topic outline about sex education

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The Importance of Access to Comprehensive Sex Education

Comprehensive sex education is a critical component of sexual and reproductive health care.

Developing a healthy sexuality is a core developmental milestone for child and adolescent health.

Youth need developmentally appropriate information about their sexuality and how it relates to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

AAP supports broad access to comprehensive sex education, wherein all children and adolescents have access to developmentally appropriate, evidence-based education that provides the knowledge they need to:

• Develop a safe and positive view of sexuality.
• Build healthy relationships.
• Make informed, safe, positive choices about their sexuality and sexual health.

Comprehensive sex education involves teaching about all aspects of human sexuality, including:

• Cyber solicitation/bullying.
• Healthy sexual development.
• Body image.
• Sexual orientation.
• Gender identity.
• Pleasure from sex.
• Sexual abuse.
• Sexual behavior.
• Sexual reproduction.
• Sexually transmitted infections (STIs).
• Abstinence.
• Contraception.
• Interpersonal relationships.
• Reproductive coercion.
• Reproductive rights.
• Reproductive responsibilities.

Comprehensive sex education programs have several common elements:

• Utilize evidence-based, medically accurate curriculum that can be adapted for youth with disabilities.
• Employ developmentally appropriate information, learning strategies, teaching methods, and materials.
• Human development , including anatomy, puberty, body image, sexual orientation, and gender identity.
• Relationships , including families, peers, dating, marriage, and raising children.
• Personal skills , including values, decision making, communication, assertiveness, negotiation, and help-seeking.
• Sexual behavior , including abstinence, masturbation, shared sexual behavior, pleasure from esx, and sexual dysfunction across the lifespan.
• Sexual health , including contraception, pregnancy, prenatal care, abortion, STIs, HIV and AIDS, sexual abuse, assault, and violence.
• Society and culture , including gender roles, diversity, and the intersection of sexuality and the law, religion, media, and the arts.
• Create an opportunity for youth to question, explore, and assess both personal and societal attitudes around gender and sexuality.
• Focus on personal practices, skills, and behaviors for healthy relationships, including an explicit focus on communication, consent, refusal skills/accepting rejection, violence prevention, personal safety, decision making, and bystander intervention.
• Help youth exercise responsibility in sexual relationships.
• Include information on how to come forward if a student is being sexually abused.
• Address education from a trauma-informed, culturally responsive approach that bridges mental, emotional, and relational health.

Comprehensive sex education should occur across the developmental spectrum, beginning at early ages and continuing throughout childhood and adolescence :

• Sex education is most effective when it begins before the initiation of sexual activity.
• Young children can understand concepts related to bodies, gender, and relationships.
• Sex education programs should build an early foundation and scaffold learning with developmentally appropriate content across grade levels.
• AAP Policy outlines considerations for providing developmentally appropriate sex education throughout early childhood, middle childhood, adolescence, and young adulthood.

Most adolescents report receiving some type of formal sex education before age 18. While sex education is typically associated with schools, comprehensive sex education can be delivered in several complementary settings:

• Schools can implement comprehensive sex education curriculum across all grade levels
• The Sexuality Information and Education Council of the United States (SIECUS) provides guidelines for providing developmentally appropriate comprehensive sex education across grades K-12.
• Pediatric health clinicians and other health care providers are uniquely positioned to provide longitudinal sex education to children, adolescents, and young adults.
• Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents outlines clinical considerations for providing comprehensive sex education at all developmental stages, as a part of preventive health care.
• Research suggests that community-based organizations should be included as a source for comprehensive sexual health promotion.
• Faith-based communities have developed sex education curricula for their congregations or local chapters that emphasize the moral and ethical aspects of sexuality and decision-making.
• Parents and caregivers can serve as the primary sex educators for their children, by teaching fundamental lessons about bodies, development, gender, and relationships.
• Many factors impact the sex education that youth receive at home, including parent/caregiver knowledge, skills, comfort, culture, beliefs, and social norms.
• Virtual sex education can take away feelings of embarrassment or stigma and can allow for more youth to access high quality sex education.

Comprehensive sex education provides children and adolescents with the information that they need to:

• Understand their body, gender identity, and sexuality.
• Build and maintain healthy and safe relationships.
• Engage in healthy communication and decision-making around sex.
• Practice healthy sexual behavior.
• Understand and access care to support their sexual and reproductive health.

Comprehensive sex education programs have demonstrated success in reducing rates of sexual activity, sexual risk behaviors, STIs, and adolescent pregnancy and delaying sexual activity. Many systematic reviews of the literature have indicated that comprehensive sex education promotes healthy sexual behaviors:

• Reduced sexual activity.
• Reduced number of sexual partners.
• Reduced frequency of unprotected sex.
• Increased condom use.
• Increased contraceptive use.

However, comprehensive sex education curriculum goes beyond risk-reduction, by covering a broader range of content that has been shown to support social-emotional learning, positive communication skills, and development of healthy relationships.

A 2021 review of the literature found that comprehensive sex education programs that use a positive, affirming, and inclusive approach to human sexuality are associated with concrete benefits across 5 key domains:

Benefits of comprehensive sex education programs 

When children and adolescents lack access to comprehensive sex education, they do not get the information they need to make informed, healthy decisions about their lives, relationships, and behaviors.

Several trends in sexual health in the US highlight the need for comprehensive sex education for all youth.

Education about condom and contraceptive use is needed:

• 55% of US high school students report having sexual intercourse by age 18 .
• Self-reported condom use has decreased significantly among high school students.
• Only 9% of sexually active high school students report using both a condom for STI-prevention and a more effective form of birth control to prevent pregnancy .

STI prevention is needed:

• Adolescents and young adults are disproportionately impacted by STIs.
• Cases of chlamydia, gonorrhea, and syphilis are rising rapidly among young people.
• When left untreated , these infections can lead to infertility, adverse pregnancy and birth outcomes, and increased risk of acquiring new STIs.
• Youth need comprehensive, unbiased information about STI prevention, including human papillomavirus (HPV) .

Continued prevention of unintended pregnancy is needed:

• Overall US birth rates among adolescent mothers have declined over the last 3 decades.
• There are significant geographic disparities in adolescent pregnancy rates, with higher rates of pregnancy in rural counties and in southern and southwestern states.
• Social drivers of health and systemic inequities have caused racial and ethnic disparities in adolescent pregnancy rates.
• Eliminating disparities in adolescent pregnancy and birth rates can increase health equity, improve health and life outcomes, and reduce the economic impact of adolescent parenting.

Misinformation about sexual health is easily available online:

• Internet use is nearly universal among US children and adolescents.
• Adolescents report seeking sexual health information online .
• Sexual health websites that adolescents visit can contain inaccurate information .

Prevention of sex abuse, dating violence, and unhealthy relationships is needed:

• Child sexual abuse is common: 25% of girls and 8% of boys experience sexual abuse during childhood .
• Youth who experience sexual abuse have long-term impacts on their physical, mental, and behavioral health.
• 1 in 11 female and 1 in 14 male students report physical DV in the last year .
• 1 in 8 female and 1 in 26 male students report sexual DV in the last year .
• Youth who experience DV have higher rates of anxiety, depression, substance use, antisocial behaviors, and suicide risk.

The quality and content of sex education in US schools varies widely.

There is significant variation in the quality of sex education taught in US schools, leading to disparities in attitudes, health information, and outcomes. The majority of sex education programs in the US tend to focus on public health goals of decreasing unintended pregnancies and preventing STIs, via individual behavior change.

There are three primary categories of sex educational programs taught in the US :

• Abstinence-only education , which teaches that abstinence is expected until marriage and typically excludes information around the utility of contraception or condoms to prevent pregnancy and STIs.
• Abstinence-plus education , which promotes abstinence but includes information on contraception and condoms.
• Comprehensive sex education , which provides medically accurate, age-appropriate information around development, sexual behavior (including abstinence), healthy relationships, life and communication skills, sexual orientation, and gender identity.

State laws impact the curriculum covered in sex education programs. According to a report from the Guttmacher Institute :

• 26 US states and Washington DC mandate sex education and HIV education.
• 18 states require that sex education content be medically accurate.
• 39 states require that sex education programs provide information on abstinence.
• 20 states require that sex education programs provide information on contraception.

US states have varying requirements on sex education content related to sexual orientation :

• 10 states require sex education curriculum to include affirming content on LGBTQ2S+ identities or discussion of sexual health for youth who are LGBTQ2S+.
• 7 states have sex education curricular requirements that discriminate against individuals who are LGBTQ2S+.Youth who live in these states may face additional barriers to accessing sexual health information.

Abstinence-only sex education programs do not meet the needs of children and adolescents.

While abstinence is 100% effective in preventing pregnancy and STIs, research has conclusively shown that abstinence-only sex education programs do not support healthy sexual development in youth.

Abstinence-only programs are ineffective in reaching their stated goals, as evidenced by the data below:

• Abstinence-only programs are unsuccessful in delaying sex until marriage .
• Abstinence-only sex education programs do not impact the rates of pregnancy, STIs, or HIV in adolescents .
• Youth who take a “virginity pledge” as part of abstinence-only education programs have the same rates of premarital sex as their peers who do not take pledges, but are less likely to use contraceptives .
• US states that emphasize abstinence-only education have higher rates of adolescent pregnancy and birth .

Abstinence-only programs can harm the healthy sexual and mental development of youth by:

• Withholding information or providing inaccurate information about sexuality and sexual behavior .
• Contributing to fear, shame, and stigma around sexual behaviors .
• Not sharing information on contraception and barrier protection or overstating the risks of contraception .
• Utilizing heteronormative framing and stigma or discrimination against students who are LGBTQ2S+ .
• Reinforcing harmful gender stereotypes .
• Ignoring the needs of youth who are already sexually active by withholding education around contraception and STI prevention.

Abstinence-plus sex education programs focus solely on decreasing unintended pregnancy and STIs.

Abstinence-plus sex education programs promote abstinence until marriage. However, these programs also provide information on contraception and condom use to prevent unintended pregnancy and STIs.

Research has demonstrated that abstinence-plus programs have an impact on sexual behavior and safety, including:

• HIV prevention.
• Increase in condom use .
• Reduction in number of sexual partners .
• Delay in initiation of sexual behavior .

While these programs add another layer of education, they do not address the broader spectrum of sexuality, gender identity, and relationship skills, thus withholding critical information and skill-building that can impact healthy sexual development.

AAP and other national medical and public health associations support comprehensive sex education for youth.

Given the evidence outlined above, AAP and other national medical organizations oppose abstinence-only education and endorse comprehensive sex education that includes both abstinence promotion and provision of accurate information about contraception, STIs, and sexuality.

National medical and public health organizations supporting comprehensive sex education include:

• American Academy of Pediatrics .
• American Academy of Family Physicians.
• American College of Obstetricians and Gynecologists .
• American Medical Association .
• American Public Health Association .
• Society for Adolescent Health and Medicine .

Pediatric clinics provide a unique opportunity for comprehensive sex education.

Pediatric health clinicians typically have longitudinal care relationships with their patients and families, and thus have unique opportunities to address comprehensive sex education across all stages of development.

The clinical visit can serve as a useful adjunct to support comprehensive sex education provided in schools, or to fill gaps in knowledge for youth who are exposed to abstinence-only or abstinence-plus curricula.

AAP policy and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents provide recommendations for comprehensive sex education in clinical settings, including:

• Encouraging parent-child discussions on sexuality, contraception, and internet/media use.
• Understanding diverse experiences and beliefs related to sexuality and sex education and meeting the unique needs of individual patients and families.
• Including discussions around healthy relationships, dating violence, and intimate partner violence in clinical care.
• Discussing methods of contraception and STI/HPV prevention prior to onset of sexual intercourse.
• Providing proactive and developmentally appropriate sex education to all youth, including children and adolescents with special health care needs.

Perspective

Karen Torres, Youth activist

There were two cardboard bears, and a person explained that one bear wears a bikini to the beach and the other bear wears shorts – that is the closest thing I ever got to sex ed throughout my entire K-12 education. I often think about that bear lesson because it was the day our institutions failed to teach me anything about my body, relationships, consent, and self-advocacy, which became even more evident after I was sexually assaulted at 16 years old. My story is not unique, I know that many young people have been through similar traumas, but many of us were also subjected to days, months, and years of silence and embarrassment because we were never given the knowledge to know how to spot abuse or the language to ask for help. Comprehensive sex ed is so much more than people make it out to be, it teaches about sex but also about different types of experiences, how to respect one another, how to communicate in uncomfortable situations, how to ask for help and an insurmountable amount of other valuable lessons.

From these lessons, people become well-rounded, people become more empathetic to other experiences, and people become better. I believe comprehensive sex ed is vital to all people and would eventually work as a part to build more compassionate communities.

Many US children and adolescents do not receive comprehensive sex education; and rates of formal sex education have declined significantly in recent decades.

Barriers to accessing comprehensive sex education include:

Misinformation, stigma, and fear of negative reactions:

• Misinformation and stigma about the content of sex education curriculum has been the primary barrier to equitable access to comprehensive sex education in schools for decades .
• Despite widespread parental support for sex education in schools, fears of negative public/parent reactions have led school administrators to limit youth access to the information they need to make healthy decisions about their sexuality for nearly a half-century.
• In recent years, misinformation campaigns have spread false information about the framing and content of comprehensive sex education programs, causing debates and polarization at school board meetings .
• Nearly half of sex education teachers report that concerns about parent, student, or administrator responses are a barrier to provision of comprehensive sex education.
• Opponents of comprehensive sex education often express concern that this education will lead youth to have sex; however, research has demonstrated that this is not the case . Instead, comprehensive sex ed is associated with delays in initiation of sexual behavior, reduced frequency of sexual intercourse, a reduction in number of partners, and an increase in condom use.
• Some populations of youth lack access to comprehensive sex education due to a societal belief that they are asexual, in need of protection, or don’t need to learn about sex. This barrier particularly impacts youth with disabilities or special health care needs .
• Sex ed curricula in some schools perpetuate gender/sex stereotypes, which could contribute to negative gender stereotypes and negative attitudes towards sex .

Inconsistencies in school-based sex education:

• There is significant variation in the content of sex education taught in schools in the US, and many programs that carry the same label (eg, “abstinence-plus”) vary widely in curriculum.
• While decisions about sex education curriculum are made at the state level, the federal government has provided funding to support abstinence-only education for decades , which incentivizes schools to use these programs.
• Since 1996, more than $2 billion in federal funds have been spent to support abstinence-only sex education in schools.
• 34 US states require schools to use abstinence-only curriculum or emphasize abstinence as the main way to avoid pregnancy and STIs.
• Only 16 US states require instruction on condoms or contraception.
• It is not standard to include information on how to come forward if a student is being sexually abused, and many schools do not have a process for disclosures made.
• Because of this, abstinence-only programs are commonly used in US schools, despite overwhelming evidence that they are ineffective in delaying sexual behavior until marriage, and withhold critical information that youth need for healthy sexual and relationship development.

Need for resources and training:

• Integration of comprehensive sex education into school curriculum requires financial resources to strengthen and expand evidence-based programs.
• Successful implementation of comprehensive sex education requires a trained workforce of teachers who can address the curriculum in age-appropriate ways for students in all grade-levels.
• Education, training, and technical assistance are needed to support pediatric health clinicians in addressing comprehensive sex education in clinical settings, as a complement to school-based education.

Lack of diversity and cultural awareness in curricula:

• A history of systemic racism, discrimination, and long-standing health, social and systemic inequities have created racial and ethnic disparities in access to sexual health services and representation in sex education materials. The legacy of intergenerational trauma in the medical system should be acknowledged in sex education curricula.
• Sex education curriculum is often centered on a white audience, and does not address or reflect the role of systemic racism in sexuality and development .
• Traditional abstinence-focused sex education programs have a heteronormative focus and do not address the unique needs of youth who are LGBTQ2S+ .
• Sex education programs often do not address reproductive body diversity, the needs of those with differences in sex development, and those who identify as intersex .
• Sex education programs often do not reflect the unique needs of youth with disabilities or special health care needs .
• Sex education programs are often not tailored to meet the religious considerations of faith communities.
• There is a need for sex education programs designed to help youth navigate sexual health and development in the context of their own culture and community .

Disparities in access to comprehensive sex education.

The barriers listed above limit access to comprehensive sex education in schools and communities. While these barriers impact youth across the US, there are some populations who are less likely to have access to comprehensive to sex education.

