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Article Contents

Introduction, purpose of the study, literature search and selection criteria, coding of the studies for exploration of moderators, decisions related to the computation of effect sizes.

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The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis

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Mónica Silva, The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis, Health Education Research , Volume 17, Issue 4, August 2002, Pages 471–481, https://doi.org/10.1093/her/17.4.471

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This review presents the findings from controlled school-based sex education interventions published in the last 15 years in the US. The effects of the interventions in promoting abstinent behavior reported in 12 controlled studies were included in the meta-analysis. The results of the analysis indicated a very small overall effect of the interventions in abstinent behavior. Moderator analysis could only be pursued partially because of limited information in primary research studies. Parental participation in the program, age of the participants, virgin-status of the sample, grade level, percentage of females, scope of the implementation and year of publication of the study were associated with variations in effect sizes for abstinent behavior in univariate tests. However, only parental participation and percentage of females were significant in the weighted least-squares regression analysis. The richness of a meta-analytic approach appears limited by the quality of the primary research. Unfortunately, most of the research does not employ designs to provide conclusive evidence of program effects. Suggestions to address this limitation are provided.

Sexually active teenagers are a matter of serious concern. In the past decades many school-based programs have been designed for the sole purpose of delaying the initiation of sexual activity. There seems to be a growing consensus that schools can play an important role in providing youth with a knowledge base which may allow them to make informed decisions and help them shape a healthy lifestyle ( St Leger, 1999 ). The school is the only institution in regular contact with a sizable proportion of the teenage population ( Zabin and Hirsch, 1988 ), with virtually all youth attending it before they initiate sexual risk-taking behavior ( Kirby and Coyle, 1997 ).

Programs that promote abstinence have become particularly popular with school systems in the US ( Gilbert and Sawyer, 1994 ) and even with the federal government ( Sexual abstinence program has a $250 million price tag, 1997 ). These are referred to in the literature as abstinence-only or value-based programs ( Repucci and Herman, 1991 ). Other programs—designated in the literature as safer-sex, comprehensive, secular or abstinence-plus programs—additionally espouse the goal of increasing usage of effective contraception. Although abstinence-only and safer-sex programs differ in their underlying values and assumptions regarding the aims of sex education, both types of programs strive to foster decision-making and problem-solving skills in the belief that through adequate instruction adolescents will be better equipped to act responsibly in the heat of the moment ( Repucci and Herman, 1991 ). Nowadays most safer-sex programs encourage abstinence as a healthy lifestyle and many abstinence only programs have evolved into `abstinence-oriented' curricula that also include some information on contraception. For most programs currently implemented in the US, a delay in the initiation of sexual activity constitutes a positive and desirable outcome, since the likelihood of responsible sexual behavior increases with age ( Howard and Mitchell, 1993 ).

Even though abstinence is a valued outcome of school-based sex education programs, the effectiveness of such interventions in promoting abstinent behavior is still far from settled. Most of the articles published on the effectiveness of sex education programs follow the literary format of traditional narrative reviews ( Quinn, 1986 ; Kirby, 1989 , 1992 ; Visser and van Bilsen, 1994 ; Jacobs and Wolf, 1995 ; Kirby and Coyle, 1997 ). Two exceptions are the quantitative overviews by Frost and Forrest ( Frost and Forrest, 1995 ) and Franklin et al . ( Franklin et al ., 1997 ).

In the first review ( Frost and Forrest, 1995 ), the authors selected only five rigorously evaluated sex education programs and estimated their impact on delaying sexual initiation. They used non-standardized measures of effect sizes, calculated descriptive statistics to represent the overall effect of these programs and concluded that those selected programs delayed the initiation of sexual activity. In the second review, Franklin et al . conducted a meta-analysis of the published research of community-based and school-based adolescent pregnancy prevention programs and contrary to the conclusions forwarded by Frost and Forrest, these authors reported a non-significant effect of the programs on sexual activity ( Franklin et al ., 1997 ).

The discrepancy between these two quantitative reviews may result from the decision by Franklin et al . to include weak designs, which do not allow for reasonable causal inferences. However, given that recent evidence indicates that weaker designs yield higher estimates of intervention effects ( Guyatt et al ., 2000 ), the inclusion of weak designs should have translated into higher effects for the Franklin et al . review and not smaller. Given the discrepant results forwarded in these two recent quantitative reviews, there is a need to clarify the extent of the impact of school-based sex education in abstinent behavior and explore the specific features of the interventions that are associated to variability in effect sizes.

The present study consisted of a meta-analytic review of the research literature on the effectiveness of school-based sex education programs in the promotion of abstinent behavior implemented in the past 15 years in the US in the wake of the AIDS epidemic. The goals were to: (1) synthesize the effects of controlled school-based sex education interventions on abstinent behavior, (2) examine the variability in effects among studies and (3) explain the variability in effects between studies in terms of selected moderator variables.

The first step was to locate as many studies conducted in the US as possible that dealt with the evaluation of sex education programs and which measured abstinent behavior subsequent to an intervention.

The primary sources for locating studies were four reference database systems: ERIC, PsychLIT, MEDLINE and the Social Science Citation Index. Branching from the bibliographies and reference lists in articles located through the original search provided another source for locating studies.

The process for the selection of studies was guided by four criteria, some of which have been employed by other authors as a way to orient and confine the search to the relevant literature ( Kirby et al ., 1994 ). The criteria to define eligibility of studies were the following.

Interventions had to be geared to normal adolescent populations attending public or private schools in the US and report on some measure of abstinent behavior: delay in the onset of intercourse, reduction in the frequency of intercourse or reduction in the number of sexual partners. Studies that reported on interventions designed for cognitively handicapped, delinquent, school dropouts, emotionally disturbed or institutionalized adolescents were excluded from the present review since they address a different population with different needs and characteristics. Community interventions which recruited participants from clinical or out-of-school populations were also eliminated for the same reasons.

Studies had to be either experimental or quasi-experimental in nature, excluding three designs that do not permit strong tests of causal hypothesis: the one group post-test-only design, the post-test-only design with non-equivalent groups and the one group pre-test–post-test design ( Cook and Campbell, 1979 ). The presence of an independent and comparable `no intervention' control group—in demographic variables and measures of sexual activity in the baseline—was required for a study to be included in this review.

