent of this exclusion.”

Szkody works in the Lab for Scalable Mental Health , which is directed by Jessica Schleider, associate professor of medical social sciences and pediatrics at Feinberg.

Of more than 800 survey respondents, most participants reported a lack of LGBTQ+ content in their sexual health-education experiences. In order to be educated on sexual health, most were using extracurricular sources including online spaces, friends and personal experiences with sexual exploration. The authors found these extracurricular sources are frequently preferred by LGBTQ+ youth; but may lack accuracy and reliability.

Overall, participants described feeling marginalized by curricula that were based on abstinence-only approaches, religious principles or contained oppressive and suppressive elements, such as negative remarks about LGBTQ+ individuals or skipping required LGBTQ+ content altogether.

“The exclusion of LGBTQ+ students from the curricula may contribute to poor health outcomes in LGBTQ+ youth, with some research beginning to document these experiences and provide recommendations for curricula changes,” said lead author Steven Hobaica, clinical psychologist and research scientist at The Trevor Project, whose mission is to end suicide among LGBTQ+ young people. “Addressing this negligence is urgent and could be life-saving.”

“Given the current political climate, with legislation attempting to exclude LGBTQ+ information in schools, we encourage policymakers to continue fighting for LGBTQ+ inclusion in curricula as a means to prevent health problems for a vulnerable group,” he said.

The survey also provided LGBTQ+ young people the opportunity to openly share on their experiences and recommendations for change regarding sexual health education:

These suggestions included:

• More LGBTQ+ content in sexual health education curricula, as well as more detail on healthy and diverse relationships (e.g., non-monogamy, polyamory), consent, safety in relationships and communication skills.
• Creating safe and supportive spaces while considering legitimate fears due to a possible increase in bullying, as they had heard students make fun of the material or use discriminatory language during past implementation.
• Updating sexual health-education materials to reflect LGBTQ+ lived experiences, history and risk factors.
• Creating sexual health interventions focused on LGBTQ+ experiences and concerns. Improving access to reliable sexual health information.
• Creating more accessible sexual-health information via other avenues, such as online and through mobile applications.

Other comments from survey respondents include:

“I wish others understood that while the anatomy-related knowledge is important, we need sexual [health] education that is relevant to today’s world. This involves sexual [health] education [about] dangers and safety on the Internet, [same-sex/gender] relations, and education geared towards attraction and feelings rather than a lesson only [regarding] heterosexual procreation. I wish they took our real-life experiences and insecurities into account.”

“It is NOT HARMFUL to talk about gender identity and sexuality with high schoolers. It SAVES LIVES.”

The authors hope their findings contribute to a “critical” policy shift toward including LGBTQ+ young people in sexual health education, a community that is “often underserved.”

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US sexual health curriculum could force LGBTQ+ students to seek education outside of school, survey suggests

by Taylor & Francis

Children across the United States who identify as LGBTQ+ say the sexual health education curricula they receive is leaving them without essential information to make informed decisions about their sexual health—which could force them to seek potentially dangerous advice elsewhere.

The results of a new national survey show that these young people —aged 13 to 17—believe crucial topics surrounding sexual orientation and gender identity are being omitted from sexual health education programs.

Experts who led the study—published in The Journal of Sex Research , as people around the world celebrate Pride month—say the addition of key items in the curricula could be "life-saving."

"The exclusion of LGBTQ+ students from the curricula may contribute to poor health outcomes in LGBTQ+ youth, with some research beginning to document these experiences and provide recommendations for curricula changes," explains lead author Steven Hobaica, a clinical psychologist and Research Scientist at The Trevor Project, whose mission is to end suicide among LGBTQ+ young people.

"Addressing this negligence is urgent and could be life-saving.

"Given the current political climate, with legislation attempting to exclude LGBTQ+ information in schools, we encourage policymakers to continue fighting for LGBTQ+ inclusion in curricula as a means to prevent health problems for a vulnerable group."

Of more than 800 respondents to the survey, most participants reported a lack of LGBTQ+ content in their sexual health education experiences. In order to be educated on sexual health, most were using extracurricular sources including online spaces, friends, and personal experiences with sexual exploration. The authors found that these extracurricular sources are frequently preferred by LGBTQ+ youth; but may lack accuracy and reliability.