Youth who are LGBTQ2S+:

• Only 8% of students who are LGBTQ2S+ report having received sexual education that was inclusive .
• Students who are LGBTQ2S+ are 50% more likely than their peers who are heterosexual to report that sex education in their schools was not useful to them .
• Only 13% of youth who are bisexual+ and 10% of youth who are transgender and gender expansive report receiving sex education in schools that felt personally relevant.
• Only 20% of youth who are Black and LGBTQ2S+ and 13% of youth who are Latinx and LGBTQ2S+ report receiving sex education in schools that felt personally relevant.
• Only 10 US states require affirming content on LGBTQ2S+ relationships in sex education curriculum.

Youth with disabilities or special health care needs:

• Youth with disabilities or special health care needs have a particular need for comprehensive sex education, as these youth are less likely to learn about sex or sexuality form their parents , healthcare providers , or peer groups .
• In a national survey, only half of youth with disabilities report that they have participated in sex education .
• Typical sex education may not be sufficient for youth with Autism Spectrum Disorder, and special methods and curricula are necessary to match their needs .
• Lack the desire or maturity for romantic or sexual relationships.
• Are not subject to sexual abuse.
• Do not need sex education.
• Only 3 states explicitly include youth with disabilities within their sex education requirements.

Youth from historically underserved communities:

• Students who are Black in the US are more likely than students who are white to receive abstinence-only sex education , despite significant support from parents and students who are Black for comprehensive sex education.
• Youth who are Black and female are less likely than peers who are white to receive education about where to obtain birth control prior to initiating sexual activity.
• Youth who are Black and male and Hispanic are less likely than their peers who are white to receive formal education on STI prevention or contraception prior to initiating sexual activity.
• Youth who are Hispanic and female are less likely to receive instruction about waiting to have sex than youth of other ethnicities.
• Tribal health educators report challenges in identifying culturally relevant sex education curriculum for youth who are American Indian/Alaska Native.
• In a 2019 study, youth who were LGBTQ2S+ and Black, Latinx, or Asian reported receiving inadequate sex education due to feeling unrepresented, unsupported, stigmatized, or bullied.
• In survey research, many young adults who are Asian American report that they received inadequate sex education in school.

Youth from rural communities:

• Adolescents who live in rural communities have faced disproportionate declines in formal sex education over the past two decades, compared with peers in urban/suburban areas.
• Students who live in rural communities report that the sex education curriculum in their schools does not serve their needs .

Youth from communities and schools that are low-income:

• Data has shown an association between schools that are low-resource and lower adolescent sexual health knowledge, due to a combination of fewer school resources and higher poverty rates/associated unmet health needs in the student body.
• Youth with family incomes above 200% of the federal poverty line are more likely to receive education about STI prevention, contraception, and “saying no to sex,” than their peers below 200% of the poverty line.

Youth who receive sex education in some religious settings:

• Most adolescents who identify as female and who attended church-based sex education programs report instructions on waiting until marriage for sex, while few report receiving education about birth control.
• Young people who received sex education in religious schools report that education focused on the risks of sexual behavior (STIs, pregnancy) and religious guilt; leading to them feeling under-equipped to make informed decisions about sex and sexuality later in life.
• Youth and teachers from religious schools have identified a need for comprehensive sex education curriculum that is tailored to the needs of faith communities .

Youth who live in states that limit the topics that can be covered in sex education:

• Students who live in the 34 states that require sex education programs to stress abstinence are less likely to have access to critical information on STI prevention and contraception.
• Prohibitions on addressing abortion in sex education or mandates that sex education curricula include medically inaccurate information on abortion designed to dissuade youth from terminating a pregnancy.
• Limitations on the types of contraception that can be covered in sex education curricula.
• Requirements that sex education teachers promote heterosexual, monogamous marriage in sex education.
• Lack of requirements to address healthy relationships and communication skills.
• Lack of requirements for teacher training or certification.

Comprehensive sex education has significant benefits for children and adolescents.

Youth who are exposed to comprehensive sex education programs in school demonstrate healthier sexual behaviors:

• Increased rates of contraception and condom use.
• Fewer unplanned pregnancies.
• Lower rates of STIs and HIV.
• Delayed initiation of sexual behavior.

More broadly, comprehensive sexual education impacts overall social-emotional health , including:

• Enhanced understanding of gender and sexuality.
• Lower rates of homophobia and related bullying.
• Lower rates of dating violence, intimate partner violence, sexual assault, and child sexual abuse.
• Healthier relationships and communication skills.
• Understanding of reproductive rights and responsibilities.
• Improved social-emotional learning, media literacy, and academic achievement.

Comprehensive sex education curriculum goes beyond risk reduction, to ensure that youth are supported in understanding their identity and sexuality and making informed decisions about their relationships, behaviors, and future. These benefits are critical to healthy sexual development.

Impacts of a lack of access to comprehensive sex education.

When youth are denied access to comprehensive sex education, they do not get the information and skill-building required for healthy sexual development. As such, they face unnecessary barriers to understanding their gender and sexuality, building positive interpersonal relationships, and making informed decisions about their sexual behavior and sexual health.

Impacts of a lack of comprehensive sex education for all youth can include :

• Less use of condoms, leading to higher risk of STIs, including HIV.
• Less use of contraception, leading to higher risk of unplanned pregnancy.
• Less understanding and increased stigma and shame around the spectrum of gender and sexual identity.
• Perpetuated stigma and embarrassment related to sex and sexual identity.
• Perpetuated gender stereotypes and traditional gender roles.
• Higher rates of youth turning to unreliable sources for information about sex, including the internet, the media, and informal learning from peer networks.
• Challenges in interpersonal communication.
• Challenges in building, maintaining, and recognizing safe, healthy peer and romantic relationships.
• Lower understanding of the importance of obtaining and giving enthusiastic consent prior to sexual activity.
• Less awareness of appropriate/inappropriate touch and lower reporting of child sexual abuse.
• Higher rates of dating violence and intimate partner violence, and less intervention from bystanders.
• Higher rates of homophobia and homophobic bullying.
• Unsafe school environments.
• Lower rates of media literacy.
• Lower rates of social-emotional learning.
• Lower recognition of gender equity, rights, and social justice.

In addition, the lack of access to comprehensive sex education can exacerbate existing health disparities, with disproportionate impacts on specific populations of youth.

Youth who identify as women, youth from communities of color, youth with disabilities, and youth who are LGBTQ2S+ are particularly impacted by inequitable access to comprehensive sex education, as this lack of education can impact their health, safety, and self-identity. Examples of these impacts are outlined below.

A lack of comprehensive sex education can harm young women.

• Female bodies are more prone to STI infection and more likely to experience complications of STI infection than male bodies.
• Female bodies are disproportionately impacted by long-term health consequences of STIs , including pelvic inflammatory disease, infertility, and ectopic pregnancy.
• Female bodies are less likely to have or recognize symptoms of certain STI infections .
• Human papillomavirus (HPV) is the most common STI in young women , and can cause long-term health consequences such as genital warts and cervical cancer.
• Women bear the health and economic effects of unplanned pregnancy.
• Comprehensive sex education addresses these issues by providing medically-accurate, evidence based information on effective strategies to prevent STI infections and unplanned pregnancy.
• Students who identify as female are more likely to experience sexual or physical dating violence than their peers who identify as male. Some of this may be attributed to underreporting by males due to stigma.
• Students who identify as female are bullied on school property more often than students who identify as male.
• Young women ages 16-19 are at higher risk of rape, attempted rape, or sexual assault than the general population.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful gender norms, and building the skills required for respectful, equitable relationships.

A lack of comprehensive sex education can harm youth from communities of color.

• Youth of color benefit from seeing themselves represented in sex education curriculum.
• Sex education programs that use a framing of diversity, equity, rights, and social justice , informed by an understanding of systemic racism and discrimination, have been found to increase positive attitudes around reproductive rights in all students.
• There is a critical need for sex education programs that reflect youth’s cultural values and community .
• Comprehensive sex education can address these needs by developing curriculum that is inclusive of diverse communities, relationships, and cultures, so that youth see themselves represented in their education.
• Racial and ethnic disparities in STI and HIV infection.
• Racial and ethnic disparities in unplanned pregnancy and births among adolescents.
• Nearly half of youth who are Black ages 13-21 report having been pressured into sexual activity .
• Adolescent experience with dating violence is most prevalent among youth who are American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial.
• Adolescents who are Latinx are more likely than their peers who are non-Latinx to report physical dating violence .
• Youth who are Black and Latinx and who experience bullying are more likely to suffer negative impacts on academic performance than their white peers.
• Students who are Asian American and Pacific Islander report bullying and harassment due to race, ethnicity, and language.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful stereotypes, and building the skills required for respectful, equitable relationships.
• Young people of color—specifically those from Black , Asian-American , and Latinx communities– are often hyper-sexualized in popular media, leading to societal perceptions that youth are “older” or more sexually experienced than their white peers.
• Young men of color—specifically those from Black and Latinx communities—are often portrayed as aggressive or criminal in popular media, leading to societal perceptions that youth are dangerous or more sexually aggressive or experienced than white peers.
• These media portrayals can lead to disparities in public perceptions of youth behavior , which can impact school discipline, lost mentorship and leadership opportunities, less access to educational opportunities afforded to white peers, and greater involvement in the juvenile justice system.
• Comprehensive sex education addresses these issues by including positive representations of diverse youth in curriculum, challenging harmful stereotypes, and building the skills required for respectful relationships.

A lack of comprehensive sex education can harm youth with disabilities or special health care needs.

• Youth with disabilities need inclusive, developmentally-appropriate, representative sex education to support their health, identity, and development .
• Youth with special health care needs often initiate romantic relationships and sexual behavior during adolescence, similar to their peers.
• Youth with disabilities and special health care needs benefit from seeing themselves represented in sex education to access the information and skills to build healthy identities and relationships.
• Comprehensive sex education addresses this need by including positive representation of youth with disabilities and special health care needs in curriculum and providing developmentally-appropriate sex education to all youth.
• When youth with disabilities and special health care needs do not get access to the comprehensive sex education that they need, they are at increased risk of sexual abuse or being viewed as a sexual offender.
• Youth with disabilities and special health care needs are more likely than peers without disabilities to report coercive sex, exploitation, and sexual abuse.
• Youth with disabilities and special health care needs report more sexualized behavior and victimization online than their peers without disabilities.
• Youth with disabilities are at greater risk of bullying and have fewer friend relationships than their peers.
• Comprehensive sex education addresses these issues by providing education on healthy relationships, consent, communication, and bodily autonomy.

A lack of comprehensive sex education can harm youth who are LGBTQ2S+.

• Most sex education curriculum is not inclusive or representative of LGBTQ2S+ identities and experiences.
• Because school-based sex education often does not meet their needs, youth who are LGBTQ2S+ are more likely to seek sexual health information online , and thus are more likely to come across misinformation.
• The majority of parents support discussion of sexual orientation in sex education classes.
• Comprehensive sex education addresses these issues by including positive representation of LGBTQ2S+ individuals, romantic relationships, and families.
• Sex education curriculum that overlooks or stigmatizes youth who are LGBTQ2S+ contributes to hostile school environments and harms the healthy sexual and mental development .
• Youth who are LGBTQ2S+ face high levels of discrimination at school and are more likely to miss school because of bullying or victimization .
• Ongoing experiences with stigma, exclusion, and harassment negatively impact the mental health of youth who are LGBTQ2S+.
• Comprehensive sex education provides inclusive curriculum and has been shown to improve understanding of gender diversity, lower rates of homophobia, and reduce homophobic bullying in schools.
• Youth who are LGBTQ2S+ are more likely than their heterosexual peers to report not learning about HIV/STIs in school .
• Lack of education on STI prevention leaves LGBTQ2S+ youth without the information they need to make informed decisions, leading to discrepancies in condom use between LGBTQ2S+ and heterosexual youth.
• Some LGBTQ2S+ populations carry a disproportionate burden of HIV and other STIs: these disparities begin in adolescence , when youth who are LGBTQ2S+ do not receive sex education that is relevant to them.
• Comprehensive sex education provides the knowledge and skills needed to make safe decisions about sexual behavior , including condom use and other forms of STI and HIV prevention.
• Youth who are LBGTQ2S+ or are questioning their sexual identity report higher rates of dating violence than their heterosexual peers.
• Youth who are LGBTQ2S+ or are questioning their sexual identity face higher prevalence of bullying than their heterosexual peers.
• Comprehensive sex education teaches youth healthy relationship and communication skills and is associated with decreases in dating violence and increases in bystander interventions .

A lack of comprehensive sex education can harm youth who are in foster care.

• More than 70% of children in foster care have a documented history of child abuse and or neglect.
• More than 80% of children in foster care have been exposed to significant levels of violence, including domestic violence.
• Youth in foster care are racially diverse, with 23% of youth identifying as Black and 21% of identifying as Latinx, who will have similar experiences as those highlighted in earlier sections of this report.
• Removal is emotionally traumatizing for almost all children. Lack of consistent/stable placement with a responsive, nurturing caregiver can result in poor emotional regulation, impulsivity, and attachment problems.
• Comprehensive sex education addresses these issues by providing evidence-based, culturally appropriate information on healthy relationships, consent, communication, and bodily autonomy.

Sex education is often the first experience that youth have with understanding and discussing their gender and sexual health.

Youth deserve to a strong foundation of developmentally appropriate information about gender and sexuality, and how these things relate to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

Decades of data have demonstrated that comprehensive sex education programs are  effective  in reducing risk of STIs and unplanned pregnancy. These benefits are critical to public health. However, comprehensive sex education goes even further, by instilling youth with a broad range of knowledge and skills that are  proven  to support social-emotional learning, positive communication skills, and development of healthy relationships.

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American Academy of Pediatrics

What Works In Schools : Sexual Health Education

CDC’s  What Works In Schools  Program improves the health and well-being of middle and high school students by:

• Improving health education,
• Connecting young people to the health services they need, and
• Making school environments safer and more supportive.

What is sexual health education?

Quality provides students with the knowledge and skills to help them be healthy and avoid human immunodeficiency virus (HIV), sexually transmitted infections (STI) and unintended pregnancy.

A quality sexual health education curriculum includes medically accurate, developmentally appropriate, and culturally relevant content and skills that target key behavioral outcomes and promote healthy sexual development. 1

The curriculum is age-appropriate and planned across grade levels to provide information about health risk behaviors and experiences.

Sexual health education should be consistent with scientific research and best practices; reflect the diversity of student experiences and identities; and align with school, family, and community priorities.

Quality sexual health education programs share many characteristics. 2-4 These programs:

• Are taught by well-qualified and highly-trained teachers and school staff
• Use strategies that are relevant and engaging for all students
• Address the health needs of all students, including the students identifying as lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ)
• Connect students to sexual health and other health services at school or in the community
• Engage parents, families, and community partners in school programs
• Foster positive relationships between adolescents and important adults.

How can schools deliver sexual health education?

A school health education program that includes a quality sexual health education curriculum targets the development of functional knowledge and skills needed to promote healthy behaviors and avoid risks. It is important that sexual health education explicitly incorporate and reinforce skill development.

Giving students time to practice, assess, and reflect on skills taught in the curriculum helps move them toward independence, critical thinking, and problem solving to avoid STIs, HIV, and unintended pregnancy. 5

Quality sexual health education programs teach students how to: 1

• Analyze family, peer, and media influences that impact health
• Access valid and reliable health information, products, and services (e.g., STI/HIV testing)
• Communicate with family, peers, and teachers about issues that affect health
• Make informed and thoughtful decisions about their health
• Take responsibility for themselves and others to improve their health.

What are the benefits of delivering sexual health education to students?

Promoting and implementing well-designed sexual health education positively impacts student health in a variety of ways. Students who participate in these programs are more likely to: 6-11

• Delay initiation of sexual intercourse
• Have fewer sex partners
• Have fewer experiences of unprotected sex
• Increase their use of protection, specifically condoms
• Improve their academic performance.

In addition to providing knowledge and skills to address sexual behavior , quality sexual health education can be tailored to include information on high-risk substance use * , suicide prevention, and how to keep students from committing or being victims of violence—behaviors and experiences that place youth at risk for poor physical and mental health and poor academic outcomes.

*High-risk substance use is any use by adolescents of substances with a high risk of adverse outcomes (i.e., injury, criminal justice involvement, school dropout, loss of life). This includes misuse of prescription drugs, use of illicit drugs (i.e., cocaine, heroin, methamphetamines, inhalants, hallucinogens, or ecstasy), and use of injection drugs (i.e., drugs that have a high risk of infection of blood-borne diseases such as HIV and hepatitis).

What does delivering sexual health education look like in action?

To successfully put quality sexual health education into practice, schools need supportive policies, appropriate content, trained staff, and engaged parents and communities.

Schools can put these four elements in place to support sex ed.

• Implement policies that foster supportive environments for sexual health education.
• Use health content that is medically accurate, developmentally appropriate, culturally inclusive, and grounded in science.
• Equip staff with the knowledge and skills needed to deliver sexual health education.
• Engage parents and community partners.