Studies had to be published between January 1985 and July 2000. A time period restriction was imposed because of cultural changes that occur in society—such as the AIDS epidemic—which might significantly impact the adolescent cohort and alter patterns of behavior and consequently the effects of sex education interventions.

Five pairs of publications were detected which may have used the same database (or two databases which were likely to contain non-independent cases) ( Levy et al ., 1995 / Weeks et al ., 1995 ; Barth et al ., 1992 / Kirby et al ., 1991 /Christoper and Roosa, 1990/ Roosa and Christopher, 1990 and Jorgensen, 1991 / Jorgensen et al ., 1993 ). Only one effect size from each pair of articles was included to avoid the possibility of data dependence.

The exploration of study characteristics or features that may be related to variations in the magnitude of effect sizes across studies is referred to as moderator analysis. A moderator variable is one that informs about the circumstances under which the magnitude of effect sizes vary ( Miller and Pollock, 1994 ). The information retrieved from the articles for its potential inclusion as moderators in the data analysis was categorized in two domains: demographic characteristics of the participants in the sex education interventions and characteristics of the program.

Demographic characteristics included the following variables: the percentages of females, the percentage of whites, the virginity status of participants, mean (or median) age and a categorization of the predominant socioeconomic status of participating subjects (low or middle class) as reported by the authors of the primary study.

In terms of the characteristics of the programs, the features coded were: the type of program (whether the intervention was comprehensive/safer-sex or abstinence-oriented), the type of monitor who delivered the intervention (teacher/adult monitor or peer), the length of the program in hours, the scope of the implementation (large-scale versus small-scale trial), the time elapsed between the intervention and the post-intervention outcome measure (expressed as number of days), and whether parental participation (beyond consent) was a component of the intervention.

The type of sex education intervention was defined as abstinence-oriented if the explicit aim was to encourage abstinence as the primary method of protection against sexually transmitted diseases and pregnancy, either totally excluding units on contraceptive methods or, if including contraception, portraying it as a less effective method than abstinence. An intervention was defined as comprehensive or safer-sex if it included a strong component on the benefits of use of contraceptives as a legitimate alternative method to abstinence for avoiding pregnancy and sexually transmitted diseases.

A study was considered to be a large-scale trial if the intervention group consisted of more than 500 students.

Finally, year of publication was also analyzed to assess whether changes in the effectiveness of programs across time had occurred.

The decision to record information on all the above-mentioned variables for their potential role as moderators of effect sizes was based in part on theoretical considerations and in part on the empirical evidence of the relevance of such variables in explaining the effectiveness of educational interventions. A limitation to the coding of these and of other potentially relevant and interesting moderator variables was the scantiness of information provided by the authors of primary research. Not all studies described the features of interest for this meta-analysis. For parental participation, no missing values were present because a decision was made to code all interventions which did not specifically report that parents had participated—either through parent–youth sessions or homework assignments—as non-participation. However, for the rest of the variables, no similar assumptions seemed appropriate, and therefore if no pertinent data were reported for a given variable, it was coded as missing (see Table I ).

Once the pool of studies which met the inclusion criteria was located, studies were examined in an attempt to retrieve the size of the effect associated with each intervention. Since most of the studies did not report any effect size, it had to be estimated based on the significance level and inferential statistics with formulae provided by Rosenthal ( Rosenthal, 1991 ) and Holmes ( Holmes; 1984 ). When provided, the exact value for the test statistic or the exact probability was used in the calculation of the effect size.

Alternative methods to deal with non-independent effect sizes were not employed since these are more complex and require estimates of the covariance structure among the correlated effect sizes. According to Matt and Cook such estimates may be difficult—if not impossible—to obtain due to missing information in primary studies ( Matt and Cook, 1994 ).

Analyses of the effect sizes were conducted utilizing the D-STAT software ( Johnson, 1989 ). The sample sizes used for the overall effect size analysis corresponded to the actual number used to estimate the effects of interest, which was often less than the total sample of the study. Occasionally the actual sample sizes were not provided by the authors of primary research, but could be estimated from the degrees of freedom reported for the statistical tests.

The effect sizes were calculated from means and pooled standard deviations, t -tests, χ 2 , significance levels or from proportions, depending on the nature of the information reported by the authors of primary research. As recommended by Rosenthal, if results were reported simply as being `non-significant' a conservative estimate of the effect size was included, assuming P = 0.50, which corresponds to an effect size of zero ( Rosenthal, 1991 ). The overall measure of effect size reported was the corrected d statistic ( Hedges and Olkin, 1985 ). These authors recommend this measure since it does not overestimate the population effect size, especially in the case when sample sizes are small.

The homogeneity of effect sizes was examined to determine whether the studies shared a common effect size. Testing for homogeneity required the calculation of a homogeneity statistic, Q . If all studies share the same population effect size, Q follows an asymptotic χ 2 distribution with k – 1 degrees of freedom, where k is the number of effect sizes. For the purposes of this review the probability level chosen for significance testing was 0.10, due to the fact that the relatively small number of effect sizes available for the analysis limits the power to detect actual departures from homogeneity. Rejection of the hypothesis of homogeneity signals that the group of effect sizes is more variable than one would expect based on sampling variation and that one or more moderator variables may be present ( Hall et al ., 1994 ).

To examine the relationship between the study characteristics included as potential moderators and the magnitude of effect sizes, both categorical and continuous univariate tests were run. Categorical tests assess differences in effect sizes between subgroups established by dividing studies into classes based on study characteristics. Hedges and Olkin presented an extension of the Q statistic to test for homogeneity of effect sizes between classes ( Q B ) and within classes ( Q W ) ( Hedges and Olkin, 1985 ). The relationship between the effect sizes and continuous predictors was assessed using a procedure described by Rosenthal and Rubin which tests for linearity between effect sizes and predictors ( Rosenthal and Rubin, 1982 ).

Q E provides the test for model specification, when the number of studies is larger than the number of predictors. Under those conditions, Q E follows an approximate χ 2 distribution with k – p – 1 degrees of freedom, where k is the number of effect sizes and p is the number of regressors ( Hedges and Olkin, 1985 ).

The search for school-based sex education interventions resulted in 12 research studies that complied with the criteria to be included in the review and for which effect sizes could be estimated.

The overall effect size ( d +) estimated from these studies was 0.05 and the 95% confidence interval about the mean included a lower bound of 0.01 to a high bound of 0.09, indicating a very minimal overall effect size. Table II presents the effect size of each study ( d i ) along with its 95% confidence interval and the overall estimate of the effect size. Homogeneity testing indicated the presence of variability among effect sizes ( Q (11) = 35.56; P = 0.000).

