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APHA Scientific Session and Event Listing

Samuel Olaiya, PhD, MBA, MHA¹, Kenneth Steinman, PhD, MPH¹, and Enriqué Seoane-Vazquez, PhD². (1) School of Public Health, The Ohio State University, 1841 Millikin Road, 436 Cunz Hall, Columbus, OH 43210, 614-292-3158, ksteinman@sph.osu.edu, (2) College of Pharmacy, The Ohio State University, 500 West 12th Avenue, Parks Hall Room 129B, Columbus, OH 43210

BACKGROUND: Significant medical costs are associated with pregnancy and sexually transmitted infections (STIs) in adolescents. Comprehensive sex education programs (CSE) produce changes in sexual behaviors that could prevent negative health outcomes and attached costs. Yet the limited duration of program effects may constrain cost savings. OBJECTIVE: To estimate potential medical cost savings associated with changes in sexual behavior attributable to CSE. METHODS: Program effect sizes, STIs' prevalence and incidence, pregnancy incidence and outcomes, and the direct medical cost of these events were derived from the scientific literature. The behavioral changes attributed to CSE included: delaying first sexual intercourse, delaying further sexual intercourse among “non-virgins” and increasing condom use. A decision model was used to estimate CSE effects on these behaviors, the association of these behaviors with pregnancies and STI's prevention, and direct medical costs averted. Costs were discounted and reported in year 2000 dollars. Separate models by gender and age group were created. A sensitivity analysis was conducted on program effects and contraceptive effectiveness and STIs prevention rates. RESULTS: The typical CSE cost $54 per person. If implemented nationally, CSE would produce medical cost savings of less than $5 per 13-14 year old adolescent; less than $99 per 15-17 year old adolescent; and less than $280 per 18-19 year old adolescent. CONCLUSION: Taking only into account direct medical costs, CSE would yield cost savings for older adolescents, but not for younger adolescents. We discuss these findings in the context of the broader societal costs associated with adolescent pregnancy and STI's.

Learning Objectives:

• Describe the range of effectiveness of rigorously evaluated comprehensive sex education (CSE) programs for adolescents.
• List the specific sexual behaviors that CSE programs are most likely to influence.
• State the projected medical cost savings attribute to CSE programs, were such programs to be implemented nationally.
• Discuss the types of adolescent populations where CSE programs are most likely to be cost effective.
• Identify two factors that limit the cost effectiveness of CSE programs among younger adolescents.

Keywords: School-Based Programs, Economic Analysis

Presenting author's disclosure statement:

Any relevant financial relationships? No