The Importance of Comprehensive K-12 Sexual Education Programs

Tatiana M. Smith, University of New Haven

The purpose of this paper is to discuss the current status of existing evidence-based health education programs designed for K-12 students. The content of well-informed K-12 health education programs is intended to clarify definitions and reduce future at-risk and criminal behaviors. This may include evidence-based curriculums encompassing such topics as mental health, sexual education, learning difficulties, sexuality, bullying, suicide, substance abuse, biological puberty, and more. However, the focus here will be on sexual education curriculums for K-12 health education programs. The goal is to evaluate whether existing health programs properly educate K-12 students about recognizing and practicing positive interactions within sexual situations. The intended audience includes legislators and school administrators who effect policy changes in K-12 academic public-school curricula (specifically sex education), with the expectation of enhancing course content to be more comprehensive and to decrease the likelihood of at-risk and criminal behavior in the future, both in the U.S. and perhaps globally (Leung, Shek, Leung, & Shek, 2019).

K-12 Sexual Health Education Programs

According to the Bureau of Justice Statistics (Morgan & Oudekerk, 2018), from 2017 to 2018, the rate of sexual assault among victims 12-years old or older increased from 1.4 to 2.7 per 1,000 persons. This increasing rate of victimization is in line with recent research from the Centers for Disease Control and Prevention (CDC, 2019). An updated release of the National Intimate Partner and Sexual Violence Survey (NISVS) data illustrates the risk to male and female victims, between ages 10-17, to be approximately 1 in 4 and 1 in 3 individuals, respectively (Smith, Zhang, Basile, Merrick, Wang, Kresnow, & Chen, 2018).

These data reveal the ongoing threat of sexual offending and violence among youth. The importance of this information is linked to sexual education programs for K-12 students, which is present in less than 30 states (Fay, 2019). Based upon state laws and corresponding education standards, existing sexual education programs discuss healthy relationships, sexual assault, and/or consent in only 11 states and the District of Columbia (Shapiro & Brown, 2018). In sum, the availability and standards of sex education programs in public schools are widely diverse.

The National Institute of Health reports that between 20 and 27 states only require sexual education on topics that include contraception, sex and/or HIV education, abstinence-only, and sexual activity only being acceptable within marriage (Shapiro & Brown, 2018; National Conference of State Legislatures (NCSL), 2020). Furthermore, states provide parental rights concerning the curriculum that public schools enact, including notification of parents, requiring parental consent, and/or allowing parents to opt-out of sexual education on behalf of their children (NCSL, 2020).

 
Background

The history of sex education in the United States has been widely debated for decades, dating to the 1960s, on whether to become more restrictive or more comprehensive (NCSL, 2020; Planned Parenthood, 2016; Schmidt et al., 2015). Sex education has diverged into separate directions across U.S. schools, when it is present. Research has found that previous approaches intending to provide medically comprehensive information about sexual health are not the most successful at reducing risk-taking behaviors among youth (Planned Parenthood. 2016). Rather, studies have uncovered evidence indicating comprehensive programs are successful when they include health goals, preventive methods, physical/psychosocial risk and protective factors, fostering of safe environments, and the incorporation of active participation and multiple activities throughout the course (Planned Parenthood, 2016; Leung et al., 2019).

Sexual Health Education Curricula

The issue of a widely inconsistent and generally lacking sexual education curriculum, both nationally and internationally, is becoming more and more relevant. Rates of sexual violence victimization are not decreasing, but instead have been increasing, even in the context of substantial non-reporting (Smith et al., 2018; Morgan & Oudekerk, 2018; CDC, 2019). The purpose of drawing attention to the improvement of existing sexual education curricula is to decrease rates of sexual violence victimization in the future. The implementation of evidence-based comprehensive programs has shown positive results in prior studies, in that the risk-taking behaviors of youth decreased (Planned Parenthood, 2016). A review of current state legislation indicates, however, at least half of the nation receives limited to no sexual education in K-12 public schools (Planned Parenthood, 2016; Leung et al., 2019; NCSL, 2020).

