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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS

Effects of Health and Sexual Education on Teenage Risky Behaviors

Tayler Flanders

Azusa Pacific University

According to the Center for Disease Control (2015), 96% of females and 97% of males

received a formal sex education prior to turning 18 years old, with 47% females and 38% of

males reporting their first contraceptive education in high school. In the home, 67% of females

and 40% of males felt comfortable and had discussed ways to refuse sex or decline sex with the

help of their parents (CDC, 2015). While these statistics seem promising, showing that the

majority of teens under the age of 18 have had some type of formal education, it is important to

note that 42.4% of 15 to 19 year old females are sexually active, with the average first sex

occurring at 17.3 years old (CDC, 2017). However, 62.9% of 18 and 19-year-old males are

sexually active, with the average male being 17.0 years old when first having sex, defined as

male and female intercourse (CDC, 2017).

In addition, the National Survey of Family Growth, taken between 2006 and 2008,

reports that for teens between 15 and 19 years old, 93% of females and 92% of males were

educated on sexually transmitted infections (STIs) and how to prevent them, along with 89% of

males and 88% of females that were taught how to prevent HIV (CDC, 2015). Given this

information, 75% of women and 66% of men admit that they never use condoms, while 10.2% of

males and 5.8% of females agree to using them occasionally (CDC, 2017). Females reported that

20% of them had used an emergency contraceptive method, 15.9% had relied on the calendar

method, and 64.8% had at some point depended on withdrawal to prevent pregnancies (CDC,

2017).

Current Health Education Trends

With these statistics in mind, the state of the United States sexual and health education

needs to be considered as a way to help prevent risky behaviors in teens that can end in
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
unplanned pregnancies, infections, diseases, and other consequences. Currently, sexual education

is supported by up to 96% of parents at the high school level, providing information on STIs,

puberty, relationships, birth control methods, and sexuality (Planned Parenthood, 2020). Planned

Parenthood (2020), reports that less than half of the high schools and 20% of junior high schools

actually provide information on all recommended topics, reducing the formal education actually

being taught. The timeliness of the information is also key because, as mentioned, teens that

choose to be sexually active start at the average age of 17 years old, but the measure of sexual

education is up to 18 years old or through high school, which could be too late (CDC, 2015;

CDC, 2017). Schools need to be more proactive, providing a curriculum that adjusts to the needs

of students, providing more well-rounded sexual education throughout every year of schooling,

starting in elementary school with relationship education and continuing throughout teen years.

With teens already easily peer pressured and at a vulnerable state in their life, it is important that

they at least have all of the scientifically appropriate information to keep themselves and any

partners safe.

History and Practices of Sexual Education

According to Hall, McDermott, and Komro (2016), the need for sexual education in

public schools was initiated after HIV/AIDS began to surface and spread in the 1980s. There was

a need for more information on safety, contraception, and sexually transmitted infections,

keeping youth safe. Shortly after, in the 1990s, abstinence only until marriage (AOUM)

curriculum spread and was funded in 49 states (Hall et al., 2016). This curriculum was not

successful in reducing teen pregnancy, sexual transmitted diseases, or other risky behaviors.

Even though it is not necessarily effective, the funding for the program is still in effect in many

states, with 37 states requiring abstinence be taught, only 33 providing information on HIV, and
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
only 18 states providing contraceptive information. In addition, about 87% of public schools

allow parents to pull their children from sexual education units in school. Hall, McDermott, and

Komro (2016) believe that some other factors of sex education need to be considered, including

consistency of types of information, resources, and timing of the information, as previously

mentioned. Another factor to consider is inclusion of scientific and medically accurate data,

models, diversity, and inclusivity in order to help reduce teenage pregnancy rates, stop the spread

of STIs, and provide accurate information (Hall et al., 2016).

Similarly, Welbourne-Moglia and Moglia’s (1989) article about sexual education in the

United States, discusses the need for and curriculum for sexuality in public schools, taking place

in the 1980’s, prior to Common Core and current standards in place. This study is important to

consider as a way to understand what was and what may still be lacking in the education system,

identifying similarities and differences as a way to identify positive and negative changes that

have been made. As they mention, sexuality education encompasses more than reproduction, but

rather the overall wellbeing of a person (Welbourne-Moglia & Moglia, 1989). This wellbeing is

a combination of biology, psychology, ethics, and culture, all of which are unique to the

individual. In order to have a comprehensive sexual education curriculum, each part must be

touched upon, providing phases of education from the beginning of school to the end, otherwise

known as kindergarten through twelfth grade. Welbourne-Moglia and Moglia (1989) explained

that while parents need to be responsible for helping their children at home and educating, not

everyone can rely on this, so professionals need to be able to start this education in the school

system. They believe that certifications to provide appropriate educators for the subject need to

be done, providing skills, understanding, and information for individuals to use later.

