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Bring in jen or shafia

timeline of health education, past, present, future

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talk about past ways sex ed was taught compared to now

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Consequences of excluding topics from sex ed --> misinformation and harmful ideologies

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how lack of access impacts life (and opposite)

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Important theme: States with worse health education are more aggressively banning and limiting abortion

Question to research further: maybe explore other decisions made in US states and connect them to the type of sex education taught in schools --> likely continually relevant to abortion, voting, LGBTQ+ rights, etc

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Graphic: Many States That Restrict or Ban Abortion Don’t Teach Kids about Sex and Pregnancy

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States that protect abortion rights tend to have more comprehensive sex ed policies

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how politics effect sex ed, what states require it? is it linked to abortion + contraception access?

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especially in the 1990s ideas thet sex ed was associated with communism or pornography kind of creates the idea of this "wrongness" and being the "wrong" type of person or culture, which is a big thing in America and is used to alienate people and communities by excluding them from what is "right" or what is more "American"

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Theme: Gives some history about how sex education grew to be so controversial in the 60s-80s and how the Christian right believed it promoted deviance and depravity.

Further questions: could be interesting to explore how people are oppressed by not being given honest and accurate education and information about their own bodies. Connects to inequality in the healthcare system as well, and medical gaslighting.

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This database is only available to Urban School students and staff. Please login using your Urban login and password.

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Themes: Disparities in sex ed for students of color, women, and queer students

Main Ideas: sex education is lacking particularly in marginalized communities, meaning youth are taught less about their bodies and their rights, often experiencing health/emotional consequences later in life.

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Only half of young people in the United States are getting sex education that meets minimum standards, according to a new study.

While the findings show that adolescents are not receiving critical information, of even greater concern is that a significant percentage of young people don't receive any information about birth control and sexually transmitted disease prevention before they begin to have sexual intercourse.

"...most adolescents are not receiving sex education that will enable them to manage their sexual lives."

The study, published in the Journal of Adolescent Health, also found significant gender and racial disparities in adolescents' access to comprehensive sex education.

Females were more likely than males to report receiving instruction in waiting until marriage to have sex, while males were more likely than females to report instruction in condom use.

The study also found that significantly fewer Black and Hispanic males than white males received instruction in saying no to sex, birth control, and HIV and STI prevention. Queer youth were less likely than their straight peers to report instruction about HIV/STI prevention and where to get birth control.

And while religious institutions in the United States play a central role in sex education for many adolescents, teens that report religious settings as their main source are not receiving any information about birth control.

"The findings show that most adolescents are not receiving sex education that will enable them to manage their sexual lives," says Leslie M. Kantor, professor and chair of the urban-global public health department at the Rutgers School of Public Health.

"Of even more concern is that young people of color and queer youth are receiving less sex education and males and females are receiving different messages. Policymakers at every level must invest in inclusive and comprehensive sex education programs with an eye toward greater equity and inclusivity."

In the study, the researchers looked at data from 7,946 adolescents in the National Survey of Family Growth from 2011-2015 and 2015-2019 to examine changes in formal sex education by gender and race/ethnicity for content, timing, and location of instruction.

More than 75% of adolescents received instruction about "how to say no to sex," versus about 60% who received instruction about birth control. In 1995, more than 80% of young people reported receiving information about birth control.

"The United States is failing adolescents and their families by providing limited sex education to so many of its youth," adds Kantor.

"Federal, state, and local policy makers must work harder to ensure that sex education is provided that is age appropriate and that education is equitable and meets the needs of all youth rather than leaving some youth less equipped to lead sexually healthy lives."

Additional researchers are from the Guttmacher Institute.
Source: Rutgers University

Original Study DOI: 10.1016/j.jadohealth.2021.08.027

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Young people get less sex ed now than 25 years ago

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A significant number of young people in the US receive no sex ed information about birth control and STI prevention before they have sexual intercourse.

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American Bar Association website; gives a legal perspective on abstinence only education which is really interesting. I hadn't previously considered that it could be viewed as a violation of rights NOT to give comprehensive education to someone on their body. Interesting case.

Further question: Curious if any action has been taken using this strategy.

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Has an interesting comment from a pro-abstinence education person saying that they can't "give in" to promoting sexual activity in youth.

Further questions: Interesting to consider what is threatening about the idea of sex education... potentially bodily autonomy, or straying from traditional "American" or Christian values?

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Abstaining from sexual activity is a surefire way to prevent pregnancy and avoid sexually transmitted diseases. But programs advocating abstinence often fail to prevent young people from having sex, researchers write in the September issue of the Journal of Adolescent Health.

Such programs, sometimes referred to as "abstinence only until marriage" programs, typically advocate monogamous, heterosexual marriage as the only appropriate context for sexual intercourse and as the only certain way to avoid unwanted pregnancies and sexually transmitted diseases.

That's "not just unrealistic, but it leaves our young people without the information and skills that they need," said Laura Lindberg, a coauthor of the report and a research scientist at the Guttmacher Institute, a reproductive health research group that supports abortion rights. "We fail our young people when we don't provide them with complete and medically accurate information."

The analysis confirms previous public health findings that abstinence-only education programs don't succeed in reducing rates of teen pregnancies or STDs. Moreover, public health data indicate that such programs "have little demonstrated efficacy in helping adolescents to delay intercourse," the authors write.

When American teens do begin having sex, they may fail to use condoms or other forms of contraception, unlike their peers in other countries who have routine access to contraceptive education and counseling, the report suggests.

Promoting abstinence until marriage as the only legitimate option for young people "violates medical ethics and harms young people," Lindberg says, because such programs generally withhold information about pregnancy and STD prevention and overstate the risk of contraceptive failure.

According to a 2004 report prepared for House Democrats, language used in abstinence-based curricula often reinforces "gender stereotypes about female passivity and male aggressiveness" - attitudes that often correlate with harmful outcomes including domestic violence, the report notes.

The new analysis argues there's another reason that abstinence until marriage is increasingly unrealistic: Americans are marrying later, on average, and some are not marrying at all, but they're not waiting longer to begin having sex. The average age for initiating sexual activity has remained around 17 or 18 since the early 1990s. The net effect, the report concludes, is a substantial increase in premarital sex.

Conservative groups have long advocated abstinence education in public schools, pointing to a smaller number of studies that support abstinence-based approaches. Reacting to the report, Concerned Women for America CEO Penny Nance noted that abstinence is the only 100 percent effective form of birth control.

"It seems we have swung so far left as to embrace promiscuity for our kids," Nance said in a statement to NPR. "And at the least, we are surrendering to the idea that teenagers will be sexually active. We, as a culture, can do better."

Nance added, "Schools and public health advocates owe it to parents and people of faith to support the young girl or boy who wants to delay sexual behavior. Marriage, and delaying sex until at least adulthood, are good goals."

The U.S. government has funded abstinence programs in schools and community organizations since the early 1980s. An increased focus on and funding for them began as part of welfare reform efforts undertaken during the Clinton administration. According to Guttmacher, the federal government has spent about $2 billion over the past 20 years on abstinence-based education.

President Trump has also been friendly to such programs, naming Valerie Huber, an advocate for abstinence-only education, to a post at the Department of Health and Human Services. The administration recently cut more than $200 million in federal funds for teen pregnancy prevention programs. Meanwhile, the administration's budget proposal includes millions of dollars to extend the "Abstinence Education and Personal Responsibility Education Program."

That approach pleases much of Trump's conservative base. In a statement to NPR, Arina Grossu, director of the Center for Human Dignity at the Family Research Council, said abstinence-based programs "provide the optimal message for teens." She compared the approach to "other public health models used to address underage drinking and drug use" that aim to discourage such behaviors.

Guttmacher's Lindberg takes the comparison in a different direction in arguing that teens should be given comprehensive sex education that includes training in contraception and STD prevention.

"We tell people not to drink and drive," she says. "We don't teach them not to drive. ... We would never withhold information about seat belts because they wouldn't know how to protect themselves."

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Abstinence-Only Education Is Ineffective And Unethical, Report Argues

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Abstaining from sexual activity is a surefire way to prevent pregnancy and avoid sexually transmitted diseases. But programs advocating abstinence often fail to prevent young people from having sex, researchers write in the September issue of the Journal of Adolescent Health.

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-inadequate and inconsistent health education comes from religion, legislation, and misconceptions

-results in pregnancies, STD transmissions,

-there is no universal curriculum for sex ed

-US has one of the highest rates of teen pregnancies

-high rates of physical health conditions, stds, social stigma for lgbtq individuals

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Summary+

Sexual health education across the United States is inconsistent and inadequate in providing the information necessary to allow individuals to make informed, healthy decisions about their sexuality and sexual activity. Only about half of states require sex education to be taught, and only a quarter require medically accurate information to be taught. This incomplete and sometimes inaccurate curriculum results from contradicting morals and religious teachings, legislation created by state and national governments, and misconceptions about the effects of comprehensive teachings. This inadequate education leads to high rates of teen pregnancies, STD transmissions, and social stigma for LGBTQ individuals. Organizations have attempted to intervene by creating comprehensive curriculums, providing assistance for implementation into school curriculums, and providing information on websites so that individuals can access them for free. In other countries, this form of intervention has proved successful through outcome and impact evaluations. However, while these organizations working in the United States have completed output and outcome measurements, they have done little to evaluate their impact.

Key Takeaways+

There is no universal curriculum for sexual health education across the United States.

Inadequate sexual health education is a result of moral and religious controversies, legislation, and misconceptions about the consequences of teaching safe sex for heterosexual and LGBTQ individuals.

Because of the lack of adequate sex education, the US has one of the highest rates of teen pregnancy in all developed countries.

High rates of physical health issues, including HIV, chlamydia, gonorrhea, and other STDs, are a consequence of inadequate sexual health education.

Social stigma for LGBTQ individuals is a significant consequence of incomplete or lack of sex education.

Best practices exist, and interventions in the form of comprehensive sex education curriculums demonstrate the most significant outcomes, but the complete implementation of a universal curriculum is the most crucial challenge.

Key Terms+

Sexually Transmitted Disease (STD)-An infection transmitted through sexual contact caused by bacteria, viruses, or parasites. ¹

Abstinence-Only-A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ²

Comprehensive Sex Education-A form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence. ³

Contraceptives-A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. ⁴

Teen Pregnancy-A pregnancy that occurs for a woman under the age of 20, including girls who are under 12. ⁵

Human Immunodeficiency Virus (HIV)-A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ⁶

Stigma-Occurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities. ⁷

Heteronormativity-Refers to heterosexuality being the norm and dominating other forms of sexuality. ⁸

Sexual Orientation-The identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual. ⁹

Acquired Immunodeficiency Syndrome (AIDS)-The final stage of infection with HIV; it happens when the body's immune system is badly damaged because of the virus. ¹⁰

Human Rights Approach-Access to complete and accurate HIV, AIDS, and sexual health information has been recognized internationally as a basic human right and essential to realizing the human right to the highest attainable standard of health. ¹¹

Q: How are we defining adequate sexual health education in this brief?

A pregnancy that occurs for a woman under the age of 20, including girls who are under 12.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.Access to complete and accurate HIV, AIDS, and sexual health information has been recognized internationally as a basic human right and essential to realizing the human right to the highest attainable standard of health. A: Adequate sexual health education, through the scope of this brief, is defined as having a comprehensive curriculum, being medically accurate, and being taught by trained teachers. The adequacy of sexual health education programs can be indicated by lower teen pregnancy ⁵ and STD rates. ¹² Curriculums that are comprehensive in nature address issues such as disease prevention, contraceptives ¹³ These programs are more successfully taught when the teachers are trained and qualified to address these different topics. ⁴, relationships, communication, and sexuality. ¹⁴ To improve training for teachers, it should include the human rights approach ¹⁵ ¹¹: providing complete and accurate information in order to allow teenagers to make an informed decision regarding their sexual health, sexual activity, and how to potentially prevent disease.

Q: What inadequacies exist in current sexual health education curriculums in the United States?

A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. A: Sexual health education in American high schools is lacking in curriculum, qualified teachers, and inclusive speech. One of the main inadequacies has to do with incomplete curriculums. In 20 out of 34 states that teach abstinence, the curriculum stresses abstinence-only ², which is a type of sex education that presents not having sex outside of marriage as the only safe and effective way to prevent pregnancy and STIs. 16, 17 These programs often eliminate other topics, including human development, relationships, sexual behavior, and sexual health. This focus means that through current sexual health education programs, students are not guaranteed to receive the necessary information to make informed decisions regarding condom use, consent, and whether or not to participate in sexual behaviors. ¹⁸ Because knowing about safe sex practices is necessary for people to make an educated decision regarding their health, access to this information is considered a human right by the American Public Health Association. 19, 20 Another inadequacy includes improperly trained or unqualified teachers. In a qualitative study including 335 sex education teachers at Illinois middle schools and high schools, half of the teachers lacked confidence in teaching about topics regarding condoms and birth control. This may be due to inadequate training these teachers received, as 30% of them said that they had no special training in teaching sex education. ²¹ The last main inadequacy that exists within US sexual health education programs is the lack of or inaccuracy of information related to the LGBTQ community. They are often omitted from current high school sexual health education curriculums or spoken of in a derogatory manner. 22,23,24 This style of teaching may leave those individuals who experience something else, for themselves or in their family, feeling isolated. ²⁵ Due to inadequacies in the current sexual health curriculum, many high schoolers lack important knowledge that affects their physical, social, and mental well-being. ²⁶

Q: Who is affected by this?

