Improving adolescent sexual health: Behavioral and psychosocial outcomes from two sexual health education curricula for middle school youth

Background: Effective approaches for sexual education are urgently needed. We evaluated two multi-media, middle school curricula, one risk avoidance (RA), one risk reduction (RR), comparable in duration, delivery, and theory, to examine impact on delayed sexual initiation. Methods: Predominantly Hispanic and African American 7th graders in 15 Texas middle schools were randomly assigned to RA, RR, or control conditions. The RA curriculum followed federal abstinence education guidelines; the RR curriculum emphasized abstinence but included condom/contraceptive skills-training. Both curricula addressed norms, attitudes, refusal and communication skills related to healthy relationships, dating, and sex. Youth completed ACASI surveys in 7th and 9th grade (76% retention). Results: Participants (n=1258) were 59.8% female, mean age 12.6 years. Relative to controls, the RR program delayed sexual initiation in the overall sample (adjusted odds ratio [AOR]: 1.54, 95% CI: 1.20-1.99), among females (AOR: 2.31, 95% CI: 1.67-3.20) and African-Americans (AOR: 2.63, 95% CI: 1.27-5.45); it increased condom use at last intercourse (AOR: 1.50, 95% CI: 1.04-2.15) and reduced past three months' frequency of anal sex (AOR: 0.53, 95% CI: 0.33-0.84) and unprotected vaginal sex (AOR: 0.59, 95% CI: 0.36-0.95). The RA program delayed sexual initiation among Hispanics (AOR: 2.48, 95% CI: 1.16-5.30), increased condom use at last intercourse (AOR: 1.44, 95% CI: 1.07-1.92) but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively impacted psychosocial outcomes. Conclusions: Middle school sexual education programs can delay sexual debut and reduce risky sexual behavior. Wide-spread implementation of evidence-based programs should be encouraged.