Sexual Health Education for Behavior Change: Revisiting How Much is Enough

Successful implementation of school sexual health curricula relies on students receiving sufficient exposure to lesson content. This large replication study assesses the longitudinal association between exposure to sexual health lesson frequency and content domains and delayed sexual initiation of middle school students.

Post hoc data analysis was conducted using a large harmonized dataset from 3 randomized controlled trials evaluating It's Your Game curricula in the South Central United States. The sample comprised 1,022 sexually inexperienced middle school students (grades 7 and 8) who completed grade 9 follow-up after using either a 24-lesson hybrid (classroom and computer-based) (It's Your Game…Keep It Real!) or a 13-lesson computer-based (It's Your Game-Tech) curriculum. Multilevel logistic regression was used to assess the association of lesson exposure variables on initiation of any sex by grade 9 while adjusting for covariates of age, gender, and race/ethnicity.

Delayed initiation was directly associated with lesson exposure (odds ratio = 1.06; p < .001). The greatest association of exposure on delayed sexual initiation was a duration of 13 or more lessons (odds ratio = 2.09; p = .01). Significant univariate associations of delayed sexual initiation (refusal skills, pregnancy consequences) were not significant in the multivariate model. No single topic was predictive of delayed initiation of sex in the multivariate model.

Results support previous exposure studies indicating the need for adequate lesson exposure and the importance of broad-based content. Findings contribute to guidance on how effective sexual health curricula can meet the delivery challenges in a reduced and "crowded" academic schedule.