A: High school students, ages 14-18, are most in need of adequate sexual health education. This demographic has a high rate of STDs as compared to other age groups, and, according to the CDC, 44% of males and 43% of females participate in intercourse by age 17. 27, 28 Evidence shows that adequate sex education can increase contraceptive use, decreasing STD and pregnancy rates for teenagers. ²⁹ Teenagers require this education because they are going through puberty and are subject to new media with implicit or explicit messages about sex and sexuality. Studies show that 1 out of 5 youth ages 9-17 are exposed to unwanted sexual content online. ³⁰ This exposure has been linked to risky sexual health behavior, which is why providing necessary information can help them make informed decisions. ³¹ Nearly 40% of all high school students in the US report they have had sex, and 9.7% of high school students have had sex with 4 or more partners during their lifetime. ³² Through adequate sexual health education, teens can be more informed about consent and better understand their bodily autonomy. 33, 34

Q: Who is most negatively affected by inadequate sex education?

A: To be more effective, sexual health education programs can also be inclusive to LGBTQ individuals to support healthy relationships. ³⁵ LGBTQ youth are greatly affected by a lack of inclusivity in many current sexual health education programs. For example, a national survey conducted in 2011 found that 4% of LGBTQ students in middle and high school reported experiencing any positive discussion of LGBTQ-related issues in their sexual health classes. ³⁶ This demonstrates the level of exclusion the LGBTQ community experiences due to inadequate sexual health education programs and, because of its severity, the effects will be discussed throughout this brief. 37, 38

Q: Who determines the curriculum?

A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. A: In the United States Constitution, education is placed under the authority of individual states. ³⁹ Because of this, no nationwide curriculum can be instituted by the federal government. While the federal government does not play a direct role in determining the curriculum for sexual health education, it still has a large influence through funding. ⁴⁰ At the state level, many state governments have certain required parameters for sexual health education if it is taught in schools, but most allow individual districts to determine their own curriculum requirements. These districts allow the school boards and sometimes advisory boards in which the community (parents, students, teachers, religious leaders, and so on) can make their voices heard and implement the curriculum they agree upon. ⁴¹ While these school boards essentially determine the subject and scope of sex education and the budget of these programs, they cannot implement any changes contrary to the current state laws unless they work to change the laws. ⁴² Thirty states require some form of sexual health education, and 22 states require that if sex or HIV ⁶ education is provided, it must be medically accurate. 43, 44 California Code 3913 defines medically accurate as "verified or supported by research conducted in compliance with scientific methods and published in peer-reviewed journals, where appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field." ⁴⁵

Q: How has sexual health education evolved in the US?

The final stage of infection with HIV; it happens when the body's immune system is badly damaged because of the virus.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. A: Sexual health education has both expanded and been reduced throughout its history in US education. After World War I, during which many American soldiers contracted STIs, public schools began teaching sex education in high schools in response to the increased public focus on the prevention of STIs. ⁴⁶ The Chamberlain-Kahn Act allocated federal funding to training teachers in STI prevention for high school sex education programs in the 1919-1920 school year. ⁴⁷ During WWII, concern for STIs became mainstream due to the significant increase in STI cases, which made sexual health education an important topic of conversation. ⁴⁸ Then in 1960, sex education became about more than disease prevention and started to include topics such as sexuality, which largely remained heterosexually focused. The AIDS ¹⁰ epidemic, which began in the 1980s, initiated the debate on whether to teach a comprehensive curriculum or an abstinence-only ⁴⁹ ² curriculum. The federal government influenced the lean toward abstinence-only education with the Adolescent Family Life Act (AFLA) created in 1981, which subsidized abstinence-only curricula in schools. During the 1990s and early 2000s, abstinence-only-until-marriage curricula were created by conservative organizations. In 2000, a new federal funding source, the Community-Based Abstinence Education program, supported community-based organizations in teaching abstinence-only-until-marriage material. Then, in 2010, The Office of Adolescent Health (OAH) was created and developed the Teen Pregnancy Prevention Program (TPPP) to fund evidence-based initiatives. There continues to be a push and pull between sex education programs that have created unclear standards and inadequate programs.

Q: How do US sexual health education programs compare to other countries?

A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. A: When comparing the US to similarly developed countries, the US has a limited and underdeveloped sexual health program. Studies show that introducing sexual health education topics in primary school can decrease child sex abuse, dating, and interpersonal violence and increase healthy relationships and appreciation of sexual diversity. ⁵⁰ For example, the Netherlands, France, and Australia have sexual health education programs that begin in primary school. ⁵¹ Throughout the program, teachers are required to be qualified, meaning they have the training and are up to date with the current medical information available. ⁵² The US, on the other hand, does not require teachers to be qualified or trained to teach sexual health education and begins teaching it at the secondary school level. ⁵³ The comparison between the US and other similarly developed countries demonstrates that other countries have more developed and effective programs. This is evident in the birth rates per 1,000 adolescents (children aged 15-17) across the 4 countries. ⁵⁴ The US birth rate is approximately 8.5 times greater than the Netherlands, 5.5 times greater than France, and 3 times greater than Australia. ⁵⁵ The US also has significantly more HIV ⁶ cases in men ages 15-24 than in countries in Europe. This includes the US HIV rate being 5 times that of Germany, 3 times as high as the Netherlands, and 1.5 times higher than France. The difference in these rates can be partially tied to less effective sexual health education systems in the United States. ⁵⁶

Federal funding influences inadequate sexual health education in the US by perpetuating abstinence-only A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ² education. An abstinence-only curriculum is not an adequate form of sexual health education because it excludes important information and is not comprehensive. States and districts are more likely to adapt this curriculum in order to receive grants and funding from the federal government for their programs. ⁵⁷ This can often lead to less comprehensive sexual health education and more inadequate curriculums. In 2017, one-third of the $299 million in federal funding for teen sexual health education programs was for abstinence education which equates to about $99.7 million. ⁵⁸ The federal government has several avenues through which they disseminate funding for sexual health education programs, such as the Title V Abstinence-Only-Until-Marriage (AOUM) law, which was established in 1996.

This law dictates that states must match every $4 from the federal government with $3 from the state, and this money must be used for sexual education programs that omit talk of contraceptives A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. ⁴ and condoms except to emphasize their failure rates. ⁵⁹ In 2017, $75 million of the $99.7 million in federal funding given was under Title V, indicating that it is the most influential and abundant source of funding for sexual health programs in the US. ⁶⁰ Due to its required parameters, it also indicates that schools in the 44 states and 5 territories that receive this funding are adapting their sexual health education curricula to teach abstinence-only curricula or other restricted curricula that do not adequately teach sexual health. ⁶¹ These preconditions for funding lead to the furthering of inadequate sexual health education, specifically by teaching abstinence-only and not including talk about contraceptives ⁴ or condoms.

In 2012, the abstinence-only A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ² curriculum was rebranded to be called Sexual-Risk Avoidance Education. ⁶² This new legislation provides funds to programs educating youth about how to voluntarily refrain from non-marital sexual activity. 63,64 A downside to teaching sex in this manner is that it can inadvertantly contribute to the 11% of high school students who have experienced sexual assault to feel guilty for situations that were beyond their control. ⁶⁵ Despite Sexual-Risk Avoidance Education programs failing to address all the necessary topics of comprehensive sexual health education, ⁶⁶ federal funding in the US has increased since 2015, from $55 million to $1.1 billion in 2021. ⁶⁷ With current legislation, inadequate curriculums continue to be implemented in schools, contributing to inadequate sexual health education among high schoolers in the US.

The current policies, at the national and state level, lead to incomplete and inaccurate sexual health education curriculums across states because the policies do not require principles from adequate sexual health education to be taught. Without a universal sexual health education curriculum for the country, states are left to determine their own parameters for sexual health education programs taught in schools underneath their jurisdiction, causing many programs to be inadequate. ⁶⁸ A total of 22 out of the 50 states required some type of sexual health education to be taught; 34 states required that if sex education is taught in schools, abstinence must be covered (of which 20 states require it to be stressed), and 13 required that information on contraception must be taught. ⁶⁹ This inconsistency leads to teenagers that are receiving parts of a sexual health education and not being guaranteed the information that will allow them to make informed decisions about relationships and sexual activity. ⁷⁰ The absence of national guidelines causes high schoolers throughout the United States to have inconsistent sexual health education that is usually inadequate.

Along with the inconsistencies between states, individual states' policies contribute to inadequate sexual health education for high schoolers. Under the Utah code 53G-10-402, the state requires that sex education be taught but prohibits the advocacy or encouragement of contraceptive methods or devices.A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.A pregnancy that occurs for a woman under the age of 20, including girls who are under 12.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. 71, 72 This policy contributes to inadequate sexual health education by not guaranteeing that high school-aged youth are provided with the information that could prevent the effects of unprotected and unplanned sexual activity. This policy does not provide the information necessary for them to make the most informed decisions for themselves and their body. Other states' policies are similar to that of Utah and lead to a lack of emphasis on important topics that are part of comprehensive sexual health education programs. ⁷³ The Centers for Disease Control and Prevention conducted a survey in 2014 and found that across high schools, sexual health programs spent an average of 6.2 hours on human sexuality and 4 or fewer hours on preventing HIV ⁶, STIs, and teen pregnancy ⁷⁴ This study demonstrates the little emphasis that states put on sexual health education, especially the topics covered in more comprehensive programs. Without coverage on topics like ⁵.contraceptives ⁴, states' policies can promote inadequate sexual health education.

While examining abstinence curriculum, US congressman Henry Waxman observed that the curricula often taught false information about exaggerated failures of contraceptives A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ⁴ and risks of abortion and reinforced male and female stereotypes. ⁷⁵ These abstinence-only ⁷⁶ Communication skills, decision-making skills, violence prevention, and consent are important topics, but all 4 of these topics are only currently being taught in 9 out of the 50 states. ² curriculums also fail to address important topics such as healthy relationships. ⁷⁷ Inconsistencies between states dictating whether or not sexual health education should be taught in schools as well as in the type of information that is taught, leads to incomplete and inadequate sexual health education.

Perceptions of Sexual Health Education

An important contributing factor to the current inadequacies in sexual health education in the United States is the historical beliefs and opinions that originally shaped the curriculums. While these beliefs and opinions no longer represent the majority of the population, their influences remain evident in the current sexual health curriculums. One of the most influential beliefs is that teaching healthy sexual practices to individuals who are part of the LGBTQ community will influence other youth to change their sexuality. A case study in Merrimack, New Hampshire, demonstrated that strong anti-homosexual beliefs led to a policy known as the Prohibition of Alternate Lifestyle Instruction. This case led to the removal of all books and topics from the curriculum that had any connection to homosexuality, including AIDS The final stage of infection with HIV; it happens when the body's immune system is badly damaged because of the virus. ¹⁰ prevention. ⁷⁸ This type of censorship of curricula relating to homosexuality was present across the US and contributed heavily to the specific aspect of inadequate sexual health education of exclusivity. As of April 2022, Mississippi, Oklahoma, and Texas have "no promo homo" laws in place, and more than a dozen other states are proposing "don't say gay" bills that restrict conversation about homosexuality in the school curricula. 79,80

Another influential historical belief is that teaching safe sex practices, including contraceptives A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ⁴, will increase sexual behavior among high school students. These beliefs were supported by people such as Judith Reisman in the 1990s, who led many national groups and claimed that sex education in schools was leading children to be more sexual and participate in more sexual behavior. ⁸³ These beliefs contributed to the creation of programs that teach abstinence-only ⁸⁴ As of 2018, 98% of voters believe that it is important to teach sexual health education in high schools. ² until marriage and are incomplete, inaccurate, and not inclusive. ⁸⁵ Similarly, 73% of parents support federal funding being allocated to sexual health programs that delay sex, improve contraceptive use, and prevent unintended pregnancy. ⁸⁶ Public opinion is in favor of comprehensive sexual health education in high schools across the United States, but the curriculums being taught continue to maintain elements that make them inadequate.