Overall, participants described feeling marginalized by curricula that were based on abstinence-only approaches, religious principles, or contained oppressive and suppressive elements—such as negative remarks about LGBTQ+ individuals or skipping required LGBTQ+ content altogether.

"LGBTQ+ youth expressed a strong desire to learn more about topics related to their sexual orientation and gender identity, highlighting a critical gap in existing curricula," says co-author Dr. Erica Szkody, who is a Postdoctoral Research Associate, at the Lab for Scalable Mental Health, at Northwestern University.

"Despite the well-known benefits of comprehensive sexual health education, the majority of school sexual health education curricula in the U.S. is non-comprehensive and excludes LGBTQ+ students.

"Our analyses underscore the extent of this exclusion."

The survey also provided LGBTQ+ young people the opportunity to openly share on their experiences, as well as recommendations for change, in regard to sexual health education:

These suggestions included:

• More LGBTQ+ content in sexual health education curricula, as well as more detail on healthy and diverse relationships (e.g., non-monogamy, polyamory), consent, safety in relationships, and communication skills.
• Creating safe and supportive spaces, while considering legitimate fears due to a possible increase in bullying, as they had heard students make fun of the material or use discriminatory language during past implementation.
• Updating sexual health education materials to reflect LGBTQ+ lived experiences, history, and risk factors.
• Creating sexual health interventions focused on LGBTQ+ experiences and concerns.
• Improving access to reliable sexual health information.
• Creating more accessible sexual health information via other avenues, such as online and through mobile applications.

Summarizing their experiences of sexual health curricula in the U.S., LGBTQ+ study participants left heartfelt responses:

"I wish I was taught about gay sex, sexual orientation, and all the other controversial topics that [are deemed] 'grooming.' When kids aren't taught good sex ed, they learn how to do it in an unhealthy way from other sources like the internet or word of mouth. If we teach children about these topics, they'll be safer when they become teenagers," one said.

Another added, "I wish others understood that while the anatomy-related knowledge is important, we need sexual [health] education that is relevant to today's world. This involves sexual [health] education [about] dangers and safety on the Internet, [same-sex/gender] relations, and education geared towards attraction and feelings rather than a lesson only [regarding] heterosexual procreation. I wish they took our real-life experiences and insecurities into account."

One more exclaimed, "It is NOT HARMFUL to talk about gender identity and sexuality with high schoolers. It SAVES LIVES."

The authors hope that their findings contribute to a "critical" policy shift toward including LGBTQ+ young people in sexual health education , a community that is "often underserved."

"By including the voices of LGBTQ+ young people in curricula design, we can not only provide the necessary knowledge for youth to engage in healthy relationships and health behaviors, but also can contribute to a more accepting and equitable society for years to come," states Hobaica.

Although this study incorporated quantitative and qualitative analyses with a large national sample of LGBTQ+ youth, it had limitations. "Given sample size constraints, we could not draw conclusions regarding recommendations from students with specific identities," explain the authors who state future work could collect similar data from even larger samples for further generalizability and comparisons.

Journal information: Journal of Sex Research

Provided by Taylor & Francis

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Lack of Sex Education in US Schools Leaves Youth at Risk: CDC Releases New Data

For Immediate Release: Dec. 10, 2015

NEW YORK, NY  — Today, the US Centers for Disease Control and Prevention (CDC)  announced  that in most U.S. states, fewer than half of high schools and just one in five middle schools teach all the essential sex education topics recommended by the Centers for Disease Control and Prevention. The number of topics covered varied by state and states that teach all recommended topics range from a low of 21 percent (in AZ) to 90 percent (in NJ) in high schools and from 4 percent (in AZ) to 46 percent (in NC) in middle schools.

Statement from Leslie Kantor, PhD, MPH, Vice President of Education at Planned Parenthood Federation of America:

“Sex education is essential to adolescents’ overall health and well-being.  The fact that young people in so many states are being deprived of information critical to their sexual health is unacceptable.  More than 90% of parents support sex education that covers a wide range of topics in both high school and middle school.  Planned Parenthood is available throughout the country to partner with schools in providing high quality sex education.  We hope that the new CDC data serves as a wakeup call that we can and must do better in giving young people the sex education they need and deserve.” 