Recommendations include a curriculum that repeats concepts and builds from start to finish of
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
the public education system, much like what is supposed to be implemented in current

educational methods (Welbourne-Moglia and Moglia, 1989).

Current Sexual Education Models and Resources

Similar to Hall, McDermott, and Komro’s ideas for implementation, the introduction of

“Sex and Relationships Education: A Step-by-Step Guide for Teachers”, by Simon (2016),

introduces the idea that sex education is not something that should be feared, but rather provide

information and evidence for students so that they can become comfortable with their sexuality,

their resources, and open up the conversation. This text uses evidence-based research to help

teachers become comfortable with the curriculum and how to present it in a way for students to

feel comfortable asking questions. Simon (2016) also goes into detail on how to talk to certain

age groups, ethnicity and racial groups, students of all ability levels, and strategies for how to do

so. This resource is helpful for teachers and any other staff members in schools so they can make

sure the topic is not something their students squirm at, but rather feel at ease with by the end.

History has implicated a need for more inclusive sexual education to help students and

young adults understand how to safely have sex. Beyond the sexual relationships though is the

idea that psychologically, teens can feel more comfortable and open with each other and adults,

if education included things like safe relationships, communication, ethnic, racial, and social

group variations, and even LGBTQ curriculum.

Current Education and Risk Factors in Teens

Dance et al. (2009), in partnership with the Center for Disease Control (CDC) observed

youth behavior risks that could cause injuries, alcohol or drug use, sexual behaviors that lead to

STIs or unintentional pregnancy, decreased physical activity, and dietary or nutrition concerns.

This study looked beyond just sexual risk, but all risks to health, reporting the risks for the 10 to
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
24-year-old age group from a combination of 42 state-wide surveys and 20 other local surveys.

Overall, Dance et al. (2009) found that about 28% did not wear seat belts, 42% had used alcohol,

21% had used marijuana, 34% were sexually active of which 39% hadn’t used a contraceptive

method, 2% had used an illegal drug, 20% had smoked, 78% did not eat their daily servings of

fruits and vegetables, and 82% were not active daily. These statistics put the teens at risk for

higher morbidity and mortality rates, but the hope is that this study will continue to track

progress towards the Healthy People 2010 objectives (Dance et al., 2009). Overall, these

behaviors put teens at higher risk than other populations and give example for what a vulnerable

and influential population they can be.

Current Sexual Behaviors to Consider

According to Chandra, Copen, and Mosher (2013), the public health of individuals

between the age of 15 and 44 years are significantly impacted by sexual activity due to the

number of partners within the year (same or opposite sex), types of behaviors, attraction, and

identity. Currently, people living with HIV, for example, are spending about 20,000 dollars per

year on medications, with 50,000 Americans diagnosed each year (Chandra et al., 2013). With

this information, Chandra, Copen, and Mosher (2013) used the National Survey of Sexual Health

and Behavior to observe the sexual behaviors of men and women in the United States, including

types of sexual encounters and with which gender, ages 14 to 94 years old. Their sample

consisted of 5,865 participants between 2006 and 2008. Surveys were done via internet survey,

and short online or phone interviews. The study showed that of the participants, 12% of women

had a sexual encounter with another woman, while only about 6% of men had an encounter with

the same sex (Chandra et al., 2013). This study aimed to use this information as a way to identify

risks and patterns for the population and its connections to certain diseases, including STIs, while
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
also identifying sexual attraction to the same sex (Chandra et al., 2013). This information is

important in identifying proper health education curriculum, watching specific activity of certain

at-risk age groups and identifying appropriate LGBTQ curriculum to incorporate in schools.

At Risk Youth Groups

Becker and Barth (2000) address the need for sexual education in terms of youth that are

in foster care, group homes, or government care, which may mean they move schools more

frequently or have gaps in their learning. This puts this group of students at high risk for STI

transmission, multiple partners, teen pregnancy, HIV, and lack of contraceptives. Studies show

that about 60% of women from this population had at least child in the four years after they had

“aged out” of the system (Becker and Barth, 2000). Other reports showed that children as young

as eight years old had engaged in sexual activity, with 34% of the youth from eight to 18 years

being active, and 64% from age 13 to 18 years old. Of this population, 33% did not use

contraceptives and more than 15% had contracted an STI, but further observation showed that

70% had more concerning behaviors such as alcohol and drug use, mental disabilities, attempted

suicide, and behavior issues. About half of a 55-person sample of adults, who had previously

been a part of this population, reported that they never received or used family planning services

while in care. A more comprehensive curriculum for sexual education can prevent some of the

gaps and reinforce resources available to those that otherwise do not receive the support from

family at home (Becker and Barth, 2000).