An assessment of interaction effects among significant moderators could not be explored since it would have required partitioning of the studies according to a first variable and testing of the second within the partitioned categories. The limited number of effect sizes precluded such analysis.

Parental participation appeared to moderate the effects of sex education on abstinence as indicated by the significant Q test between groups ( Q B(1) = 5.06; P = 0.025), as shown in Table III . Although small in magnitude ( d = 0.24), the point estimate for the mean weighted effect size associated with programs with parental participation appears substantially larger than the mean associated with those where parents did not participate ( d = 0.04). The confidence interval for parent participation does not include zero, thus indicating a small but positive effect. Controlling for parental participation appears to translate into homogeneous classes of effect sizes for programs that include parents, but not for those where parents did not participate ( Q W(9) = 28.94; P = 0.001) meaning that the effect sizes were not homogeneous within this class.

Virginity status of the sample was also a significant predictor of the variability among effect sizes ( Q B(1) = 3.47 ; P = 0.06). The average effect size calculated for virgins-only was larger than the one calculated for virgins and non-virgins ( d = 0.09 and d = 0.01, respectively). Controlling for virginity status translated into homogeneous classes for virgins and non-virgins although not for the virgins-only class ( Q W(5) = 27.09; P = 0.000).

The scope of the implementation also appeared to moderate the effects of the interventions on abstinent behavior. The average effect size calculated for small-scale intervention was significantly higher than that for large-scale interventions ( d = 0.26 and d = 0.01, respectively). The effects corresponding to the large-scale category were homogeneous but this was not the case for the small-scale class, where heterogeneity was detected ( Q W(4) = 14.71; P = 0.01)

For all three significant categorical predictors, deletion of one outlier ( Howard and McCabe, 1990 ) resulted in homogeneity among the effect sizes within classes.

Univariate tests of continuous predictors showed significant results in the case of percentage of females in the sample ( z = 2.11; P = 0.04), age of participants ( z = –1.67; P = 0.09), grade ( z = –1.80; P = 0.07) and year of publication ( z = –2.76; P = 0.006).

All significant predictors in the univariate analysis—with the exception of grade which had a very high correlation with age ( r = 0.97; P = 0.000)—were entered into a weighted least-squares regression analysis. In general, the remaining set of predictors had a moderate degree of intercorrelation, although none of the coefficients were statistically significant.

In the weighted least-squares regression analysis, only parental participation and the percentage of females in the study were significant. The two-predictor model explained 28% of the variance in effect sizes. The test of model specification yielded a significant Q E statistic suggesting that the two-predictor model cannot be regarded as correctly specified (see Table IV ).

This review synthesized the findings from controlled sex education interventions reporting on abstinent behavior. The overall mean effect size for abstinent behavior was very small, close to zero. No significant effect was associated to the type of intervention: whether the program was abstinence-oriented or comprehensive—the source of a major controversy in sex education—was not found to be associated to abstinent behavior. Only two moderators—parental participation and percentage of females—appeared to be significant in both univariate tests and the multivariable model.

Although parental participation in interventions appeared to be associated with higher effect sizes in abstinent behavior, the link should be explored further since it is based on a very small number of studies. To date, too few studies have reported success in involving parents in sex education programs. Furthermore, the primary articles reported very limited information about the characteristics of the parents who took part in the programs. Parents who were willing to participate might differ in important demographic or lifestyle characteristics from those who did not participate. For instance, it is possible that the studies that reported success in achieving parental involvement may have been dealing with a larger percentage of intact families or with parents that espoused conservative sexual values. Therefore, at this point it is not possible to affirm that parental participation per se exerts a direct influence in the outcomes of sex education programs, although clearly this is a variable that merits further study.

Interventions appeared to be more effective when geared to groups composed of younger students, predominantly females and those who had not yet initiated sexual activity. The association between gender and effect sizes—which appeared significant both in the univariate and multivariable analyses—should be explored to understand why females seem to be more receptive to the abstinence messages of sex education interventions.

Smaller-scale interventions appeared to be more effective than large-scale programs. The larger effects associated to small-scale trials seems worth exploring. It may be the case that in large-scale studies it becomes harder to control for confounding variables that may have an adverse impact on the outcomes. For example, large-scale studies often require external agencies or contractors to deliver the program and the quality of the delivery of the contents may turn out to be less than optimal ( Cagampang et al ., 1997 ).

Interestingly there was a significant change in effect sizes across time, with effect sizes appearing to wane across the years. It is not likely that this represents a decline in the quality of sex education interventions. A possible explanation for this trend may be the expansion of mandatory sex education in the US which makes it increasingly difficult to find comparison groups that are relatively unexposed to sex education. Another possible line of explanation refers to changes in cultural mores regarding sexuality that may have occurred in the past decades—characterized by an increasing acceptance of premarital sexual intercourse, a proliferation of sexualized messages from the media and increasing opportunities for sexual contact in adolescence—which may be eroding the attainment of the goal of abstinence sought by educational interventions.

In terms of the design and implementation of sex education interventions, it is worth noting that the length of the programs was unrelated to the magnitude in effect sizes for the range of 4.5–30 h represented in these studies. Program length—which has been singled out as a potential explanation for the absence of significant behavioral effects in a large-scale evaluation of a sex education program ( Kirby et al ., 1997a )—does not appear to be consistently associated with abstinent behavior. The impact of lengthening currently existing programs should be evaluated in future studies.

As it has been stated, the exploration of moderator variables could be performed only partially due to lack of information on the primary research literature. This has been a problem too for other reviewers in the field ( Franklin et al ., 1997 ). The authors of primary research did not appear to control for nor report on the potentially confounding influence of numerous variables that have been indicated in the literature as influencing sexual decision making or being associated with the initiation of sexual activity in adolescence such as academic performance, career orientation, religious affiliation, romantic involvement, number of friends who are currently having sex, peer norms about sexual activity and drinking habits, among others ( Herold and Goodwin, 1981 ; Christopher and Cate, 1984 ; Billy and Udry, 1985 ; Roche, 1986 ; Coker et al ., 1994 ; Kinsman et al ., 1998 ; Holder et al ., 2000 ; Thomas et al ., 2000 ). Even though randomization should take care of differences in these and other potentially confounding variables, given that studies can rarely assign students to conditions and instead assign classrooms or schools to conditions, it is advisable that more information on baseline characteristics of the sample be utilized to establish and substantiate the equivalence between the intervention and control groups in relevant demographic and lifestyle characteristics.