Include enough time during professional development and training for teachers to practice and reflect on what they learned (essential knowledge and skills) to support their sexual health education instruction.

By law, if your school district or school is receiving federal HIV prevention funding, you will need an HIV Materials Review Panel (HIV MRP) to review all HIV-related educational and informational materials.

This review panel can include members from your School Health Advisory Councils, as shared expertise can strengthen material review and decision making.

For More Information

Learn more about delivering quality sexual health education in the Program Guidance .

Check out CDC’s tools and resources below to develop, select, or revise SHE curricula.

• Health Education Curriculum Analysis Tool (HECAT), Module 6: Sexual Health [PDF – 70 pages] . This module within CDC’s HECAT includes the knowledge, skills, and health behavior outcomes specifically aligned to sexual health education. School and community leaders can use this module to develop, select, or revise SHE curricula and instruction.
• Developing a Scope and Sequence for Sexual Health Education [PDF – 17 pages] .This resource provides an 11-step process to help schools outline the key sexual health topics and concepts (scope), and the logical progression of essential health knowledge, skills, and behaviors to be addressed at each grade level (sequence) from pre-kindergarten through the 12th grade. A developmental scope and sequence is essential to developing, selecting, or revising SHE curricula.
• Centers for Disease Control and Prevention. Health Education Curriculum Analysis Tool, 2021 , Atlanta: CDC; 2021.
• Goldfarb, E. S., & Lieberman, L. D. (2021). Three decades of research: The case for comprehensive sex education. Journal of Adolescent Health, 68(1), 13-27.
• Centers for Disease Control and Prevention (2016). Characteristics of an Effective Health Education Curriculum .
• Pampati, S., Johns, M. M., Szucs, L. E., Bishop, M. D., Mallory, A. B., Barrios, L. C., & Russell, S. T. (2021). Sexual and gender minority youth and sexual health education: A systematic mapping review of the literature.  Journal of Adolescent Health ,  68 (6), 1040-1052.
• Szucs, L. E., Demissie, Z., Steiner, R. J., Brener, N. D., Lindberg, L., Young, E., & Rasberry, C. N. (2023). Trends in the teaching of sexual and reproductive health topics and skills in required courses in secondary schools, in 38 US states between 2008 and 2018.  Health Education Research ,  38 (1), 84-94.
• Coyle, K., Anderson, P., Laris, B. A., Barrett, M., Unti, T., & Baumler, E. (2021). A group randomized trial evaluating high school FLASH, a comprehensive sexual health curriculum.  Journal of Adolescent Health ,  68 (4), 686-695.
• Marseille, E., Mirzazadeh, A., Biggs, M. A., Miller, A. P., Horvath, H., Lightfoot, M.,& Kahn, J. G. (2018). Effectiveness of school-based teen pregnancy prevention programs in the USA: A systematic review and meta-analysis. Prevention Science, 19(4), 468-489.
• Denford, S., Abraham, C., Campbell, R., & Busse, H. (2017). A comprehensive review of reviews of school-based interventions to improve sexual-health. Health psychology review, 11(1), 33-52.
• Chin HB, Sipe TA, Elder R. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. Am J Prev Med 2012;42(3):272–94.
• Mavedzenge SN, Luecke E, Ross DA. Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: A systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014;66:S154–69.

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Comprehensive sexuality education: For healthy, informed and empowered learners

Did you know that only 37% of young people in sub-Saharan Africa can demonstrate comprehensive knowledge about HIV prevention and transmission? And two out of three girls in many countries lack the knowledge they need as they enter puberty and begin menstruating? Early marriage and early and unintended pregnancy are global concerns for girls’ health and education: in East and Southern Africa pregnancy rates range 15-25%, some of the highest in the world. These are some of the reasons why quality comprehensive sexuality education (CSE) is essential for learners’ health, knowledge and empowerment. 

What is comprehensive sexuality education or CSE?

Comprehensive sexuality education - or the many other ways this may be referred to - is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that empowers them to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives.

CSE presents sexuality with a positive approach, emphasizing values such as respect, inclusion, non-discrimination, equality, empathy, responsibility and reciprocity. It reinforces healthy and positive values about bodies, puberty, relationships, sex and family life.

How can CSE transform young people’s lives?

Too many young people receive confusing and conflicting information about puberty, relationships, love and sex, as they make the transition from childhood to adulthood. A growing number of studies show that young people are turning to the digital environment as a key source of information about sexuality.

Applying a learner-centered approach, CSE is adapted to the age and developmental stage of the learner. Learners in lower grades are introduced to simple concepts such as family, respect and kindness, while older learners get to tackle more complex concepts such as gender-based violence, sexual consent, HIV testing, and pregnancy.

When delivered well and combined with access to necessary sexual and reproductive health services, CSE empowers young people to make informed decisions about relationships and sexuality and navigate a world where gender-based violence, gender inequality, early and unintended pregnancies, HIV and other sexually transmitted infections still pose serious risks to their health and well-being. It also helps to keep children safe from abuse by teaching them about their bodies and how to change practices that lead girls to become pregnant before they are ready.

Equally, a lack of high-quality, age-appropriate sexuality and relationship education may leave children and young people vulnerable to harmful sexual behaviours and sexual exploitation.

What does the evidence say about CSE?

The evidence on the impact of CSE is clear:

• Sexuality education has positive effects, including increasing young people’s knowledge and improving their attitudes related to sexual and reproductive health and behaviors.
• Sexuality education leads to learners delaying the age of sexual initiation, increasing the use of condoms and other contraceptives when they are sexually active, increasing their knowledge about their bodies and relationships, decreasing their risk-taking, and decreasing the frequency of unprotected sex.
• Programmes that promote abstinence as the only option have been found to be ineffective in delaying sexual initiation, reducing the frequency of sex or reducing the number of sexual partners. To achieve positive change and reduce early or unintended pregnancies, education about sexuality, reproductive health and contraception must be wide-ranging.
• CSE is five times more likely to be successful in preventing unintended pregnancy and sexually transmitted infections when it pays explicit attention to the topics of gender and power
• Parents and family members are a primary source of information, values formation, care and support for children. Sexuality education has the most impact when school-based programmes are complemented with the involvement of parents and teachers, training institutes and youth-friendly services .

How does UNESCO work to advance learners' health and education?

Countries have increasingly acknowledged the importance of equipping young people with the knowledge, skills and attitudes to develop and sustain positive, healthy relationships and protect themselves from unsafe situations.

UNESCO believes that with CSE, young people learn to treat each other with respect and dignity from an early age and gain skills for better decision making, communications, and critical analysis. They learn they can talk to an adult they trust when they are confused about their bodies, relationships and values. They learn to think about what is right and safe for them and how to avoid coercion, sexually transmitted infections including HIV, and early and unintended pregnancy, and where to go for help. They learn to identify what violence against children and women looks like, including sexual violence, and to understand injustice based on gender. They learn to uphold universal values of equality, love and kindness.

In its International Technical Guidance on Sexuality Education , UNESCO and other UN partners have laid out pathways for quality CSE to promote health and well-being, respect for human rights and gender equality, and empower children and young people to lead healthy, safe and productive lives. An online toolkit was developed by UNESCO to facilitate the design and implementation of CSE programmes at national level, as well as at local and school level. A tool for the review and assessment of national sexuality education programmes is also available. Governments, development partners or civil society organizations will find this useful. Guidance for delivering CSE in out-of-school settings is also available.

Through its flagship programme, Our rights, Our lives, Our future (O3) , UNESCO has reached over 30 million learners in 33 countries across sub-Saharan Africa with life skills and sexuality education, in safer learning environments. O3 Plus is now also reaching and supporting learners in higher education institutions.

To strengthen coordination among the UN community, development partners and civil society, UNESCO is co-convening the Global partnership forum on CSE together with UNFPA. With over 65 organizations in its fold, the partnership forum provides a structured platform for intensified collaboration, exchange of information and good practices, research, youth advocacy and leadership, and evidence-based policies and programmes.

Good quality CSE delivery demands up to date research and evidence to inform policy and implementation . UNESCO regularly conducts reviews of national policies and programmes – a report found that while 85% of countries have policies that are supportive of sexuality education, significant gaps remain between policy and curricula reviewed. Research on the quality of sexuality education has also been undertaken, including on CSE and persons with disabilities in Asia and East and Southern Africa .

How are young people and CSE faring in the digital space?

More young people than ever before are turning to digital spaces for information on bodies, relationships and sexuality, interested in the privacy and anonymity the online world can offer. UNESCO found that, in a year, 71% of youth aged 15-24 sought sexuality education and information online.

With the rapid expansion in digital information and education, the sexuality education landscape is changing . Children and young people are increasingly exposed to a broad range of content online some of which may be incomplete, poorly informed or harmful.

UNESCO and its Institute of Information Technologies in Education (IITE) work with young people and content creators to develop digital sexuality education tools that are of good quality, relevant and include appropriate content. More research and investment are needed to understand the effectiveness and impact of digital sexuality education, and how it can complement curriculum-based initiatives. Part of the solution is enabling young people themselves to take the lead on this, as they are no longer passive consumers and are thinking in sophisticated ways about digital technology.

A foundation for life and love

• Safe, seen and included: report on school-based sexuality education
• International Technical Guidance on Sexuality Education
• Safe, seen and included: inclusion and diversity within sexuality education; briefing note
• Comprehensive sexuality education (CSE) country profiles
• Evidence gaps and research needs in comprehensive sexuality education: technical brief
• The journey towards comprehensive sexuality education: global status report
• Definition of Sustainable Development Goal (SDG) thematic indicator 4.7.2: Percentage of schools that provided life skills-based HIV and sexuality education within the previous academic year
• From ideas to action: addressing barriers to comprehensive sexuality education in the classroom
• Facing the facts: the case for comprehensive sexuality education
• UNESCO strategy on education for health and well-being
• UNESCO Health and education resource centre
• Campaign: A foundation for life and love
• UNESCO’s work on health and education

Related items

• Health education
• Sex education

What is comprehensive sexuality education?

Comprehensive sexuality education  ( CSE ) is a curriculum -based process of teaching and learning about the cognitive, emotional, physical, and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes, and values that will empower them to: realize their health, well-being, and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  pp.16-17.]

Depending on the country or region, CSE may go by other names. It may be referred to as ‘ life skills ’, ‘ family life ’, or ‘ HIV ’ education . It is sometimes called ‘holistic sexuality education’. It is important to confirm with ministries what they use to describe CSE, particularly as context-based terms can inform the most effective approach to take when partnering with and supporting these ministries.

• delivered in formal and non-formal settings , in school or out of school ;
• scientifically accurate , based on research, facts, and evidence;
• incremental , starting at an early age with foundational content and skills, with new information building upon previous learning, using a spiral-curriculum approach that returns to the same topics at a more advanced level each year;
• age- and developmentally appropriate , with content and skills growing in abstractness and explicitness with the age and developmental level of the learners; it also must accommodate developmental diversity, adapting for learners with cognitive and emotional development differences;
• curriculum-based , following a written curriculum that includes key teaching and learning objectives, and the delivery of clear content and skills in a structured way;
• comprehensive , and about much more than just sexual behaviours.

The comprehensive aspect of CSE refers to the breadth, depth, and consistency of topics, as opposed to one-off lessons or interventions. CSE addresses sexual and reproductive health issues, including, but not limited to:

• sexual and reproductive anatomy and physiology;
• puberty and menstruation;
• reproduction, contraception , pregnancy, and childbirth;
• STIs, including HIV and AIDS .

CSE also addresses the psychological, social, and emotional issues relating to these topics, including those that may be challenging in some social and cultural contexts. It supports learners’ empowerment by improving their analytical, communication, and other life skills for health and well-being in relation to:

• human rights,
• a healthy and respectful family life and interpersonal relationships,
• personal and shared values,
• cultural and social norms,
• gender equality,
• non-discrimination,
• sexual behaviour,
• gender-based and other violence,
• consent and bodily integrity,
• sexual abuse and harmful practices such as child , early, and forced marriage, and female genital mutilation/cutting.

Key values of CSE

CSE builds on and promotes universal human rights for all, including children and young people. It emphasizes all persons’ rights to health, education, information equality, and non-discrimination. It raises awareness among young people that they have their own rights, and that they must acknowledge and respect the rights of others, and advocate for those whose rights are violated.

Integrating a gender perspective throughout CSE curricula is integral to effective CSE programmes. CSE analyses how gender norms can influence inequality, and how inequality can affect the overall health and well-being of children and young people, as well as the efforts to prevent issues such as HIV, STIs, early and unintended pregnancies, and gender-based violence . CSE contributes to gender equality by building awareness of the centrality and diversity of gender identities and expressions in people’s lives; examining gender norms shaped by cultural, social and biological differences and similarities; and by encouraging the creation of respectful and equitable relationships based on empathy and understanding.

CSE must be delivered in the context of the range of values, beliefs, and experiences that exist even within a single culture. It enables learners to examine, understand, and challenge the ways in which cultural structures, norms, and behaviours affect their choices and relationships within a variety of settings.

CSE impacts whole cultures and communities, not simply individual learners. It can contribute to the development of a fair and compassionate society by empowering individuals and communities, promoting critical thinking skills, and strengthening young people’s sense of citizenship. It empowers young people to take responsibility for their own decisions and behaviours, and how they may affect others. It builds the skills and attitudes that enable young people to treat others with respect, acceptance, tolerance, and empathy, regardless of their ethnicity, race, social, economic, or immigration status, religion, disability, sexual orientation , gender identity or expression, or sex characteristics.

CSE teaches young people to reflect on the information around them in order to make informed decisions, communicate and negotiate effectively, and develop assertiveness rather than passivity or aggression. These skills foster the creation of respectful and healthy relationships with family members, peers, friends, and romantic or sexual partners.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  pp 16-17.]

‘ Sexuality ’ is defined as ‘a core dimension of being human which includes: the understanding of, and relationship to, the human body; emotional attachment and love; sex; gender; gender identity; sexual orientation; sexual intimacy; pleasure and reproduction. Sexuality is complex and includes biological, social, psychological, spiritual, religious, political, legal, historic, ethical and cultural dimensions that evolve over a lifespan’.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  p.17.]

The word ‘sexuality’ has different meanings in different languages and in different cultural contexts. Taking into account a number of variables and the diversity of meanings in different languages, the following aspects of sexuality need to be considered in the context of CSE:

• Sexuality refers to the individual and social meanings of interpersonal and sexual relationships, in addition to biological aspects. It is a subjective experience and a part of the human need for both intimacy and privacy.
• Simultaneously, sexuality is a social construct, most easily understood within the variability of beliefs, practices, behaviours and identities. ‘Sexuality is shaped at the level of individual practices and cultural values and norms’ (Weeks, 2011).
• Sexuality is linked to power. The ultimate boundary of power is the possibility of controlling one’s own body. CSE can address the relationship between sexuality, gender and power, and its political and social dimensions. This is particularly appropriate for older learners.
• The expectations that govern sexual behaviour differ widely across and within cultures. Certain behaviours are seen as acceptable and desirable, while others are considered unacceptable. This does not mean that these behaviours do not occur, or that they should be excluded from discussion within the context of sexuality education.
• Sexuality is present throughout life, manifesting in different ways and interacting with physical, emotional and cognitive maturation. Education is a major tool for promoting sexual well-being and preparing children and young people for healthy and responsible relationships at the different stages of their lives.

[Source: UNESCO. 2017. International technical guidance on sexuality education,  p. 17.]

When viewed holistically and positively: 

• Sexual health is about well-being, not merely the absence of disease. 
• Sexual health involves respect, safety and freedom from discrimination and violence. 
• Sexual health depends on the fulfilment of certain human rights. 
• Sexual health is relevant throughout the individual’s lifespan, not only to those in the reproductive years, but also to both the young and the elderly. 
• Sexual health is expressed through diverse sexualities and forms of sexual expression. 
• Sexual health is critically influenced by gender norms, roles, expectations and power dynamics.
• Sexual health needs to be understood within specific social, economic and political contexts.
• Characteristics of effective CSE programmes

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Sex Education in America: the Good, the Bad, the Ugly

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The debate over the best way to teach sexual health in the U.S. continues to rage on, but student voice is often left out of the conversation when schools are deciding on what to teach. So Myles and PBS NewsHour Student Reporters from Oakland Military Institute investigate the pros and cons of the various approaches to sex ed and talk to students to find out how they feel about their sexual health education.

TEACHERS: Guide your students to practice civil discourse about current topics and get practice writing CER (claim, evidence, reasoning) responses.  Explore lesson supports.

What is comprehensive sex education?