Planned Parenthood is the nation’s leading provider and advocate of high-quality, affordable health care for women, men, and young people, as well as the nation’s largest provider of sex education. With approximately 700 health centers across the country, Planned Parenthood organizations serve all patients with care and compassion, with respect and without judgment. Through health centers, programs in schools and communities, and online resources, Planned Parenthood is a trusted source of reliable health information that allows people to make informed health decisions. We do all this because we care passionately about helping people lead healthier lives.

Planned Parenthood Federation of America

Planned Parenthood Federation of America media office: 212-261-4433

December 09, 2015

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News | Georgia senators again push conservative aims…

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News | Georgia senators again push conservative aims for schools

Georgia’s republican state senators are making another attempt to impose a conservative stamp on the state’s public schools.

The Senate voted 33-21 along party lines for House Bill 1104 , a measure that originally dealt with suicide prevention, but was radically overhauled in Senate committee by adding a number of other bills that had earlier failed to pass the Senate. The measures mirror bills brought by Republicans in other states.

“Simply, what this bill does is it protects children and it empowers parents,” said Sen. Clint Dixon, a Buford Republican who shepherded the bill.

But Sen. Elena Parent, an Atlanta Democrat, called the measure “an amalgamation of a whole number of wrongheaded culture war bills.”

Although it’s unclear whether the more moderate House will be receptive to the measure, it was pushed forward by Republican Lt. Gov. Burt Jones , who has been building a conservative record in advance of a possible run for governor in 2026.

“As the father of a daughter who plays sports, I will never stop fighting to preserve the integrity of women’s sports so that the next generation of Georgia’s female athletes can compete on a safe and level playing field,” Jones said in a statement.

The measure would ban transgender girls from competing in girls’ high school sports. It does not ban transgender males from competing against other males, and it applies not only to public schools but to private schools that compete against public schools. The Georgia High School Association, which regulates high school sports, already enacted such a ban after an earlier law encouraged it.

It would also ban transgender boys and girls playing sports from using multi-occupancy restrooms or locker rooms of the gender with which they identify. However, the bill does not appear to ban transgender boys and girls from all bathrooms matching their gender identity.

Jennifer Hadley of Bethlehem, who has a transgender son, said she wasn’t sure how it would affect his participation in band. She said her son is “already having a hard enough time as it is just being a teenager, much less being a trans teenager.”

“The uncertainty that this enters into their lives — it has its mental toll over time,” Hadley said.

In another section of the bill, schools could drop sex education and students would only be enrolled if parents specifically opt in. The measure would ban all sex education in fifth grade and below.

Currently state sex education standards call for little explicit discussion of human reproduction below eighth grade, although second graders are supposed to learn the names of all body parts and “appropriate boundaries around physical touch.” Fifth graders are supposed to learn about puberty, and most mandated sex education happens in a high school health course.

The bill says schools can still talk about child abuse and assault awareness and prevention and menstruation. But it’s unclear if a teacher could explain to a fifth grader why she is menstruating. Dixon said in committee that his wife had explained menstruation to one of his daughters without explaining human reproduction.

The measure would require school boards to provide 45 days of public review and comment, and two public hearings before adopting a sex education curriculum. Another two-week notice would be required before material is actually presented in school.

“Children only have a finite time of innocence and we should be wanting to protect that,” Dixon said.

But opponents warn that the opt-in provision will lead to many parents unintentionally failing to enroll their students.

“What is this bill?” asked Sen. Josh McLaurin, an Atlanta Democrat. “It’s nothing more than banning everyone from talking about sex so a few parents who feel uncomfortable don’t have to have the talk until later in life. It’s weak.”

A third portion of the bill would let parents choose to receive an email any time their child obtains library material. It also creates a parental right to all information about a student including reports of behavioral patterns, academic intervention strategies, or any material made available to a student including classroom, library and extracurricular activities.

Rep. Omari Crawford, the Decatur Democrat who sponsored the original part of the bill dealing with suicide prevention among high school athletes, said he’s now working against its passage.

“The language that was added is probably going to exacerbate suicide rates,” Crawford said. “So I don’t think it’s going to prevent suicide.”

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