In terms of the communication of research findings, the richness of a meta-analytic approach will always be limited by the quality of the primary research. Unfortunately, most of the research in the area of sex education do not employ experimental or quasi-experimental designs and thus fall short of providing conclusive evidence of program effects. The limitations in the quality of research in sex education have been highlighted by several authors in the past two decades ( Kirby and Baxter, 1981 ; Card and Reagan, 1989 ; Kirby, 1989 ; Peersman et al ., 1996 ). Due to these deficits in the quality of research—which resulted in a reduced number of studies that met the criteria for inclusion and the limitations that ensued for conducting a thorough analysis of moderators—the findings of the present synthesis have to be considered merely tentative. Substantial variability in effect sizes remained unexplained by the present synthesis, indicating the need to include more information on a variety of potential moderating conditions that might affect the outcomes of sex education interventions.

Finally, although it is rarely the case that a meta-analysis will constitute an endpoint or final step in the investigation of a research topic, by indicating the weaknesses as well as the strengths of the existing research a meta-analysis can be a helpful aid for channeling future primary research in a direction that might improve the quality of empirical evidence and expand the theoretical understanding in a given field ( Eagly and Wood, 1994 ). Research in sex education could be greatly improved if more efforts were directed to test interventions utilizing randomized controlled trials, measuring intervening variables and by a more careful and detailed reporting of the results. Unless efforts are made to improve on the quality of the research that is being conducted, decisions about future interventions will continue to be based on a common sense and intuitive approach as to `what might work' rather than on solid empirical evidence.

References marked with an asterisk indicate studies included in the meta-analysis.

Description of moderator variables

Effect sizes of studies

Tests of categorical moderators for abstinence

Weighted least-squares regression and test of model specification

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• least-squares analysis
• sex education

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Sex education in the spotlight: what is working systematic review.

1. Introduction

2. methodology, 2.2. methods, 2.3. search strategy, 2.4. inclusion criteria, 2.5. exclusion criteria.

• Their primary focus was adult people and adolescents were not included.
• Their primary focus was sexual-health screening, sexual abuse or assault or prevention of sexual abuse or rape.
• The studies targeted specific populations (e.g., pre-pubertal children, children with developmental disorders, migrant and refugee, or sexual minorities).
• The interventions focused on low- and middle-income countries or if high income countries were not included in the study.
• Recipients were professionals, teachers, parents or a combination of the latter.

2.6. Risk of Bias and Assessment of Study Quality

2.7. data synthesis, 3.1. results of search, 3.2. risk of bias in included studies, 3.3. reviews included, 3.3.1. setting, 3.3.2. population, 3.3.3. interventions/types of study, 3.3.4. outcomes, 3.3.5. country of review, 3.3.6. year of last paper included, 3.3.7. search tools, 3.3.8. multicenter studies and number of studies included, 3.3.9. number of reviews covered that include meta-analysis, 3.4. effectiveness, 3.4.1. school settings, 3.4.2. online platforms, 3.4.3. blended learning, 4. discussion, 4.1. interventions reviewed, 4.2. effectiveness, 4.3. limitations, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Share and Cite

Lameiras-Fernández, M.; Martínez-Román, R.; Carrera-Fernández, M.V.; Rodríguez-Castro, Y. Sex Education in the Spotlight: What Is Working? Systematic Review. Int. J. Environ. Res. Public Health 2021 , 18 , 2555. https://doi.org/10.3390/ijerph18052555

Lameiras-Fernández M, Martínez-Román R, Carrera-Fernández MV, Rodríguez-Castro Y. Sex Education in the Spotlight: What Is Working? Systematic Review. International Journal of Environmental Research and Public Health . 2021; 18(5):2555. https://doi.org/10.3390/ijerph18052555

Lameiras-Fernández, María, Rosana Martínez-Román, María Victoria Carrera-Fernández, and Yolanda Rodríguez-Castro. 2021. "Sex Education in the Spotlight: What Is Working? Systematic Review" International Journal of Environmental Research and Public Health 18, no. 5: 2555. https://doi.org/10.3390/ijerph18052555

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Sexuality education that prioritizes sexual well-being: Initiatives and impact

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All children and young people should receive comprehensive sexuality education, from a variety of sources, that empowers them to develop a positive self-identity and provides them with the tools necessary to form healthy relationships, and to manage their own sexuality and sexual health. The positive impact ...

Keywords : sexuality education, sexual well-being, instructional design, program evaluation

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Three Decades of Research: The Case for Comprehensive Sex Education

Affiliations.

• 1 Department of Public Health, Montclair State University, Montclair, New Jersey. Electronic address: [email protected].
• 2 Department of Public Health, Montclair State University, Montclair, New Jersey.
• PMID: 33059958
• DOI: 10.1016/j.jadohealth.2020.07.036

Purpose: School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education.

Methods: Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving 39. In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence reflecting the full range of topic areas. Eighty articles constituted the final review.

Results: Outcomes include appreciation of sexual diversity, dating and intimate partner violence prevention, development of healthy relationships, prevention of child sex abuse, improved social/emotional learning, and increased media literacy. Substantial evidence supports sex education beginning in elementary school, that is scaffolded and of longer duration, as well as LGBTQ-inclusive education across the school curriculum and a social justice approach to healthy sexuality.

Conclusions: Review of the literature of the past three decades provides strong support for comprehensive sex education across a range of topics and grade levels. Results provide evidence for the effectiveness of approaches that address a broad definition of sexual health and take positive, affirming, inclusive approaches to human sexuality. Findings strengthen justification for the widespread adoption of the National Sex Education Standards.

Keywords: CSE; K-12; National Sex Education Standards; National Sexuality Education Standards; Sex education; Sexuality education; Systematic Literature Review; comprehensive sex education.

Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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• Sex Education: Broadening the Definition of Relevant Outcomes. Kantor LM, Lindberg LD, Tashkandi Y, Hirsch JS, Santelli JS. Kantor LM, et al. J Adolesc Health. 2021 Jan;68(1):7-8. doi: 10.1016/j.jadohealth.2020.09.031. J Adolesc Health. 2021. PMID: 33349360 No abstract available.