The most prevalent and pervasive negative consequence of inadequate sexual education is teen pregnancy A pregnancy that occurs for a woman under the age of 20, including girls who are under 12.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.A form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A pregnancy that occurs for a woman under the age of 20, including girls who are under 12. ⁵. Abstinence-only ⁸⁷ In 2017, 194,377 babies were born to girls ages 15-19 in the United States, which constituted a birth rate of 18.8 per 1,000 girls. ² education programs have proven ineffective at decreasing teen pregnancy and, in some cases, have shown a correlation with an increase in pregnancies of girls under 20 years old, not due to increased sexual activity but due to a lack of contraceptive use. ⁸⁸ When compared to 2006 numbers of 72.2 pregnancies per 1,000 girls with 41.9 births per 1,000 girls, teen pregnancy rates have decreased. ⁸⁹ However, the United States still has one of the highest teen pregnancy rates in developed countries. It also has the most limited sexual health education curriculum out of the developed countries. ⁹⁰ In a study done on the effectiveness of abstinence education, the youth who received education and the control group who did not were equally as likely to remain abstinent, indicating that abstinence-only curriculums do not decrease sexual activity. Overall, 52% of those who participated in the program participated in sexual intercourse anyway, as opposed to 51% of the control group who participated in sexual intercourse. ⁹¹ There was no effect on the level of sexual activity of teenagers because of abstinence education. Studies analyzing comprehensive sex education contraceptives ³ programs showed that 47% of the programs increased condom use, 44% increased the use of ⁹² Comprehensive education teaches teenagers about contraceptives, which would decrease the number of teen pregnancies ⁴, and 63% reduced sexual risk behavior or unprotected sex. Studies also show that comprehensive programs reduce birth rates. ⁹³ Between 1991 and 2004 US teen birth rate fell from 62 to 41 births per 1,000 female teens. Although the influence of sex education programs taught during this time is inconclusive, experts attribute decreased pregnancy rates to increased contraceptive use and the delaying of the initiation of sex. ⁹⁴ Both of these principles are taught to individuals in comprehensive sex education curriculums, and learning protective information can only encourage teens to take precautionary measures. 95, 96 Inadequate sexual health education programs do not properly teach teenagers about contraceptives, which increases pregnancy rates. ⁵ as well as the number of abortions, which are positively correlated with teen pregnancies.

Sexually Transmitted Diseases

A major consequence of inadequate sexual health education is higher levels of unprotected sex which leads to sexually transmitted diseases An infection transmitted through sexual contact caused by bacteria, viruses, or parasites.A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ¹. According to the CDC, in 2019, there were 1.8 million cases of chlamydia and 616,392 cases of gonorrhea. These numbers are 19% and 56% higher than in 2015, respectively. ⁹⁷ This increase in sexually transmitted diseases reflects the continuance of inadequate sexual health education in the US since comprehensive education programs have shown that they decrease sexually transmitted diseases. ⁹⁸ A report analyzing 56 studies analyzed the effectiveness of abstinence programs compared with comprehensive programs and found that 15 of the 24 comprehensive programs reduced sexual risk-taking while none of the abstinence programs had any effect on risky behaviors. ⁹⁹ HIV ¹⁰⁰ An estimated 44.9% of young people ages 13-24 who had HIV in 2018 were unaware. ⁶ is another sexually transmitted disease affected by sexual health education. Young people are the most at risk for not knowing they have HIV because they participate in unprotected sex, which leads to HIV.

The Youth Risk Behavior Surveillance system lists sexual behavior contributing to pregnancy and sexually transmitted diseases An infection transmitted through sexual contact caused by bacteria, viruses, or parasites.A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ¹ as one of the six major risk factors for youth, as HIV 101, 102 Lack of education about how STDs are contracted and how to avoid them also leads to an increase in risky behavior. A major consequence of the lack of inclusivity in sexual health programs in high schools is that LGBTQ youth are not provided with information about sexually transmitted diseases. Gay and bisexual men are disproportionately at risk for HIV, and in 2019 they accounted for 70% of the 34,800 new HIV diagnoses in the US. ⁶ is also the sixth leading cause of death for young people. 103, 104 When compared with white heterosexual women, who had 900 cases in 2014 and 910 cases in 2018, gay men are at a much higher risk of contracting HIV. ¹⁰⁵ The exclusion they experience from inadequate sexual health education programs further exacerbates this problem because they are not provided with information about how to protect themselves against HIV and therefore continue to experience a disproportionately high rate of HIV. Programs that do not discuss condom usage increase rates of unprotected sex, which increase the spread of STDs. ¹⁰⁶

Social Stigma Towards the LGBTQ Community

Inadequate sexual health education programs in the US have excluded the LGBTQ community, which has led to increased social stigma Occurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities.The identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual. ⁷. Within these sexual health programs, LGBTQ youth are often left out of sexual education by being left out of the conversation or are talked about negatively by their peers and teachers. ¹⁰⁷ Although recent data is limited, according to a study done in 2017, only 13 states required discussion of sexual orientation 108,109 The lack of sexual education in a majority of schools in the United States can leave LGBTQ individuals feeling unrepresented and uninformed. ⁹ in sexual education classes, 9 of which required the discussion to be inclusive, while the 4 others required only negative information about sexual orientation to be taught.

On average, 1 in 3 LGBTQ students have skipped class because of feeling unsafe, and they attempt suicide at a rate 4 times that of other youth. In contrast, LGBTQ youth who go to schools that offer inclusive sexual health education report experiencing lower levels of victimization related to their sexual orientation The identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual.Occurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities. ⁹ and gender expression. ¹¹⁰ Over 58% of LGBTQ youth who went to schools without inclusive sexual health programs reported hearing homophobic remarks such as "fag" or "dyke." This proportion was reduced to 38.6% in schools that did offer inclusive sexual health education. ¹¹¹ In addition, a study published in 2019 found that a 10% increase in schools teaching LGBTQ-inclusive sex education led to a significant decrease in the amount of gay and lesbian youth experiencing bullying at school. ¹¹² This social stigma ¹¹³ They also had an increased likelihood of attempting suicide. The rates of suicide attempts by LGBTQ students are 2 to 7 times higher than the rates for individuals that identify as heterosexual. ⁷ created by exclusive sexual health education programs led to many mental health issues for LGBTQ youth. Specifically, LGBTQ individuals had lower self-esteem and feel that they must hide longer for fear of rejection. ¹¹⁴ Other mental health issues include feeling victimized and depression. ¹¹⁵ Another negative effect of exclusive sex education programs is that LGBTQ individuals are led to seek information from outside sources, including websites, chatrooms, LGBTQ-specific groups, and pornography. 116, 117, 118 While some of these sources can be beneficial and provide needed information, they can also be extremely harmful and inaccurate. Porn, especially, is associated with increased anxiety, body-image issues, poor self-image, relationship problems, insecurity, and depression. ¹¹⁹ Including LGBTQ youth in sexual health education will improve many of the negative mental health issues and will lead to more inclusive environments within high schools. ¹²⁰

Long Live Love is a sexual health education curriculum incorporated into the Netherlands biology curriculum. This program was designed to provide students with communication and negotiation skills to enable safe sex practices. Developed 24 years ago and regularly updated to include the most up-to-date information, Long Live Love is a 6-lesson, 26-activity program. The main objective of these activities is to prevent STDs, HIV A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ⁶, and unplanned pregnancies.

The program is designed to be taught in the 2nd, 4th, and 5th year of the vocational schools, and each has an age-appropriate curriculum that builds on the student's previous education. The themes taught throughout the curriculum include puberty, falling in love, relationships, homosexuality, what you want, drawing the line and assertiveness, the internet, groomers, the first time, problems with sex, getting help, safe sex, condoms, and contraception. As a comprehensive sex education A form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence. ³ program, Long Live Love not only teaches about safe sex practices but how to have and develop healthy relationships and how to be clear on what you want. One of the most important aspects of the program is its implementation in schools. Long Live Love recognizes that a curriculum is of no use to the youth if it is not implemented fully and properly in the classrooms and therefore focuses on this as part of their intervention.

The Long Live Love program has few measurements available to the public. More measurements regarding the number of people entering their program and how it has affected them will be necessary to see the true impact of the program.

Preferred Citation: Harwood, McKinley. "Inadequate Sexual Health Education for High School Students in the United States." Ballard Brief. April 2023. www.ballardbrief.byu.edu.
Viewpoints published by Ballard Brief are not necessarily endorsed by BYU or The Church of Jesus Christ of Latter-day Saints

McKinley is an Economics major with a minor in design thinking. She is a part of the Honors Program and has received the Ballard Scholar for Social Impact Award. Her desire to make a difference led her to the Ballard Center early on in her college career. She has taken classes, participated in an internship, and worked at the Ballard Center throughout her time at BYU. She plans to combine her passion for solving social issues with her economics background as she works both in the private and public sectors.

Summary+

Sexual health education across the United States is inconsistent and inadequate in providing the information necessary to allow individuals to make informed, healthy decisions about their sexuality and sexual activity. Only about half of states require sex education to be taught, and only a quarter require medically accurate information to be taught. This incomplete and sometimes inaccurate curriculum results from contradicting morals and religious teachings, legislation created by state and national governments, and misconceptions about the effects of comprehensive teachings. This inadequate education leads to high rates of teen pregnancies, STD transmissions, and social stigma for LGBTQ individuals. Organizations have attempted to intervene by creating comprehensive curriculums, providing assistance for implementation into school curriculums, and providing information on websites so that individuals can access them for free. In other countries, this form of intervention has proved successful through outcome and impact evaluations. However, while these organizations working in the United States have completed output and outcome measurements, they have done little to evaluate their impact.

Key Takeaways+

There is no universal curriculum for sexual health education across the United States.

Inadequate sexual health education is a result of moral and religious controversies, legislation, and misconceptions about the consequences of teaching safe sex for heterosexual and LGBTQ individuals.

Because of the lack of adequate sex education, the US has one of the highest rates of teen pregnancy in all developed countries.

High rates of physical health issues, including HIV, chlamydia, gonorrhea, and other STDs, are a consequence of inadequate sexual health education.

Social stigma for LGBTQ individuals is a significant consequence of incomplete or lack of sex education.

Best practices exist, and interventions in the form of comprehensive sex education curriculums demonstrate the most significant outcomes, but the complete implementation of a universal curriculum is the most crucial challenge.

Key Terms+

Sexually Transmitted Disease (STD)-An infection transmitted through sexual contact caused by bacteria, viruses, or parasites. ¹

Abstinence-Only-A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ²

Comprehensive Sex Education-A form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence. ³

Contraceptives-A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. ⁴

Teen Pregnancy-A pregnancy that occurs for a woman under the age of 20, including girls who are under 12. ⁵

Human Immunodeficiency Virus (HIV)-A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ⁶

Stigma-Occurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities. ⁷

Heteronormativity-Refers to heterosexuality being the norm and dominating other forms of sexuality. ⁸

Sexual Orientation-The identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual. ⁹

Acquired Immunodeficiency Syndrome (AIDS)-The final stage of infection with HIV; it happens when the body's immune system is badly damaged because of the virus. ¹⁰

Human Rights Approach-Access to complete and accurate HIV, AIDS, and sexual health information has been recognized internationally as a basic human right and essential to realizing the human right to the highest attainable standard of health. ¹¹

Q: How are we defining adequate sexual health education in this brief?

A pregnancy that occurs for a woman under the age of 20, including girls who are under 12.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.Access to complete and accurate HIV, AIDS, and sexual health information has been recognized internationally as a basic human right and essential to realizing the human right to the highest attainable standard of health. A: Adequate sexual health education, through the scope of this brief, is defined as having a comprehensive curriculum, being medically accurate, and being taught by trained teachers. The adequacy of sexual health education programs can be indicated by lower teen pregnancy ⁵ and STD rates. ¹² Curriculums that are comprehensive in nature address issues such as disease prevention, contraceptives ¹³ These programs are more successfully taught when the teachers are trained and qualified to address these different topics. ⁴, relationships, communication, and sexuality. ¹⁴ To improve training for teachers, it should include the human rights approach ¹⁵ ¹¹: providing complete and accurate information in order to allow teenagers to make an informed decision regarding their sexual health, sexual activity, and how to potentially prevent disease.

Q: What inadequacies exist in current sexual health education curriculums in the United States?

A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. A: Sexual health education in American high schools is lacking in curriculum, qualified teachers, and inclusive speech. One of the main inadequacies has to do with incomplete curriculums. In 20 out of 34 states that teach abstinence, the curriculum stresses abstinence-only ², which is a type of sex education that presents not having sex outside of marriage as the only safe and effective way to prevent pregnancy and STIs. 16, 17 These programs often eliminate other topics, including human development, relationships, sexual behavior, and sexual health. This focus means that through current sexual health education programs, students are not guaranteed to receive the necessary information to make informed decisions regarding condom use, consent, and whether or not to participate in sexual behaviors. ¹⁸ Because knowing about safe sex practices is necessary for people to make an educated decision regarding their health, access to this information is considered a human right by the American Public Health Association. 19, 20 Another inadequacy includes improperly trained or unqualified teachers. In a qualitative study including 335 sex education teachers at Illinois middle schools and high schools, half of the teachers lacked confidence in teaching about topics regarding condoms and birth control. This may be due to inadequate training these teachers received, as 30% of them said that they had no special training in teaching sex education. ²¹ The last main inadequacy that exists within US sexual health education programs is the lack of or inaccuracy of information related to the LGBTQ community. They are often omitted from current high school sexual health education curriculums or spoken of in a derogatory manner. 22,23,24 This style of teaching may leave those individuals who experience something else, for themselves or in their family, feeling isolated. ²⁵ Due to inadequacies in the current sexual health curriculum, many high schoolers lack important knowledge that affects their physical, social, and mental well-being. ²⁶

Q: Who is affected by this?

