Education program design may benefit from health professionals' involvement.

The likelihood that Texas middle school students felt that sexual involvement should be postponed at least until after high school rose significantly after the youngsters took a sex education course designed by a team from an academic medical center. (1) Most of the change was attributable to an increase in the proportion who said that people should wait until marriage to have sex. Among the characteristics that were associated with a belief in delaying sexual activity were having taken a virginity pledge, intending to avoid substance use and achieving a high score on a test measuring knowledge of sexuality-related issues. Knowledge scores also increased after students took the course.

The curriculum was developed after school administrators in an area of Texas whose school system lacked a sex education program asked members of the obstetrics and gynecology department of an academic medical center for assistance in choosing one. Because the health care professionals were dissatisfied with the content and medical accuracy of available curricula, they collaborated with child psychologists, attorneys and educators to design a new one. In accordance with the preferences of parents and school officials, the program focuses on consequences of teenage sexual activity, the importance of delaying sexual initiation, skill building, character development and refusal skills.

Specially trained teachers in 33 school districts presented the curriculum in science classes for students in grades 6-8 during the 2002-2003 school year. Before and immediately after participating in the two week program, students completed surveys assessing their demographic characteristics, behaviors, attitudes and knowledge of sexuality-related issues (including reproductive anatomy and physiology, STDs, teenage pregnancy, sexual abuse and legal issues). Researchers compared data from the two survey rounds and used multivariate logistic regression to identify characteristics associated with attitudes toward sexual activity.

Approximately 26,000 students completed surveys before taking the course, and 25,000 immediately afterward. In both groups, equal proportions of respondents were male and female; nearly one-half were white, one in five were Hispanic, one in seven were black and the rest were members of other racial or ethnic groups. About half of the youth lived with both parents, and half said that their parents were married. The majority of students reported that they usually got As or B's in school, that they participated in at least one extracurricular activity and that they watched 1-4 hours of TV on school nights.

Students scored significantly higher on the knowledge test after the program than before. On average, sixth graders' scores rose from 60 to 79, seventh graders' from 68 to 77 and eighth graders' from 61 to 73. Students also demonstrated a shift in attitude toward the timing of sexual activity: Whereas 84% said before taking the sex education course that people should wait until after high school, until after postsecondary school or until marriage to have sex, 87% gave these answers after participating in the course. The difference, although small, was statistically significant and mainly reflected an increase from 60% to 71% in the proportion who thought that sexual activity should be postponed until marriage. Comparisons of data from the two survey rounds also revealed increases in the proportions of youth who said that sex is not a safe activity for teenagers, that it is not acceptable for unmarried teenagers to become pregnant and that they intend to wait until they are married to have sex.

In multivariate analyses, the characteristics associated with students' believing that young people should delay sexual initiation were similar before and after presentation of the sex education curriculum. Youth who had taken a virginity pledge had the most sharply elevated odds of expressing this attitude (odds ratio, 7.4 in the second survey): the odds also were markedly elevated among those who reported an intention to abstain from use of alcohol and drugs (2.6). More modest increases were associated with weekly attendance at religious services, having married parents, watching no more than two hours of TV on school nights, being female, being white and scoring 70 or higher on the knowledge test (1.1-1.6). Students who reported current substance use had significantly reduced odds of believing that teenagers should postpone sexual involvement (0.4).

The researchers acknowledge that the study is limited by the lack of a control group and of long-term behavioral measures. However, they note that involving medical professionals in the development of sex education programs "can assure medically correct content, appropriate research outcomes, and enhanced quality of medical information in this important area of adolescent health."

REFERENCE

(1.) Sulak PJ et al., Impact of an adolescent sex education program that was implemented by an academic medical center, American Journal of Obstetrics and Gynecology, 2006, 195(1):78-84.