Comprehensive sex education teaches that not having sex is the best way to avoid STIs and unintended pregnancies, but it also includes medically accurate information about STI prevention, reproductive health, as well as discussions about healthy relationships, consent, gender identity, LGBTQ issues and more. What is sexual risk avoidance education? Sexual risk avoidance education is also known as abstinence only or abstinence-leaning education. It generally teaches that not having sex is the only morally acceptable, safe and effective way to prevent pregnancy and STIs — some programs don’t talk about birth control or condoms– unless it is to emphasize failure rates.

What are the main arguments for comprehensive sex education?

“Comprehensive sex ed” is based on the idea that public health improves when students have a right to learn about their sexuality and to make responsible decisions about it. Research shows it works to reduce teen pregnancies, delay when teens become sexually active and reduce the number of sexual partners teens have.

What are the main arguments against comprehensive sex education?

Some people, particularly parents and religious groups, take issue with comprehensive sex ed because they believe it goes against their cultural or religious values, and think that it can have a corrupting influence on kids. They say that by providing teens with this kind of information you are endorsing and encouraging sex and risk taking. Some opponents also argue that this type of information should be left up to parents to teach their kids about and shouldn’t be taught in schools.

State Laws and Policies Across the US (SIECUS) 

STDs Adolescents and Young Adults (CDC) 

Myths and Facts about Comprehensive Sex Education (Advocates for Youth)

Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy (Journal of Adolescent Health)

Abstinence-Only-Until Marriage: An Updated Review of US Policies and Programs and Their Impact (Journal of Adolescent Health) 

Sexual Risk Avoidance Education: What you need to know (ASCEND) 

We partnered with PBS NewsHour Student Reporting Labs for this episode. Check out their journalism resources for students: https://studentreportinglabs.org/

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Sex Education that Goes Beyond Sex

• Posted November 28, 2018
• By Grace Tatter

Historically, the measure of a good sex education program has been in the numbers: marked decreases in the rates of sexually transmitted diseases, teen pregnancies, and pregnancy-related drop-outs. But, increasingly, researchers, educators, and advocates are emphasizing that sex ed should focus on more than physical health. Sex education, they say, should also be about relationships.

Giving students a foundation in relationship-building and centering the notion of care for others can enhance wellbeing and pave the way for healthy intimacy in the future, experts say. It can prevent or counter gender stereotyping and bias. And it could minimize instances of sexual harassment and assault in middle and high school — instances that may range from cyberbullying and stalking to unwanted touching and nonconsensual sex. A recent study from Columbia University's Sexual Health Initative to Foster Transformation (SHIFT) project suggests that comprehensive sex education protects students from sexual assault even after high school.

If students become more well-practiced in thinking about caring for one another, they’ll be less likely to commit — and be less vulnerable to — sexual violence, according to this new approach to sex ed. And they’ll be better prepared to engage in and support one another in relationships, romantic and otherwise, going forward. 

Giving students a foundation in relationship-building can enhance wellbeing and pave the way for healthy intimacy in the future, experts say. It can also prevent or counter gender stereotyping, and it could minimize instances of sexual harassment and assault in middle and high school.

Introducing Ethics Into Sex Ed

Diving into a conversation even tangentially related to sex with a group of 20 or so high school students isn’t easy. Renee Randazzo helped researcher Sharon Lamb pilot the Sexual Ethics and Caring Curriculum while a graduate student at the University of Massachusetts Boston. She recalls boys snickering during discussions about pornography and objectification. At first, it was hard for students to be vulnerable.

But the idea behind the curriculum is that tough conversations are worth having. Simply teaching students how to ask for consent isn’t enough, says Lamb, a professor of counseling psychology at UMass Boston, who has been researching the intersection between caring relationships, sex, and education for decades. Students also to have understand why consent is important and think about consent in a variety of contexts. At the heart of that understanding are questions about human morality, how we relate to one another, and what we owe to one another. In other words, ethics.

“When I looked at what sex ed was doing, it wasn’t only a problem that kids weren’t getting the right facts,” Lamb says. “It was a problem that they weren’t getting the sex education that would make them treat others in a caring and just way.”

She became aware that when schools were talking about consent — if they were at all — it was in terms of self-protection. The message was: Get consent so you don’t get in trouble.

But there’s more at play, Lamb insists. Students should also understand the concept of mutuality — making decisions with a partner and understanding and addressing other people’s concerns or wishes — and spend time developing their own sense of right and wrong. 

“If a young person is not in a healthy relationship, they can’t negotiate sex in a meaningful way. Even if they’re not having sex yet, they’re grappling with the idea of what a healthy relationship is.”

The curriculum she developed invites students to engage in frank discussions about topics like objectification in the media and sexting. If a woman is shamed for being in a sexy video, but she consented to it, does she deserve the criticism? Regardless of what you think, can you justify your position?

“How do they want to treat people, what kind of partner do they want to be? That takes discussion,” Lamb says. “It’s not a skill-training thing.”

The idea behind the curriculum isn’t that anything goes, so long as students can discuss their reasoning. Instead, the goal is that students develop the critical-reasoning skills to do the right thing in tricky situations. 

After Randazzo’s students got over their cases of the giggles, the conversations were eye-opening, she says. “You give them the opportunity unpack their ideas and form their own opinions,” she says.

Healthy Relationships — and Prevention

Most sexual assault and violence in schools is committed by people who know their victims — they’re either dating, friends, or classmates. Regardless, they have a relationship of some sort, which is why a focus on relationships and empathy is crucial to reducing violence and preparing students for more meaningful lives.

And while it might seem uncomfortable to move beyond the cut-and-dried facts of contraception into the murkier waters of relationships, students are hungry for it. A survey by researchers at the Harvard Graduate School of Education's  Making Caring Common  initiative found that 65 percent of young-adult respondents wished they had talked about relationships at school.

“It’s so critical that kids are able to undertake this work of learning to love somebody else,” says developmental psychologist Richard Weissbourd , the director of Making Caring Common and lead author of a groundbreaking report called The Talk: How Adults Can Promote Young People’s Healthy Relationships and Prevent Misogyny and Sexual Harassment . “They’re not going to be able to do it unless we get them on the road and are willing to engage in thoughtful conversations.”

Nicole Daley works with OneLove , a nonprofit focused on teen violence prevention. She previously worked extensively with Boston Public Schools on violence prevention. She echoes Lamb and Weissbourd: A focus on relationships is key to keeping students safe.

“If a young person is not in a healthy relationship, they can’t negotiate sex in a meaningful way,” she says. “Really discussing healthy relationships and building that foundation is important. Even if they’re not having sex yet, they’re grappling with the idea of what healthy relationship is.”

And it’s critical to start that work before college.

Shael Norris spent the first two decades of her career focusing on college campuses, but now is focused on younger students with her work through Safe BAE . By college, many people’s ideas about how to act when it comes to sex or romance are entrenched, she says. The earlier young people can start interrogating what they know about sex and relationships, the better.

Safe BAE is led by Norris and young survivors of sexual assault. The organization works to educate students about healthy relationships, sexual violence, students’ rights under Title IX, and other related topics.

Movement to change middle and high school curricula to include a focus on healthy relationships and consent has been slow, Norris notes. In 2015, Senators Tim Kaine (D-Va.) and Claire McCaskill (D-Mo.) introduced the Teach Safe Relationships Act, which would have mandated secondary schools teach about safe relationships, including asking for consent, in health education courses. It didn’t go anywhere. And while eight states now mandate some sort of sexual consent education , there’s no consensus about what that should entail.

Instead, the momentum for a more comprehensive sexual education that considers relationships and violence prevention is coming from individual teachers, students and parents.

“We don’t have to wait for politicians to start having conversations about this,” Norris says.

A New Approach to Sex Ed

• Develop an ethical approach to sex ed. Place emphasis on helping students learn how to care for and support one another. This will reduce the chance they’ll commit, or be vulnerable to, sexual violence.
• Don’t just tell students how to ask for consent; prompt them to consider why concepts like consent are important. It’s not just about staying out of legal trouble — it’s also about respecting and caring for others.
• Respect students’ intelligence and engage them in discussions about who they want to be as people. Serious dialogue about complicated topics will hone their critical-thinking skills and help them be prepared to do the right thing.
• Even without access to a curriculum, students, parents and educators can work together to facilitate conversations around sexual violence prevention through clubs, with help from organizations like Safe BAE.

Additional Resource

• National Sexuality Education Standards: Core Content and Skills, K–12

Part of a special series about preventing sexual harassment at school.  Read the whole series .

Illustration by Wilhelmina Peragine

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The State of Sex Education

The journey towards comprehensive sexuality education: Global status report

Publication year: 2021.

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Comprehensive sexuality education is central to children and young people’s health and well-being, equipping them with the knowledge and skills they need to make healthy, informed, and responsible choices in their lives, including to prevent HIV and promote gender equality.

This report seeks to provide an analysis of countries’ progress towards delivering good quality school-based comprehensive sexuality education to all learners around the world.

The report is intended to help inform continued advocacy and resourcing efforts, as governments and partners work towards the goal of ensuring all learners receive good quality comprehensive sexuality education throughout their schooling.

The review maps out a number of forward-looking recommendations to countries, including actions to ensure implementation of policies and programmes that:

• support the availability of good quality comprehensive sexuality education for all learners;
• increase investments in quality curriculum reform and teacher training; and
• strengthen monitoring of the implementation of comprehensive sexuality education.

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Comprehensive sexuality education as a primary prevention strategy for sexual violence perpetration

Madeline schneider.

Mailman School of Public Health, Columbia University

Jennifer S. Hirsch

Professor of Sociomedical SciencesMailman School of Public Health, Columbia University

Sexual violence (SV) represents a serious public health problem, with high rates ( Smith et al., 2017 ) and numerous health consequences. Current primary prevention strategies to reduce SV perpetration have been shown to be largely ineffective – not surprisingly, since as others have pointed out ( DeGue et al., 2014 ) current prevention largely fails to draw on existing knowledge about the characteristics of effective prevention ( Nation et al., 2003 ). In this paper, we examine the potential of K-12 comprehensive sexuality education (CSE), guided by the National Sexuality Education Standards (NSES), to be an effective strategy. Our discussion uses socio-ecological and feminist theories as a guide, examines the extent to which NSES-guided CSE could both meet the qualities of effective prevention programs and mitigate the risk factors that are most implicated in perpetration behavior, and considers the potential limitations of this approach. We suggest that sequential, K-12 program has potential to prevent the emergence of risk factors associated with SV perpetration by starting prevention early on in the lifecourse. CSE has not yet been evaluated with SV perpetration behavior as an outcome, and this paper synthesizes what is known about drivers of SV perpetration and the potential impacts of CSE to argue for the importance of future research in this area. The primary recommendation is for longitudinal research to examine the impact of CSE on SV perpetration as well as on other sexual and reproductive health outcomes.

Introduction

There is growing awareness in the United States about the nation’s high rates of sexual violence (SV). SV is defined by the Centers for Disease Control and Prevention as a sexual act committed against someone without that person’s freely given consent—including completed forced penetration (rape), attempted forced penetration, coerced penetration, unwanted sexual contact, and non-contact sexual experiences such as harassment. A 2010–2012 nationally representative survey of adults found that approximately 1 in 3 (36.3%) women and 1 in 6 (17.1%) men reported experiencing some form of sexual violence during their lifetime, with 19.1% of women and 1.5% of men experiencing completed or attempted rape, and 13.2% of women and 5.8% of men experiencing sexual coercion at some time in their lives. Among women who have been raped, 41.3% first experienced that rape before the age of 18 and an additional 36.5% were first raped between ages 18–24 ( Smith et al., 2017 ). There is strong evidence that SV affects individuals throughout the life course ( Basile, Smith, Breiding, Black, & Mahendra, 2014 ).

These alarming statistics underline the dire need to implement, evaluate, and scale up primary prevention – that is, effective programming to prevent SV before it happens. In a public health framework, primary prevention entails “looking upstream” at the underlying risk factors and mitigating those risk factors before they come to fruition and result in violent behavior ( Harvey, Garcia-Moreno, & Butchart, 2007 ). The Centers for Disease Control and Prevention has recommended that research and programs to prevent SV be grounded in the socio-ecological approach to prevention ( Basile et al., 2016 ), which addresses risk factors at the individual, interpersonal, community, and social-structural levels across the lifecourse that may lead someone to perpetrate SV. This ecological approach conceptualizes violence as an interplay among these multiple levels of influence ( Casey & Lindhorst, 2009 ; Heise, 1998 ; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002 ).

Drawing on that ecological lifecourse perspective, this paper examines one promising strategy for the primary prevention of sexual violence perpetration that would operate by modifying the known risk factors associated with perpetration. A primary prevention of perpetration approach, instead of a focus on the risk factors that make someone likely to be victimized, places the onus for SV prevention on perpetrators. While victimization prevention approaches should be part of a larger sexual violence prevention strategy, the historical emphasis on preventing victimization neglects the role of the perpetrator in violence; this can fuel victim-blaming narratives, self-blame, and a focus on whether victims could have done something differently to prevent an attack ( DeGue et al., 2012 ). Furthermore, a prevention focus on those at risk for being assaulted does not necessarily reduce attempts to perpetrate sexual violence nor does it address the social norms that lie on the outer level of the ecological model that allows sexual violence to continue. In order to achieve measurable reductions in violence, perpetration needs to be the focal point of intervention ( DeGue et al., 2012 ).

There are few programs with demonstrated effectiveness at mitigating perpetration behavior ( DeGue et al., 2014 ). A 2014 review found only three programs shown by rigorous, controlled evaluation to prevent perpetration behavior ( DeGue et al., 2014 ). Furthermore, it found that the vast majority of programs target college-level students, but that none of the effective programs were in this age group. Instead, program effectiveness was found earlier on in the life course, during adolescence ( DeGue et al., 2014 ). Given the substantial limitations of the literature on effective perpetration prevention, the current paper draws on Banyard’s 2013 commentary encouraging sexual violence researchers to “locate and use opportunities for bridging across areas of prevention … and across the life span (e.g., finding ways to connect skill building in childhood and adolescence with prevention education in early adulthood)” ( Banyard, 2013 , p. 115).

The specific step this paper takes to advance SV prevention is to examine the potential for K-12 comprehensive sex education (CSE), guided by the National Sexuality Education Standards (NSES)—and henceforth referred to as NSES-CSE—to effectively prevent perpetration behavior. Currently, most school-based SV programs are independent from any CSE program, and many CSE programs fall short of their potential to comprehensively address SV perpetration. An NSES-CSE program can effectively merge the two and address SV while simultaneously fulfilling its more traditional goals of preventing unplanned teen pregnancy, HIV/STI acquisition, and other adverse health outcomes. There are several reasons for this, all of which are discussed at greater length below, but in brief: (1) research across multiple areas of behavioral prevention highlights a number of criteria for effectiveness, all of which can be met by high-quality NSES-CSE; (2) a number of well-documented risk factors for SV perpetration are addressed in a NSES-CSE curriculum; (3) these risk factors have individually been shown to be amenable via small group or educational interventions, and sex education creates an opportunity to comprehensively address many of them in one intervention; and (4) a sequential, K-12 program begins early on in the life course when many risk factors are only just beginning to develop, and by reaching young children while they are still in development, it presents the best opportunity to address the problem before it occurs. The field of SV prevention is in desperate need of population-level solutions. The interventions currently being implemented in the field primarily target an age group in which intervention is past the point of being “primary” prevention. NSES-CSE may present one promising strategy to address this critical public health issue. Figure 1 visually depicts the mechanism through which NSES-CSE could be effective.

Conceptual model of pathways through which Comprehensive Sexuality Education based on National Sexuality Education Standards (NSES-CSE) could prevent sexual violence perpetration

Because, as noted above, there is so little in the way of published literature on effective primary prevention for SV, we did not take a systematic literature review approach. Rather, cued by Banyard (2013) to mine other areas in which successful and relevant prevention programs have been developed, our literature search, conducted on EBSCOHost using all databases, sought relevant literature for each section in this paper. We first searched for current SV primary prevention literature to understand the current state of the field. We then searched for an existing systematic review of risk factors for SV perpetration. We clustered the risk factors found in this review into themes (see Figure 1 ) and conducted a search for all clusters to find existing reviews of each.

Because this article is not intended to be a systematic review, not every article yielded in the search is included. This article synthesizes evidence from review articles in several different areas to examine the potential of CSE as an effective population-level strategy for the prevention of SV perpetration. Search terms used for these different research areas are displayed in Table 1 .