A: High school students, ages 14-18, are most in need of adequate sexual health education. This demographic has a high rate of STDs as compared to other age groups, and, according to the CDC, 44% of males and 43% of females participate in intercourse by age 17. 27, 28 Evidence shows that adequate sex education can increase contraceptive use, decreasing STD and pregnancy rates for teenagers. ²⁹ Teenagers require this education because they are going through puberty and are subject to new media with implicit or explicit messages about sex and sexuality. Studies show that 1 out of 5 youth ages 9-17 are exposed to unwanted sexual content online. ³⁰ This exposure has been linked to risky sexual health behavior, which is why providing necessary information can help them make informed decisions. ³¹ Nearly 40% of all high school students in the US report they have had sex, and 9.7% of high school students have had sex with 4 or more partners during their lifetime. ³² Through adequate sexual health education, teens can be more informed about consent and better understand their bodily autonomy. 33, 34

Q: Who is most negatively affected by inadequate sex education?

A: To be more effective, sexual health education programs can also be inclusive to LGBTQ individuals to support healthy relationships. ³⁵ LGBTQ youth are greatly affected by a lack of inclusivity in many current sexual health education programs. For example, a national survey conducted in 2011 found that 4% of LGBTQ students in middle and high school reported experiencing any positive discussion of LGBTQ-related issues in their sexual health classes. ³⁶ This demonstrates the level of exclusion the LGBTQ community experiences due to inadequate sexual health education programs and, because of its severity, the effects will be discussed throughout this brief. 37, 38

Q: Who determines the curriculum?

A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. A: In the United States Constitution, education is placed under the authority of individual states. ³⁹ Because of this, no nationwide curriculum can be instituted by the federal government. While the federal government does not play a direct role in determining the curriculum for sexual health education, it still has a large influence through funding. ⁴⁰ At the state level, many state governments have certain required parameters for sexual health education if it is taught in schools, but most allow individual districts to determine their own curriculum requirements. These districts allow the school boards and sometimes advisory boards in which the community (parents, students, teachers, religious leaders, and so on) can make their voices heard and implement the curriculum they agree upon. ⁴¹ While these school boards essentially determine the subject and scope of sex education and the budget of these programs, they cannot implement any changes contrary to the current state laws unless they work to change the laws. ⁴² Thirty states require some form of sexual health education, and 22 states require that if sex or HIV ⁶ education is provided, it must be medically accurate. 43, 44 California Code 3913 defines medically accurate as "verified or supported by research conducted in compliance with scientific methods and published in peer-reviewed journals, where appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field." ⁴⁵

Q: How has sexual health education evolved in the US?

The final stage of infection with HIV; it happens when the body's immune system is badly damaged because of the virus.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. A: Sexual health education has both expanded and been reduced throughout its history in US education. After World War I, during which many American soldiers contracted STIs, public schools began teaching sex education in high schools in response to the increased public focus on the prevention of STIs. ⁴⁶ The Chamberlain-Kahn Act allocated federal funding to training teachers in STI prevention for high school sex education programs in the 1919-1920 school year. ⁴⁷ During WWII, concern for STIs became mainstream due to the significant increase in STI cases, which made sexual health education an important topic of conversation. ⁴⁸ Then in 1960, sex education became about more than disease prevention and started to include topics such as sexuality, which largely remained heterosexually focused. The AIDS ¹⁰ epidemic, which began in the 1980s, initiated the debate on whether to teach a comprehensive curriculum or an abstinence-only ⁴⁹ ² curriculum. The federal government influenced the lean toward abstinence-only education with the Adolescent Family Life Act (AFLA) created in 1981, which subsidized abstinence-only curricula in schools. During the 1990s and early 2000s, abstinence-only-until-marriage curricula were created by conservative organizations. In 2000, a new federal funding source, the Community-Based Abstinence Education program, supported community-based organizations in teaching abstinence-only-until-marriage material. Then, in 2010, The Office of Adolescent Health (OAH) was created and developed the Teen Pregnancy Prevention Program (TPPP) to fund evidence-based initiatives. There continues to be a push and pull between sex education programs that have created unclear standards and inadequate programs.

Q: How do US sexual health education programs compare to other countries?

A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. A: When comparing the US to similarly developed countries, the US has a limited and underdeveloped sexual health program. Studies show that introducing sexual health education topics in primary school can decrease child sex abuse, dating, and interpersonal violence and increase healthy relationships and appreciation of sexual diversity. ⁵⁰ For example, the Netherlands, France, and Australia have sexual health education programs that begin in primary school. ⁵¹ Throughout the program, teachers are required to be qualified, meaning they have the training and are up to date with the current medical information available. ⁵² The US, on the other hand, does not require teachers to be qualified or trained to teach sexual health education and begins teaching it at the secondary school level. ⁵³ The comparison between the US and other similarly developed countries demonstrates that other countries have more developed and effective programs. This is evident in the birth rates per 1,000 adolescents (children aged 15-17) across the 4 countries. ⁵⁴ The US birth rate is approximately 8.5 times greater than the Netherlands, 5.5 times greater than France, and 3 times greater than Australia. ⁵⁵ The US also has significantly more HIV ⁶ cases in men ages 15-24 than in countries in Europe. This includes the US HIV rate being 5 times that of Germany, 3 times as high as the Netherlands, and 1.5 times higher than France. The difference in these rates can be partially tied to less effective sexual health education systems in the United States. ⁵⁶

Federal funding influences inadequate sexual health education in the US by perpetuating abstinence-only A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ² education. An abstinence-only curriculum is not an adequate form of sexual health education because it excludes important information and is not comprehensive. States and districts are more likely to adapt this curriculum in order to receive grants and funding from the federal government for their programs. ⁵⁷ This can often lead to less comprehensive sexual health education and more inadequate curriculums. In 2017, one-third of the $299 million in federal funding for teen sexual health education programs was for abstinence education which equates to about $99.7 million. ⁵⁸ The federal government has several avenues through which they disseminate funding for sexual health education programs, such as the Title V Abstinence-Only-Until-Marriage (AOUM) law, which was established in 1996.

This law dictates that states must match every $4 from the federal government with $3 from the state, and this money must be used for sexual education programs that omit talk of contraceptives A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. ⁴ and condoms except to emphasize their failure rates. ⁵⁹ In 2017, $75 million of the $99.7 million in federal funding given was under Title V, indicating that it is the most influential and abundant source of funding for sexual health programs in the US. ⁶⁰ Due to its required parameters, it also indicates that schools in the 44 states and 5 territories that receive this funding are adapting their sexual health education curricula to teach abstinence-only curricula or other restricted curricula that do not adequately teach sexual health. ⁶¹ These preconditions for funding lead to the furthering of inadequate sexual health education, specifically by teaching abstinence-only and not including talk about contraceptives ⁴ or condoms.

In 2012, the abstinence-only A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ² curriculum was rebranded to be called Sexual-Risk Avoidance Education. ⁶² This new legislation provides funds to programs educating youth about how to voluntarily refrain from non-marital sexual activity. 63,64 A downside to teaching sex in this manner is that it can inadvertantly contribute to the 11% of high school students who have experienced sexual assault to feel guilty for situations that were beyond their control. ⁶⁵ Despite Sexual-Risk Avoidance Education programs failing to address all the necessary topics of comprehensive sexual health education, ⁶⁶ federal funding in the US has increased since 2015, from $55 million to $1.1 billion in 2021. ⁶⁷ With current legislation, inadequate curriculums continue to be implemented in schools, contributing to inadequate sexual health education among high schoolers in the US.

The current policies, at the national and state level, lead to incomplete and inaccurate sexual health education curriculums across states because the policies do not require principles from adequate sexual health education to be taught. Without a universal sexual health education curriculum for the country, states are left to determine their own parameters for sexual health education programs taught in schools underneath their jurisdiction, causing many programs to be inadequate. ⁶⁸ A total of 22 out of the 50 states required some type of sexual health education to be taught; 34 states required that if sex education is taught in schools, abstinence must be covered (of which 20 states require it to be stressed), and 13 required that information on contraception must be taught. ⁶⁹ This inconsistency leads to teenagers that are receiving parts of a sexual health education and not being guaranteed the information that will allow them to make informed decisions about relationships and sexual activity. ⁷⁰ The absence of national guidelines causes high schoolers throughout the United States to have inconsistent sexual health education that is usually inadequate.

Along with the inconsistencies between states, individual states' policies contribute to inadequate sexual health education for high schoolers. Under the Utah code 53G-10-402, the state requires that sex education be taught but prohibits the advocacy or encouragement of contraceptive methods or devices.A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated.A pregnancy that occurs for a woman under the age of 20, including girls who are under 12.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. 71, 72 This policy contributes to inadequate sexual health education by not guaranteeing that high school-aged youth are provided with the information that could prevent the effects of unprotected and unplanned sexual activity. This policy does not provide the information necessary for them to make the most informed decisions for themselves and their body. Other states' policies are similar to that of Utah and lead to a lack of emphasis on important topics that are part of comprehensive sexual health education programs. ⁷³ The Centers for Disease Control and Prevention conducted a survey in 2014 and found that across high schools, sexual health programs spent an average of 6.2 hours on human sexuality and 4 or fewer hours on preventing HIV ⁶, STIs, and teen pregnancy ⁷⁴ This study demonstrates the little emphasis that states put on sexual health education, especially the topics covered in more comprehensive programs. Without coverage on topics like ⁵.contraceptives ⁴, states' policies can promote inadequate sexual health education.

While examining abstinence curriculum, US congressman Henry Waxman observed that the curricula often taught false information about exaggerated failures of contraceptives A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ⁴ and risks of abortion and reinforced male and female stereotypes. ⁷⁵ These abstinence-only ⁷⁶ Communication skills, decision-making skills, violence prevention, and consent are important topics, but all 4 of these topics are only currently being taught in 9 out of the 50 states. ² curriculums also fail to address important topics such as healthy relationships. ⁷⁷ Inconsistencies between states dictating whether or not sexual health education should be taught in schools as well as in the type of information that is taught, leads to incomplete and inadequate sexual health education.

Perceptions of Sexual Health Education

An important contributing factor to the current inadequacies in sexual health education in the United States is the historical beliefs and opinions that originally shaped the curriculums. While these beliefs and opinions no longer represent the majority of the population, their influences remain evident in the current sexual health curriculums. One of the most influential beliefs is that teaching healthy sexual practices to individuals who are part of the LGBTQ community will influence other youth to change their sexuality. A case study in Merrimack, New Hampshire, demonstrated that strong anti-homosexual beliefs led to a policy known as the Prohibition of Alternate Lifestyle Instruction. This case led to the removal of all books and topics from the curriculum that had any connection to homosexuality, including AIDS The final stage of infection with HIV; it happens when the body's immune system is badly damaged because of the virus. ¹⁰ prevention. ⁷⁸ This type of censorship of curricula relating to homosexuality was present across the US and contributed heavily to the specific aspect of inadequate sexual health education of exclusivity. As of April 2022, Mississippi, Oklahoma, and Texas have "no promo homo" laws in place, and more than a dozen other states are proposing "don't say gay" bills that restrict conversation about homosexuality in the school curricula. 79,80

Another influential historical belief is that teaching safe sex practices, including contraceptives A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates. ⁴, will increase sexual behavior among high school students. These beliefs were supported by people such as Judith Reisman in the 1990s, who led many national groups and claimed that sex education in schools was leading children to be more sexual and participate in more sexual behavior. ⁸³ These beliefs contributed to the creation of programs that teach abstinence-only ⁸⁴ As of 2018, 98% of voters believe that it is important to teach sexual health education in high schools. ² until marriage and are incomplete, inaccurate, and not inclusive. ⁸⁵ Similarly, 73% of parents support federal funding being allocated to sexual health programs that delay sex, improve contraceptive use, and prevent unintended pregnancy. ⁸⁶ Public opinion is in favor of comprehensive sexual health education in high schools across the United States, but the curriculums being taught continue to maintain elements that make them inadequate.

The most prevalent and pervasive negative consequence of inadequate sexual education is teen pregnancy A pregnancy that occurs for a woman under the age of 20, including girls who are under 12.A form of sex education teaching that not having sex outside of marriage is the only morally acceptable option for youth, and the only safe and effective way to prevent unintended pregnancy and STIs. It generally does not discuss contraceptive methods or condoms unless to emphasize their failure rates.A form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence.A device or drug serving to prevent pregnancy by interfering with the normal process of ovulation, fertilization, and implantation.A pregnancy that occurs for a woman under the age of 20, including girls who are under 12. ⁵. Abstinence-only ⁸⁷ In 2017, 194,377 babies were born to girls ages 15-19 in the United States, which constituted a birth rate of 18.8 per 1,000 girls. ² education programs have proven ineffective at decreasing teen pregnancy and, in some cases, have shown a correlation with an increase in pregnancies of girls under 20 years old, not due to increased sexual activity but due to a lack of contraceptive use. ⁸⁸ When compared to 2006 numbers of 72.2 pregnancies per 1,000 girls with 41.9 births per 1,000 girls, teen pregnancy rates have decreased. ⁸⁹ However, the United States still has one of the highest teen pregnancy rates in developed countries. It also has the most limited sexual health education curriculum out of the developed countries. ⁹⁰ In a study done on the effectiveness of abstinence education, the youth who received education and the control group who did not were equally as likely to remain abstinent, indicating that abstinence-only curriculums do not decrease sexual activity. Overall, 52% of those who participated in the program participated in sexual intercourse anyway, as opposed to 51% of the control group who participated in sexual intercourse. ⁹¹ There was no effect on the level of sexual activity of teenagers because of abstinence education. Studies analyzing comprehensive sex education contraceptives ³ programs showed that 47% of the programs increased condom use, 44% increased the use of ⁹² Comprehensive education teaches teenagers about contraceptives, which would decrease the number of teen pregnancies ⁴, and 63% reduced sexual risk behavior or unprotected sex. Studies also show that comprehensive programs reduce birth rates. ⁹³ Between 1991 and 2004 US teen birth rate fell from 62 to 41 births per 1,000 female teens. Although the influence of sex education programs taught during this time is inconclusive, experts attribute decreased pregnancy rates to increased contraceptive use and the delaying of the initiation of sex. ⁹⁴ Both of these principles are taught to individuals in comprehensive sex education curriculums, and learning protective information can only encourage teens to take precautionary measures. 95, 96 Inadequate sexual health education programs do not properly teach teenagers about contraceptives, which increases pregnancy rates. ⁵ as well as the number of abortions, which are positively correlated with teen pregnancies.