This educational gap deprives K-12 students from learning about proper sexual health, healthy sexual interactions, the meaning and importance of consent, healthy relationships, sexuality, gender discussions, the significance of behavior, and more (Shegog, Baulmer, Addy, Peskin, & Thiel, 2017; Schmidt, Wandersman, & Hills, 2015; Shapiro & Brown, 2018; Leung et al., 2019; NCSL, 2020). The lack of action to enact new legislation, which could enhance sex education curricula, reduces the likelihood of declines in sexual victimization, including at the developmental stages for K-12 students (Mallet, 2017; CDC, 2019; Leung et al., 2019; NCSL, 2020; Shapiro & Brown, 2018; Smith, Park, Ireland, Elwyn, & Thornberry, 2013).

Pre-Existing K-12 Sexual Health Education Policies

The American public has been demanding an increased focus in schools on teen pregnancy and unhealthy relationships, but sex education standards vary significantly across states, preventing access to critical intervention tools that would provide more comprehensive sex education for students (Shapiro & Brown, 2018). This unbalanced focus creates vulnerability amongst K-12 students for increased risk of victimization and perpetration.

As previously discussed, sex education is not mandated nationwide, nor is the curriculum consistent across states that have implemented legislation. This disparity continues to impact young adults after graduation, placing them at a higher risk for a variety of social and health problems unknown to them (Fay, 2019). The benefit of updated legislation nationwide, in a comprehensive and uniform manner, would be in producing more informed students who will have the ability to make better decisions (Fay, 2019). Knowledge is power, and nearly half the nation does not have any form of sex education in their K-12 public schools, while the majority of those that have programs focus solely on abstinence, sex within marriage, contraception, and/or medically accurate information (Fay, 2019; Leung et al., 2019; NCSL, 2020).

Despite research showing these restrictive educational curricula to be ineffective, the movement to strengthen legislation on sex education requirements and make programs more comprehensive does not have strong traction nationwide (Fay, 2019; NCSL, 2020; Leung et al., 2019; Smith et al., 2013; Planned Parenthood, 2016). Lack of action by legislators in states with restrictive or non-existent programs suggests there is little desire to change or create policies, despite public health risks (CDC, 2019; Planned Parenthood, 2016; Shapiro & Brown, 2018).

Presently, there are no known specific programs that focus on non-heterosexual orientations, nor do existing sexual education courses give much attention to this topic (Schmidt et al., 2015). Although the majority of sexuality education programs in U.S. schools discuss sexually transmitted diseases, pregnancies, abstinence, and the use of contraception, there is a significant amount of content missing (Schmidt et al., 2015). For instance, such topics as what constitutes a healthy dating relationship, interpersonal violence, consent, and discussion of gender roles often are not included (Children & Families Directorate, 2019; Planned Parenthood, 2016; Schmidt et al., 2015; Shegog et al., 2017).

K-12 Sexual Health Education Policy Options

An initial policy proposal can be modeled after a study that associated professional development of teachers with increases in sexual education content coverage (Clayton, Brener, Barrios, Jayne, & Jones, 2018). This model acknowledges the efficacy of sexual health education for middle and high school students, which could be utilized for policies that provide guidance for K-12 sexual health education (Clayton et al., 2018). The positive impact uncovered in the study suggests that professional development of teachers is essential, as they are more likely to teach an expansive content of sexual health than are teachers without similar experience.

A second policy proposal may be constructed using the Reproductive Health Education (RHE) programs implemented and analyzed through a study focused on middle school students from Lebanon (Mouhanna, DeJon, Afifi, Asmar, Nazha, & Zurayk, 2017). These programs also found positive associations between expanded program content and student outcomes. Furthermore, this study developed a baseline for future research on this issue, to be used in informing future stakeholders and assessing the necessity and implementation of RHE programs in developing countries (Mouhanna et al., 2017).

A third and final policy proposal follows the structure of a peer education program known as Students with a Realistic Mission (SWARM; Butler, Jeter, & Andrades, 2002). This program model was found to be successful in integrating service learning and peer education within the health education curriculum (Butler et al., 2002). The original SWARM program included a focus on drugs, service learning, and healthy living-learning competencies. Additionally, it incorporated student feedback, which had been largely positive but included constructive criticism (Butler et al., 2002). Due to its earlier success and integration into an academic institution, a collaborative approach with education and community aspects likely would be an adaptable policy option for K-12 sexual health education.

Advantages of Each K-12 Sexual Health Education Policy Option

The advantages of the first policy proposal modeled after the combination of professional development of teachers and expanded content coverage in K-12 sexual health education (Clayton et al., 2018) may include:

 Focus on preventing adverse sexual behavior and subsequent consequences.
 Professional development specifically targeted to teaching sexual health content.
 Focus on teaching four domains (including several specific topics under each domain):

o Human sexuality
o Pregnancy prevention
o HIV prevention
o Sexually transmitted diseases prevention.