In addition to foster children, Stranger-Hall and Hall (2011) found that in 2005, there

were 21 of 48 states that emphasized abstinence-only education, seven provided a variety of

resources and comprehensive education, and eleven covered a combination of the two. The level

of abstinence education, meaning the higher stress on abstinence-only, directly correlated with a
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
higher rate of teenage pregnancy, while abortion rates had no correlation (Stranger-Hall and

Hall, 2011). Factors like socio-economic status, education, and racial or ethnic differences also

directly correlated to teen pregnancy rates. In lower income populations and racial or ethnic

groups, there were higher percentages of teen pregnancy, while education level did not have a

significant difference (Stranger-Hall and Hall, 2011).

All of these high-risk populations also need a conceptual, comprehensive, and accurate

sexual education that is easily applicable to their culture and life. Students that are considered

minorities or are in the foster care system, do not have the at-home support to continue the

education or give certain aspects of information, often relying on older siblings or friends for

inaccurate information. Curriculum needs to adjust for these students, considering the

circumstances and realities that teachers can prepare them for.

Teenage Pregnancies

Grose, Grabe, and Kohfeldt (2013) express the importance of sexual education in

schools, by addressing the United Stated high teen pregnancy rate for an industrialized nation,

with the fact that half of the occurrences of STIs are passed in the teenage population, with 82%

of teenage pregnancies unplanned. Current sexual health education programs lack the resources

and the components to address social factors, gender, and consent, all of which could help to

provide more positive outcomes. Examples of this include situations in which women are in

more traditional gender roles within a relationship, feeling as though they are forced, often

contracting or at higher risk to contract STIs, and resulting in more unplanned pregnancies

(Grose et al., 2013). The researchers used the Walnut Avenue Women’s Center in California,

which provides domestic violence, youth, family, and childhood education, as well as resources

for those that would like them, to conduct their survey and classes to middle school students
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
about sexual education. The classes took place once per day, for 50-minute periods, over the

course of ten days, with both female and male instructors, to about 120 students. Grose et al.

(2013) measured gender ideology, sexual knowledge, and contraceptive beliefs in their surveys.

After a pre-test, relationships between the belief in more traditional relationships correlated with

less information and use of contraceptives, but after the program and the post-test, the students

showed an increased knowledge in contraceptive use and practice, gender roles and healthy

relationships, healthy practices, and resources (Grose et al., 2013).

In opposition, Tortolero et al. (2011) describe the state of teen pregnancy in Texas and

how the education status has proven problematic. Teen pregnancy can be the result of the lack of

information in sexual education for teens (Tortolero, et al., 2011). For Texas youth, data found

that 800,000 teens were sexually active, which resulted in 50,000 teens births per year, and 22%

of them resulted in a repeated teen pregnancy in the following years. According to Tortolero et

al. (2011), nationwide, teens represent 12% of all pregnancies in a year, and six-billion dollars go

toward sexually transmitted diseases for youth every year. As mentioned, minority groups and

low-income families are higher risk for teen pregnancy. The idea of abstinence in sexual

education has caused controversy on what should be taught in school, from contraceptive use, to

other resources. Toltolero et al. (2011), found that Texas takes more abstinence-only funding

than other states, 96% of the schools teaching it, and 41% of the schools providing

misinformation. After a survey in one particular county, 93% of the population believed that sex

education should start in either junior high or high school, with the rest believing it should not be

taught at all. Those of higher income supported it more than those that were considered low-

income. About 67% of parents thought that information should be abstinence and contraception,

27% believing it should be abstinence only, and the rest not wanting any taught in school
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
(Toltero et al., 2011). Overall, the acceptance of sexual education and a combination of

abstinence and contraception had the highest rate in the results, but students can still benefit from

this and hopefully it can help reduce the teen pregnancies seen, along with the financial

conditions that are caused by them.

Teenage pregnancies can be one of the largest consequences from risky sexual behaviors,

but also from lack of information about how to safely have sexual relationships for teens. It is

obvious that more information of a comprehensive and inclusive sexual education curriculum

and its effect on teenage pregnancy rates is needed, but the overall outcome of more education is

the correlation between safer sex practices, which hopefully can help to reduce teen pregnancies.