Sexually Transmitted Diseases

A major consequence of inadequate sexual health education is higher levels of unprotected sex which leads to sexually transmitted diseases An infection transmitted through sexual contact caused by bacteria, viruses, or parasites.A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ¹. According to the CDC, in 2019, there were 1.8 million cases of chlamydia and 616,392 cases of gonorrhea. These numbers are 19% and 56% higher than in 2015, respectively. ⁹⁷ This increase in sexually transmitted diseases reflects the continuance of inadequate sexual health education in the US since comprehensive education programs have shown that they decrease sexually transmitted diseases. ⁹⁸ A report analyzing 56 studies analyzed the effectiveness of abstinence programs compared with comprehensive programs and found that 15 of the 24 comprehensive programs reduced sexual risk-taking while none of the abstinence programs had any effect on risky behaviors. ⁹⁹ HIV ¹⁰⁰ An estimated 44.9% of young people ages 13-24 who had HIV in 2018 were unaware. ⁶ is another sexually transmitted disease affected by sexual health education. Young people are the most at risk for not knowing they have HIV because they participate in unprotected sex, which leads to HIV.

The Youth Risk Behavior Surveillance system lists sexual behavior contributing to pregnancy and sexually transmitted diseases An infection transmitted through sexual contact caused by bacteria, viruses, or parasites.A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ¹ as one of the six major risk factors for youth, as HIV 101, 102 Lack of education about how STDs are contracted and how to avoid them also leads to an increase in risky behavior. A major consequence of the lack of inclusivity in sexual health programs in high schools is that LGBTQ youth are not provided with information about sexually transmitted diseases. Gay and bisexual men are disproportionately at risk for HIV, and in 2019 they accounted for 70% of the 34,800 new HIV diagnoses in the US. ⁶ is also the sixth leading cause of death for young people. 103, 104 When compared with white heterosexual women, who had 900 cases in 2014 and 910 cases in 2018, gay men are at a much higher risk of contracting HIV. ¹⁰⁵ The exclusion they experience from inadequate sexual health education programs further exacerbates this problem because they are not provided with information about how to protect themselves against HIV and therefore continue to experience a disproportionately high rate of HIV. Programs that do not discuss condom usage increase rates of unprotected sex, which increase the spread of STDs. ¹⁰⁶

Social Stigma Towards the LGBTQ Community

Inadequate sexual health education programs in the US have excluded the LGBTQ community, which has led to increased social stigma Occurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities.The identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual. ⁷. Within these sexual health programs, LGBTQ youth are often left out of sexual education by being left out of the conversation or are talked about negatively by their peers and teachers. ¹⁰⁷ Although recent data is limited, according to a study done in 2017, only 13 states required discussion of sexual orientation 108,109 The lack of sexual education in a majority of schools in the United States can leave LGBTQ individuals feeling unrepresented and uninformed. ⁹ in sexual education classes, 9 of which required the discussion to be inclusive, while the 4 others required only negative information about sexual orientation to be taught.

On average, 1 in 3 LGBTQ students have skipped class because of feeling unsafe, and they attempt suicide at a rate 4 times that of other youth. In contrast, LGBTQ youth who go to schools that offer inclusive sexual health education report experiencing lower levels of victimization related to their sexual orientation The identity of who you are attracted to and want to have relationships with, including gay, lesbian, straight, bisexual, and asexual.Occurs when an individual is blocked from acceptance within society, reducing them from a whole person to a tainted, discounted one. Stigma occurs at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities. ⁹ and gender expression. ¹¹⁰ Over 58% of LGBTQ youth who went to schools without inclusive sexual health programs reported hearing homophobic remarks such as "fag" or "dyke." This proportion was reduced to 38.6% in schools that did offer inclusive sexual health education. ¹¹¹ In addition, a study published in 2019 found that a 10% increase in schools teaching LGBTQ-inclusive sex education led to a significant decrease in the amount of gay and lesbian youth experiencing bullying at school. ¹¹² This social stigma ¹¹³ They also had an increased likelihood of attempting suicide. The rates of suicide attempts by LGBTQ students are 2 to 7 times higher than the rates for individuals that identify as heterosexual. ⁷ created by exclusive sexual health education programs led to many mental health issues for LGBTQ youth. Specifically, LGBTQ individuals had lower self-esteem and feel that they must hide longer for fear of rejection. ¹¹⁴ Other mental health issues include feeling victimized and depression. ¹¹⁵ Another negative effect of exclusive sex education programs is that LGBTQ individuals are led to seek information from outside sources, including websites, chatrooms, LGBTQ-specific groups, and pornography. 116, 117, 118 While some of these sources can be beneficial and provide needed information, they can also be extremely harmful and inaccurate. Porn, especially, is associated with increased anxiety, body-image issues, poor self-image, relationship problems, insecurity, and depression. ¹¹⁹ Including LGBTQ youth in sexual health education will improve many of the negative mental health issues and will lead to more inclusive environments within high schools. ¹²⁰

Long Live Love is a sexual health education curriculum incorporated into the Netherlands biology curriculum. This program was designed to provide students with communication and negotiation skills to enable safe sex practices. Developed 24 years ago and regularly updated to include the most up-to-date information, Long Live Love is a 6-lesson, 26-activity program. The main objective of these activities is to prevent STDs, HIV A virus that attacks the body's immune system and can lead to acquired immunodeficiency syndrome (AIDS) if not treated. ⁶, and unplanned pregnancies.

The program is designed to be taught in the 2nd, 4th, and 5th year of the vocational schools, and each has an age-appropriate curriculum that builds on the student's previous education. The themes taught throughout the curriculum include puberty, falling in love, relationships, homosexuality, what you want, drawing the line and assertiveness, the internet, groomers, the first time, problems with sex, getting help, safe sex, condoms, and contraception. As a comprehensive sex education A form of sex education that aims to give students the knowledge, attitudes, skills, and values to make appropriate and healthy choices in their sexual lives. Includes information about condoms and contraceptives as well as abstinence. ³ program, Long Live Love not only teaches about safe sex practices but how to have and develop healthy relationships and how to be clear on what you want. One of the most important aspects of the program is its implementation in schools. Long Live Love recognizes that a curriculum is of no use to the youth if it is not implemented fully and properly in the classrooms and therefore focuses on this as part of their intervention.

The Long Live Love program has few measurements available to the public. More measurements regarding the number of people entering their program and how it has affected them will be necessary to see the true impact of the program.

Preferred Citation: Harwood, McKinley. "Inadequate Sexual Health Education for High School Students in the United States." Ballard Brief. April 2023. www.ballardbrief.byu.edu.
Viewpoints published by Ballard Brief are not necessarily endorsed by BYU or The Church of Jesus Christ of Latter-day Saints

McKinley is an Economics major with a minor in design thinking. She is a part of the Honors Program and has received the Ballard Scholar for Social Impact Award. Her desire to make a difference led her to the Ballard Center early on in her college career. She has taken classes, participated in an internship, and worked at the Ballard Center throughout her time at BYU. She plans to combine her passion for solving social issues with her economics background as she works both in the private and public sectors.

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Inadequate Sexual Health Education for High School Students in the United States - Ballard Brief

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Sexual health education across the United States is inconsistent and inadequate in providing the information necessary to allow individuals to make informed, healthy decisions about their sexuality and sexual activity.

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Sex Ed Can’t Wait: How Sex Education is Falling Behind in Our Schools

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-sex ed is not thorough, it is not comprehensive, inclusive nor always accurate.

a lot of US sex ed focuses on abstinence rather than contraception, consent, and LGBTQ inclusion.

needs to be more inclusive and diverse to help everyone

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As the topic of sexual and reproductive health re-enters the public consciousness in America through the overturning of Roe v. Wade, it becomes increasingly important to access American Sex Education, or rather, the failures of it, and how we teach these topics to our most impressionable population, children. The state of sex-education in this country is in shambles. Though the majority of Americans support sex-education in middle school and in high school, what exactly does that education look like?

The first and one of the most important things to note about sex-education in the states is that there is no universal regulation of it. Only thirty nine states, plus DC, even have government mandated sex-education [5]. Within the states with mandated sex-education, only thirteen must provide "medically accurate" sex-education [1]. The content of what is covered in sex-education varies widely from state to state, within states that do have government mandated sex-education, it is often left to individual districts to decide what to put into their sex-education curriculums [5]. The sex-education of so many young Americans is falling through the cracks.

In addition to many schools simply not providing sex-education, oftentimes the education that is provided is subpar. The CDC recommends that schools cover 20 essential topics in their sex-education, in a 2018 study, they found that less than half of American high schools, and fewer than one fifth of American middle schools touched on the topics outlined by the CDC [4]. Some states even prohibit sex education to touch on topics such as sexual orientation and contraception. There are only nine states where it is mandated that sex-education must be inclusive of the LGBTQ+ community. Additionally, there are five states where sex-education relating to sexual orientation must be negative, for example in Oklahoma it is taught that "homosexual activity" is one cause of contracting HIV/AIDS [1].

Taking all of this background into account, it is time to address the elephant in the room, abstinence-only sex-education. In a study by the Guttmacher Institute, it was found that from the years of 2015-2019, more American teens had received the advice to abstain or wait till marriage than had been told how to obtain birth control or condoms [6]. This method of sex-education, to put it simply, does not work. In 2008, a study by the Journal of Adolescent Health found that there was a higher likelihood of pregnancy among teens that received abstinence-only sex-education in comparison to those who were taught about proper contraceptive methods [2]. Despite the fact that abstinence-only education does not work, twelve states mandate that abstinence must be covered in their sex-ed courses and twenty five states must stress the importance of abstinence in their sex-ed courses [1].

Discussing sex-education is of the utmost importance because comprehensive sex-education keeps kids and teens safe. The United States already has higher teen pregnancy rates than many other developed nations. The Netherlands begins sex education starting in kindergarten, and their teen pregnancy rate is five times lower than in the United States [3]. In states where comprehensive sex-education is taught, the teen pregnancy rate is in fact lower. As US sex-education has trended towards teaching more about contraception and less about abstinence, the overall teen pregnancy rate in the country has dropped. Similarly to teen pregnancy, STD and STI rates are also much lower in states that teach comprehensive sex-education [1]. Sex-education works.

Despite how important preventing teen pregnancy as well as STDs and STIs is, comprehensive sex-education is much more than just a preventative measure. It teaches teens and children about important topics such as consent from a young age. It allows young people to feel comfortable and empowered in their own bodies. Abstinence-only sex-education breeds shame and discomfort among young people. This shame and fear can have long-lasting negative effects on the mental health of teens as they continue on into adulthood. It is important to start teaching kids how to be respectful of their bodies and other bodies from a young age. Comprehensive sex-education creates a space where young people do not need to feel afraid of themselves and their bodies, thus allowing them to feeling comfortable and safe.

References

1. "America's Sex Education: How We Are Failing Our Students." , 1 Dec. 2020, https://nursing.usc.edu/blog/americas-sex-education/ .

2. Hall, Kelli Stidham et al. "The State of Sex Education in the United States." The Journal of adolescent health : official publication of the Society for Adolescent Medicine vol. 58,6 (2016): 595-7. doi:10.1016/j.jadohealth.2016.03.032

3. Melker, Saskia de. "The Case for Starting Sex Education in Kindergarten." , Public Broadcasting Service, 27 May 2015, https://www.pbs.org/newshour/health/spring-fever.

4. "Results." Centers for Disease Control and Prevention , Centers for Disease Control and Prevention, 15 Nov. 2019, https://www.cdc.gov/healthyyouth/data/profiles/results.htm.

5. "State of Sex Education in USA: Health Education in Schools." Planned Parenthood , https://www.plannedparenthood.org/learn/for-educators/whats-state-sex-education-us.

6. "US Adolescents' Receipt of Formal Sex Education." Guttmacher Institute , 18 Feb. 2022, https://www.guttmacher.org/fact-sheet/adolescents-teens-receipt-sex-education-united-states.

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As the topic of sexual and reproductive health re-enters the public consciousness in America through the overturning of Roe v. Wade, it becomes increasingly important to access American Sex Education, or rather, the failures of it, and how we teach these topics to our most impressionable population, children.