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Comprehensive sexuality education

Comprehensive sexuality education (CSE) gives young people accurate, age-appropriate information about sexuality and their sexual and reproductive health, which is critical for their health and survival.

While CSE programmes will be different everywhere, the United Nations’ technical guidance – which was developed together by UNESCO, UNFPA, UNICEF, UN Women, UNAIDS and WHO – recommends that these programmes should be based on an established curriculum; scientifically accurate; tailored for different ages; and comprehensive, meaning they cover a range of topics on sexuality and sexual and reproductive health, throughout childhood and adolescence.

Topics covered by CSE, which can also be called life skills, family life education and a variety of other names, include, but are not limited to, families and relationships; respect, consent and bodily autonomy; anatomy, puberty and menstruation; contraception and pregnancy; and sexually transmitted infections, including HIV.

Sexuality education equips children and young people with the knowledge, skills, attitudes and values that help them to protect their health, develop respectful social and sexual relationships, make responsible choices and understand and protect the rights of others. 

Evidence consistently shows that high-quality sexuality education delivers positive health outcomes, with lifelong impacts. Young people are more likely to delay the onset of sexual activity – and when they do have sex, to practice safer sex – when they are better informed about their sexuality, sexual health and their rights.

Sexuality education also helps them prepare for and manage physical and emotional changes as they grow up, including during puberty and adolescence, while teaching them about respect, consent and where to go if they need help. This in turn reduces risks from violence, exploitation and abuse.

Children and adolescents have the right to be educated about themselves and the world around them in an age- and developmentally appropriate manner – and they need this learning for their health and well-being.

Intended to support school-based curricula, the UN’s global guidance indicates starting CSE at the age of 5 when formal education typically begins. However, sexuality education is a lifelong process, sometimes beginning earlier, at home, with trusted caregivers. Learning is incremental; what is taught at the earliest ages is very different from what is taught during puberty and adolescence.

With younger learners, teaching about sexuality does not necessarily mean teaching about sex. For instance, for younger age groups, CSE may help children learn about their bodies and to recognize their feelings and emotions, while discussing family life and different types of relationships, decision-making, the basic principles of consent and what to do if violence, bullying or abuse occur. This type of learning establishes the foundation for healthy relationships throughout life.

Many people have a role to play in teaching young people about their sexuality and sexual and reproductive health, whether in formal education, at home or in other informal settings. Ideally, sound and consistent education on these topics should be provided from multiple sources. This includes parents and family members but also teachers, who can help ensure young people have access to scientific, accurate information and support them in building critical skills. In addition, sexuality education can be provided outside of school, such as through trained social workers and counsellors who work with young people. 

Well-designed and well-delivered sexuality education programmes support positive decision-making around sexual health. Evidence shows that young people are more likely to initiate sexual activity later – and when they do have sex, to practice safer sex – when they are better informed about sexuality, sexual relations and their rights.

CSE does not promote masturbation. However, in our documents, WHO recognizes that children start to explore their bodies through sight and touch at a relatively early age. This is an observation, not a recommendation. 

The UN’s guidance on sexuality education aims to help countries, practitioners and families provide accurate, up-to-date information related to young people’s sexuality, which is appropriate to their stage of development. This may include correcting misperceptions relating to masturbation such as that it is harmful to health, and – without shaming children – teaching them about their bodies, boundaries and privacy in an age-appropriate way.

There is sound evidence that unequal gender norms begin early in life, with harmful impacts on both males and females. It is estimated that 18%, or almost 1 in 5 girls worldwide, have experienced child sexual abuse.

Research shows, however, that education in small and large groups can contribute to challenging and changing unequal gender norms. Based on this, the UN’s international guidance on sexuality education recommends teaching young people about gender relations, gender equality and inequality, and gender-based violence. 

By providing children and young people with adequate knowledge about their rights, and what is and is not acceptable behaviour, sexuality education makes them less vulnerable to abuse. The UN’s international guidance calls for children between the age of 5 and 8 years to recognize bullying and violence, and understand that these are wrong. It calls for children aged 12–15 years to be made aware that sexual abuse, sexual assault, intimate partner violence and bullying are a violation of human rights and are never the victim’s fault. Finally, it calls for older adolescents – those aged 15–18 – to be taught that consent is critical for a positive sexual relationship with a partner. Children and young people should also be taught what to do and where to go if problems like violence and abuse occur.

Through such an approach, sexuality education improves children’s and young people’s ability to react to abuse, to stop abuse and, finally, to find help when they need it. 

There is clear evidence that abstinence-only programmes – which instruct young people to not have sex outside of marriage – are ineffective in preventing early sexual activity and risk-taking behaviour, and potentially harmful to young people’s sexual and reproductive health.

CSE therefore addresses safer sex, preparing young people – after careful decision-making – for intimate relationships that may include sexual intercourse or other sexual activity. Evidence shows that such an approach is associated with later onset of sexual activity, reduced practice of risky sexual behaviours (which also helps reduce the incidence of sexually transmitted infections), and increased contraception use.

On sexuality education, as with all other issues, WHO provides guidance for policies and programmes based on extensive research evidence and programmatic experience.

The UN global guidance on sexuality education outlines a set of learning objectives beginning at the age of 5. These are intended to be adapted to a country’s local context and curriculum. The document itself details how this process of adaptation should occur, including through consultation with experts, parents and young people, alongside research to ensure programmes meet young people’s needs.

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Sex education star 'kicked and pepper sprayed' and was ‘racially profiled’ by police after witnessing car crash

17 September 2024, 12:19

By Asher McShane

An actor from the hit Netflix show Sex Education has claimed he was pepper sprayed and kicked by police who ‘racially profiled’ him as he made his way home from performing in a musical.

Listen to this article

Reece Richards, who played Eugene in Sex Education, accused the Met police of ‘racially profiling him’ late at night after he witnessed a car crash in the early hours of the morning while returning home.

He witnessed a car crash, and police were pursuing three men who fled a crashed car near his home.

He said police mistook him for one of the suspects and he was arrested.

View this post on Instagram A post shared by Reece Richards 🇧🇧 (@reecejrichards)

Police quickly de-arrested him when it became clear he was a bystander.

But he says he was ‘kicked’ and ‘handcuffed’ and said police kicked his legs out from under him and handcuffed him.

 Mr Richards wrote: 'They pepper-sprayed me, kicked my legs out from under me, threw me to the ground, and handcuffed me. 

