1 Abstinence and Comprehensive Sex/HIV Education Programs: Their Impact on Behavior In Developed and Developing countries Douglas Kirby, Ph.D., ETR Associates August 2008

2 Based in Part on the Reports: Sex and HIV Education Programs: Their Impact on Sexual Behaviors of Young People Throughout the World −By Douglas Kirby, B.A Laris, & Lori Rolleri −Published in the Journal of Adolescent Health Emerging Answers 2007: Research Findings on Programs to Reduce the Problems of Teen Pregnancy and Sexually Transmitted Diseases −Published by the National Campaign to Prevent Teen and Unplanned Pregnancy

3 Sex and STD/HIV Programs Goals:  Decrease unintended pregnancy  Decrease STD including HIV/AIDS  Improve sexual health in other ways

4 Study Criteria Programs:  Targeted young people up through age 19 in the U.S. or age 25 elsewhere  Were curriculum-based with structured activities involving groups of youth (not one- on-one interaction  Focused on sexual behavior (not drugs, violence, etc and sexual risk)  Were implemented in schools or community settings  Were implemented anywhere in the world

5 Studies:  Employed experimental or quasi-experimental design  Had a sample size of 100 or larger  Measured impact on initiation of sex for at least 6 months and other behaviors for at least 3 months  Were published in 1990 or later Study Criteria

6 The Number of Programs with Indicated Effects on Sexual Behaviors (U.S. Only)

7

8 The Number of Comprehensive Programs with Indicated Effects on Sexual Behaviors

9

10 The Number and Percent of Comprehensive Programs with Indicated Effects on Any Behavior

11 The Number and Percent of Comprehensive Programs with Indicated Effects on Two or More Behaviors

12 Conclusions about the Impact of Sex and STD/HIV Education Programs  Abstinence programs have little evidence of positive impact  Some are not effective  Sex/HIV education programs  Do not increase sexual activity  Some sex/HIV education programs:  Delay initiation of intercourse  Reduce number of sexual partners or  Increase use of condoms/contraception  Some do all three

13 Conclusions about the Impact of Sex/HIV Education Programs continued  Emphases upon abstinence, fewer partners and condoms/contraception are compatible, not conflicting

14 Conclusions about the Impact of Sex/HIV Education Programs continued  Programs are quite robust; they are effective with multiple groups:  Males and females  Different racial and ethnic groups  Sexually experienced and inexperienced  Youth in advantaged and disadvantaged communities  Youth in countries throughout the world  Programs may be especially effective:  With higher risk youth in disadvantaged communities  In communities where they address a salient issue

15 Conclusions about the Impact of Sex/HIV Education Programs continued Sex/HIV education programs:  Are not a complete solution  Can reduce sexual risk by roughly one-third  Can be an effective component in a more comprehensive initiative

Characteristics of Effective Programs 17 Characteristics distinguish the programs that changed behavior from those that did not 16

17 Are programs effective when they are replicated by others?

18 Yes, if implemented with fidelity All activities as designed Similar settings

Barriers To Implementation There are at least eight important barriers to implementing effective programs. These are listed in my handout. 19

Conclusion Should overcome barriers and implement with fidelity comprehensive sex education programs demonstrated to be effective with similar populations 20

21 Thank You

Barriers to Implementation 1. Belief that teaching young people about sex and protection will encourage them to have sex Partial Solution Provide the strong evidence that comprehensive programs do not increase sexual behavior when abstinence is also emphasized 22

Barriers to Implementation 2. Belief that kids don’t need sex education, because they should remain abstinent until marriage Partial Solution Emphasize that in many youth cultures, youth still need skills to refuse sex and will need information and skill later in their lives 23

Barriers to Implementation 3. Parents fear that comprehensive sex education may teach values inconsistent with parental values Partial Solution −Involve parents in the development and review of the curriculum −Include homework assignments to have youth talk with their parents about their parents’ values 24

Barriers to Implementation 4. Policy-makers fear that opponents will produce controversy Partial Solution −Measure parent support through surveys and provide evidence of that support 25

Barriers to Implementation 5. Too little classroom time for sex ed -- schools must emphasize the basics, not sexual skills Partial Solution −Emphasize sexuality is a basic – just ask teens −Emphasize the impact on education and life goals of unplanned pregnancies and STD/HIV 26

Barriers to Implementation 6. Few educational policies support comprehensive sex education Partial Solution −Provide evidence of impact and get policies passed 27

Barriers to Implementation 7. No resources, training or other support for comprehensive sex education teachers Partial Solution −Develop training programs in educational programs in universities −Hold annual training programs in different regions 28

Barriers to Implementation 8. Ineffective programs are implemented Partial Solution −Conduct rigorous impact studies and implement programs that are effective at changing behavior −Implement programs that incorporate the characteristics of effective programs 29

Evidence for Impact of Replications The following slides provide the results of replications of comprehensive sex education curricula They suggest curricula remain effective when implemented with fidelity (all lessons in the same setting) 30

31 California schools: 16 sessions  Delayed sex; increased contraceptive use Arkansas schools: 16 sessions  Delayed sex; increased condom use Kentucky schools: 16 sessions  Delayed sex; no impact on condom use* Kentucky schools: 12 sessions  Delayed sex; no impact on condom use Replications of Studies: Reducing the Risk

32 Philadelphia: 5 hours on Saturdays  Reduced sex & # partners; increased condom use Philadelphia: 8 hours on Saturdays  Reduced freq of sex; increased condom use 86 CBO in northeast: 8 hours on Saturdays  Increased condom use Philadelphia: 8 hours on Saturdays  Reduced sex & # partners; increased condom use Cleveland: 8 sessions in school  Deleted one condom activity  No significant effects on any behavior Replications of Studies: “Be Proud, Be Responsible” or “Making Proud Choices”

33 Jackson, Miss health center: minute sessions  Delayed sex; reduced frequency; increased condom use Residential drug treatment: minute sessions  Reduced sex & # partners; increased condom use Juvenile reformatory: 6 1-hour sessions  No effects Replications of Studies: Becoming a Responsible Teen

34 Replications of Studies: Focus on Kids Baltimore recreation center: 8 sessions  Increased condom use West Virginia rural areas: 8 90-minute sessions  Deleted some condom activities  No effects

35  Curricula can remain effective when implemented with fidelity by others!  Fidelity: All activities; similar structure  Substantially shortening programs may reduce behavioral impact  Deleting condom activities may reduce impact on condom use  Moving from voluntary after-school format to school classroom may reduce effectiveness Replications of Studies: Preliminary Conclusions