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-comprehensive sex ed is a right

arguments made because of parents and religion

question: does this promote not having sex? seems unrealistic

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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: Get your students in the discussion on KQED Learn, a safe place for middle and high school students to investigate controversial topics and share their voices. Download lesson plan and get started on KQED Learn.

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.

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

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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.

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Importance of Sex Education + Its Accessibility

Pertinent Themes:

Adolescent health

Sex education

Public health policy

Golden Idea:

The article "Sex Education Is Essential" underscores the critical importance of comprehensive sex education in promoting adolescent health and well-being. It emphasizes that evidence-based sex education programs play a pivotal role in equipping young people with the knowledge and skills to make informed decisions about their sexual health. By addressing topics such as contraception, consent, and healthy relationships, comprehensive sex education empowers adolescents to navigate complex issues and reduce their risk of negative health outcomes.

Thorn:

A notable concern raised in the article is the prevalence of abstinence-only education programs in certain regions, which often prioritize ideology over evidence-based approaches. This narrow focus on abstinence fails to provide adolescents with the comprehensive information they need to protect their sexual health and make responsible choices.

Question for Further Research:

How can policymakers and educators overcome barriers to implementing comprehensive sex education programs in communities where resistance or opposition exists?

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Together, by advocating in our communities, we can ensure Sex Ed for All.

As April starts to wind down, and as we look ahead to the start of May on the horizon, we wanted to take a moment to share with you the history behind May as Sex Ed for All Month. We also wanted to share-for you to also use and adapt-some of the main reasons why sex education is essential and we should join together to advocate for Sex Ed for All.

Background

We all want the best education for our kids, including sex education. Sex education helps young people learn how to have healthy relationships, make informed decisions, love themselves for who they are, and have respect and compassion for all, including those who are different from them.

Each May since 2019, Sex Ed for All Month is an opportunity to voice our shared commitment to a world where all young people get equitable access to the education and care they deserve. We invite you to join us in raising awareness and calling for real investment in sex education in schools and communities. Too many young people fail to receive the sexual health information, education, and access to the care they need to live healthy lives-oftentimes based on who they are and where they live.

This is also an opportunity to push back on efforts by organized, well-funded right-wing groups to dismantle our democratic institutions, including our nation's public schools.

While May was formerly known as Teen Pregnancy Prevention Month, the shift to Sex Ed for All Month marked a dramatic turn away from what was previously often stigmatizing and problematic messaging. Instead, we want to stand with young people, so they have the power and the right to access the sex education and health care they need to achieve the best positive outcomes for themselves.

This is also an opportunity to push back on efforts by organized, well-funded right-wing groups to dismantle our democratic institutions, including our nation's public schools. Schools are ground zero for the culture wars, and conservative groups are intentionally lying to confuse and frighten parents/caregivers, intimidate educators and administrators, and limit young people's access to information . They are zeroing in on comprehensive sex education, especially lessons related to puberty, gender identity, sexual orientation, and pregnancy. Multiple states have passed outright bans on discussing some of these topics in K-12 environments. These same groups are also behind attacks on abortion and contraception, safe schools for LGBTQ youth, books written by and about BIPOC and LGBTQ+ people, and the teaching of inclusive U.S. history and social-emotional learning as part of an agenda to ensure that they maintain power and control.

Sex education is about so much more than risk reduction and disease prevention. Sex Ed for All Month provides an opportunity to adjust the lens through which our field has historically viewed adolescent sexual and reproductive health and address more holistically the sex education young people deserve so they can have healthy relationships, make healthy decisions, and have positive health outcomes. While May was formerly known as Teen Pregnancy Prevention Month, the shift to Sex Ed for All Month marked a dramatic turn away from what was previously often stigmatizing and problematic messaging. Instead, we want to stand with young people, so they have the power and the right to access the sex education and health care they need to achieve positive outcomes for themselves.

Main Message

Sex education gives young people age-appropriate, medically accurate, and culturally relevant information and answers to their questions about sex and relationships without being shamed or judged. It has been proven to positively impact young people's lives. But too many young people don't have access to sex education, or the programs in their school are shaming or inaccurate. By advocating in our communities, we can ensure Sex Ed for All.

Talking Points

We all want the best education for our kids, including sex education. Sex education helps young people learn how to have healthy relationships, make informed decisions, love themselves for who they are, and have respect and compassion for all, including those who are different from them.

Sex education is more than just putting condoms on bananas. And it's even more than just STI prevention and avoiding unintended pregnancy. Sex education teaches young people how to have healthy relationships with themselves and others.

Sex education is more than just putting condoms on bananas. And it's even more than just STI prevention and avoiding unintended pregnancy. Sex education teaches young people how to have healthy relationships with themselves and others.

Sex education in elementary school covers foundational building blocks around things like consent and boundary setting with friends, understanding our bodies and puberty, and acknowledging and respecting different kinds of families.

Sex education in middle school addresses relevant issues such as healthy peer relationships and anti-bullying, staying safe online, and media literacy skills to support kids in developing a healthy body image.

Sex education in high school covers everything from birth control and safer sex to sexual decision-making and communication skills to understanding how society and culture shape our ideas about sex, gender, and race.

Sex education addresses a wide range of topics in age-appropriate ways to help keep young people safe, healthy, and happy.

Sex education works. It gives young people the knowledge and skills they need to grow up safe, healthy, and confident, and it sets them up for success in a diverse society.

Research shows that sex education that is culturally responsive and inclusive helps young people develop the social and emotional skills they need to become kind and empathetic human beings. This type of sex education (early and often) leads to better body image, more empathy and respect for others, better communication skills, better management of feelings, better sense of self-control and safety, prevention of child sex abuse and dating and intimate partner violence, development of healthy relationships, better understanding of gender equity and appreciation of sexual diversity, and more protection against mis/disinformation, both online and from peers.

Sex education that is age-appropriate and covers a range of topics is what young people need from trusted, unbiased experts.

Research also shows that sex education helps students become healthier and more well-adjusted adults. It leads to lower STI rates, fewer unintended pregnancies , better self-esteem, healthier relationships, and many more benefits.

All kids deserve to feel safe and proud of who they are. Young people who receive sex education have better self-esteem and healthier relationships.

Sex education teaches young people the importance of treating everyone with dignity and respect , including themselves. These lessons are important to help young people develop into healthy adults. Sex education that teaches diversity, equity, and inclusivity can also help build school connectedness, which in turn supports student achievement .

Sex education is not a controversial issue. The overwhelming majority of Americans want young people to get sex education-including parents and young people themselves.

96% of parents support having sex education in high school, and 84% of parents support having sex education in middle school.

Parents/caregivers want their kids to have the facts and feel safe and supported at school. Sex education that includes LGBTQ+ identities has been shown to reduce bullying, discrimination, and harassment, meaning schools are safer for all youth.

Sex education at school supports sex education at home. School programs reinforce the role of family communication about sex and relationships, supporting young people in talking with their parents/caregivers.

Sex education has never been universally accessible, but now it's even more at risk due to anti-sex education movements funded by powerful groups.

Where you live shouldn't determine the quality of the education you receive. However, without a national sex education program or full funding at the federal level, the quality of programs varies across the country, if they exist at all. Young people deserve the facts about sex and relationships, free of shame, stigma, and personal or political agendas, no matter who they are, where they live, or what their income is.

Opposition to honest education is nothing new . There has always been a vocal minority intent on stopping honest, equity-centered education that could lead to positive social change.

In the 1950s, this same vocal minority focused on keeping Black students out of all-white schools. In the 1990s, the goal was to censor facts regarding evolution in science classes. Now, this very same vocal minority is creating a false panic about sex education and all equity work in schools.

Extreme groups are funding and organizing a vocal minority of individuals-wrongly portrayed as a grassroots effort-to stoke fear and outrage around sex education in communities across the country. Groups like Moms for Liberty blatantly lie to cause panic so they can dictate what is and isn't allowed in schools-including pushing for abstinence-only-until-marriage programs and banning students from safely using the bathroom that matches their gender identity.

To create an illusion of grassroots resistance, these groups have brought people from other towns or states to pretend they live locally and take over school board meetings . They fund big social media disinformation campaigns and harass young people, parents, and school staff who advocate for real education and safe schools.

Young people are increasingly left alone, without the information or services they need to keep themselves safe and help them set boundaries with others.

Without adequate sex education or access to things like contraception, abortion, or gender-affirming care, young people suffer, particularly our most vulnerable youth-LGBTQ+ youth and youth of color.

You can take action to advocate for sex education in your community starting today. All you need to do is ask the right questions and join with others in your community to ensure sex education for all.

You can ask young people what, if any, sex education they've gotten in school. Find out what they're being taught, if they feel included, and what they wish school would teach that they currently don't.

You can find out from your local school's PTA and/or school board what sex education is taught in your community. This includes how often and when sex education is being taught, as well as what topics are being taught, what curriculum is being used, and who is teaching the program.

Want more information on #SexEdForAll? These talking points were developed by the Sex Education Collaborative as part of Sex Ed For All Month.

At Healthy Teen Network, we believe every young person has the right to be who they are and love who they love . And we see you, the professionals and caring adults, helping them do this. We know you do your best when you're connected to great opportunities and resources. That's why we're here...to help make those connections and support you. Read more about us.

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Sex Education Is Essential (Sex Ed for All Talking Points)

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Sex ed WORKS. It gives young people the tools, knowledge, and skills they need for success in this life. Join us in raising awareness and calling for more investment in sex ed for all young people, regardless of who they are or where they live. #SexEdForAll

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Too many young people are not getting the sex education they need and deserve.

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Archives of Public Health 78, Article number: 20 (2020) Cite this article

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Abstract

Background

A clear understanding of the macro-level contexts in which education impacts health is integral to improving national health administration and policy. In this research, we use a visual analytic approach to explore the association between education and health over a 20-year period for countries around the world.

Method

Using empirical data from the OECD and the World Bank for 26 OECD countries for the years 1995-2015, we identify patterns/associations between education and health indicators. By incorporating pre- and post-educational attainment indicators, we highlight the dual role of education as both a driver of opportunity as well as of inequality.

Results

Adults with higher educational attainment have better health and lifespans compared to their less-educated peers. We highlight that tertiary education, particularly, is critical in influencing infant mortality, life expectancy, child vaccination, and enrollment rates. In addition, an economy needs to consider potential years of life lost (premature mortality) as a measure of health quality.

Conclusions

We bring to light the health disparities across countries and suggest implications for governments to target educational interventions that can reduce inequalities and improve health. Our country-level findings on NEET (Not in Employment, Education or Training) rates offer implications for economies to address a broad array of vulnerabilities ranging from unemployment, school life expectancy, and labor market discouragement. The health effects of education are at the grass roots-creating better overall self-awareness on personal health and making healthcare more accessible.

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Introduction

Is education generally associated with good health? There is a growing body of research that has been exploring the influence of education on health. Even in highly developed countries like the United States, it has been observed that adults with lower educational attainment suffer from poor health when compared to other populations [ 36]. This pattern is attributed to the large health inequalities brought about by education. A clear understanding of the health benefits of education can therefore serve as the key to reducing health disparities and improving the well-being of future populations. Despite the growing attention, research in the education-health area does not offer definitive answers to some critical questions. Part of the reason is the fact that the two phenomena are interlinked through life spans within and across generations of populations [ 36], thereby involving a larger social context within which the association is embedded. To some extent, research has also not considered the variances in the education-health relationship through the course of life or across birth cohorts [ 20], or if there is causality in the same. There is therefore a growing need for new directions in education-health research.

The avenues through which education affects health are complex and interwoven. For one, at the very outset, the distribution and content of education changes over time [ 20]. Second, the relationship between the mediators and health may change over time, as healthcare becomes more expensive and/or industries become either more, or less hazardous. Third, some research has documented that even relative changes in socioeconomic status (SES) can affect health, and thus changes in the distribution of education implies potential changes in the relationship between education and health. The relative index of inequality summarizes the magnitude of SES as a source of inequalities in health [ 11, 21, 27, 29]. Fourth, changes in the distribution of health and mortality imply that the paths to poor health may have changed, thereby affecting the association with education.

Research has proposed that the relationship between education and health is attributable to three general classes of mediators: economic; social, psychological, and interpersonal; and behavioral health [ 31]. Economic variables such as income and occupation mediate the relationship between education and health by controlling and determining access to acute and preventive medical care [ 1, 2, 19]. Social, psychological, and interpersonal resources allow people with different levels of education to access coping resources and strategies [ 10, 34], social support [ 5, 22], and problem-solving and cognitive abilities to handle ill-health consequences such as stress [ 16]. Healthy behaviors enable educated individuals to recognize symptoms of ill health in a timely manner and seek appropriate medical help [ 14, 35].

While the positive association between education and health has been established, the explanations for this association are not [ 31]. People who are well educated experience better health as reflected in the high levels of self-reported health and low levels of morbidity, mortality, and disability. By extension, low educational attainment is associated with self-reported poor health, shorter life expectancy, and shorter survival when sick. Prior research has suggested that the association between education and health is a complicated one, with a range of potential indicators that include (but are not limited to) interrelationships between demographic and family background indicators [ 8] - effects of poor health in childhood, greater resources associated with higher levels of education, appreciation of good health behaviors, and access to social networks. Some evidence suggests that education is strongly linked to health determinants such as preventative care [ 9]. Education helps promote and sustain healthy lifestyles and positive choices, nurture relationships, and enhance personal, family, and community well-being. However, there are some adverse effects of education too [ 9]. Education may result in increased attention to preventive care, which, though beneficial in the long term, raises healthcare costs in the short term. Some studies have found a positive association between education and some forms of illicit drug and alcohol use. Finally, although education is said to be effective for depression, it has been found to have much less substantial impact in general happiness or well-being [ 9].