Search terms and key articles used

Sexual Violence as a Public Health Problem

Preventing SV is an important public health priority for a multitude of reasons. In addition to the obvious human rights violations described by the statistics above, experiencing SV also has both immediate and long-term health consequences. Physical consequences include pregnancy (over 32,000 of which occur every year as a result of rape) as well as STI/HIV acquisition, chronic pain, gastrointestinal disorders, gynecological complications, migraines, cervical cancer, and genital injuries ( Centers for Disease Control and Prevention, 2017 ). Immediate psychological consequences of SV include shock, denial, fear, confusion, anxiety, withdrawal, guilt, shame, distrust of others, and post-traumatic stress disorder, and longer-term psychological consequences include depression, generalized anxiety, attempted or completed suicide, diminished interest or avoidance of sex, and low self-esteem ( Centers for Disease Control and Prevention, 2017 ).

Research also shows a variety of subsequent health risk behaviors associated with having experienced SV, including earlier sexual debut, unprotected sex, having multiple sexual partners, cigarette use, drunk driving, and illicit drug use. These behaviors put victims at risk of unplanned pregnancies, sexually transmitted infections, HIV, and cigarette, drug, and alcohol related injuries and illnesses ( Centers for Disease Control and Prevention, 2017 ). Furthermore, the estimated lifetime cost of rape is $122,461 for the victim, with a population economic burden of $3.1 trillion over the victims’ lifetimes. These cost estimates include medical costs (39%), lost work productivity (52%), criminal justice related activities (8%), among other costs such as property loss and damage (1%) ( Peterson, DeGue, Florence, & Lokey, 2017 ).

The Current State of the Sexual Violence Field

The state of the SV field is not adequate to successfully prevent perpetration. Instead, the field features a plethora of different programs, including one-off, on-line sessions intended to prevent perpetration and promote bystander behavior ( DeGue et al., 2014 ) or secondary and tertiary prevention programs that work with survivors of violence to prevent re-victimization and help the criminal justice system successfully prosecute perpetrators ( The White House Council on Women and Girls, 2014 ). For example, The Violence Against Women Act (VAWA), which is the backbone of the nation’s sexual violence response ( The White House Council on Women and Girls, 2014 ) and which was reauthorized in 2013 through Fiscal Year 2018 ( Sacco, 2015 ), funds 28 grant programs, the vast majority of which are geared towards victim services and enhancing the criminal justice response to violence ( Sacco, 2015 ). This re-authorization brought with it set-aside funding and new purpose areas for multidisciplinary sexual assault response teams, sexual assault nurse examiners, specialized law enforcement units, and training for criminal justice professionals ( The White House Council on Women and Girls, 2014 ). It also includes new provisions to help previously overlooked survivors of SV, including immigrants and the LGBTQ community. The 2013 reauthorization doubled funding for the Sexual Assault Service Formula Grant Program, which exclusively funds initiatives that help survivors on various steps in their road to recovery ( The White House Council on Women and Girls, 2014 ). Unquestionably these are all crucial aspects of a comprehensive approach to violence, yet these programs reflect a predominant focus on care and response, rather than on primary prevention.

DeGue et al. (2014) conducted a systematic review of 140 outcome evaluations to describe the current primary prevention interventions being employed in the field and to assess the effectiveness of these programs for SV perpetration. Two-thirds of the studies they reviewed consisted of brief, one-session interventions with college populations (n=84). Only 11 of those measured sexually violent behavioral outcomes, none of which were found to consistently affect those behaviors. Rather, the majority of these intervention evaluations measured knowledge or attitudinal change as program outcomes; these are certainly related to behavior but are not necessarily sufficient to change behavior and may not be sustained over time. The review found only three primary prevention strategies in total for which there was sufficient evidence that they reduced sexual violence perpetration behavior in a rigorous outcome evaluation, two of which were implemented among adolescent populations and one based on funding associated with the 1994 U.S. Violence Against Women Act (VAWA). Their review makes clear that the vast majority of efforts being made to curb perpetration are being implemented among college groups, and that none of these interventions have been found to be effective; together these two conclusions suggest that a paradigm shift is warranted to focus on younger groups and to emphasize primary prevention. The recent finding from a population-based survey of undergraduates in one campus context that more than one-quarter of women and nearly one-tenth of the men surveyed had experienced some form of pre-matriculation sexual assault ( Mellins et al., 2017 , p. 12) only underlines the importance of targeting primary prevention efforts at pre-college students.

Moving Towards Effectiveness: Prevention Science

The field of prevention science has identified nine characteristics of effective prevention: (1) comprehensiveness; (2) varied teaching methods; (3) sufficient dosage; (4) theory driven; (5) fosters positive relationships; (6) appropriately timed; (7) sociocultural relevance; (8) well-trained staff; and (9) outcome evaluations ( Nation et al., 2003 ). DeGue et al. (2014) analyzed whether and to what extent the programs in their review met these criteria—and they by and large did not, which indicates why they may have collectively been so unsuccessful at reducing SV perpetration. Table 2 provides further detail about the ways in which the 140 outcome evaluations reviewed by DeGue et al. failed to meet the qualities of effective prevention. Table 2 also shows by comparison how a program that adheres to the National Sexuality Education Standards—which serves as the foundation for this paper’s argument on best-practices CSE— fulfills many of these same characteristics of effective prevention.

Qualities of Effective Prevention: Comparison of studies reviewed in DeGue et al. and of the National Sexuality Education Standards (NSES)

Experts in the field of sex education created the NSES in 2012 to serve as a guideline for the base minimum that all sex education programs should follow ( Future of Sex Ed Initiative, 2012 ). The Standards’ aim is to “provide clear, consistent and straightforward guidance on the essential minimum, core content for sexuality education that is developmentally and age-appropriate for students in grades K–12” ( Future of Sex Ed Initiative, 2012 ). The NSES were informed by the National Health Education Standards ( Joint Committee on National Health Education Standards, 2007 ); the Centers for Disease Control and Prevention’s Health Education Curriculum Analysis Tool ( Centers for Disease Control and Prevention, 2007 ); existing state and international education standards that include sexual health content ( Future of Sex Ed, 2012 ); and the Guidelines for Comprehensive Sexuality Education: Kindergarten – 12th Grade ( Sexuality Information and Education Council of the United States, 2004 ).

An NSES-guided CSE program meets the qualities of effective prevention in multiple ways. As the name implies, the standards are comprehensive, spanning a wide range of topics related to sexuality, sexual health, and overall well-being: anatomy and physiology; puberty and adolescent development; identity; pregnancy and reproduction; sexually transmitted diseases and HIV; healthy relationships; and personal safety ( Future of Sex Ed Initiative, 2012 ). The standards are theory-driven, drawing on social learning theory, social cognitive theory, and the social ecological model ( Future of Sex Ed Initiative, 2016 ). Positive relationships are stressed as a key component of the standards. They emphasize age-appropriateness of the topics covered, spanning kindergarten through 12 th grade, with different learning objectives in each grade level, thereby ensuring that students are reached before the onset of any risk behaviors and at a developmental moment where the information provided is relevant and appropriate. The standards recommend pre-service teacher training, professional development, and ongoing support and mentoring to ensure that staff are well trained ( Future of Sex Ed Initiative, 2016 ). The standards also recommend the use of varied teaching methods. Lastly, the Standards cover multiple topics, and thus intrinsically require a much higher ‘dosage’ than the typical SV prevention program, with the NSES outline of the entire curriculum spanning K-12 with a multitude of learning objectives and topics to be included ( Future of Sex Ed Initiative, 2012 ). Table 2 maps out the NSES with the qualities of effective prevention in more detail.

Risk Factors for Sexual Violence Perpetration

The fact that an NSES-guided curriculum meets the qualities of effective prevention in general, however, is only one piece of conceptualizing why it makes sense to explore it as a strategy for primary prevention of sexual violence. Indeed, sex education traditionally aims to prevent health outcomes such as unplanned teenage pregnancy and HIV/STI acquisition, not sexual violence ( Chin et al., 2012 ; Haberland, 2015a ; Kirby, Laris, & Rolleri, 2007 ; Lindberg & Maddow-Zimmet, 2012 ). The authors were not able to identify any published work to date evaluating the impact of sexuality education on sexual violence behavior as a dependent variable. Healthy relationships are a component of sexuality education curricula that meet NSES standards, and yet the impact on unhealthy relationship behaviors such as sexual violence or teen dating violence have not been evaluated as outcome measures, or at least not evaluated in a way that has been disseminated through the searchable peer-reviewed scientific literature. The goal of this paper is to map out conceptually the potential of CSE, in order to encourage research that examines the hypothesis that sex education could be effective prevention for sexual violence perpetration behavior in addition to the more traditional health outcomes, and thus that it should be evaluated as a dependent variable of an NSES-guided K-12 CSE program. The other crucial elements in proposing evaluation of the impact of best-practices CSE on SV are 1) to examine whether known risk factors for SV perpetration have been shown to be amenable to modification through educational intervention in the past and 2) to assess the extent to which these risk factors would be addressed through NSES-CSE.

Teten Tharp et al.’s (2012) systematic review of risk and protective factors for SV perpetration summarized 191 published empirical studies that examined perpetration by and against adolescents and adults. Two societal and community factors, 23 relationship factors, and 42 individual level factors were identified (n=67). Out of these 67 factors, 35 of them displayed consistently significant association with SV. All 35 of these factors, which were at the individual, interpersonal, or relationship level of the social-ecological model, are presented in Table 3 . That these factors exist across multiple levels of the ecological model underlines the need for a prevention approach that works across the models’ different levels. (Some of those risk factors, such as previous suicide attempt, sports and fraternity participation, or having experienced physical or emotional abuse as a child, fall substantively outside of the goals of NSES-CSE, underlining that even if it is found to be effective at reducing sexual violence by addressing some of the underlying risk factors, a truly comprehensive approach will be comprised of layered strategies across the ecological level over multiple points in the life course.) The risk factors can be grouped into four overarching categories: sex, gender, and violence-related risk factors, child abuse-related risk factors, sexual-behavior-related risk factors, and social and emotional intelligence-related risk factors.

Sexual violence perpetration risk factors found to be significant ( Adapted from Teten Tharp et al. (2012) ) and potential for CSE to mitigate those risk factors

Sex, Gender, and Violence

The largest category of risk factors found to be significant in Teten Tharp et al.’s (2012) review fall under sex, gender, and violence ( Table 3 ). At the individual level, these include: having sexual fantasies supportive of SV; willingness to commit SV; engaging in victim blaming; rape myth acceptance; hostility towards women/adversarial sexual beliefs; traditional gender role adherence; hypermasculinity; acceptance of violence; dominance; and competitiveness. At the peer-relationship level, these include: peer approval of forced sex; peer pressure for sexual activity; peer sexual aggression; membership in a fraternity; and sports participation. At the romantic-relationship level, these include: having a casual relationship status and having interrelationship conflict. These risk factors are fundamentally tied to gender and sexual norms and cognitions ( Casey & Lindhorst, 2009 ; Heise, 1998 ).

Teten Tharp’s review failed to find the structural-level risk factor of gender as significant for SV perpetration, despite the intrinsic relationship between the broader social organization of gender and these relationship and individual-level manifestations of gendered practices and beliefs. This failure to find empirical evidence for the structural concept of gender as a risk factor may reflect the review’s exclusion of qualitative and ethnographic research and their focus on biomedical rather than social scientific research. Ethnographic and qualitative empirical work (e.g., Armstrong, Hamilton, & Sweeney, 2006 ; Sanday 1981 , 1996 ) grounded in social scientific theory certainly demonstrates that the social organization of gendered power is a critical underlying social driver of the sexual assault of women, as does both foundational work in gender theory ( Connell, 1987 ) and quantitative social scientific research that looks comparatively at social organization and gender power ( Whaley, 2001 ). An extensive discussion of the range of research not included in the Teten Tharp et al. (2012) is beyond the scope of this article, but because our argument for NSES-CSE as a strategy to prevent sexual violence relies on the ecological model, this question about the role of broader community and social norms is critical because of their framing, in the ecological model, as shaping factors at the individual, family, peer, and relationship levels ( Casey & Lindhorst, 2009 ; Fulu et al., 2013 ; Heise, 1998 ; Jewkes, Flood, & Lang, 2015 ). An understanding of inequitable gender relations as a foundational structural driver of sexual violence is thus necessary in any discussion of SV perpetration prevention ( Fulu et al., 2013 ; Jewkes, Flood, & Lang, 2015 ).

There is without question evidence from other sources that unequal gendered access to power is an underlying cause of sexual violence ( Breger, 2014 ; Casey & Lindhorst, 2009 ; Courtenay, 2000 ; Fulu et al., 2013 ; Heise, 1998 ; Jewkes, Flood, & Lang, 2015 ; Kagesten, 2016 ). These manifestations include many of the risk factors identified in this review clustered within the sex, gender, and violence risk factors category. Feminist theory offers at least two ways of thinking about the social processes through which gender, masculinity, and violence are related ( Anderson, 2005 ). The first is that violence is a mechanism through which men can prove their masculinity, and thus performing acts of violence causes or leads to a societally accepted depiction of masculinity ( Anderson, 2005 ). The second is that gender is a social structure which influences opportunities and rewards for violent behavior. Men who fit the acceptable ideal of masculinity—or hegemonic masculinity—are rewarded for their behavior by maintaining power and control within society ( Anderson, 2005 ). Hegemonic masculinity in much of the world, and especially in the United States, encompasses heterosexual success, dominance and control over women, sexual entitlement, and strength and toughness ( Jewkes, Flood, & Lang, 2015 ). When combined in a society that allows men to perpetrate with fairly little consequences, these qualities can contribute to a dangerous formula for sexual violence perpetration.

The ecological model is conceptualized as embedded levels of causality ( Heise, 1998 ), and thus shifting the societal, inequitable gender norms that sit in the outer level of the model will in turn affect relationship, peer, and individual gendered relations, cognitions, and behaviors. “Gender-transformative” interventions are defined as those that aim to “reconfigure gender roles in the direction of more gender equitable relationships” ( Dworkin, Treves-Kagan, & Lippman, 2013 , p. 2846). Furthermore, they “view masculinities as a set of social norms that are modifiable in order to attain reduced rates of violence, decreased levels of unsafe sex, and improvements in inequitable gender relations” (p. 2846) These interventions acknowledge gender as the central component in the perpetration of SV, and thus place it at the epicenter of the theory of change.

Based on this definition, NSES-CSE would be defined as gender-transformative ( Table 4 ). A mere glance at the standards delineate this clearly: by the end of 2nd grade, programs provide children with the critical thinking capacity to discuss the similarities and differences in how boys and girls may be expected to act; provide examples of how friends, family, media, and culture can influence the ways girls and boys think they should act; and learn about gender and gender roles. By the end of 5th grade students can define sexual orientation and demonstrate ways to show respect and treat others with dignity. By the end of 8th grade, students explore gender expression and analyze the potential impact of individual, family, and cultural expectations on gender, gender roles, and gender stereotypes; they begin to analyze the impact of gender inequities on relationships, including on power dynamics, communication, and decision-making; they can differentiate between sexual orientation and gender identity; and they can demonstrate respectful communication with people of all gender identities, gender expressions, and sexual orientations ( Future of Sex Ed Initiative, 2012 ).

How NSES-CSE addresses the majority of risk factors for SV perpetration

To examine what is known about whether effective interventions exist to transform gender norms, Dworkin, Treves-Kagan, and Lippman (2013) conducted a systematic review of gender-transformative programming in relation to HIV. The review included 15 research articles. To be included, articles had to measure either a reduction in HIV/STI incidence; sexual risk behaviors; violence against women; or normative change in attitudes as outcomes. Of the 15 studies included, 9 evaluated a change in gender norms through small group educational interventions with adolescents and young adults. There was a high degree of variability in indicators measuring a change in gender norms, including: attitudes about gender and masculinity; discussing sex, HIV prevention, condom use, and HIV testing with a main or casual partner; recognition of abuse; and acceptance of violence towards women. Eight of these showed statistically significant results on at least one indicator of gender norms. This review delineates that gender-transformative interventions employed in small group educational settings can be successful at changing gender norms with adolescents and young adults, indicating that NSES-CSE could also successfully change gender norms, leading to a potential reduction in SV perpetration through mitigation of this risk factor. Furthermore, comprehensive sex education programs that address gender and power have had markedly better results on pregnancy and STI reduction than sex education programs that fail to do so ( Haberland, 2015b ). Different types of sexual and reproductive health programs, such as reproductive health interventions for married girls, men in maternity projects, and microcredit programs for marginalized women, have also found that programs that address gender and power yields much more significant results than programs that don’t, indicating that gender is a core component of sexual and reproductive health generally ( Haberland, 2015b ). As sexual violence is a component of sexual and reproductive health, this is likely to hold true in the SV prevention arena as well.