'In a flash, I was face-down on the pavement with multiple officers holding me down, forcing my head into the ground. 

'I was already injured from the show, but having four officers on top of me worsened my injuries to my back, ribs, and stomach. 

'I couldn't see anything, but I could hear my mum nearby, screaming and crying, begging them to let me go.'

The Met police have confirmed they have received a complaint over the incident.

A spokesperson for the Met Police said: “We are aware of a video circulating on social media of a man being detained in the Fulham area. 

“Officers often find themselves in dynamic, challenging situations and have to make split-second judgements on which course of action to take.

“Officers had been pursuing three men who had run out of a car that had crashed in Fulham Palace Road after it failed to stop for police. 

“It is clear the man shown in the footage was an innocent bystander and he was dearrested as soon as this was established by officers at the scene.

“All officers know any use of force must be proportionate and reasonable and they understand their actions will be scrutinised.

“A complaint has been received in relation to his arrest. 

“This is currently being assessed by officers from the Met’s Directorate of Professional Standards (DPS), along with other material including the officers’ body worn video footage.

“None of the officers involved are subject to restrictions at this time.”

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Sex Education in School, are Gender and Sexual Minority Youth Included?: A Decade in Review

Comprehensive sexual health education increases sexual health knowledge and decreases adverse health outcomes and high-risk behaviors in heterosexual youth but lacks information relevant to gender and sexual minority youth. Universal access to comprehensive sexual health education that includes information relevant to gender and sexual minority individuals is lacking in the United States, leading to poor health outcomes for gender and sexual minority youth. The purpose of this review was to examine sexual health education programs in schools in the United States for the inclusion of information on gender identity and sexual orientation. The review provides information on current programs offered in schools and suggestions to make them more inclusive to gender and sexual minority youth.

Is Sex Education for Everyone?: A Review

Gender and sexual minority youth (GSMY), youth who do not identify as heterosexual or their gender identity are non-binary, have increased sexual risk behaviors and adverse health outcomes compared to their heterosexual and cisgender peers ( Kann et al., 2016 ; Rasberry et al., 2017 , 2018 ). According to the 2017 YRBS youth that identified as a sexual minority (lesbian, gay, bisexual, or another non-heterosexual identity or reporting same-sex attraction or sexual partners) reported increased sexual partners, earlier sexual debut, the use of alcohol or drugs before sex, decreased condom and contraceptive use than their heterosexual peers ( Rasberry et al., 2018 ). Comprehensive sexual health education increase sexual health knowledge and decreases adverse health outcomes, sexually transmitted infections (STIs), HIV, and pregnancy and high-risk behaviors in heterosexual youth, age of sexual initiation, the number of sex partners, sex without protection, sex while under the influence of drugs and alcohol ( Bridges & Alford, 2010 ; Mustanski, 2011 ; Sexuality Information and Education Council of the United States (SIECUS)., 2004 ; Steinke et al., 2017 ). Research conducted with heterosexual adolescents shows comprehensive sexual health education, medically accurate material that includes information on STIs, HIV, pregnancy, condoms, contraceptives as well as abstinence and sexual decision making, increases sexual health knowledge and decreases adverse health outcomes, STIs, HIV, and pregnancy and high-risk behaviors ( Bridges & Alford, 2010 ; Mustanski, 2011 ; Sexuality Information and Education Council of the United States (SIECUS)., 2004 ; Steinke et al., 2017 ). Most GSMY report receiving some form of sexual health education in school ranging from comprehensive to abstinence-only, however GSMY-inclusive sexual health education, education that includes information on all genders and sexual orientations, is out of reach for a majority of youth in the United States ( Charest et al., 2016 ; Human Rights Campaign, 2015 ; Kosciw et al., 2018 ; Steinke et al., 2017 ). Not having access to GSMY-inclusive sex education, GSMY lack the information they need to understand their sexuality and gender concerns and to make informed sexual decisions ( Charest et al., 2016 ; Steinke et al., 2017 ).

Most teens, 70%, report receiving some form of sexual health education in school; while the content varies widely, from abstinence-only to comprehensive, it is primarily penile-vaginal in nature ( Human Rights Campaign, 2015 ; Lindberg et al., 2016 ). Universal access to comprehensive and GSMY-inclusive sexual health education is lacking in the United States and can lead to poor health outcomes for GSMY ( Human Rights Campaign, 2015 ). Currently, only 27 states mandate sexual health and HIV education ( Guttmacher Institute, 2020 ). Seventeen states require discussion of sexual orientation, with only 10 requiring information to be inclusive of gender and sexuality, and seven mandating only negative information be provided on homosexuality and positive information solely be provided on heterosexuality ( Guttmacher Institute, 2020 ). These laws intended to prohibit the promotion of homosexuality, deny SGMY the sexual health information they need and serve to further stigmatize them for their gender identity and sexual orientation ( Gay, Lesbian and Straight Education Network (GLSEN), 2018 ).

Significance of the Topic

Despite the effectiveness of comprehensive sexual health education in increasing sexual health outcomes in heterosexual youth, little research has been done on its effects on GSMY ( Human Rights Campaign, 2015 ; Kosciw et al., 2018 ; Steinke et al., 2017 ). The sex education offered in schools primarily describes penile-vaginal intercourse and does not include information on oral, anal, or manual intercourse or ways to practice safe sex with these types of sexual activity. Less than 7% of GSMY in the United States report receiving sexual health education that was inclusive of both gender and sexual minorities ( Charest et al., 2016 ; Human Rights Campaign, 2015 ; Kosciw et al., 2018 ; Steinke et al., 2017 ). Many GSMY look to the internet or pornography for information on sex, leading to misinformation or an unrealistic expectation of intercourse and relationships ( Arbeit et al., 2016 ; Charest et al., 2016 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Roberts et al., 2019 ).

Teens and young adults account for 21% of all new HIV cases in the United States, with 81% of newly diagnosed cases attributed to young men who have sex with men ( Centers for Disease Control and Prevention (CDC), 2019 ). Lindley & Walsemann, (2015) conducted a study of teens in New York and found that GSMY youth had between a two to seven times higher chance of being involved in a pregnancy than their heterosexual peers. According to the Centers for Disease Control and Prevention (2018) , young men who have sex with men have a higher incidence of gonorrhea, chlamydia, and syphilis compared to women and men who have sex with women only. The 2017 YRBS report revealed that GSMY reported significantly higher incidences of forced sex, dating violence, suicidal thoughts, attempted suicide, bullying, alcohol and drug use, earlier initiation into sex, more sexual partners, and were also less likely to use condoms during sexual intercourse than their heterosexual peers ( Kann et al., 2018 ; Rasberry et al., 2018 ). To improve sexual health outcomes in GSMY, they need to receive sexual health education that is comprehensive and inclusive to all genders and sexual orientations at an early age.