On a universal scale, it has been accepted that several social factors outside the realm of healthcare influence the health outcomes [ 37]. The differences in morbidity, mortality and risk factors in research, conducted within and between countries, are impacted by the characteristics of the physical and social environment, and the structural policies that shape them [ 37]. Among the developed countries, the United States reflects huge disparities in educational status over the last few decades [ 15, 24]. Life expectancy, while increasing for all others, has decreased among white Americans without a high school diploma - particularly women [ 25, 26, 32]. The sources of inequality in educational opportunities for American youth include the neighborhood they live in, the color of their skin, the schools they attend, and the financial resources of their families. In addition, the adverse trends in mortality and morbidity brought on by opioids resulting in suicides and overdoses (referred to as deaths of despair) exacerbated the disparities [ 21]. Collectively, these trends have brought about large economic and social inequalities in society such that the people with more education are likely to have more health literacy, live longer, experience better health outcomes, practice health promoting behaviors, and obtain timely health checkups [ 21, 17].

Education enables people to develop a broad range of skills and traits (including cognitive and problem-solving abilities, learned effectiveness, and personal control) that predispose them towards improved health outcomes [ 23], ultimately contributing to human capital. Over the years, education has paved the way for a country's financial security, stable employment, and social success [ 3]. Countries that adopt policies for the improvement of education also reap the benefits of healthy behavior such as reducing the population rates of smoking and obesity. Reducing health disparities and improving citizen health can be accomplished only through a thorough understanding of the health benefits conferred by education.

There is an iterative relationship between education and health. While poor education is associated with poor health due to income, resources, healthy behaviors, healthy neighborhood, and other socioeconomic factors, poor health, in turn, is associated with educational setbacks and interference with schooling through difficulties with learning disabilities, absenteeism, or cognitive disorders [ 30]. Education is therefore considered an important social determinant of health. The influence of national education on health works through a variety of mechanisms. Generally, education shows a relationship with self-rated health, and thus those with the highest education may have the best health [ 30]. Also, health-risk behaviors seem to be reduced by higher expenditure into the publicly funded education system [ 18], and those with good education are likely to have better knowledge of diseases [ 33]. In general, the education-health gradients for individuals have been growing over time [ 38].

To inform future education and health policies effectively, one needs to observe and analyze the opportunities that education generates during the early life span of individuals. This necessitates the adoption of some fundamental premises in research. Research must go beyond pure educational attainment and consider the associated effects preceding and succeeding such attainment. Research should consider the variations brought about by the education-health association across place and time, including the drivers that influence such variations [ 36].

In the current research, we analyze the association between education and health indicators for various countries using empirical data from reliable sources such as the Organization for Economic Cooperation and Development (OECD) and World Bank. While many studies explore the relationship between education and health at a conceptual level, we deploy an empirical approach in investigating the patterns and relationships between the two sets of indicators. In addition, for the educational indicators, we not only incorporate the level of educational attainment, but also look at the potential socioeconomic benefits, such as enrollment rates (in each sector of educational level) and school life expectancy (at each educational level). We investigate the influences of educational indicators on national health indicators of infant mortality, child vaccinations, life expectancy at birth, premature mortality arising from lack of educational attainment, employment and training, and the level of national health expenditure. Our research question is:

What are some key influencers/drivers in the education-health relationship at a country level?

The current study is important because policy makers have an increasing concern on national health issues and on policies that support it. The effect of education is at the root level-creating better overall self-awareness on personal health and making healthcare more accessible. The paper is organized as follows: Section 2 discusses the background for the research. Section 3 discusses the research method; Section 4 offers the analysis and results; Section 5 provides a synthesis of the results and offers an integrated discussion; Section 6 contains the scope and limitations of the research; Section 7 offers conclusions with implications and directions for future research.

Background

Research has traditionally drawn from three broad theoretical perspectives in conceptualizing the relationship between education and health. The majority of research over the past two decades has been grounded in the Fundamental Cause Theory (FCT) [ 28], which posits that factors such as education are fundamental social causes of health inequalities because they determine access to resources (such as income, safe neighborhoods, or healthier lifestyles) that can assist in protecting or enhancing health [ 36]. Some of the key social resources that contribute to socioeconomic status include education (knowledge), money, power, prestige, and social connections. As some of these undergo change, they will be associated with differentials in the health status of the population [ 12].

Education has also been conceptualized using the Human Capital Theory (HCT) that views it as a return on investment in the form of increased productivity [ 4]. Education improves knowledge, skills, reasoning, effectiveness, and a broad range of other abilities that can be applied to improving health. The third approach - the signaling or credentialing perspective [ 6] - is adopted to address the large discontinuities in health at 12 and 16 years of schooling, which are typically associated with the receipt of a high school diploma and a college degree, respectively. This perspective considers the earned credentials of a person as a potential source that warrants social and economic returns. All these theoretical perspectives postulate a strong association between education and health and identify mechanisms through which education influences health. While the HCT proposes the mechanisms as embodied skills and abilities, FCT emphasizes the dynamism and flexibility of mechanisms, and the credentialing perspective proposes educational attainment through social responses. It needs to be stated, however, that all these approaches focus on education solely in terms of attainment, without emphasizing other institutional factors such as quality or type of education that may independently influence health. Additionally, while these approaches highlight the individual factors (individual attainment, attainment effects, and mechanisms), they do not give much emphasis to the social context in which education and health processes are embedded.

In the current research while we acknowledge the tenets of these theoretical perspectives, we incorporate the social mechanisms in education such as level of education, skills and abilities brought about by enrollment, school life expectancy, and the potential loss brought about by premature mortality. In this manner, we highlight the relevance of the social context in which the education and health domains are situated. We also study the dynamism of the mechanisms over countries and over time and incorporate the influences that precede and succeed educational attainment.

Methods

We analyze country level education and health data from the OECD and World Bank for a period of 21 years (1995-2015). Our variables include the education indicators of adult education level; enrollment rates at various educational levels; NEET (Not in Employment, Education or Training) rates; school life expectancy; and the health indicators of infant mortality, child vaccination rates, deaths from cancer, life expectancy at birth, potential years of life lost and smoking rates (Table 1). The data was processed using the tools of Tableau for visualization, and SAS for correlation and descriptive statistics. Approaches for analysis include ranking, association, and data visualization of the health and education data.

Table 1 Variables in the Research

Analyses and results

In this section we identify and analyze patterns and associations between education and health indicators and discuss the results. Since countries vary in population sizes and other criteria, we use the estimated averages in all our analyses.

Comparison of health outcomes for countries by GDP per capita

We first analyzed to see if our data reflected the expectation that countries with higher GDP per capita have better health status (Fig. 1). We compared the average life expectancy at birth, average infant mortality, average deaths from cancer and average potential year of life lost, for different levels of GDP per capita (Fig. 1).

Figure 1 depicts two charts with the estimated averages of variables for all countries in the sample. The X-axis of the first chart depicts average infant mortality rate (per 1000), while that of the second chart depicts average potential years of life lost (years). The Y-axis for both charts depicts the GDP per capita shown in intervals of 10 K ranging from 0 K-110 K (US Dollars). The analysis is shown as an average for all the countries in the sample and for all the years (1995-2015). As seen in Fig. 1, countries with lower GDP per capita have higher infant mortality rate and increased potential year of life lost (which represents the average years a person would have lived if he or she had not died prematurely - a measure of premature mortality). Life expectancy and deaths from cancer are not affected by GDP level. When studying infant mortality and potential year lost, in order to avoid the influence of a control variable, it was necessary to group the samples by their GDP per capita level.

Association of Infant Mortality Rates with enrollment rates and education levels

We explored the association of infant mortality rates with the enrollment rates and adult educational levels for all countries (Fig. 2). The expectation is that with higher education and employment the infant mortality rate decreases.

Figure 2 depicts the analysis for all countries in the sample. The figure shows the years from 1995 to 2015 on the X axis. It shows two Y-axes with one axis denoting average infant mortality rate (per 1000 live births), and the other showing the rates from 0 to 120 to depict enrollment rates (primary/secondary/tertiary) and education levels (below secondary/upper secondary/tertiary). Regarding the Y axis showing rates over 100, it is worth noting that the enrollment rates denote a ratio of the total enrollment (regardless of age) at a level of education to the official population of the age group in that education level. Therefore, it is possible for the number of children enrolled at a level to exceed the official population of students in the age group for that level (due to repetition or late entry). This can lead to ratios over 100%. The figure shows that in general, all education indicators tend to rise over time, except for adult education level below secondary, which decreases over time. Infant mortality shows a steep decreasing trend over time, which is favorable. In general, countries have increasing health status and education over time, along with decreasing infant mortality rates. This suggests a negative association of education and enrollment rates with mortality rates.

Association of Education Outcomes with life expectancy at birth

We explored if the education outcomes of adult education level (tertiary), school life expectancy (tertiary), and NEET (not in employment, education, or training) rates, affected life expectancy at birth (Fig. 3). Our expectation is that adult education and school life expectancy, particularly tertiary, have a positive influence, while NEET has an adverse influence, on life expectancy at birth.

Figure 3 show the relationships between various education indicators (adult education level-tertiary, NEET rate, school life expectancy-tertiary) and life expectancy at birth for all countries in the sample. The figure suggests that life expectancy at birth rises as adult education level (tertiary) and tertiary school life expectancy go up. Life expectancy at birth drops as the NEET rate goes up. In order to extend people's life expectancy, governments should try to improve tertiary education, and control the number of youths dropping out of school and ending up unemployed (the NEET rate).

Association of Tertiary Enrollment and Education with potential years of life lost

We wanted to explore if the potential years of life lost rates are affected by tertiary enrollment rates and tertiary adult education levels (Fig. 4).

The two sets of box plots in Fig. 4 compare the enrollment rates with potential years of life lost (above set) and the education level with potential years of life lost (below set). The analysis is for all countries in the sample. As mentioned earlier, the enrollment rates are expressed as ratios and can exceed 100% if the number of children enrolled at a level (regardless of age) exceed the official population of students in the age group for that level. Potential years of life lost represents the average years a person would have lived, had he/she not died prematurely. The results show that with the rise of tertiary adult education level and tertiary enrollment rate, there is a decrease in both value and variation of the potential years of life lost. We can conclude that lower levels in tertiary education adversely affect a country's health situation in terms of premature mortality.

Association of Tertiary Enrollment and Education with child vaccination rates

We compared the performance of tertiary education level and enrollment rates with the child vaccination rates (Fig. 5) to assess if there was a positive impact of education on preventive healthcare.

In this analysis (Fig. 5), we looked for associations of child vaccination rates with tertiary enrollment and tertiary education. The analysis is for all countries in the sample. The color of the bubble represents the tertiary enrollment rate such that the darker the color, the higher the enrollment rate, and the size of the bubble represents the level of tertiary education. The labels inside the bubbles denote the child vaccination rates. The figure shows a general positive association of high child vaccination rate with tertiary enrollment and tertiary education levels. This indicates that countries that have high child vaccination rates tend to be better at tertiary enrollment and have more adults educated in tertiary institutions. Therefore, countries that focus more on tertiary education and enrollment may confer more health awareness in the population, which can be reflected in improved child vaccination rates.

Association of NEET rates (15-19; 20-24) with infant mortality rates and deaths from Cancer

In the realm of child health, we also looked at the infant mortality rates. We explored if infant mortality rates are associated with the NEET rates in different age groups (Fig. 6).

Figure 6 is a scatterplot that explores the correlation between infant mortality and NEET rates in the age groups 15-19 and 20-24. The data is for all countries in the sample. Most data points are clustered in the lower infant mortality and lower NEET rate range. Infant mortality and NEET rates move in the same direction-as infant mortality increases/decrease, the NEET rate goes up/down. The NEET rate for the age group 20-24 has a slightly higher infant mortality rate than the NEET rate for the age group 15-19. This implies that when people in the age group 20-24 are uneducated or unemployed, the implications on infant mortality are higher than in other age groups. This is a reasonable association, since there is the potential to have more people with children in this age group than in the teenage group. To reduce the risk of infant mortality, governments should decrease NEET rates through promotional programs that disseminate the benefits of being educated, employed, and trained [ 7]. Additionally, they can offer financial aid to public schools and companies to offer more resources to raise general health awareness in people.

We looked to see if the distribution of population without employment, education, or training (NEET) in various categories of high, medium, and low impacted the rate of deaths from cancer (Fig. 7). Our expectation is that high rates of NEET will positively influence deaths from cancer.

The three pie charts in Fig. 7 show the distribution of deaths from cancer in groups of countries with different NEET rates (high, medium, and low). The analysis includes all countries in the sample. The expectation was that high rates of NEET would be associated with high rates of cancer deaths. Our results, however, show that countries with medium NEET rates tend to have the highest deaths from cancer. Countries with high NEET rates have the lowest deaths from cancer among the three groups. Contrary to expectations, countries with low NEET rates do not show the lowest death rates from cancer. A possible explanation for this can be attributed to the fact that in this group, the people in the labor force may be suffering from work-related hazards including stress, that endanger their health.

