1. HEALTH ECONOMICS Health Econ. 14: 851–867 (2005) AIDS education, condom demand, and the sexual activity of American youth

2. Question of Interest How does AIDS education affect the sexual behavior of young people? How does AIDS education affect the sexual behavior of young people? ChoicesChoices Abstinence-Intercourse Decision Abstinence-Intercourse Decision Condom Decision Condom Decision

3. Literature Public health literature: AIDS education appears to discourage unprotected intercourse. Public health literature: AIDS education appears to discourage unprotected intercourse. Economics literature on sex and AIDS education has mixed results. Economics literature on sex and AIDS education has mixed results.

4. Theoretical Framework Individual will maximize the expected value of utility by choosing 1 of 3 options: Individual will maximize the expected value of utility by choosing 1 of 3 options: AbstinenceAbstinence Intercourse with a condomIntercourse with a condom Intercourse without a condomIntercourse without a condom

5. Expected value of each option depends on Expected value of each option depends on Perceived probability of acquiring HIVPerceived probability of acquiring HIV Net utility in the present periodNet utility in the present period PV of expected future net utilityPV of expected future net utility If AIDS education affects any of these factors, an individual’s choice may be affected. If AIDS education affects any of these factors, an individual’s choice may be affected.

6. AIDS education may influence an individual’s choice by: AIDS education may influence an individual’s choice by: Affecting utilityAffecting utility Altering risksAltering risks Revealing risksRevealing risks

7. Types of AIDS Education Utility-altering: Utility-altering: Conveys social acceptance of intercourse, raising relative utility of intercourse and the probability of intercourse. Risk-altering: Risk-altering: Teaches safer sex methods, reducing the expected costs of intercourse, and increasing the probability of intercourse.Teaches safer sex methods, reducing the expected costs of intercourse, and increasing the probability of intercourse. Increases the probability of condom use.Increases the probability of condom use.

8. Risk-revealing: Risk-revealing: Raises awareness of the risk and costs of HIV infection, reducing the likelihood of intercourse.Raises awareness of the risk and costs of HIV infection, reducing the likelihood of intercourse. Increases the probability of condom use.Increases the probability of condom use. Implication: The net impact of AIDS education on sexual behavior is indeterminate a priori. Implication: The net impact of AIDS education on sexual behavior is indeterminate a priori.

9. Empirical Strategy Model: Multinomial Logit Model: Multinomial Logit Data Data National Health Interview Survey-Youth Risk Behavior Supplement 1992National Health Interview Survey-Youth Risk Behavior Supplement 1992 6,156 Americans aged 14-226,156 Americans aged 14-22

10. Dependent Variable Y = 0 if the individual abstained for at least 3 months prior to the interview (mean = 0.50) Y = 0 if the individual abstained for at least 3 months prior to the interview (mean = 0.50) Y = 1 if she/he had intercourse in the last 3 months and a condom was used at most recent intercourse Y = 1 if she/he had intercourse in the last 3 months and a condom was used at most recent intercourse (mean = 0.22) Y = 2 if he/she had intercourse in the last 3 months but no condom was used at most recent intercourse (mean = 0.28) Y = 2 if he/she had intercourse in the last 3 months but no condom was used at most recent intercourse (mean = 0.28)

11. AIDS Education Variables SCHOOL = 1 if he/she studied AIDS at school but did not discuss AIDS at home with a parent or adult family member (= 0 otherwise) SCHOOL = 1 if he/she studied AIDS at school but did not discuss AIDS at home with a parent or adult family member (= 0 otherwise) HOME = 1 if she/he discussed AIDS with an adult at home but did not study AIDS at school (= 0 otherwise) HOME = 1 if she/he discussed AIDS with an adult at home but did not study AIDS at school (= 0 otherwise) BOTH = 1 if he/she studied AIDS at school and discussed it with an adult in the home (= 0 otherwise) BOTH = 1 if he/she studied AIDS at school and discussed it with an adult in the home (= 0 otherwise)

12. Control Variables RACE RACE HISP (Hispanic origin) HISP (Hispanic origin) FEM (female) FEM (female) NEVMAR (never-married) NEVMAR (never-married) CCITY (central city residence) CCITY (central city residence) INCOME (family income) INCOME (family income) ED (grades completed) ED (grades completed) PREV (prevalence of AIDS in the state of residence) PREV (prevalence of AIDS in the state of residence) AGE AGE Set of geographic division variables Set of geographic division variables

13. Samples for Estimation Total Sample Total Sample Young Men Young Men Young Women Young Women Young Teens (14-17) Young Teens (14-17) Young Adults (18-22) Young Adults (18-22)

14. Results

18. Results AIDS education does not significantly reduce the probability of abstinence in any sample. AIDS education does not significantly reduce the probability of abstinence in any sample. The probability of condom-protected intercourse is significantly higher when AIDS information comes from both home and school for the total sample, the young women sample, and the young adult sample. The probability of condom-protected intercourse is significantly higher when AIDS information comes from both home and school for the total sample, the young women sample, and the young adult sample. The impact of AIDS education on unprotected sex is negative, but not significant, in 13 of 15 cases. The impact of AIDS education on unprotected sex is negative, but not significant, in 13 of 15 cases.

19. Results These results imply that if there are any utility- enhancing effects of AIDS education, they are outweighed by risk-altering and risk-revealing effects. These results imply that if there are any utility- enhancing effects of AIDS education, they are outweighed by risk-altering and risk-revealing effects.

20. Conclusion We find that educating young people about AIDS encourages safer sex, but does not promote sex. This indicates that AIDS education may be an effective policy tool for impeding the spread of AIDS. We find that educating young people about AIDS encourages safer sex, but does not promote sex. This indicates that AIDS education may be an effective policy tool for impeding the spread of AIDS.