Effective approaches to reducing adolescent unprotected sex, pregnancy, and childbearing - Statistical Data Included

Journal of Sex Research, Feb, 2002 by Douglas Kirby

Although teenage pregnancy and birth rates have declined in the United States every year since 1991, the United States still has one of the highest pregnancy rates in the developed world (Singh & Darroch, 2000); about 40% of all young women become pregnant before they turn 20 (National Campaign to Prevent Teen Pregnancy, 1997), and about one fourth of sexually experienced teenagers contracts an STD every year (Alan Guttmacher Institute, 1994). These alarming statistics have motivated efforts to delay teenagers' initiation of sex and to increase their use of condoms and contraception more generally if they do have sex. For example, communities concerned with the reproductive health of youth have implemented curriculum-based sexuality and HIV education programs in both school and community settings, sex and HIV education programs for parents and their families, family planning services for teenagers, clinic instructional programs with one-on-one consultation with a medical provider, school-based and school-linked clinics, school condom-availability programs, community-wide pregnancy or HIV prevention initiatives with many components, early childhood programs, and youth development programs for adolescents (e.g., service-learning programs, vocational education and employment programs, and other youth development programs).

This paper summarizes a review of 73 studies meeting specified criteria (Kirby, 2001). The six primary criteria include (a) the study was published in 1980 or later, (b) the study was conducted in the United States or Canada, (c) the program targeted adolescents of middle school or high school age (roughly 12 to 18), (d) the study used an appropriate experimental or quasi-experimental design, (e) the sample size was at least 100 in the combined treatment and control group, and (f) the study measured impact on sexual or contraceptive behavior or pregnancy or childbearing. This review identified four groups of programs with strong evidence of success.

SEX AND STD/HIV EDUCATION PROGRAMS COVERING BOTH ABSTINENCE AND CONDOMS OR CONTRACEPTION

The first group of effective programs are comprehensive sex and HIV education programs. These programs typically emphasize that abstinence is the safest method for preventing STDs and pregnancy, and that condoms and other methods of contraception provide protection against STDs and pregnancy and accordingly are safer than unprotected sex. In this review, sex education programs will refer to programs that cover protection against both pregnancy and STDs (and possibly other, broader, sexuality topics), while HIV education programs will refer to programs that focus primarily upon HIV (and sometimes other STDs). Both groups include a wide variety of programs, ranging from programs taught during regular school classes, to those taught on school campuses after school, and to programs taught in homeless shelters and detention centers.

Evaluations of these programs strongly support the conclusion that sexuality and HIV education curricula do not increase sexual intercourse, either by hastening the onset of intercourse, increasing the frequency of intercourse, or increasing the number of sexual partners. Twenty-eight studies meeting the criteria discussed above have examined the impact of middle school-, high school-, or community-based sexuality or HIV education programs on the initiation of intercourse. Nine of them (or about one-third) found that the programs delayed the initiation of sex (Aarons et al., 2000; Blake et al., 2000; Coyle, Kirby, Marin, Gomez, & Gregorich, 2000; Ekstrand et al., 1996; Howard & McCabe, 1990; Hubbard, Giese, & Rainey, 1998; Jemmott, Jemmott, & Fong, 1998; Kirby, Barth, Leland, & Fetro, 1991; Klaus et al., 1987; St. Lawrence et al., 1995). Eighteen found no significant impact (Coyle et al., 1999; Eisen, Zellman, & McAlister, 1990; Gottsegen & Philliber, 2000; Jemmott, Jemmott, & Fong, 1992, 1998; Kirby, 1985; Kirby, Korpi, Adiri, & Weissman, 1997; Levy et al., 1995; Lieberman, Gray, Wier, Fiorentino, & Maloney, 2000; Little & Rankin, 2001; Main et al., 1994; Nicholson & Postrado, 1991; Thomas et al., 1992; Walter & Vaughn, 1993; Warren & King, 1994). Only 1 study out of 28 found that a sex or HIV education program hastened the initiation of sex (Moberg & Piper, 1998). It should be noted that this particular program did not focus primarily upon sexual behavior, but was a comprehensive program that addressed tobacco, alcohol, marijuana, and nutrition, as well as sexual behavior. Overall, these studies provide very strong evidence that sex and HIV education programs do not hasten sex and that some of them actually delay sex.

Nineteen studies examined the impact of sexuality and HIV education programs on the frequency of intercourse. Five studies found that they reduced the frequency of sex (Coyle et al., 2001; Howard & McCabe, 1990; Jemmott et al., 1992, 1998; St. Lawrence et al., 1995). Thirteen found no significant impact (Blake et al., 2000; Coyle et al., 1999; Jemmott et al., 1998; Kirby, 1985; Kirby et al., 1991; Kirby, Korpi, Adivi, & Weissman, 1997; Levy et al., 1995; Little & Rankin, 2001; Main et al., 1994; Moberg & Piper, 1990; Rotheram-Borus, Koopman, Haigners, & Davies, 1991). Only 1 of 19 studies found a significant increase in frequency (Moberg & Piper, 1998). Again, this is strong evidence that sex and HIV education programs do not increase the frequency of sex and that some of them reduce the frequency.