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Julian Bell
Julian Bell

Teen Model Sex


Teen sexual health outcomes over the past decade have been mixed. On one hand, teen pregnancy and birth rates have fallen dramatically, reaching record lows. On the other hand, rates of sexually transmitted infections (STIs) among teens and young adults have been on the rise. Many schools and community groups have adopted programming that incorporates abstinence from sexual activity as an approach to reduce teen pregnancy and STI rates. The content of these programs, however, can vary considerably, from those that stress abstinence as the only option for youth, to those that address abstinence along with medically accurate information about safer sexual practices including the use of contraceptives and condoms. Early action from the Trump administration has signaled renewed support for abstinence-only programming. This fact sheet reviews the types of sex education models and state policies surrounding them, the major sources of federal funding for both abstinence and safer sex education, and summarizes the research on impact of these programs on teen sexual behavior.




teen model sex


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The type of sex education model used can vary by school district, and even by school. Some states have enacted laws that offer broad guidelines around sex education, though most have no requirement that sex education be taught at all. Only 24 states and DC require that sex education be taught in schools (Text Box 1). More often, states enact laws that dictate the type of information included in sex education if it is taught, leaving up to school districts, and sometimes the individual school, whether to require sex education and which curriculum to use.


Under the Obama Administration, there was a notable shift in abstinence education funding toward more evidence-based sex education initiatives. The current landscape of federal sex education programs is detailed in Table 2 and includes newer programs such as Personal Responsibility Education Program (PREP), the first federal funding stream to provide grants to states in support of evidence-based sex education that teach about both abstinence and contraception. In addition, the Teen Pregnancy Prevention Program (TPPP) was established to more narrowly focus on teen pregnancy prevention, providing grants to replicate evidence-based program models, as well as funding for implementation and rigorous evaluation of new and innovative models.


In 2007, a nine-year congressionally mandated study that followed four of the programs during the implementation of the Title V AOUM program found that abstinence-only education had no effect on the sexual behavior of youth.7 Teens in abstinence-only education programs were no more likely to abstain from sex than teens that were not enrolled in these programs. Among those who did have sex, there was no difference in the mean age at first sexual encounter or the number of sexual partners between the two groups. The study also found that youth that participated in the programs were no more likely to engage in unprotected sex than youth who did not participate. While teens who participated in these programs could identify types of STIs at slightly higher rates than those who did not, program youth were less likely to correctly report that condoms are effective at preventing STIs. A more recent review also suggests that these programs are ineffective in delaying sexual initiation and influencing other sexual activity.8 Studies conducted in individual states found similar results.9,10 One study found that states with policies that require sex education to stress abstinence, have higher rates of teenage pregnancy and births, even after accounting for other factors such as socioeconomic status, education, and race.11


There is, however, considerable evidence that comprehensive sex education programs can be effective in delaying sexual initiation among teens, and increasing use of contraceptives, including condoms. One study found that youth who received information about contraceptives in their sex education programs were at 50% lower risk of teen pregnancy than those in abstinence-only programs.14 It also found that teens in these more comprehensive programs were no more likely than those receiving abstinence-only education to engage in sexual intercourse, as some critics argue. Another study found that over 40% of programs that addressed both abstinence and contraception delayed the initiation of sex and reduced the number of sexual partners, and more than 60% of the programs reduced the incidence of unprotected sex.15,16,17 Despite this growing evidence, in 2014, roughly three-fourths of high schools and half of middle schools taught abstinence as the most effective method to avoid pregnancy, HIV, and other STDs, just under two-thirds of high schools taught about the efficacy of contraceptives, and about one-third of high schools taught students how to correctly use a condom (Figure 2).


The Trump administration continues to shift the focus towards abstinence-only education, revamping the Teen Pregnancy Prevention Program and increasing federal funding for sexual risk avoidance programs. Despite the large body of evidence suggesting that abstinence-only programs are ineffective at delaying sexual activity and reducing the number of sexual partners of teens, many states continue to seek funding for abstinence-only-until-marriage programs and mandate an emphasis on abstinence when sex education is taught in school. There will likely be continued debate about the effectiveness of these programs and ongoing attention to the level of federal investment in sex education programs that prioritize abstinence-only approaches over those that are more comprehensive and based on medical information.


In 2010, the Ministry of Education in Trinidad and Tobago converted 20 low-performing secondary schools from coeducational to single-sex. I exploit these conversions to identify the policy-relevant causal effect of introducing single-sex education into existing schools (holding other school inputs constant). After accounting for student selection, boys in single-sex cohorts at conversion schools score higher on national exams taken around age 15, both boys and girls take more advanced coursework, and girls perform better on secondary school completion exams. There are also important nonacademic effects. All-boys cohorts have fewer arrests as teens, and all-girls cohorts have lower teen pregnancy rates. Survey evidence suggests that these single-sex conversion effects reflect both direct gender peer effects, due to interactions among classmates, and indirect effects generated through changes in teacher behavior.


Objective: Prior research has suggested that parents of children with chronic illness perceive poor coordination of care between primary care physicians (PCP) and specialty care physicians. The aims of this study were to examine parental preferences for locus of service delivery for management of their teen's general health and congenital heart disease (CHD)-related concerns.


Results: Overall, 18 distinct CHD lesions were represented with the following classification: 40 low severity, 36 moderate severity, and 10 high severity (N = 86). For all 11 general health concerns, 96-100% of parents preferred seeing the PCP. With regards to CHD-related concerns, most parents preferred seeing the PCP: chest pain (52%), syncope (73%), appearing seriously ill (79%), a sports physical examination (79%), and antibiotics for dental visit (94%). Conversely, most parents preferred the cardiologist for heart medication prescription refills (65%) and sports participation questions (59%). For 5 of 7 CHD-related concerns, there was a significant trend toward preferring cardiologist use with increasing disease severity (p=0.002 to p=0.04). Overall, 58% of parents, regardless of CHD severity, preferred a PCP-cardiologist co-management model as opposed to a specialist-dominated model for their teen's CHD care. Co-management model parents had increased preference for PCP use for CHD-related prophylactic activities (p=0.002). Multivariable regression analysis that adjusted for disease severity, age, and sex, showed increasing family income was associated with decreased odds of co-management model preference (odds ratio 0.65, 95% confidence interval 0.44 to 0.96).


Conclusions: The majority of parents of teens with CHD desire a co-management model between their PCP and cardiologist, regardless of severity of CHD. Most parents preferred PCP use for both general health and CHD-related concerns, although this preference declined with increasing disease severity. This study suggests that parents desire collaboration between primary and specialty care physicians with significant reliance on PCPs for their teen's chronic illness. 041b061a72


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