Child Abuse

The prevention of child abuse – which includes not just sexual abuse but also physical abuse more broadly as well as emotional abuse – is important for several reasons, the foremost being to stop the current abuse being faced by the child. Secondarily, child abuse prevention may halt the cycle of abuse that occurs when people who have been formerly abused become perpetrators as adults. Child abuse and witnessing family violence are both risk factors for perpetration later in life ( Teten Tharp et al., 2012 ). Abuse can leave emotional, psychological, and developmental scars and children who are exposed to abuse in early childhood can become prone to aggression, impulsivity, and an absence of empathy or remorse ( Heise, 1998 ; Jewkes, Flood, & Lang, 2015 ). Furthermore, Social Learning Theory adds that children may learn that violence can be used as a mechanism to get one’s way and adopt this behavior as an adult ( Heise, 1998 ).

Both conceptual and empirical work suggests that NSES-CSE can help prevent child sexual abuse (CSA). Research shows that “the ability of a child to prevent or report child abuse is dependent, in part, on their understanding of their bodies, including the correct names of body parts, the recognition that they have bodily autonomy, and the skills to communicate with a caring adult regarding perceived or real danger” (Future of Sex Ed Initiative, 2016). The American Academy of Pediatrics (2011) recommends that children learn the names of genitals along with other body parts to understand that “the genitals, while private, are not so private that you can’t talk about them.” In the NSES ( Table 4 ), by the end of 2nd grade, children learn the correct names of their body parts and that they have the right to tell others not to touch their bodies when they do not want to be touched; students identify a parent or other trusted adults in whom they can confide if they are feeling uncomfortable about being touched; and they practice how to respond if someone touches them in a way that makes them uncomfortable (Future of Sex Ed Initiative, 2012).

A recent systematic review ( Walsh, Zwi, Woolfenden, & Shlonsky, 2015 ) compiled evidence of the effectiveness of a school-based program to prevent CSA. The review included 24 studies, with ten aimed at younger participants from kindergarten through third grade; eight aimed at 4th grade and older; and six studies had both younger and older participants. Programs ranged from a single 45-minute session to eight 20-minute sessions on consecutive days. This review was conducted to assess whether programs are effective in improving students’ protective behaviors and knowledge about sexual abuse prevention; if behaviors and skills are retained over time; and whether participation results in disclosures of sexual abuse, produces harms, or both. Protective behaviors were enhanced at immediate post-test; the intervention group had gains in factual and applied knowledge up to 2 weeks post-intervention with studies having a 1–6 month follow-up showing maintenance of knowledge; and odds of disclosure were as much as 3.5 times higher in the intervention participants.

These results suggest that schools can be an effective vehicle for CSA prevention and intervention, as well as underlining the need for complementary strategies that focus on the prevention of emotional and physical abuse. The studies included in the review all had the primary goal of reducing CSA, and were not significantly long in duration or fully comprehensive. Including CSA prevention within a larger CSE framework, as is done in the NSES, may produce better results because it would feature the qualities of effective prevention described at length above. Furthermore, it is important to note that education tailored to the child should be part of a larger strategy to prevent CSA and the onus of prevention should not be placed on the child. However, being able to recognize signs of abuse, name body parts, develop bodily autonomy, and tell a trusted adult can help a child get out of a sexually abusive situation.

Sexual Behavior

Teten Tharp et al. (2012) identify a number of sexual behavior-related factors that consistently demonstrate a strong association with perpetrating sexual violence: having multiple sexual partners; impersonal sex; early initiation of sex; sexual risk taking; and being positive for an STI. One factor that the literature has attributed this association to is that enacting these behaviors are mechanisms to negotiate power, demonstrate masculinity, and display an emphasized heterosexuality ( Courtenay, 2000 ; Grazian, 2007 ; Jewkes, 2012 ; O’Sullivan, Hoffman, Harrison, & Dolezal, 2006 ; Ott, 2010 ; Pleck, Sonenstein, & Ku, 1993 ; Santana, Raj, Decker, Marche, & Silverman, 2006 ; Shearer, Hosterman, Gillen, & Lefkowitz, 2005 ), all of which fall under the domain of gender inequity across the social ecology and have already been discussed as risk factors for sexual violence perpetration above. Another factor that can help to explain this association is that early (consensual) initiation of sexual activity and increased high-risk sexual behaviors are associated with childhood sexual abuse ( Jewkes, 2012 ), which has also already been discussed as a major risk factor in perpetration. Proposed pathways from childhood sexual abuse to high risk sexual activity include the development of: maladaptive sexual scripts; avoidant coping mechanisms such as alcohol and drug use which could lead to sexual risk behavior; difficulties with attachment and trust which can lead to a series of short or concurrent sexual relationships; and self-efficacy issues that inhibit formerly abused individuals from being able to control sexual situations as adolescents ( Senn, Carey, & Vanable, 2008 ). The fact that these sexual behaviors and sexual violence perpetration share a host of risk factors may contribute to the strong association between the two.

Our discussion has already explained the ways in which NSES-CSE can potentially affect gender-related risk factors, as well as its potential to intervene in and prevent childhood sexual abuse. As these are two prominent explanations linking sexual risk behaviors to sexual violence perpetration, it is likely that the gender transformative components and childhood sexual abuse components of NSES-CSE can also have effects on the sexual behavior-related risk factors identified in Teten Tharp et al (2012) . The traditional aim of comprehensive sex education is to impact sexual risk behaviors such as early sexual initiation, impersonal sex, and multiple sexual partners, as well as their associated outcomes such as pregnancy and HIV/STI acquisition, and there is substantial evidence that it is successful in doing so ( Chin et al., 2012 ; Haberland, 2015a ; Kirby, Laris, & Rolleri, 2007 ; Lindberg & Maddow-Zimmet, 2012 ). As has been previously noted, evidence also suggests that CSE programs that address gender and power are more successful at achieving its intended results than conventional sex education programs that do not address these risk factors ( Haberland, 2015b ). As the NSES takes a gender-transformative approach to comprehensive sex education, it is likely that it will be successful in reducing sexual risk behaviors as well as these shared risk factors.

Social-Emotional Skills

The last group of risk factors for SV perpetration fall under “social-emotional” skills that young children acquire and develop through adolescence, which include the ability to recognize and manage emotions, establish and maintain positive relationships, make responsible decisions, appreciate the perspective of others, and handle interpersonal situations constructively ( Elias et al., 1997 ). Manifestations of poor social-emotional skills include several risk factors for SV perpetration, including a lack of empathy, cue misinterpretation, and delinquency. Social-emotional learning (SEL) programs aim to enhance the social-emotional skills of students, with the proximal goals being to foster “the development of five interrelated sets of cognitive, affective, and behavioral competencies: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making” ( Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011 , p. 406)

The NSES include a core set of learning objectives explicitly aimed at enhancing the social-emotional skills of students ( Table 4 ). By the end of 2nd grade, students should be able to identify healthy ways to express feelings, show respect, and control their behaviors. By the end of 5th grade, students practice recognizing and managing their emotions, learn healthy ways to communicate differences of opinions, explore the differences between healthy and unhealthy relationships, and practice skills necessary to treat themselves and others with dignity and respect. By the end of 8th grade, students learn to communicate respectfully, negotiate conflict fairly, apply effective decision-making strategies, and demonstrate ways to show empathy and treat each other with dignity and respect (Future of Sex Ed Initiative, 2012). This instruction falls directly under the purview of a SEL program.

A 2011 meta-analysis of SEL programs ( Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011 ) delineated the effects that SEL can have on a variety of skills, attitudes, and behaviors in children and adolescents relevant to SV perpetration risk factors. The meta-analysis combined findings from 213 studies. More than half of the programs were administered to elementary school students (56%) and about a third to middle school students (31%). Compared to control groups, students in the SEL intervention displayed enhanced SEL-related skills, attitudes, and positive social behaviors, demonstrated fewer conduct problems, had lower levels of emotional distress, and had improved academic performance. These programs thus show efficacy in affecting risk factors for SV perpetration, indicating that a school-based SEL program, like the NSES, can be successful.

K-12 Justification

One of the potentially most controversial dimensions of the prevention approach proposed here is that SV prevention begin in kindergarten. While some advocate strongly for this, others have argued just as strongly against the idea of providing “sex education” to kindergarteners ( de Melker, 2015 ; Rohter, 2008 ), who will not begin engaging in perpetration behavior or sexual activity for some time. However, in line with the public health approach to prevention, it is crucial to look upstream at when in the developmental process the risk factors for perpetration begin to form ( Harvey, Garcia-Moreno, & Butchart, 2007 ). As this paper has shown, a plethora of risk factors that can lead to perpetration do in fact begin to form early on in the life course, and thus engaging in prevention during this window is crucial. There are at least three important reasons for beginning prevention early.

The first and most obvious of the risk factors that need to be addressed early on is the prevention of child sexual abuse (CSA). The substantial burden of suffering associated with CSA underlines the importance of addressing sexual violence prevention early on. One in 9 girls and 1 in 53 boys under the age of 18 experience sexual abuse or assault at the hands of an adult (RAINN). From 2009–2013, Child Protective Services data show that 63,000 children a year were victims of sexual abuse—a statistic that is most likely an underestimate due to lack of reporting (RAINN). Of the 63,000 cases, 80% of perpetrators were parents and 6% were other relatives, and 88% of CSA cases involve a male perpetrator (RAINN). Taking a life course approach to prevention, and attending to the substantial evidence linking experiences of CSA to future perpetration of SV ( Greathouse, Saunders, Matthews, Keller, & Miller, 2015 ) emphasizes the importance of integrating CSA prevention into a wider CSE curriculum as a strategy to reduce later perpetration.

The second and less obvious reason to begin early is that the formulation of gender roles and cognitions begins in childhood. While a comprehensive overview of feminist developmental psychology is beyond the scope of this paper, one key insight from that work is the idea that the gender inequities in power and status which exist in society influence children’s development ( Leaper, 2000 ). A host of socialization practices exist that can conform children to gender roles and stereotypes very early on in the life course that go on to create their gender schemas in adolescence and adulthood. Children learn gender through their social interactions and daily activities, for example, when toys, sports, and activities are gender-typed, which can groom boys to compete for dominance. Children also learn gender by observing their own and the other genders and inferring patterns of appropriate behavior. From there, they begin socializing one another to conform to gender norms as part of peer group behavior. This can often manifest in “masculine protest,” the complete avoidance and devaluation of feminine-stereotyped qualities very early on ( Leaper, 2000 ). These gender-shaping processes that often lead to male adherence to gender roles happen in early childhood development, and schools are often a vehicle through which this occurs ( Adler, Kless, & Adler, 1992 ; Connell, 1996 ; Jordan, 1995 ; Messner, 2000 ; Renold, 2000 , 2001 ; Swain, 2000 ). It is therefore critical to intervene in the gender-stereotyping process as early on as possible. Furthermore, teaching children about what it means to give and receive permission to do something and how to share and play with others can offer early, age-appropriate instruction about what it means to elicit or convey consent. Starting instruction as early as possible could help mitigate rigid and harsh gender stereotypes from forming, reducing potential perpetration behavior that stems from these risk factors later on in life. Intervening beginning in kindergarten, before children have engrained gender norms that guide their self-concepts, motivations, and expectations of others, could mitigate the potential harm that comes from rigid- and hyper-masculinity. Furthermore, early instruction to address gender-stereotyping might create safer climates for lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) and gender non-confirming (GNC) students as they grow up, who experience much higher rates of sexual harassment and violence than heterosexual and cisgender populations ( Ford & Soto-Marquez, 2016 ; Katz-Wise & Hyde, 2012 ; Mitchell, Ybarra, & Korchmaros, 2014 ).

Lastly, as DeGue et al. (2014) delineated, most of the work in SV prevention thus far has focused on college students (70%), with the next highest number of interventions focusing on students in high school (14.3%). This may be in response to the legal requirements at the federal and state level (20 USCS § 1092; Lebioda, 2015 ; Morse, Sponsler, & Fulton, 2015 ; Office of Civil Rights, 2011 ) for institutions of higher education to offer or require some form of prevention education. However, the overwhelming focus on higher education as a site for SV prevention is intrinsically in tension with the underlying notion of primary prevention grounded in an understanding of the risk factors discussed throughout this paper. Even if college programs had been shown to be effective, many people experience sexual assault before entering college ( Smith et al., 2017 ), and only roughly 59% of the adult population ever attends “some college” ( Ryan & Bauman, 2016 ). Between half and three-quarters of the men who commit rape first do so as teenagers ( Jewkes, Floor, & Lang, 2015 ). Therefore, while college-level interventions are most definitely part of the solution, there is a need to start primary prevention earlier in the lifecourse to reach individuals before they start perpetration behavior.

College-level interventions are most certainly necessary in an overarching SV prevention plan, but should not be the first interaction that individuals have with sexual violence prevention. The whole conceptualization of a life-course approach to primary prevention of SV presented in this paper, as well as the discussion of preventing the initial perpetration of SV by targeting the risk factors that are most implicated in the behavior, underlines the limits of having a first encounter with prevention concepts at the college level.

Limitations

Without question, while NSES-CSE holds the potential to successfully mitigate many of the risk factors implicated in sexual violence perpetration and—if implemented widely—subsequently curb the high rates of societal SV, it cannot do so alone. Child abuse provides a good example of both the promise and the limits of NSES-CSE as a prevention strategy; while evidence exists that it can have an impact on child sexual abuse, there are clearly a host of risk factors that CSE does not reach, such as events and interactions that happen in the home, and there is little evidence that NSES-CSE would be an appropriate or effective strategy for preventing the emotional or physical abuse of children. We have explored the role that NSES-CSE can play in preventing and stopping child sexual abuse, but there are other strategies that must also be employed to reach within the family where CSE cannot. Enhanced primary care and behavioral parent training programs are two such approaches ( Fortson, Klevens, Merrick, Gilbert, & Alexander, 2016 ).

Furthermore, gender stereotypes that go on to create hypermasculinity complexes and entrench traditional gender roles often begin before a child is born—at “gender reveal” parties and via painting bedrooms pink or blue. NSES-CSE alone will not undo the inequitable societal gender norms that permeate every level of society. It cannot undo the gendered structure of the labor market, for example, or the gendered stereotypes disseminated through popular culture. It does, however, have the power to buffer and help students develop critical attitudes towards beliefs, attitudes, and behaviors about gender, and in that way mitigate the gender-related risk factors that can lead to perpetration.

A multipronged strategy is necessary to curb rampant sexual violence. Primary prevention of perpetration must be complemented by strategies that include secondary and tertiary prevention, such as initiatives that address perpetration recidivism, as well as strategies that help prevent victimization and work with survivors in the aftermath of their attack in a trauma-informed way, through the criminal justice system and elsewhere. For example, rape crisis centers and women’s shelters play a critical role in keeping women safe from violent household situations or in getting help after being attacked, and this paper does not aim to diminish those services in any way.

The work that we present here is not a systematic review, because there is very little in the way of evidence for effective prevention of sexual violence perpetration. Instead, we selected literature, including review articles that already synthesized various bodies of literature, to knit together knowledge across topic areas to suggest a new approach to prevention – one that is urgently in need of research and evaluation. This included summarizing the state of the field of SV perpetration, the risk factors for SV perpetration, interventions that have been shown to reduce these risk factors, and how NSES-CSE can effectively mitigate those risk factors. The authors conceptualized this endeavor as piecing together a puzzle: the pieces to the puzzle already exist (systematic reviews of perpetration risk factors, of the evidence regarding perpetration intervention effectiveness, and of how different risk factors can be mitigated by different types of interventions) but they needed to be assembled, so that future researchers could then take this as a charge to examine empirically the impact of NSES-CSE on SV perpetration ( Figure 1 ). This paper’s aim is to stimulate research in sex education and sexual violence perpetration by connecting these previously separate bodies of research ( Figure 1 ), all of which already had systematic reviews and analyses.

A further limitation is the focus here on cisgender, heterosexual men and women. Numerically, data suggest that the preponderance of assaults are perpetrated by cisgender heterosexual men and experienced by cisgender heterosexual women. However, the rates of sexual violence have been shown to be very high among LGBTQ populations ( Ford & Soto-Marquez, 2016 ; Katz-Wise & Hyde, 2012 ; Mitchell, Ybarra, & Korchmaros, 2014 ). It is vital therefore for other work to fill the gap that we have left here, mapping the potential impact of CSE for those groups, and for subsequent evaluation research to explicitly examine the impact of CSE on rates of sexual assault among LGBTQ populations.