 Middle and high school sexual education courses.
 Reducing sexual risk behaviors and increasing adult/parental support for school-based sexual health education.
 Teachers achieving expertise through preservice training.

The advantages of the second policy proposal, constructed using RHE programs with a focus on middle school students from Lebanon (Mouhanna et al., 2017), may include:

 Advocacy and effective implementations of RHE programs for greater numbers and types of youth.
 Tailored interventions for the needs, concerns, and expectations of students.
 Young people being educated to make informed decisions for their sexual health.
 Expanded health education topics reviewed in school.

Finally, the advantages of the third policy proposal follow the structure of the SWARM program, which provides integrated service learning and peer education in the health education curriculum (Butler et al., 2002), and may include:

 Aspects of the community, peers, youth, and academic collaboration in the health education curriculum.
 Primary focus on HIV/AIDS, STD prevention, alcohol, and drug education, with possible incorporation of sexual health education
 Student feedback, including thoughtful and constructive criticism.

Disadvantages of Each K-12 Sexual Health Education Policy Option

The disadvantages of the first policy proposal (Clayton et al., 2018) may include:

 The preservice and ongoing educational training required may be a challenge due to issues with training, funding, and administrational support.
 This could result in time management issues (i.e., overburdening teachers with requirements and little or no support).
 Subjects such as mandating the use of condom instruction and discussing sexual orientation might be challenging.

The disadvantages of the second policy proposal (Mouhanna et al., 2017) may include:

 Lack of generalizability and replication of research on this program.
 Variation in culture, attitudes, religion, and political orientation might impact implementation and effectiveness.

The disadvantages of the third policy proposal (Butler et al., 2002) may include:

 Limited research on the continued success of SWARM.
 Little research on whether significant challenges have been identified since the initial analysis.

Recommendations for a K-12 Sexual Health Education Policy

An overall general recommendation would be to utilize an evidence-based program to restructure sexual health education in K-12 schools in the United States, with an emphasis on a collaborative approach at the micro and macro levels (Schmidt et al., 2015; Whillier, Spence, Giuriato, & Chiro, 2019). This could include, for instance, collaboration between academics, researchers, legislators, community leaders, and school personnel. Evidence-based curricula have been shown to be successful in U.S. school settings. However, for successful implementation, the curricula cannot be compromised by content and competing academic priorities (Shegog et al., 2017).

Based upon the three proposed policy options, the most effective and realistic option would likely be based on the first policy model. Research successfully associated ongoing professional development of teachers with a current, well developed curriculum in K-12 school-based sexual health education programs (Clayton et al., 2018). Ongoing professional development requirements for sexual health educators, combined with their educational pedigree upon entry into their position, could create a highly informed and comprehensive curricula in K-12 schools.

The addition of qualified sexual health educators and ongoing professional development requirements could aid in implementing K-12 school-based sexual health educational programs nationwide. This may be especially influential for policy legislators and in generating parental support, particularly in areas where sexual health education is presently limited or non-existent. The choice of this recommendation is intended to minimize at-risk behaviors, in addition to reducing both criminal victimization and perpetration.

Annotated Bibliography

Butler, K. L., Jeter, A., & Andrades, R. (2002). SWARMing for a solution: Integrating service
learning and peer education into the health education curriculum. American Journal of Health Education, 33(4), 240-244. https://eric.ed.gov/?id=EJ854088
Butler, Jeter, & Andrades (2002) evaluated the program Students with a Realistic Mission (SWARM), which focused on health concerns such as drugs, alcohol, HIV/AIDS, and STD prevention. This article provides the framework for an integrated health education program that could be the basis for proposed legislation for comprehensive sexual education. This framework is especially resourceful as it has a successful history, and feedback had been both largely positive and constructive.

Centers for Disease Control and Prevention (CDC). (2019). CDC healthy school. National health
education standards. https://www.cdc.gov/healthyschools/sher/standards/index.htm
The Centers for Disease Control and Prevention provides an outline for National Health Education Standards (NHES) that pertain to education frameworks and curricula created for K-12 students. There are eight standards that discuss the required depth of ability students much reach at each stage. Furthermore, there is assistance provided to use characteristics associated with the creation of an effective health education curriculum.

