1. An Examination of College Student Sex Practices and History of Formal Sex Education Shelly Hook, MD, Robert Casanova, MD; Linda Brice, PhD, Lisa Welch, MS, Jennifer Holmes, MSIII

2. UNPLANNED (TEEN) PREGNANCY Lubbock County 1999 - 2003 Source: Texas Department of State Health Services – Family Health Research & Program Development Unit Lubbock County (10-17 y/o): 106.6 per 1,000 Texas (13-17y/o): 27.6 per 1,000 U.S. (15-17 y/o): 22.4 per 1,000

3. Reported Cases Sexually Transmitted Diseases (Lubbock County, 2007) 1,139 cases of Chlamydia (2005 – 1,279 Cases) (2006 – 1,417 Cases) 394 cases of Gonorrhea (2005 – 429 Cases) (2006 – 489 Cases) 14 cases of syphilis (11 early) (2006 – 13 Cases – 7 Early) 11 cases of HIV (2006 – 8 Cases) 1 case of AIDS (2006 - 3 Cases) Source: Ricky Vaughn, LBSW, City of Lubbock Health Department - 2008

4. CHLAMYDIA & GONORRHEA: Cases & Rates by Count (2005) LOCATIO N 2005 CASES Chlamydia 2005 RATES* LOCATIO N 2005 CASES Gonorrhea 2005 RATES* U.S.976,445332.5U.S.339,593115.6 Texas71,621311.4Texas26,016113.1 Bell2,229872.6Bell975381.7 Lubbock1,279501.6Potter411346.1 Bexar7,421496.8Dallas5,037213.9 Travis3,679426.0McLennan457206.1 Dallas9,816416.9Lubbock429168.2 El Paso2,647358.1Travis1,367158.3 Tarrant5,234326.6Tarrant2,535158.2 Harris11,164301.1Bexar2,194146.9 Harris4,371117.9 El Paso34246.3 Rates represent cases per 100,000 Population. Source: Teen Straight Talk: 2005 Texas HIV/STD Surveillance Report (Texas Department of State Health Services )

5. Chlamydia Cases by State (2005) RANKSTATE CASERATE/100,000 1Mississippi21,268732.6 2Alaska4,355664.4 LUBBOCK1,279501.6 3New Mexico8,456444.3 4South Carolina18,296435.8 22New York63,966332.7 U.S.976,445332.5 24Indiana20,063321.1 25Texas71,860319.5 Source:Teen Straight Talk: CDC – 2005 STD Surveillance Report

6. Sexual activity Among Youth Adolescent period is marked many physical changes, cognitive changes and an interest in sexual activity “By the time they are in the 12th grade, 65% of US high school students have had sexual intercourse.” (Eaton, 2008)

7. Abstinence Only vs. Comprehensive Sex Education For more than 12 years there has been federal funding for abstinence-only-until- marriage (AOUM) sex education in spite of a lack of evidence that these programs reduce teenage pregnancy rates (Duffy et al 2008)

8. AOUM All programs receiving federal funding must: –Teach that abstinence is the only certain way to avoid unplanned pregnancy and STDs –Any educational program that provides information about contraceptive options outside of failure rates can not receive AOUM funding Duffy, 2008

9. Abstinence Pledge Results show that those who pledge to delay intercourse were less likely to use contraception at first intercourse 88% had intercourse before marriage Bearman & Bruckner, 2001

10. Abstinence Only vs. Comprehensive Sex Education For more than 12 years there has been federal funding for abstinence-only-until-marriage (AOUM) sex education in spite of a lack of evidence that these programs reduce teenage pregnancy rates (Duffy et al 2008) Formal sex education may reduce risky sexual behavior among adolescents (Meuller et al, 2008)

11. Abstinence Only vs. Comprehensive Sex Education For more than 12 years there has been federal funding for abstinence-only-until-marriage (AOUM) sex education in spite of a lack of evidence that these programs reduce teenage pregnancy rates (Duffy et al 2008) Formal sex education may reduce risky sexual behavior among adolescents (Meuller et al, 2008) Knowledge about condom use leads to ‘safer-sex’ behavior and reduces the prevalence of STDs (Gaydos et al, 2008)

12. Abstinence Only vs. Comprehensive Sex Education For more than 12 years there has been federal funding for abstinence-only-until-marriage (AOUM) sex education in spite of a lack of evidence that these programs reduce teenage pregnancy rates (Duffy et al 2008) Formal sex education may reduce risky sexual behavior among adolescents (Meuller et al, 2008) Knowledge about condom use leads to ‘safer-sex’ behavior and reduces the prevalence of STDs (Gaydos et al, 2008) Knowledge about contraceptive options increased the use of contraceptives (Peterson et al, 2007)