Another limitation is that K-12 CSE guided by the NSES has neither been widely implemented nor evaluated. The evidence chosen to support our argument was based on similar interventions—tailored to certain perpetration risk factors—in educational and small group settings that NSES-CSE would most likely resemble. It may be that the enormous recent popular media attention to sexual harassment and assault in the US ( Baumgartner & McAdon, 2017 ; Beyond Harvey Weinstein, 2017 ; Fantz, 2016 ; Gabler, Twohey, & Kantor, 2017 ; Martin & Stolberg, 2017 ; Savransky, 2017 ; Zacharek, Dockterman, & Edwards, 2017 ) will provide an impetus to re-examine opportunities for population-level prevention, and CSE certainly offers one such opportunity.

Finally, it may seem politically unrealistic in the current federal environment to implement CSE, especially when funding streams are more closely tied to abstinence-only, or “sexual risk avoidance” programs than to comprehensive sexuality programs. However, despite federal funding having emphasized abstinence-only programs since the mid 1990s, states and municipalities have acted to increase access to comprehensive programs. California passed the Healthy Youth Act in 2015, which requires all public schools to teach CSE in grades 7–12 with the option to start earlier ( California Department of Education, 2017 ), and New York City mandated in 2011 that public schools teach comprehensive sex education as well ( NYC Department of Education, 2011 ). There are also other avenues outside of government to implement CSE, such as through private foundation funding. In 2009, The Grove Foundation, a private philanthropic foundation that strives to improve adolescent health, launched the Working to Institutionalize Sex Education (WISE) initiative ( Butler, Sorace, & Beach, 2018 ). WISE’s mission is to provide support to school districts to advance comprehensive sex education programs and to document how implementation can be advanced and institutionalized. Rather than endorse a specific curriculum, WISE works with school districts to choose curricula that fit their needs. Implementation plans vary in scope from one grade level to K-12 programs, but at a minimum are all age-appropriate, evidence-informed, and compliant with state laws and standards. Since its launch, $7 million have been invested in 13 states; 88 school districts reached their implementation goals and institutionalized sex education and 788,865 unique students received new or improved sex education in school. The evaluation of WISE found that “resources and expertise help schools advance and meet their sex education institutionalization goals and that barriers that impede sex education can be mitigated, leading to increased quality and quantity of sex education in ready school districts” ( Butler, Sorace & Beach, 2018 ).

Without question, a plethora of risk factors are implicated in sexual violence perpetration. Addressing one risk factor alone is unlikely to substantially reduce the incidence of sexual violence. A comprehensive strategy is needed to affect multiple risk factors across the social ecology. Individual, interpersonal, community, environmental, and societal level risk factors all contribute to health and social problems, including sexual violence. As noted in Table 5 , NSES-CSE is potentially one powerful component of a multipronged strategy to lower the unacceptably high rates of sexual violence seen in the United States. Its unique value is implicit in the name itself: it is comprehensive ( Figure 1 ). While sex education has been traditionally designed, implemented, and evaluated to reduce unplanned teenage pregnancies, HIV/STI acquisition, and the health risk behaviors that lead to these outcomes, it holds the potential to address sexual violence perpetration as well. As a high-dosage sequential program, it not only addresses these sexual risk behaviors, but it also embodies gender transformative programming, social and emotional learning, and child abuse prevention, which are four sets of risk factors associated with sexual violence perpetration, and it adheres to the commonalities of effective prevention programs, which have been widely cited in the literature. Most importantly, it begins to address the risk factors for perpetration behavior long before the onset of that behavior. Primary prevention is the most effective way of fully preventing poor health outcomes by mitigating risk factors from developing.

Critical findings

When implemented according to best practices and over a sustained period, NSES-CSE holds tremendous potential as an intervention approach; the implications of this argument for policy and practice are summarized in Table 6 . No published peer-reviewed research to date evaluated the impact of NSES-CSE on sexually violent behavior, and this paper presents evidence for its potential to affect this outcome. The authors recommend that where NSES-CSE is implemented, it should be assessed for impact longitudinally by following students as they are exposed to CSE and looking at their behaviors over time. The social climate is certainly ripe for this work, with public figures being called out as sexual predators as a near-daily occurrence and a sustained public discussion about what, beyond holding the individuals accountable for their behavior, might produce a broader change in the climate. Remedial education on sexual violence in late adolescence and in college cannot by itself be the solution; comprehensive sex education that gets to the root of the problem before the problem begins may be one key component of a comprehensive strategy to end sexual violence.

Implications for policy, practice, and research

Acknowledgements:

The authors thank the Department of Sociomedical Sciences, the Columbia Population Research Center (P2CHD058486), and the Sexual Health Initiative to Foster Transformation (SHIFT) for their support. They also thank Dr. John Santelli for his comprehensive review of this paper.

Contributor Information

Madeline Schneider, Mailman School of Public Health, Columbia University.

Jennifer S. Hirsch, Professor of Sociomedical SciencesMailman School of Public Health, Columbia University.

• 20 USCS § 1092 (2013).
• Adler PA, Kless SJ, & Adler P (1992). Socialization to gender roles: Popularity among elementary school boys and girls . Sociology of Education , 65 ( 3 ), 169. [ Google Scholar ]
• American Academy of Pediatrics.(2011 ). Parent Tips for Preventing and Identifying Child Sexual Abuse . Retrieved from http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Parent-Tips-for-Preventing-and-Identifying-Child-Sexual-Abuse.aspx
• Anderson KL (2005). Theorizing gender in intimate partner violence research . Sex Roles , 52 ( 11–12 ), 853–865. [ Google Scholar ]
• Armstrong EA, Hamilton L, & Sweeney B (2006). Sexual assault on campus: A multilevel, integrative approach to party rape . Social Problems , 53 ( 4 ), 483–499. [ Google Scholar ]
• Banyard VL (2013). Go big or go home: Reaching for a more integrated view of violence prevention . Psychology of Violence , 3 ( 2 ),115–120. [ Google Scholar ]
• Basile KC, DeGue S, Jones K, Freire K, Dills J, Smith SG, Raiford JL (2016). STOP SV: A technical package to prevent sexual violence . Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. [ Google Scholar ]
• Basile KC, Smith SG, Breiding MJ, Black MC, & Mahendra R (2014). Sexual violence surveillance: uniform definitions and recommended data elements, Version 2.0 . Atlanta (GA): National Center for Injury Prevention and Control, Centers for Disease Control and Prevention [ Google Scholar ]
• Baumgartner FR, & McAdon S (2017, May 11). There’s been a big change in how the news media covers sexual assault. The Washington Post . Retrieved from https://www.washingtonpost.com/news/monkey-cage/wp/2017/05/11/theres-been-a-big-change-in-how-the-news-media-cover-sexual-assault/?utm_term=.9d3ed1b3bf7d
• Breger ML (2014). Transforming cultural norms of sexual violence against women . Journal of Research in Gender Studies , 4 ( 2 ), 39–51. [ Google Scholar ]
• Butler RS, Sorace D & Beach KH (2018). Institutionalizing sex education in diverse U.S. school districts . Journal of Adolescent Health , 62 ( 2 ), 149–156. [ PubMed ] [ Google Scholar ]
• California Department of Education . ( 2017 ). Comprehensive sexual health & HIV/AIDS instruction . Retrieved from https://www.cde.ca.gov/ls/he/se/
• Casey EA, & Lindhorst TP (2009). Toward a multi-level, ecological approach to the primary prevention of sexual assault . Trauma, Violence, & Abuse , 10 ( 2 ), 91–114. [ PubMed ] [ Google Scholar ]
• Centers for Disease Control and Prevention. (2017). Sexual violence: Consequences . Retrieved from https://www.cdc.gov/violenceprevention/sexualviolence/consequences.html
• Centers for Disease Control and Prevention . ( 2007 ). Health education curriculum analysis tool Retrieved from https://www.cdc.gov/healthyyouth/hecat/
• Chin HB, Sipe TA, Elder R, Mercer SL, Chattopadhyay SK Santelli J (2012). The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services . American Journal of Preventive Medicine , 42 ( 3 ), 272–294. [ PubMed ] [ Google Scholar ]
• Connell RW (c1987). Gender and Power: Society, the Person and Sexual Politics . Stanford, CA: Stanford University Press. [ Google Scholar ]
• Connell RW (1996). Teaching the boys: New research on masculinity, and gender strategies for schools . Teachers College Record , 98 ( 2 ), 206–235. [ Google Scholar ]
• Courtenay WH (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health . Social Science and Medicine , 50 ( 10 ), 1385–1401. [ PubMed ] [ Google Scholar ]
• de Melker S (2015, May 27). The case for starting sex education in kindergarten. PBS News Hour . Retrieved from https://www.pbs.org/newshour/health/spring-fever .
• DeGue S, Simon TR, Basile KC, Yee SL, Lang K, & Spivak H (2012). Moving forward by looking back: reflecting on a decade of CDC’s work in sexual violence prevention, 2000–2010 . Journal of Women’s Health , 21 ( 12 ), 1211–1218. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• DeGue S, Valle LA, Holt MK, Massetti GM, Matjasko JL, & Tharp AT (2014). A systematic review of primary prevention strategies for sexual violence perpetration . Aggression and Violent Behavior , 19 ( 4 ), 346–362. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Durlak JA, Weissberg RP, Dymnicki AB, Taylor RD, & Schellinger KB (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions . Child Development , 82 ( 1 ), 405–432. [ PubMed ] [ Google Scholar ]
• Dworkin SL, Treves-Kagan S, & Lippman SA (2013). Gender-transformative interventions to reduce HIV risks and violence with heterosexually-active men: A review of the global evidence . AIDS and Behavior , 17 ( 9 ), 2845–2863. [ PubMed ] [ Google Scholar ]
• Elias MJ, Zins JE, Weissberg RP, Frey KS, Greenberg MT, Haynes NM, … Shriver TP. (1997). Promoting social and emotional learning: Guidelines for educators . Alexandria, VA: Association for Supervision and Curriculum Development. [ Google Scholar ]
• Fantz A (2016, June 7). Outrage of 6-month sentence for Brock Turner in Stanford rape case . CNN; Retrieved from http://www.cnn.com/2016/06/06/us/sexual-assault-brock-turner-stanford/index.html [ Google Scholar ]
• Ford J & Soto-Marquez JG (2016). Sexual assault victimization among straight, gay/lesbian, and bisexual college students . Violence and Gender , 3 ( 2 ), 107–115. [ Google Scholar ]
• Fortson BL, Klevens J, Merrick MT, Gilbert LK, & Alexander SP (2016). Preventing child abuse and neglect: A technical package for policy, norm, and programmatic activities . Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. [ Google Scholar ]
• Fulu E, Warner X, Miedema S, Jewkes R, Roselli T, & Lang J (2013). Why do some men use violence against women and how can we prevent it? Quantitative findings from the United Nations multi-country study on men and violence in Asia and the Pacific . Bangkok: UNDP, UNFPA, UN Women and UNV. [ Google Scholar ]
• Future of Sex Education Initiative . ( 2012 ). National Sexuality Education Standards: Core content and skills, K-12 [a special publication of the Journal of School Health] . Retrieved from http://www.futureofsexeducation.org/documents/josh-fose-standards-web.pdf
• Future of Sex Education Initiative . ( 2016 ). Building a foundation for sexual health is a K–12 endeavor: Evidence underpinning the National Sexuality Education Standards . Retrieved from http://futureofsexed.org/documents/Building-a-foundation-for-Sexual-Health.pdf
• Gabler E, Twohey M, & Kantor J (2017, October 30). New Accusers Expand Harvey Weinstein Sexual Assault Claims Back to ‘70s . New York Times; Retrieved from https://www.nytimes.com/2017/10/30/us/harvey-weinstein-sexual-assault-allegations.html [ Google Scholar ]
• Gilman AB, Hill KG, Hawkins JD, Howell JC, & Kosterman R (2014). The developmental dynamics of joining a gang in adolescence: Patterns and predictors of gang membership . Journal of Research on Adolescence , 24 ( 2 ), 204–219. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Greathouse SM, Saunders J, Matthews M, Keller KM, & Miller LL (2015). A review of the literature on sexual assault perpetrator characteristics and behaviors . RAND Corporation; Retrieved from http://www.rand.org/content/dam/rand/pubs/research_reports/RR1000/RR1082/RAND_RR1082.pdf [ Google Scholar ]
• Grazian D (2007). The girl hunt: Urban nightlife and the performance of masculinity as collective activity . Symbolic Interaction , 30 ( 2 ), 221–243. [ Google Scholar ]
• Haberland N (2015a). Sexuality education: Emerging trends in evidence and practice . Journal of Adolescent Health , 56 ( 1 ), S15–S21. [ PubMed ] [ Google Scholar ]
• Haberland N (2015b). The case for addressing gender and power in sexuality and HIV education: A comprehensive review of evaluation studies . International Perspectives on Sexual and Reproductive Health , 41 ( 1 ), 31–51. [ PubMed ] [ Google Scholar ]
• Harvey A, Garcia-Moreno C, & Butchart A (2007). Primary prevention of intimate partner violence and sexual violence: Background paper for WHO expert meeting . World Health Organization , 1–37. [ Google Scholar ]
• Heise LL (1998). Violence against women . Violence Against Women , 4 ( 3 ), 262–290. [ PubMed ] [ Google Scholar ]
• Hill KG, Howell JC, Hawkins JD, & Battin-Pearson SR (1999). Childhood risk factors for adolescent gang membership: Results from the Seattle social development project . Journal of Research in Crime and Delinquency , 36 ( 3 ), 300–322. [ Google Scholar ]
• Jewkes R (2012). Rape perpetration: A review . Pretoria, Sexual Violence Research Initiative . [ Google Scholar ]
• Jewkes R, Flood M, & Lang J (2015). From work with men and boys to changes of social norms and reduction of inequities in gender relations: A conceptual shift in prevention of violence against women and girls . Lancet , 385 ( 9977 ), 1580–1589. [ PubMed ] [ Google Scholar ]
• Joint Committee on National Health Education Standards . ( 2007 ). National Health Education Standards, Achieving Excellence, Second Edition . Retrieved from http://www.sparkpe.org/wp-content/uploads/NHES_CD.pdf
• Jordan E (1995). Fighting boys and fantasy play: The construction of masculinity in the early years of school . Gender and Education , 7 ( 1 ), 69–86. [ Google Scholar ]
• Kågesten A, Gibbs S, Blum RW, Moreau C, Chandra-Mouli V, Herbert A, & Amin A (2016). Understanding factors that shape gender attitudes in early adolescence globally: A mixed-methods systematic review . Plos One , 11 ( 6 ). [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Katz-Wise SL & Hyde JS (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis . Journal of Sex Research , 49 ( 2–3 ), 142–167. [ PubMed ] [ Google Scholar ]
• Kirby DB, Laris BA, & Rolleri LA (2007). Sex and HIV education programs: Their impact of sexual behaviors of young people throughout the world . Journal of Adolescent Health , 40 ( 3 ), 206–2017. [ PubMed ] [ Google Scholar ]
• Krug EG, Mercy JA, Dahlberg LL, & Zwi AB (2002). The world report on violence and health . Lancet , 360 ( 9339 ), 1083–1088. [ PubMed ] [ Google Scholar ]
• Lahey BB, Gordon RA, Loeber R, Stouthamer-Loeber M, & Farrington DP (1999). Boys who join gangs: A prospective study of predictors of first gang entry . Journal of Abnormal Child Psychology , 27 ( 4 ), 261–276. [ PubMed ] [ Google Scholar ]
• Leaper C (2000). The social construction and socialization of gender during development In Miller PH& Scholnick EK Toward a Feminist Developmental Psychology (127–152). New York, NY: Routledge. [ Google Scholar ]
• Lebioda K (2015). State policy proposals to combat campus sexual assault . American Association of State College and Universities; Retrieved from https://www.aascu.org/policy/publications/policy-matters/campussexualassault.pdf [ Google Scholar ]
• Lindberg LD & Maddow-Zimmet I (2012). Consequences of sex education on teen and young adult sexual behaviors and outcomes . Journal of Adolescent Health , 51 ( 4 ), 332–338. [ PubMed ] [ Google Scholar ]
• Los Angeles Times. (2017 , October 26). Beyond Harvey Weinstein: 33 other high-profile men accused of sexual misdeeds or related behavior . Retrieved from http://www.latimes.com/entertainment/la-et-accused-20171017-htmlstory.html
• Martin J, & Stolberg SG (2017, November 13). Roy Moore is accused of sexual misconduct by a fifth woman . New York Times; Retrieved from https://www.nytimes.com/2017/11/13/us/politics/roy-moore-alabama-senate.html [ Google Scholar ]
• Mellins CA, Walsh K, Sarvet AL, Wall M, Gilbert L, Santelli JS Hirsch JS (2017). Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk . PLoS ONE , 12 ( 11 ), e0186471. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Messner MA (2000). Barbie girls versus sea monsters: Children constructing gender . Gender & Society , 14 ( 6 ), 765–784. [ Google Scholar ]
• Mitchell KJ, Ybarra ML & Korchmaros SD (2014). Sexual harassment among adolescents of different sexual orientations and gender identities . Child Abuse & Neglect , 38 , 280–295. [ PubMed ] [ Google Scholar ]
• Morse A, Sponsler BA, & Fulton M (2015). State legislative developments on campus sexual violence: Issues in the context of safety . NASPA--Student Affairs Administrators in Higher Education and Education Commission of the States; Retrieved from https://www.naspa.org/images/uploads/main/ECS_NASPA_BRIEF_DOWNLOAD3.pdf [ Google Scholar ]
• Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane E, & Davino K (2003). What works in prevention: Principles of effective prevention programs . American Psychologist , 58 ( 6–7 ), 449–456. [ PubMed ] [ Google Scholar ]
• NYC Department of Education. (2011). Sexual health education in middle and high school . Retrieved from http://schools.nyc.gov/NR/rdonlyres/E8BEF0FA-1165-47A3-852D-618E2E0744A4/0/WQRG_SexualHealthEducation.pdf
• O’Sullivan LF, Hoffman S, Harrison A, & Dolezal C (2006). Men, multiple sexual partners, and young adults’ sexual relationships: Understanding the role of gender in the study of risk . Journal of Urban Health , 83 ( 4 ), 695–708. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Office for Civil Rights, Department of Education . ( 2011 ). Dear Colleague Letter . Retrieved from https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201104.pdf
• Ott MA (2010). Examining the development and sexual behavior of adolescent males . Journal of Adolescent Health , 46 ( 4 Suppl ), S3–S11. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Peterson C, Degue S, Florence C, & Lokey CN (2017). Lifetime economic burden of rape among U.S. adults . American Journal of Preventive Medicine , 52 ( 6 ), 691–701. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pleck JH, Sonenstein FL, & Ku LC (1993). Masculinity ideology: Its impact on adolescent males heterosexual relationships . Journal of Social Issues , 49 ( 3 ), 11–29. [ Google Scholar ]
• RAINN. Child and teens: Statistics . Retrieved from https:// www.rainn.org/statistics/children-and-teens
• Renold E (2000). Coming out: Gender, (hetero)sexuality and the primary school . Gender and Education , 12 ( 3 ), 309–326. [ Google Scholar ]
• Renold E (2001). Learning the hard way: Boys, hegemonic masculinity and the negotiation of learner identities in the primary school. British Journal of Sociology of Education , 22 ( 3 ), 369–385. [ Google Scholar ]
• Rohter L (2008, September 10). Ad of sex education distorts Obama policy . New York Times; Retrived from http://www.nytimes.com/2008/09/11/us/politics/11checkpoint.html . [ Google Scholar ]
• Ryan CL, & Bauman K (2016). Educational attainment in the United States: 2015 . U.S. Department of Commerce, Economics and Statistics Administration; Retrieved from https://www.census.gov/content/dam/Census/library/publications/2016/demo/p20-578.pdf [ Google Scholar ]
• Sacco L (2015, May). The Violence Against Women Act: Overview, legislation, and federal funding. (CRS Report No. R42499) . Retrieved from https://www.everycrsreport.com/reports/R42499.html .
• Sanday PR (1981). The socio-cultural context of rape: A cross-cultural study . Journal of Social Issues , 37 ( 4 ), 5–27. [ Google Scholar ]
• Sanday PR (1996). Rape-prone versus rape-free campus cultures . Violence Against Women , 2 ( 2 ), 191–208. [ PubMed ] [ Google Scholar ]
• Santana MC, Raj A, Decker MR, Marche AL, & Silverman JG (2006). Masculine gender roles associated with increased sexual risk and intimate partner violence perpetration among young adult men . Journal of Urban Health , 83 ( 4 ), 575–585. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Savransky R (2017, November 16). Woman accuses Al Franken of kissing, groping her without consent. The Hill . Retrieved from http://thehill.com/homenews/news/360656-woman-accuses-al-franken-of-kissing-groping-her-without-consent
• Senn TE, Carey MP, & Vanable PA (2008). Childhood and adolescent sexual abuse and subsequent sexual risk behavior: Evidence from controlled studies, methodological critique, and suggestions for research . Clinical psychology review , 28 ( 5 ), 711–735. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sexuality Information and Education Council of the United States . ( 2004 ). Guidelines for comprehensive sexuality education: Kindergarten-12th grade, Third Edition . Retrieved from http://www.siecus.org/_data/global/images/guidelines.pdf
• Shearer CL, Hosterman SJ, Gillen MM, & Lefkowitz ES (2005). Are traditional gender role attitudes associated with risky sexual behavior and condom-related beliefs? Sex Roles , 52 ( 5–6 ), 311–324. [ Google Scholar ]
• Smith SG, Chen J, Basile KC, Gilbert LK, Merrick MT, Patel N…Jain A (2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010–2012 State Report . Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. [ Google Scholar ]
• Swain J (2000). The moneys good, the fames good, the girls are good: The role of playground football in the construction of young boys masculinity in a junior school . British Journal of Sociology of Education , 21 ( 1 ), 95–109. [ Google Scholar ]
• Teten Tharp A, DeGue S, Valle LA, Brookmeyer KA, Massetti GM, & Matjasko JL (2012). A systematic qualitative review of risk and protective factors for sexual violence perpetration . Trauma, Violence, & Abuse , 14 ( 2 ), 133–167. [ PubMed ] [ Google Scholar ]
• Walsh K, Zwi K, Woolfenden S, & Shlonsky A (2015). School-based education programmes for the prevention of child sexual abuse (Review) . Cochrane Database of Systematic Reviews , ( 4 ), CD004380. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Whaley RB (2001). The paradoxical relationship between gender inequality and rape . Gender & Society , 15 ( 4 ), 531–555. [ Google Scholar ]
• The White House Council on Women and Girls . ( 2014, January ). Rape and sexual assault: A renewed call to action . Retrieved from https://www.knowyourix.org/wp-content/uploads/2017/01/sexual_assault_report_1-21-14.pdf
• Zackarek S, Dockterman E, & Sweetland H (2017, December 6). TIME Person of the Year: The Silence Breakers . Retrieved from http://time.com/time-person-of-the-year-2017-silence-breakers /