Association between adult education levels and health expenditure

It is interesting to note the relationship between health expenditure and adult education levels (Fig. 8). We expect them to be positively associated.

Figure 8 shows a heat map with the number of countries in different combinations of groups between tertiary and upper-secondary adult education level. We emphasize the higher levels of adult education. The color of the square shows the average of health expenditure. The plot shows that most of the countries are divided into two clusters. One cluster has a high tertiary education level as well as a high upper-secondary education level and it has high average health expenditure. The other cluster has relatively low tertiary and upper secondary education level with low average health expenditure. Overall, the figure shows a positive correlation between adult education level and compulsory health expenditure. Governments of countries with low levels of education should allocate more health expenditure, which will have an influence on the educational levels. Alternatively, to improve public health, governments can frame educational policies to improve the overall national education level, which then produces more health awareness, contributing to national healthcare.

Association of Compulsory Health Expenditure with NEET rates by country and region

Having explored the relationship between health expenditure and adult education, we then explored the relationship between health expenditure and NEET rates of different countries (Fig. 9). We expect compulsory health expenditure to be negatively associated with NEET rates.

In Fig. 9, each box represents a country or region; the size of the box indicates the extent of compulsory health expenditure such that a larger box implies that the country has greater compulsory health expenditure. The intensity of the color of the box represents the NEET rate such that the darker color implies a higher NEET rate. Turkey has the highest NEET rate with low health expenditure. Most European countries such as France, Belgium, Sweden, and Norway have low NEET rates and high health expenditure. The chart shows a general association between low compulsory health expenditure and high NEET rates. The relationship, however, is not consistent, as there are countries with high NEET and high health expenditures. Our suggestion is for most countries to improve the social education for the youth through free training programs and other means to effectively improve the public health while they attempt to raise the compulsory expenditure.

Distribution of life expectancy at birth and tertiary enrollment rate

The distribution of enrollment rate (tertiary) and life expectancy of all the countries in the sample can give an idea of the current status of both education and health (Fig. 10). We expect these to be positively associated.

Figure 10 shows two histograms with the lines representing the distribution of life expectancy at birth and the tertiary enrollment rate of all the countries. The distribution of life expectancy at birth is skewed right, which means most of the countries have quite a high life expectancy and there are few countries with a very low life expectancy. The tertiary enrollment rate has a good distribution, which is closer to a normal distribution. Governments of countries with an extremely low life expectancy should try to identify the cause of this problem and take actions in time to improve the overall national health.

Comparison of adult education levels and deaths from Cancer at various levels of GDP per capita

We wanted to see if various levels of GDP per capita influence the levels of adult education and deaths from cancer in countries (Fig. 11).

Figure 11 shows the distribution of various adult education levels for countries by groups of GDP per capita. The plot shows that as GDP grows, the level of below-secondary adult education becomes lower, and the level of tertiary education gets higher. The upper-secondary education level is constant among all the groups. The implication is that tertiary education is the most important factor among all the education levels for a country to improve its economic power and health level. Countries should therefore focus on tertiary education as a driver of economic development. As for deaths from cancer, countries with lower GDP have higher death rates, indicating the negative association between economic development and deaths from cancer.

Distribution of infant mortality rates by continent

Infant mortality is an important indicator of a country's health status. Figure 12 shows the distribution of infant mortality for the continents of Asia, Europe, Oceania, North and South America. We grouped the countries in each continent into high, medium, and low, based on infant mortality rates.

In Fig. 12, each bar represents a continent. All countries fall into three groups (high, medium, and low) based on infant mortality rates. South America has the highest infant mortality, followed by Asia, Europe, and Oceania. North America falls in the medium range of infant mortality. South American countries, in general, should strive to improve infant mortality. While Europe, in general, has the lowest infant mortality rates, there are some countries that have high rates as depicted.

Association between child vaccination rates and NEET rates

We looked at the association between child vaccination rates and NEET rates in various countries (Fig. 13). We expect countries that have high NEET rates to have low child vaccination rates.

Figure 13 displays the child vaccination rates in the first map and the NEET rates in the second map, for all countries. The darker green color shows countries with higher rates of vaccination and the darker red represents those with higher NEET rates. It can be seen that in general, the countries with lower NEET also have better vaccination rates. Examples are USA, UK, Iceland, France, and North European countries. Countries should therefore strive to reduce NEET rates by enrolling a good proportion of the youth into initiatives or programs that will help them be more productive in the future, and be able to afford preventive healthcare for the families, particularly, the children.

Average smoking rate in different continents over time

We compared the trend of average smoking rate for the years 1995-201 for the continents in the sample (Fig. 14).

Figure 14 depicts the line charts of average smoking rates for the continents of Asia, Europe, Oceania, North and South America. All the lines show an overall downward trend, which indicates that the average smoking rate decreases with time. The trend illustrates that people have become more health conscious and realize the harmful effects of smoking over time. However, the smoking rate in Europe (EU) is consistently higher than that in other continents, while the smoking rate in North America (NA) is consistently lower over the years. Governments in Europe should pay attention to the usage of tobacco and increase health consciousness among the public.

Association between adult education levels and deaths from Cancer

We explored if adult education levels (below-secondary, upper-secondary, and tertiary) are associated with deaths from cancer (Fig. 15) such that higher levels of education will mitigate the rates of deaths from cancer, due to increased awareness and proactive health behavior.

Figure 15 shows the correlations of deaths from cancer among the three adult education levels, for all countries in the sample. It is obvious that below-secondary and tertiary adult education levels have a negative correlation with deaths from cancer, while the upper-secondary adult education level shows a positive correlation. Barring upper-secondary results, we can surmise that in general, as education level goes higher, the deaths from cancer will decrease. The rationale for this could be that education fosters more health awareness and encourages people to adopt healthy behavioral practices. Governments should therefore pay attention to frame policies that promote education. However, the counterintuitive result of the positive correlation between upper-secondary levels of adult education with the deaths from cancer warrants more investigation.

We drilled down further into the correlation between the upper-secondary education level and deaths from cancer. Figure 16 shows this correlation, along with a breakdown of the total number of records for each continent, to see if there is an explanation for the unique result.

Figure 16 shows a dashboard containing two graphs - a scatterplot of the correlation between deaths from cancer and education level, and a bar graph showing the breakdown of the total sample by continent. We included a breakdown by continent in order to explore variances that may clarify or explain the positive association for deaths from cancer with the upper-secondary education level. The scatterplot shows that for the European Union (EU) the points are much more scattered than for the other continents. Also, the correlation between deaths and education level for the EU is positive. The bottom bar graph depicts how the sample contains a disproportionately high number of records for the EU than for other continents. It is possible that this may have influenced the results of the correlation. The governments in the EU should investigate the reasons behind this phenomenon. Also, we defer to future research to explore this in greater detail by incorporating other socioeconomic parameters that may have to be factored into the relationship.

Association between average tertiary school life expectancy and health expenditure

We moved our focus to the trends of tertiary school life expectancy and health expenditure from 1995 to 2015 (Fig. 17) to check for positive associations.

Figure 17 is a combination chart explaining the trends of tertiary school life expectancy and health expenditure, for all countries in the sample. The rationale is that if there is a positive association between the two, it would be worthwhile for the government to allocate more resources towards health expenditure. Both tertiary school life expectancy and health expenditure show an increase over the years from 1995 to 2015. Our additional analysis shows that they continue to increase even after 2015. Hence, governments are encouraged to increase the health expenditure in order to see gains in tertiary school life expectancy, which will have positive implications for national health. Given that the measured effects of education are large, investments in education might prove to be a cost-effective means of achieving better health.

Discussion

Our results reveal how interlinked education and health can be. We show how a country can improve its health scenario by focusing on appropriate indicators of education. Countries with higher education levels are more likely to have better national health conditions. Among the adult education levels, tertiary education is the most critical indicator influencing healthcare in terms of infant mortality, life expectancy, child vaccination rates, and enrollment rates. Our results emphasize the role that education plays in the potential years of life lost, which is a measure that represents the average years a person would have lived had he/she not died prematurely. In addition to mortality rate, an economy needs to consider this indicator as a measure of health quality.

Other educational indicators that are major drivers of health include school life expectancy, particularly at the tertiary level. In order to improve the school life expectancy of the population, governments should control the number of youths ending up unemployed, dropping out of school, and without skills or training (the NEET rate). Education allows people to gain skills/abilities and knowledge on general health, enhancing their awareness of healthy behaviors and preventive care. By targeting promotions and campaigns that emphasize the importance of skills and employment, governments can reduce the NEET rates. And, by reducing the NEET rates, governments have the potential to address a broad array of vulnerabilities among youth, ranging from unemployment, early school dropouts, and labor market discouragement, which are all social issues that warrant attention in a growing economy.

We also bring to light the health disparities across countries and suggest implications for governments to target educational interventions that can reduce inequalities and improve health, at a macro level. The health effects of education are at the grass roots level - creating better overall self-awareness on personal health and making healthcare more accessible.

Scope and limitations

Our research suffers from a few limitations. For one, the number of countries is limited, and being that the data are primarily drawn from OECD, they pertain to the continent of Europe. We also considered a limited set of variables. A more extensive study can encompass a larger range of variables drawn from heterogeneous sources. With the objective of acquiring a macro perspective on the education-health association, we incorporated some dependent variables that may not traditionally be viewed as pure health parameters. For example, the variable potential years of life lost is affected by premature deaths that may be caused by non-health related factors too. Also there may be some intervening variables in the education-health relationship that need to be considered. Lastly, while our study explores associations and relationships between variables, it does not investigate causality.

Conclusions and future research

Both education and health are at the center of individual and population health and well-being. Conceptualizations of both phenomena should go beyond the individual focus to incorporate and consider the social context and structure within which the education-health relationship is embedded. Such an approach calls for a combination of interdisciplinary research, novel conceptual models, and rich data sources. As health differences are widening across the world, there is need for new directions in research and policy on health returns on education and vice versa. In developing interventions and policies, governments would do well to keep in mind the dual role played by education-as a driver of opportunity as well as a reproducer of inequality [ 36]. Reducing these macro-level inequalities requires interventions directed at a macro level. Researchers and policy makers have mutual responsibilities in this endeavor, with researchers investigating and communicating the insights and recommendations to policy makers, and policy makers conveying the challenges and needs of health and educational practices to researchers. Researchers can leverage national differences in the political system to study the impact of various welfare systems on the education-health association. In terms of investment in education, we make a call for governments to focus on education in the early stages of life course so as to prevent the reproduction of social inequalities and change upcoming educational trajectories; we also urge governments to make efforts to mitigate the rising dropout rate in postsecondary enrollment that often leads to detrimental health (e.g., due to stress or rising student debt). There is a need to look into the circumstances that can modify the postsecondary experience of youth so as to improve their health.

Our study offers several prospects for future research. Future research can incorporate geographic and environmental variables-such as the quality of air level or latitude-for additional analysis. Also, we can incorporate data from other sources to include more countries and more variables, especially non-European ones, so as to increase the breadth of analysis. In terms of methodology, future studies can deploy meta-regression analysis to compare the relationships between health and some macro-level socioeconomic indicators [ 13]. Future research should also expand beyond the individual to the social context in which education and health are situated. Such an approach will help generate findings that will inform effective educational and health policies and interventions to reduce disparities.

Availability of data and materials

The dataset analyzed during the current study is available from the corresponding author on reasonable request.

Abbreviations

FCT:

Fundamental Cause Theory

HCT:

Human Capital Theory

NEET:

Not in Employment, Education, or Training

OECD:

Organization for Economic Cooperation and Development

SES:

Socio-economic status

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1. Koppelman School of Business, Brooklyn College of the City University of New York, 2900 Bedford Ave, Brooklyn, NY, 11210, USA

Viju Raghupathi

2. Gabelli School of Business, Fordham University, 140 W. 62nd Street, New York, NY, 10023, USA

Wullianallur Raghupathi

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Both authors contributed equally to all parts of the manuscript.

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Correspondence to Viju Raghupathi.

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Raghupathi, V., Raghupathi, W. The influence of education on health: an empirical assessment of OECD countries for the period 1995-2015. Arch Public Health 78, 20 (2020). https://doi.org/10.1186/s13690-020-00402-5
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DOI: https://doi.org/10.1186/s13690-020-00402-5

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The influence of education on health: an empirical assessment of OECD countries for the period 1995-2015 - Archives of Public Health

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Background A clear understanding of the macro-level contexts in which education impacts health is integral to improving national health administration and policy. In this research, we use a visual analytic approach to explore the association between education and health over a 20-year period for countries around the world.

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HArper- interesting to look at public school vs shafias approach

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harper- gender laws in Florida, not directly the same but along the same lines 

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harper- gender laws in Florida, not directly the same but along the same lines 

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Florida Approves Tough Discipline for College Staff Who Break Bathroom Law

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The state Board of Education on Wednesday enacted new disciplinary rules at state colleges for transgender employees — including dismissal.