Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections

Full Study Report [HTML] [PDF]
Executive Summary [HTML] [PDF]

Program Components

• Peer-led sex education, including information about abstinence and contraception, designed to augment a human sexuality curriculum
• Five, 50-minute sessions, delivered by trained peer educators, and five, 50-minute sessions on reproductive health, led by health professionals
• Referral of sexually active youth for nearby reproductive health care, including contraception

For Use With

• Eighth grade students
• Black youth
• Sexually inexperienced youth
• Youth at high risk[*]

Evaluation Methodology

• Quasi-experimental design, including treatment and comparison conditions, in inner-city schools in Atlanta, Georgia
• Urban eighth graders (n=536 who completed five surveys)
• Surveys at the beginning, middle, and end of eighth grade (during the program) and at the beginning and end of ninth grade (three months and 12 months after the intervention)

Evaluation Findings

• Delayed initiation of sexual intercourse
• Reduced frequency of sex
• Increased use of contraception

Replication Evaluation Methodology & Findings: Postponing Sexual Involvement (Omitting the Five Session Human Sexuality Curriculum)

• Experimental design, including treatment and control conditions, in 56 middle or junior high schools and 17 community-based agencies throughout California
• Seventh and eighth graders (n=10,600 at baseline; n= 3,843 at three-month follow-up; n=7,340 at 17-month follow-up)
• Surveys at baseline and at three- and 17-month follow-up
• Findings—No significant changes in sexual behavior in participants as compared to controls

Evaluators' comments: Educational programs must be age-specific, promoting attitudes and skills that young adolescents can use until they gain more mature skills in managing their sexuality…[Finally], program staff believes that the student leaders are extremely important, because they make the program more interesting and acceptable to the younger students…help[ing] them seriously consider the messages being given.
Source: Howard and, McCabe, 1990

Program Description

Postponing Sexual Involvement is designed for use in eighth grade to augment course information on human sexuality, including contraceptive information. The five-session Postponing Sexual Involvement curriculum (taught by 10th and 11th grade peer educators) involves participants in discussions about social and peer pressures to have sex. It gives youth opportunities to practice skills that help them resist these pressures. The program is based on social inoculation theory.[6]

Evaluation Methodology

The study population in Atlanta, Georgia, comprised 536 low-income, mostly black, eighth graders, followed through ninth grade. The evaluation was designed to determine the impact of augmenting the five-unit human sexuality curriculum with the five sessions of Postponing Sexual Involvement. Students in program schools were divided into two groups: those who had initiated sex and those who had not. Both these groups were compared to students who did not participate in the program. At baseline, students in program schools were slightly more likely to report having had sex than were youth in non-program schools (25 and 23 percent, respectively). At baseline, eighth grade males (44 percent) were more likely to report having had sex than were females (nine percent). Of the 536 students who completed all five interviews, 131 (25 percent) reported having had sexual intercourse before the first interview.[6]

Outcomes

• Knowledge—At the end of eighth grade, participants had more knowledge of contraception than did non-program youth.[6]
• Attitudes—At the end of eighth grade, 95 percent of participants felt that what they had learned would help them to refuse sex.[6]
• Behaviors—
  • Delayed initiation of sexual intercourse—Participants were significantly more likely than comparison youth to postpone the initiation of sexual intercourse. By the end of eighth grade:
    • Participants were five times less likely than comparison youth to have initiated sex (four and 20 percent, respectively).[6]
    • Participating males were over one third less likely than comparison males to have initiated sex (eight and 29 percent, respectively).[6]
    • Female participants were 15 times less likely than comparison females to have initiated sex (one and 15 percent, respectively).[6]
    • By the end of ninth grade, just 24 percent of participants had initiated sex, compared to 39 percent of non-participants. By gender, the percentages that had initiated sex were: males, 39 percent of participants and 61 percent of comparison youth; females, 17 and 27 percent, respectively.[6]
  • Reduced frequency of sex—After the program was offered, 55 percent of comparison youth described themselves as having sex "often" or "sometimes," compared to 39 percent of the treatment group. Students in the treatment group were more likely to report "having tried sex only once or twice" (43 percent versus 28 percent of comparison youth).[6]
  • Increased use of contraception—Among students who had never had sex at baseline but initiated sex thereafter, nearly half of participants used contraception, compared to one-third of non-participants.[6]

Replication Evaluation Methodology: Postponing Sexual Involvement (Omitting the Five Session Series on Reproductive Health)

In June 1992, the California Office of Family Planning funded a statewide, teen pregnancy prevention initiative entitled Education Now and Babies Later (ENABL), that utilized Postponing Sexual Involvement, but omitted the five sessions on human sexuality. School-wide and community-based activities, and a statewide media campaign accompanied the intervention. To evaluate the impact of the program, 10,600 youth were assigned to treatment and control conditions—students within selected schools, the entire seventh and eighth grade classes at some schools, and youth recruited at community-based agencies. The final sample included 7,340 youth who completed both the baseline and 17-month follow-up survey; 3,843 of these youth also completed the three-month post-test survey.[7,8]

ENABL differed in significant ways from the original program, implemented in Atlanta, Georgia:

• Age of students—In Georgia, eighth grade students received the program compared to seventh and eighth graders in California.[6,7]
• Five-session unit on reproductive health—In Georgia, the program was implemented along with a five-session unit that included information about human sexuality, contraception, and making decisions. In California, this five-session unit was omitted.[6,7]
• Peer educators and adult leaders—In Georgia, adults led the five-session reproductive health unit and trained youth led the five-session Postponing Sexual Involvement curriculum. In California, youth, accompanied by adults, led only about 10 percent of classroom sessions. Ninety percent of classrooms and all community-based programs were adult-led.[6,7]
• Video—A video was used faithfully in Georgia and was used by only about half of program implementers in California.[6,7]

Replication Outcomes

At three- and 17-month follow-up surveys, evaluators found no significant differences in sexual behavior between the treatment and control groups. Youth in treatment and control groups were equally likely to have initiated sexual intercourse. Moreover, youth in the treatment and control groups were equally likely to report involvement in a pregnancy or diagnosis with an STI.[7,8]

For More Information or to Order Postponing Sexual Involvement to Augment Human Sexuality Education, Contact

• Marian Apomah, Coordinator, Jane Fonda Center; Emory Unversity School of Medicine: Building A Briarcliff Campus, 1256 Briarcliff Road, Atlanta, GA, 30306; Phone, 404.712.4710; Fax, 404.712.8739

** The evaluators defined youth as being at high risk if they were low-income and relied primarily on publicly funded hospitals for their health care.