Influencing adolescent sexual health: Long-term behavioral outcomes from two sexual health education curricula for middle school youth

Background: Few studies have examined long-term behavioral impacts of middle school sexual education. We evaluated two curricula: risk avoidance (RA) emphasizing abstinence-until-marriage and risk reduction (RR), emphasizing abstinence and condom/contraceptive skills-training. Primary 9th grade outcomes (previously reported) demonstrate the RR curriculum significantly delayed any sexual initiation in the overall sample; the RA curriculum delayed any sexual initiation among Hispanics. Additional 10th grade analyses examine maintenance of effects. Methods: 15 middle schools were randomly assigned to RA, RR, or standard care control. Youth completed surveys in 7th and 10th grade (n=1187, 29% attrition). Results: Participants were 60% female, 50% Hispanic, 39% black, baseline age M=12.6 years. At 10th grade, both curricula significantly delayed anal sex initiation in the overall sample (RA: AOR: 0.64, 95% CI: 0.42-0.99; RR: AOR: 0.65, 95% CI: 0.50-0.84), and among Hispanics (RA: AOR: 0.53, 95% CI: 0.31-0.91; RR: AOR: 0.82, 95% CI: 0.74-0.93). RA and RR students were significantly more likely to report an increase from baseline in 2+ vaginal partners in past 3 months relative to controls; however actual 10th grade percentages were similar across conditions (12.0% RA, 10.0% RR, 9.2% control). RR students were significantly more likely to report an increase from baseline in 2+ lifetime oral sex partners than controls; however,10th grade percentages were similar (19.1% RR, 19.0% control). Conclusions: Findings show delayed anal sex initiation at 10th grade but overall sexual initiation was not delayed past 9th grade. Additional high school sex education may be needed to sustain education received in middle schools.