Post-K-12 Education

Post-high school attitudes are also an important consideration when developing and

implementing new curriculum. Walcott, Chenneville, and Tarquini (2011) studied the attitudes

and behaviors of undergraduate college students, such as number of partners, HIV and STI

prevention, and contraceptive use, and compared their previous high school and middle school

sex education programs. A group of 1878 students between the ages of 18 and 25 years old were

recruited from North Carolina and Florida through an online platform, providing researchers

with a survey as part of their psychology courses. Of the participants, about three-quarters were

female, a little over half were either 18 or 19 years old, 73% were Christian, and two-thirds were

Caucasian, with an overall of 90% speaking primarily English (Walcott et al., 2011). Overall,

both school sites saw that females had more precautious safe sex attitudes and behaviors. Those

in the Florida site were seen to have the intentions to have safer sex as opposed to the North

Carolina site (Walcott et al., 2011). Walcott et al. (2011) also found that out of the sample, 39%

had started sex education in elementary school and 50% in middle school, with only 3%
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
receiving no sexual education. Over 70% reported that this subject was taught as a part of

another course, 68% felt they received comprehensive sex education, including STI, HIV, and

contraceptive use, and 29% were taught abstinence-only sex education. Those that received more

comprehensive education were seen to have slightly higher scores on knowledge of HIV and

STIs, but there was no major difference in safer practices (Walcott et al., 2011). Walcott et al.

(2011) believe that the indications are to teach sex education more than just occasionally or as a

part of another course, but to make sure to include items such as contraceptive use, STI and HIV

prevention, and more detailed information in a formal class or sections that focuses on this topic

solely.

More research needs to be done in order to really see the effects of sexual education types

and future experiences. Until this time period, sexuality and sex were hushed topics, often not

discussed or looked down upon. Today, a more open relationship to sexuality can help teens and

young adults talk about their lives, ask questions, and make better, more informed choices.

Information on practices and their previous education could be helpful as feedback for future

generations of learners.

Comparisons Outside of the United States

Lastly, in comparison to other industrialized countries, the United States has higher

teenage pregnancy rates and STI contraction rates than others. Madkour, Farhat, Halpern,

Godeau, and Gabhainn (2010) observed initiation of sexual experiences compared to that of the

sex education programs within the countries of Finland, Scotland, France, Poland, and the United

States. A sample of 6111 15-year-old students participated in the Health Behaviors in School-

Aged Children Study or the National Longitudinal Study of Adolescent Health surveys, reporting

emotional and physical symptoms and their sexual experiences. Results were separated by
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
gender, with boys who had single parents, blended families, or low socioeconomic status

experiencing more of each symptom type, which was highest in the European countries rather

than the United States (Madkour et al., 2010). For girls, after controlling for the same variables,

they also showed higher rates of the two symptoms, with European countries more prevalent

than the United States. Girls in the United States and Poland showed negative symptoms as well,

correlating with sexual initiation. Overall, Madkour et al. (2010) feel that approaching more

healthy living and behavioral programs and getting more data from each country on overall

health and wellbeing may be necessary to find where the gaps are, but that there are obvious gaps

worldwide, not just in the United States curriculum.

Future Implications for Sexual Education

According to Cameron-Lewis and Allen (2013), the modern ideas that have influenced

sexual education are feminism and gender roles or structure critiques, but there is still too much

focus on the biology and reproductive process and abstinence, rather than allowing students to

understand themselves, their emotions, and their own sexuality. By teaching abstinence and

ignoring human want and need, it keeps students from understanding themselves as sexual

beings, without being able to set their own boundaries, understand their right to consent, and

really understand themselves and their partner in a relationship. Cameron-Lewis and Allen

(2013) offer the idea that the education needs to be centered around the youth as well, rather than

being based off of what adults believe they need to know and learn. Students need to see the

information as relevant and interesting, while being given information free of bias and filters.

Introducing the idea of pleasures and dangers is necessary so that students understand positive

relationships, both sexual and emotional, focusing on issues and risks of sexual harassment and

violence, but also allowing them to see positive sides (Cameron-Lewis & Allen, 2013).
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Running Head: SEX EDUCATION AND TEENAGE BEHAVIORS
Discussing these as hand-in-hand topics is important, as not everything about sexuality can be

categorized in black or white, but also because sometimes pleasure can fall very close to danger

in certain situations. Students need to understand the responsibilities they have for themselves

and others, really understanding their own desires and boundaries (Cameron-Lewis & Allen,

2013).

Conclusion and Discussion

Overall, it is obvious that a more inclusive, extensive, research-based curriculum could

be helpful in providing our teens with more information about their bodies. Sexual education has

expanded from a topic of discomfort and puberty, to a topic about relationships, public safety,

and acceptance for one another’s choices. Inclusion of sub-topics such as consent, healthy

relationships, sexuality, safe sex, contraceptives, HIV prevention, STI prevention, and so much

more need to be included as a way for students to really understand the psychological aspects of

themselves. In a world where people are becoming more diverse, a diverse curriculum needs to

be implemented to reach every student, teacher, parent, or guardian, providing understanding and

acceptance over everything.

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