Children and Families Directorate. (2019, May 17). Key messages for young people on healthy
relationships and consent: A resource for professionals working with young people. Scottish Government. https://www.gov.scot/publications/key-messages-young-people-healthy-relationships-consent-resource-professionals-working-young-people/pages/3/
The Children and Families Directorate provides a resource for professionals to consult when creating well-informed curricula in sex education for young people. It provides a model created recently by the Scottish Government which is concise and informative, especially regarding legislation and/or curricula that may not have an existing framework to amend or build upon.

Clayton, H. B., Brener, N. D., Barrios, L. C., Jayne, P. E., & Jones, S. E. (2018). Professional
development on sexual health education is associated with coverage of sexual health topics. Pedagogy in Health Promotion: The Scholarship of Teaching and Learning, 4(2), 115-124. doi: 10.1177/2373379917718562
This article examined sexual health education programs emphasizing the professional development of teachers with a focus on middle and high school health education courses. This study illustrates the importance of comprehensive sexual health education, as it is essential in the prevention of sexual behavior consequences. This structure for professional development associated with school-based sexual health education has proven to be effective, with a positive impact on both the health content covered and the students.

Fay, L. (2019, April 1). Just 24 states mandate sex education for K-12 students, and only 9 require any discussion of consent. See how your state stacks up. The 74 Media: The Big Picture. https://www.the74million.org/article/just-24-states-mandate-sex-education-for-k-12-students-and-only-9-require-any-discussion-of-consent-see-how-your-state-stacks-up/
Fay discusses the attention that sexual education programs in the United States are receiving, both in content and state education requirements. This article further states that during Sexual Assault Awareness Month, lawmakers have been considering legislation related to sex education for K-12 students. It is important to stress that the bills vary in whether the comprehensive nature of the sex education course requirements will be strengthened or restricted.

Leung, H., Shek, D. T. L., Leung, E., & Shek, E. Y. W. (2019). Development of contextually-
relevant sexuality education: Lessons from a comprehensive review of adolescent sexuality education across cultures. International Journal of Environmental Research and Public Health, 16(4), 1-24. doi: 10.3390/ijerph16040621
The authors provide a comprehensive review of literature of sexuality education in the United States as well as abroad. This article reviews the policy, practice, training, evaluation, and research associated with the sex education programs in each of the evaluated countries. This highly comprehensive approach illustrates concern over the effectiveness of sexuality programs has been increasing globally, with youth specified as the target population. Furthermore, this review also supports the need for a more informed perspective and curricula that will enhance the effectiveness of these programs.

Mallett, C. A. (2017). The school-to-prison pipeline: Disproportionate impact on vulnerable
children and adolescents. Education and Urban Society, 49(6), 563-592. doi: 10.1177/0013124516644053
Mallet presents the significant effect that a punitive school environment can have upon child and adolescent groups, specifically in urban schools. This study examines how certain traits may act as vulnerabilities such as their sexual orientation, socioeconomic class, race, disabilities, and more place these individuals at risk for what has become known as the school-to-prison pipeline. It is important to consider not only academics, but also the environmental factors that may increase an individual’s vulnerability to future criminal victimization or perpetration.

Morgan, R. E., & Oudekerk, B. A. (2019). Criminal victimization, 2018. The Bureau of Justice
Statistics. U.S. Department of Justice: Office of Justice Programs. https://www.bjs.gov/content/pub/pdf/cv18.pdf
This brief provides the most recently collected data from the Bureau of Justice Statistics regarding a range of criminal victimization, such as aggravated assault, sexual assault, robbery, and stranger violence. The authors provide data on the current rate of victimization regarding sexual assault victims from 2017 to 2018, which subsequently suggests a rise in victimization.

Mouhanna, F., DeJong, J., Afifi, R., Asmar, K., Nazha, B., & Zurayk, H. (2017). Student support
for reproductive health education in middle schools: Findings from Lebanon. Sex Education, 17(2), 195-208. doi: 10.1080/14681811.2017.1280011
The authors present a study that acknowledges the critical developmental phase of youth can be more vulnerable to risky sexual behaviors and the associated negative health outcomes. This study is significant as it recognizes the importance of school-based health programs that are well-informed, as well as the significance of grade level and exposure to additional health education topics. This design would be a valuable model to replicate, as effective programs enhance positive attitudes and their implementation could be tailored to key interventions with specific individuals.