Sex Education Resources

Here you can find relevant research as well as tools, templates and sample documents for each phase of the toolkit.  

Displaying 36 resources

Addressing Sexual Health in Schools: Policy Considerations

This resource provides an overview of key policy components for sexual health education in schools. It includes sample policies and other resources pertaining to parental notification and involvement, curriculum selection and materials review, professional development, the role of external agencies and more.  

Best Practices for Family Engagement

Best Practices for Family Engagement provides tips on how to engage parents and guardians before, during and after sex education implementation.  

Brochure for School District Engagement

Eyes Open Iowa created a high-level brochure to introduce school districts to the project, purpose, student need, and resources available which can help clarify the CSE opportunity and pathway to success.  

Capacity Assessment and Planning Tool (CAPT)

The Capacity Assessment and Planning Tool (CAPT) aids in determining how ready a school district is to engage in sex education efforts.  This can be adapted to respond to a specific state or regional context. 

Common Core Standards for English Language and Mathematics

Because the majority of states have voluntarily adopted the Common Core Standards for mathematics and English language arts/literacy (ELA), some WISE grantee partners have aligned their sexuality curriculum with the ELA components.  

Comprehensive Sex Education and Academic Success: Effective Programs Foster Student Achievement

This fact sheet provides a summary of recent research highlighting the connections between sex education and academic success.  

Curriculum Selection Tool

This curriculum selection tool lists a variety of criteria to consider including curriculum, training and TA availability and cost, alignment with standards and best practices, etc.  

Division of Adolescent and School Health  (DASH)

DASH supports 19 state and 17 local education agencies to support schools and school districts in implementing exemplary sexual health education, increase adolescent access to sexual health services and establish safe and supportive environments for students and staff.

Florida's Sexual Health Education Community Outreach Toolkit

This Tool Kit was created to provide valuable information, innovative ideas, and strategies for community members to build awareness and support for policies and programs that improve sexual health outcomes among youth.

Georgia State and Regional Sex Education Policy Overview

School districts and teachers may not be aware of current sex education policies and education codes that govern sex education. Creating a simple, accessible handout with the key policies and codes can ensure stakeholders understand what is mandated and where opportunities for tailoring to local contexts exist. GCAPP created a state-level overview and regional fact sheets to allow regions to compare their policies with the state policy.

Health Education Curriculum Analysis Tool

The Health Education Curriculum Analysis Tool (HECAT) can help school districts, schools, and others conduct a clear, complete, and consistent analysis of health education curricula based on the National Health Education Standards and CDC’s Characteristics of Effective Health Education Curricula.

How Schools Work and How to Work with Schools

This publication, produced by the National Association of State Boards of Education (NASBE), provides a summary of the federal, state and local educational systems of governance, outlines key tips for engaging and partnering with schools and answers frequently asked questions about education.  

Implementation Planning Worksheet

The Implementation Planning Worksheet assists school district staff in planning who will be delivering sex education and when.  

Making Adaptations to Evidence-Based Pregnancy and STD/HIV Prevention Programs

ETR offers adaptation kits which contain practical tools and resources to guide adolescent reproductive health practitioners in making effective adaptations and maintaining fidelity to program core components. The adaptation kits were developed to provide clarity on how each program was designed, its core components, and the types of adaptations that are considered safe and those that should be avoided.

Memorandum of Understanding

This memorandum of understanding template outlines potential roles and responsibilities of the partners involved in sex education implementation efforts. Not only does an MOU clarify expectations, but also helps to institutionalize efforts so that agreements can continue even if a key stakeholder changes positions.

National Health Education Standards

The National Health Education Standards provide a framework to help teachers, administrators, and policymakers promote health-enhancing behaviors among students in grade levels Pre-K through 12. The framework, consisting of eight health education standards, includes performance indicators that can be applied to a variety of health topics.

National Sexuality Education Standards Curricula Mapping Tools

By mapping state or local standards and/or programs and curricula to the National Sexuality Education Standards, school professionals can identify which topics are currently covered in sex education class by grade level and which are not. 

National Sexuality Education Standards, Second Edition (2020)

The goal of the National Sex Education Standards: Core Content and Skills, K–12 (Second Edition) is to provide clear, consistent, and straightforward guidance on the essential, minimum, core content and skills needed for sex education that is age-appropriate for students in grades K–12 to be effective. The National Sexuality Education Standards were developed and align to the National Health Education Standards.

North Carolina Parent Opinion Survey of Public School Sexuality Education

SHIFT NC created a report to document the findings from their parent survey. They used the positive reactions from parents about inclusion of sex education in schools to substantiate their efforts and allay school district leadership fears.

Parent Opinion Survey Questions

Georgia Campaign for Adolescent Power and Potential (GCAPP), a WISE lead partner, developed a parent survey to find out what parents wanted their students to learn.

Pipeline Tracking Tool

This spreadsheet can be helpful in tracking status of potential partner school districts.  

Preliminary Assessment

Based on a similar tool developed by SHIFT NC, this preliminary assessment provides an early gauge of whether or not a school district shows promise. 

Sample School District Stakeholder Message Development

Georgia Campaign for Adolescent Power & Potential (GCAPP), a WISE lead partner, developed a simple tool to document the various needs of key constituency groups. This sample shows the different school district stakeholders they engaged and how they tailored their message to distinct stakeholder needs. GCAPP staff would reference this document before conversations with these key stakeholders to ensure they were connecting their efforts to each stakeholder’s needs during every interaction.

Sample Table Showing Curriculum Mapped to Education Code

ETR Associates mapped two curricula --  Making Healthy Choices and P ositive Prevention   -- to mandated HIV and CSE education codes to determine alignment between curricula and policy. This table provides an example of what mapping and alignment looks like in practice.

School Health Advisory Council

This sample presentation discusses the role and function of School Health Advisory Councils (SHACs) as well as tips for successful recruitment and retention of SHAC members.

School Health Policies and Practices Study (SHPPS)

SHPPS is a national survey periodically conducted to assess school health policies and practices at the state, district, school, and classroom levels.

School Health Profiles

The School Health Profiles are a system of surveys assessing school health policies and practices in states, large urban school districts, territories, and tribal governments. Profiles are conducted biennially by education and health agencies among middle and high school principals and lead health education teachers.

Sex and HIV Education Programs For Youth: Their Impact and Important Characteristics

This research summarizes sex and HIV education programs and hones in on 17 characteristics of programs that led to behavior change.

State Education Data Profiles

This database provides access to statewide information on education system characteristics (e.g., number of students, schools, teachers), finances, assessments and selected demographics. Cross-state comparison tools are also available.

State Policies in Brief, Sex and HIV Education

The Guttmacher Institute’s State Policies in Brief  provide state-by-state information on key issues affecting sexual and reproductive health and rights. The publications are updated monthly to reflect the most recent legislative, administrative, and judicial actions. The Sex and HIV Education brief summarizes state-level sex and HIV education policies, as well as specific content requirements, based on a review of state laws, regulations and other legally binding policies

State Profiles

SIECUS State Profiles is a state-by-state resource that describes sexuality education and abstinence-only-until-marriage programs in each state.  Each state profile includes a summary of state laws and policies related to sexuality education.  It also includes information about a variety of federal funding programs that support sexuality education and/or abstinence-only-until-marriage programs as well as how much money each state is receiving from each federal program (if applicable) and a summary of how it is being used. 

State School Health Policy Database

The NASBE State School Health Policy Database contains brief descriptions of laws, legal codes, rules, regulations, administrative orders, mandates, standards, resolutions, and other written means of exercising authority. It also includes guidance documents and other non-binding materials that provide a more detailed picture of a state’s school health policies and activities. Hyperlinks to full written policies are provided whenever possible. The database is searchable by state, topic, and keyword.

Technical Assistance Action Plan

This Technical Assistance Action Plan is a tool to assist in the process of moving from planning to action. The planning tables below can help bridge the gap between the roll-out plan and the provision of needed technical assistance. Tables may be adapted to serve individual districts, as needed.

Tool to Assess the Characteristics of Effective Sex and STD/HIV Programs

Based on the Sex and HIV Education Programs for Youth: Their Impact and Important Characteristics research, this tool is designed to assess, select, improve, or design a sex or STD/HIV education program.

WISE Toolkit

This PDF of the WISE Toolkit includes content related to the each of the four phases and corresponding steps.  

Youth Risk Behavior Surveillance System (YRBSS)

The YRBSS monitors six priority health-risk behaviors among youth and young adults including sexual behaviors that contribute to unintended pregnancy and STDs/HIV, alcohol and other drug use as well as violence. Annual and trend data is available.  

Youngsters using porn to learn with sex education 'failing young people'

The Women and Equalities Committee said there was an "unacceptable risk of harm" from online information about sex and described NHS services as being at "breaking point".

By Dylan Donnelly, news reporter

Tuesday 26 March 2024 05:38, UK

Young people are learning about sex from online pornography because conventional sex education is "failing" them, MPs have said, amid a surge of sexually transmitted infections.

The Women and Equalities Committee said that there is an "unacceptable risk of harm" from online information about sex and sexual health because of an "absence of authoritative advice".

MPs said there is "compelling evidence that relationships and sex education is failing young people" and the benefits of condom use "must be a key part of the curriculum".

They also criticised the government for "failing to heed warnings", with funding for sexual health services reducing year-on-year.

In their report, the committee found that gonorrhoea cases rose to 82,592 in 2022 - the highest number since records began in 1918.

Read more from Sky News: 'I'm going to ruin your life': Inside the Revenge Porn Helpline Porn websites may have to use photo ID and credit card checks US state bans children under 14 from social media

They also found infectious syphilis diagnoses increased to 8,692 in 2022 - the largest annual number since 1948 - and that overall, there were 392,453 diagnoses of new sexually transmitted infections (STIs) in England in 2022, more than 1,000 a day.

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Caroline Nokes MP, chair of the Women and Equalities Committee, called the figures a "red flag" and said: "Sexual health services are at breaking point. They are underfunded and in many cases unable to provide the services their local area needs.

"It is not sustainable and an obvious false economy to substantially reduce funding for sexual health services during a period of increasing demand upon them."

Keep up with all the latest news from the UK and around the world by following Sky News

A government spokesperson said: "In 2020 we made it compulsory for all secondary schools to offer relationships and sex education to ensure that young people are equipped to make safe, informed and healthy choices.

"Content includes information about safer sex and contraception and how these can reduce STIs.

"This year we have allocated more than £3.5bn to local authorities in England to fund public health services, including sexual health services, and this funding will increase in each of the next three years."

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