The purpose of this review was to examine the sexual health education programs in public and private schools in the United States for the inclusion of information on gender identity and sexual orientation. Further, this review provides an understanding of the sexual health education needs of GSMY, how it is reflected in the programs offered to young adults, and what changes could be made. A review of studies published between 2010 and 2020 was conducted to evaluate the inclusion of gender and sexual minority information in sexual health education offered in schools.

Literature Search

The review was conducted according to the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA) guidelines ( Moher et al., 2009 ). The search was conducted using three online databases: CINAHL, PubMed, and Scopus. The search strategy for CINAHL was as follows: limits were set to include research articles published in English in peer-reviewed academic journals, age restriction set to “all child” major heading “sex education” and “sexual health”. The search date was set from January 2010 to March 2020. The reason for the 2010 start date was to get the latest information on sexual health education programs. The combinations of the search terms used were “sex education” and “sexual minority”; “sexual health education” and “sexual minority”; “inclusive” and “sex education” and “school”; “LGBT” and “sex education”. The same searches were conducted in each of the other databases. The process is illustrated in Figure 1 . The initial searches yielded a total of 83 articles after duplicates were removed; 56 articles could be excluded after reading the title or abstract due to location or not discussing sex education in the primary or high school setting, 27 articles were viewed in full text. After reading the full-text articles, 14 articles were excluded for the following reasons: seven did not discuss sex education programs in school, five discussed program implementations, and two were not set in the United States. A total of 13 peer reviewed articles were included in this review ( Table 1 ).

PRISMA diagram showing search and screening process, and selection of studies for inclusion in the review.

Review of Studies Related to Inclusive Sexual Health Education

Current Education Offered

Heteronormative information.

A majority of the research reported the content of the sexual health education offered in schools was heteronormative, the belief that heterosexuality and binary gender are the norms, and the intercourse discussed was penile-vaginal intercourse ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Steinke et al., 2017 ). The lessons primarily consisted of information about puberty, the dangers of sex, penile-vaginal intercourse, STIs, and pregnancy; information the GSMY in the studies reported as irrelevant to them ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Roberts et al., 2019 ). Of the 13 studies, eight mentioned students being taught about external condoms, one mentioned internal condoms, 1 discussed students being shown a condom demonstration and none reported information being given on dental dams or finger condoms. ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Roberts et al., 2019 ). In seven of the studies, participants reported their questions regarding gender identity or sexual orientation went unanswered in class. This was due to the teacher ignoring the question, the teacher lacking the information to answer, or the teacher not being allowed to answer due to school and state policy ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Mahdi et al., 2014 ; Pingel et al., 2013 ; Steinke et al., 2017 ).

Supplying only heteronormative education contributed to poorer mental outcomes for GSMY. Non-heterosexual, non-binary, and gender-nonconforming individuals and their behavior were often pathologized in the education presented, leading to internalized homophobia, increased depression, increased anxiety, and self-loathing in GSMY ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Steinke et al., 2017 ). The exclusion of information about gender and sexual minorities made GSMY feel confused about how they were feeling, made them feel something was wrong with them and made them feel like they did not exist ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Roberts et al., 2019 ). Lack of GSMY-inclusive information also led to an increase in bullying of GSMY in schools from both students and teachers ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; W. J. Hall et al., 2019 ; McCarty-Caplan, 2015 ; Roberts et al., 2019 ). Numerous studies described a decrease in bullying of GSMY in schools with GSMY-inclusive education, potentially due to a normalizing non-heterosexual, non-binary, and gender-nonconforming individuals, ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Proulx et al., 2019 ; Roberts et al., 2019 ).

Incomplete and Inaccurate Information

The negative impact an incomplete sex education had on GSMY health was a common theme in the literature ( Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ). Many of the lessons taught in school only covered the “mechanics” of penile-vaginal intercourse and the problems that can occur from that action, with few reporting receiving lessons about other types of sex (anal, oral, manual, masturbation), healthy relationships, consent, or the enjoyment of sex ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Roberts et al., 2019 ). No studies reported information being taught on transgender identity, non-binary identity, or use of proper pronouns ( Haley et al., 2019 ; Hobaica et al., 2019 ; Roberts et al., 2019 ).

Several authors discussed inaccurate information being offered to students in schools ( Haley et al., 2019 ; K. S. Hall et al., 2016 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ). Hobaica and Kwon (2017) reported in 2016 only 20 states required sexual health information provided to students in school to be medically accurate. Inaccurate information given to youth included inflated failure rates of condoms and birth control, inaccurate information on the transmission of STIs, and inaccurate representation of gender and sexual minority individuals ( Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Roberts et al., 2019 ; Steinke et al., 2017 ). Lack of information and inaccurate information contributed to GSMY making uninformed decisions about sex, leading to increased sexual experiences, increased number of partners, non-consensual sexual experiences, unprotected sex, sex while intoxicated, STIs, and pregnancy ( Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ).

Timing of Information

The timing of education being offered to students occurred in middle school and high school ( Bodnar & Tornello, 2019 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ). For some GSMY this information came too late to be helpful. Sexual minority youth report earlier initiation into sex and many received sex education after they had already become sexually active leading to early risky sexual behaviors and pregnancy ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Haley et al., 2019 ; Hobaica & Kwon, 2017 ). Gender minority and non-binary individuals recommended that information about gender and puberty start as early as 1 st and 2 nd grade to help with the problems associated with gender dysphoria.

Recommendations

There were many recommendations included in the literature on how to make sexual health education more inclusive and appropriate for GSMY. To be relevant to all students sexual health education must be inclusive of all genders and sexual orientations and it is important that affirming gender and sexuality inclusive language and pronouns are used when describing different subgroups of GSMY ( Arbeit et al., 2016 ; Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Rasberry et al., 2017 ; Roberts et al., 2019 ; Steinke et al., 2017 ). It is important that the education provided be medically accurate and cover different types of sex acts, not just penile-vaginal intercourse, include information on the type of protection needed to have safe sex based on the sexual act being performed, and local resources where it can be obtained ( Arbeit et al., 2016 ; Bodnar & Tornello, 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Roberts et al., 2019 ). Education should also include information on medical and non-medical gender-affirming interventions, information on relationships, consent, and reputable resources for healthcare and sexual health information ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ; Roberts et al., 2019 ). There was a reported need for inclusion of historical gender and sexual minority individuals in the core curriculum. This would allow GSMY to have role models and would allow others could see gender and sexual minority individuals in a different light ( Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Pingel et al., 2013 ).