National Conference of State Legislatures (NCLS). (2020, April 1). State policies on sex
education in schools. Why is sexual education taught in schools? https://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx
The National Conference of State Legislators provides updated information as of March 1, 2020 regarding the sex education for public schools in all states. The brief includes summaries of state laws for the medical accuracy in sex or HIV education specifically. However, it does not include the same comprehensive summaries about other sex education programs and their content.

Planned Parenthood. (2016). History of sex education in the U.S.
https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-a446d90fd1e3/20170209_sexed_d04_1.pdf
This Planned Parenthood brief reviews the history of sex education in the United States. This is significant brief, as it includes the World Health Organization’s (WHO) definition of sexual health, in addition to the curriculums and programs offered nationally and worldwide, including content evaluations, roles of the educators, agency roles, and parental roles. Furthermore, this brief acknowledges the concerns of this education curricula, the evolving differences in understanding sex education, as well as associated goals.

Schmidt, S. C., Wandersman, A., & Hills, K. J. (2015). Evidence-based sexuality education
programs in schools: Do the align with the national sexuality education standards? American Journal of Sexuality, 10(2), 177-195. doi: 10.1080/15546128.2015.1025937
This article presents an evidence-based review of sexuality education programs in a sample of 10 schools from the Office of Adolescent Health (OAH). This analysis assesses whether the programs are following a comprehensive education model endorsed by the National Sexuality Education Standards. This review is essential, as it highlights pros and cons of the sexuality education programs based upon the level of comprehensiveness regarding the content.

Shapiro, S., & Brown, C. (2018, May 9). Sex education standards across the states. Center for
American Progress. https://www.americanprogress.org/issues/education-k-12/reports/2018/05/09/450158/sex-education-standards-across-states/
Shapiro and Brown present a brief that discusses the importance of states moving towards a comprehensive sex education curriculum and current state sex education standards. This brief also highlights the significant diversity in state sex education standards in public schools nationally, but also cautions against focusing on limited topics like teen pregnancy and abstinence. The authors further emphasize the importance of consistent messaging as opposed to the current structure, which may produce inconsistent, confusing, and/or misleading information about sex education.

Shegog, R., Baumler, E., Addy, R. C., Peskin, M., & Thiel, M. A. (2017). Sexual health
education for behavior change: How much is enough? Journal of Applied Research on Children: Informing Policy for Children at Risk, 8(1), 1-13.
This article highlights the importance of an evidence-based program on sexual health curricula at the K-12 education levels. The authors discuss the significant impact of competing academic priorities, such as standardized testing schedules, which do not always enable students to receive effective sexual health curricula through both the quantity and quality of a program’s exposure.

Smith, C. A., Park, A., Ireland, T. O., Elwyn, L., & Thornberry, T. P. (2013). Long-term
outcomes of young adults exposed to maltreatment: The role of educational experiences in promoting resilience to crime and violence in early adulthood. Journal of Interpersonal Violence, 28(1), 121-156. doi: 10.1177/0886260512448845
This study examines whether educational experiences in adolescence may have any mitigating impact on exposure to maltreatment and/or violence in early adulthood. The authors found that while a high G.P.A. had the most positive association with resilience to crime and violence, that the study’s results were consistent with literature that associates promotion of school achievement to increase resilience in urban youth.

Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M., & Chen, J.
(2018). The national intimate partner and sexual violence survey (NISVS): Data brief – Updated release. Atlanta: GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 1-25.
The National Intimate Partner and Sexual Violence Survey (NISVS), originally collected in 2015 and recently updated in 2018, includes qualitative and quantitative data that relates to current victimization rates. These surveys provide rates that may not have been captured in other data sets to more accurately highlight the risk of sexual violence in the United States among different gender, age, and racial groups.

Whillier, S., Spence, N., Giuriato, R., & Chiro, G. D. (2019). A collaborative process for a
program redesign for education in evidence-based health care. The Journal of Chiropractic Education, 33(1), 40-48. doi: 10.7899/JCE-17-31
The authors provide a perspective, not focused on sexual education curricula for K-12 students, which advocates for the importance of a restructured program created through a collaborative process. This supports the need for sexual education to be restructured nationally while acknowledging that this cannot be accomplished nor implemented successfully without collaboration. For instance, a program that is created with research experts, academics, professionals, community leaders, and state officials.

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