13. Abstinence Only vs. Comprehensive Sex Education For more than 12 years there has been federal funding for abstinence-only-until-marriage (AOUM) sex education in spite of a lack of evidence that these programs reduce teenage pregnancy rates (Duffy et al 2008) Formal sex education may reduce risky sexual behavior among adolescents (Meuller et al, 2008) Knowledge about condom use leads to ‘safer-sex’ behavior and reduced STD prevalence (Gaydos et al, 2008) Knowledge about contraceptive options increased the use of contraceptives (Peterson et al, 2007) Knowledge about contraceptive options leads to increased contraceptive use and lower rates of teenage pregnancy. (Chung- Park, 2008)

14. Materials and Methods Students participating in a Texas Tech University sponsored health fair voluntarily completed a survey requesting information about age, gender, history of sex education and sexual practices. The Texas Tech University Health Sciences Center’s Internal Review Board approved the survey and only students 18 years and older participated in the study.

15. Sex Survey 1. Age: ____ 2. Sex:  M  F 3. Marital Status:  Single  Married  Divorced Separated Widowed 4. Race/Ethnicity: Caucasian  Black (African-American) Black (other) Asian Hispanic Middle Eastern Other 5. First three digits of your HOME zip code __ __ __ XX 6. Did you have Sex Education in High School Yes No 7. If Yes, was it Abstinence only Abstinence and contraception Abstinence, contraception and sexually transmitted infection 8. Are you sexually active? Yes No 9. How old were you when you first had vaginal/penile sex? ___ 10. How old were you when you first had oral sex? ___ 11. How many partners have you had in your lifetime? ___ 12. How many partners have you had in the last 12 months? ___ 13. Are you sexually active with same sex partners opposite sex partners both 14. Do you use condoms? Yes No 15. Do you use other forms of birth control? Yes No 16. Do you engage in oral sex? Yes No 17. Do you engage in anal sex? Yes No 18. Do you engage in vaginal/penile sex? Yes No 19. Have you ever had Chlamydia Gonorrhea Herpes Syphilis HPV HIV

16. Data Summary 520 surveys completed Mean age of 20.73 (SD 2.47) Males: 277 (53%) Females: 243 (47%) Mean age of initiation of sexual activity –*Oral sex: 16.71 (SD 2.32) –*Vaginal/Penile sex: 17.11 (SD 2.15) –Significance p ≤ 0.015

17. Sexually Transmitted Diseases Chlamhydia7 (1.3%) Gonorrhea3 (0.6%) Herpes3 (0.6%) Syphilis2 (0.4%) HPV7 (1.3%) HIV2 (0.6%)

18. Type of Sex Education

19. Type of Sexual Activity

20. Reported Condom Use p< 0.014

21. Conclusions Type of sex education does not influence reported sexual activity Those with comprehensive sex education are less likely to engage is risky sexual behavior by using barrier contraception (condoms) than those with abstinence only sex education An interesting trend is that the data suggests that those with no formal sex education are more likely to report condom use than those with abstinence only education (75% vs 68%).

22. References 1. Bearman P, and Bruckner H, Promoising the future: virginity pledes and the transition to first intercourse. American Journal of Sociology, 2001, 106: 859-912. 2. Centers for Disease Control – 2005 STD Surveillance Report 3. Chung-Park MS, Evaluation of a pregnancy prevention program using the contraceptive behavior change model. Journalcompilation Blackwell Publishing Ltd, 2007, 1: 81-84. 4. City of Lubbock Health Department – 2008 surveillance data 5. Duffy K, Lynch DA and Santinelli J, Government support for abstinence-only-until-marriage education. Clinical Pharmacology & Therapeutics, 2008, 84(6): 746-748. 6. Eaton D, Youth risk behavior surveillance - United States, 2007. MMWR Surveillance Summary, 2007, 57, 1- 131. 7. Gaydos CA, Hsieh YH, Galbraith JS, Barnes M, Waterfield G and Stanton B, Focus-on-teens, sexual risk- reduction intervention for high-school adolescents: impact on knowledge, change or risk-behaviors, and prevalence of sexually transmitted diseases. International Journal of STD & AIDS, 2008, 19: 704-710. 8. Mueller TE, Gavin LE and Kulkarni A, The association between sex education and youth ’ s engagement in sexual intercourse, age at first intercourse and birth control use at first sex. Journal of Adolescent Health, 2007, 42: 89-96. 9. Peterson R, Albright J, Garrett JM and Curtis KM, Pregnancy and STD prevention counseling using an adaptation of motivational interviewing: a randomized controlled trial. Perspectives on Sexual and Reproductive Health, 2007, 39(1): 21-27. 10. Texas Department of State Health Services – Family Health Research & Program Development Unit, 2005 Texas HIV/STD Surveillance Report

23. Questions?