This paper reviewed how sexual health education has been presented in schools over the past ten years. All studies reported participants receiving some form of sexual health education in school. However, the education presented was almost exclusively heteronormative and exclusive to GSMY needs leaving them feeling left out and lacking the information they needed to better understand themselves and make informed sexual health decisions ( Bodnar & Tornello, 2019 ; Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ).

School administrators need to be aware of the specific sexual health needs of GSMY and tailor education to meet the needs of all the students, not only cisgender, heterosexual students. Providing comprehensive GSMY-inclusive education improves the physical and mental health outcomes of all youth and decreases bullying of GSMY in school ( Hobaica et al., 2019 , 2019 ; Human Rights Campaign, 2015 ; Proulx et al., 2019 ; Roberts et al., 2019 ). GSMY-inclusive education has been shown to decrease negative mental health outcomes and bullying by normalize the LGBT experience ( Gowen & Winges-Yanez, 2014 ; Proulx et al., 2019 ; Roberts et al., 2019 ) and potentially decrease pregnancy and STI rates, and increase the use of condoms and the age of sexual debut ( Haley et al., 2019 ; Hobaica et al., 2019 ; Pingel et al., 2013 ). If school administrators are unable to provide GSMY-inclusive sex education due to policy at the local or state level, it is important to offer vetted outside resources for students and to work with politicians to change these stigmatizing laws ( W. J. Hall et al., 2019 ; Human Rights Campaign, 2015 ; Steinke et al., 2017 ).

The needs of students should take precedent when creating sexual health education programs. Administration, faculty, and staff should be educated on the needs of GSMY. Curricula presented to students in schools must be evidence-based and facilitated by trained LGBT (lesbian, gay, bisexual, and transgender) affirming educators ( Gowen & Winges-Yanez, 2014 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Human Rights Campaign, 2015 ; Steinke et al., 2017 ).

Limitations

This review is not without limitations. The search databases used were health and medical and not educational in nature due to the author examining the physical and mental health aspects of sex education on GSMY. The number of articles included was small and more may have been included had educational databases been used. MeSH terms were not used in the search as they had a limiting effect on the results. Lastly, there is very little research on the long-term benefits of GSMY-inclusive sex education in the United States. One of the reasons for this is there is no consistent sex education offered to students, with instructional content often being based on state, local, mandate or teacher preference.

This review indicated that schools are still presenting sexual health education exclusive of gender and sexual minority needs. Sex education is a public health necessity, allowing individuals to make informed decisions concerning their sexual health and wellbeing, and GSMY are being overlooked, leading to poorer mental and physical health outcomes ( Gowen & Winges-Yanez, 2014 ; Haley et al., 2019 ; Hobaica et al., 2019 ; Hobaica & Kwon, 2017 ; Rasberry et al., 2017 ; Roberts et al., 2019 ). Sex education in schools needs to be medically accurate, affirming, and reflect all genders and sexual orientations to help reduce health disparities and increase the quality of life for GSMY. Future research should focus on strategies to implement comprehensive and GSMY-inclusive sex education in schools to evaluate its impact on the health and wellness of all youth.

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I'm a survivor of human trafficking. My criminal record is not my fault.

Our arrests were related to our exploitation and criminal record relief must be available and accessible to survivors. congress should pass the trafficking survivors relief act now..

As a survivor of familial trafficking, I grew up believing what was happening to me was normal. When I got away, I didn’t know there was a name for what I experienced or where to go for help. Since then, much has changed in the anti-trafficking world. The public is more aware of both the crime and service providers, including here in Kentucky , who understand trauma and help survivors work through to the other side.

But further change is needed – especially creating opportunities for trafficking survivors to clear criminal records that resulted from our trafficking experiences. One example is the Trafficking Survivors Relief Act , which would create the first pathway for record relief at the federal level.

I know the need for this relief from personal experience. In my case, I was forced to write bad checks as a teenager and forged checks on my trafficker’s account. As a young adult, I ended up with 15 felony charges from my trafficking and spent two years in prison. Then I struggled to find a job. My record often disqualified me during background checks. When I would make it to an interview, I didn’t know what I would have to disclose about my trafficking and having to explain everything frustrated and embarrassed me.

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Human trafficking victims deserve relief from criminal records

Eventually, I was able to secure employment in restaurants that didn’t ask about my background. I was grateful for these jobs, but they couldn’t sustain me – I wasn’t getting benefits like health insurance, and the physical work and the process of healing from trauma took a toll.

I tried to advance my job prospects with more education, but employers still wouldn’t look past my background. This experience drove me into addiction to avoid thinking about how difficult life was. I felt stuck.

Trafficking victim faces prison time: Judge sends sex trafficking victim who fought back to prison. How is that justice?

So many survivors face the same insurmountable barrier. According to the National Survivor Study, 42% of survivors have criminal records , with 90% reporting that some or all of our arrests were related to our exploitation. We struggle to get housing, work and education – and some of us are forced to resort to illegal activity or even return to an abuser.

To stop that from happening, criminal record relief must be available and accessible to survivors.

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At the federal level, Congress should pass the Trafficking Survivors Relief Act (TSRA) now. At the state level, lawmakers can introduce or improve relief statutes, and ensure that survivors benefit from existing laws , such as Kentucky’s. Legislation like the TSRA gives us hope that we can move forward from what we have survived to a place where we can heal and thrive. 

That’s what I’m hoping for myself. Now over a decade since completing parole, I’ve been able to pass background checks and begin working as a cashier.

I’m going back to school to finish my degree to fulfill my dream of becoming a therapist to help others. And I’m advocating for criminal record relief – the chance for survivors to secure employment, take care of our families and live healthy and productive lives.

A Kentucky resident, Sonia Martin is a fun-loving, people person who enjoys living life. She also enjoys helping others and learning from everyone. This column originally appeared in the Louisville Courier Journal .

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