• By Dartington SRU
  • Posted on Tuesday 14th August, 2012

The seX Factor: the search continues for sex education that works

Sex education programs designed to combat high rates of teenage pregnancy and sexually transmitted infection struggle to produce convincing results. Over the years, different approaches have come into fashion and fallen out again. Scare tactics, promoting contraception, teaching abstinence – none of these worked. All failed to produce reductions in teenage pregnancy and STI rates. In response, researchers designed skill-based programs aimed at developing teenagers’ refusal and negotiation skills – and to positive effect. One such program, Reducing the Risk, demonstrated some limited reductions in the number of sexual partners and frequency of sex, alongside increases in condom use and sexual abstinence. However, researchers from the University of Kentucky believe that program developers are yet to find the “X factor” in sex education programs. Programs assume that people make rational decisions – glossing over the way that different people might respond to different messages. Could a variation on Reducing the Risk – one that was designed to engage sensation-seeking teenagers – improve on the original? The study found that students who received the new version of Reducing the Risk did delay initiating sexual intercourse compared to a control group. But the “new-and-improved” curriculum was no better than the old version – perhaps partly because it proved so difficult to implement.What’s personality got to do with it?The researchers believed that the program would be improved by targeting impulsive and sensation-seeking teenagers, who “act in ways that might not be predicted by rational models of health-related behavior; they act, instead, ‘without thinking’.” Perhaps programs could increase the appeal factor of their safe sex and abstinence messages through manipulating their “sensation value” and by making impulsive students aware of their own impulsivity. Finding the seX FactorTo test their theory, the researchers conducted a three-year trial comparing Reducing the Risk, a successful classroom-based HIV, pregnancy and alcohol prevention program, with a modified version designed to be more exciting and engaging. The new version used media, games and prizes, peer facilitation, discussions led by young HIV-positive speakers, and gave the students video cameras to tape role-plays. Seventeen high schools in Louisville and Cleveland serving a diverse, urban population were matched and randomly assigned to either the standard Reducing the Risk curriculum, the modified curriculum, or the control group receiving standard sex education. The study surveyed over 2,600 high schoolers each year for three years on their sexual behaviors and their degree of impulsivity and sensation-seeking. The team believed that students receiving the modified curriculum would be more likely to remain abstinent or use condoms, and less likely to mix alcohol and sex than those who received the standard Reducing the Risk curriculum. Moreover, they predicted that high-sensation seeking and impulsive decision makers would benefit the most from the modified program. The results: new but not improved?Contrary to expectations, the modified curriculum did not produce better results than the standard Reducing the Risk curriculum. However, when combined, the two intervention groups displayed significantly lower levels of initiating sexual activity than their control group counterparts. Interestingly, outcomes for African American students were significantly better than for white students. The search continues…Why did the modified curriculum fail to produce the expected results? On the one hand, perhaps the theory was wrong: maybe personality is not the “X factor” in developing effective sex education programs. On the other hand, perhaps the problem lies in implementation: the study also shows just how difficult it is to carry out classroom sessions that students will rate as having “sensation value.” As the researchers note, students were less than engrossed by some of the key elements of both the standard and revised Reducing the Risk curricula. Students videotaping role-playing activities spent “a significant amount of time off-task,” while “in some classrooms, the HIV-positive speakers could hardly be attended to because the teachers could not control student behavior.” Further, the low 52% retention rate of participants at the three-year follow-up could have affected the results. The authors propose that focusing on increasing students’ awareness of their own impulsivity and teaching them how to structure situations to avoid the use of impulsive decision-making may be a key to having a larger impact on impulsive students. They conclude by highlighting the difficulties of improving on an already-proven model of sex education – and so the search for the “X factor” in classroom-based programs to target risk behaviors in adolescents continues. *********Reference:Zimmerman, R.S., Cupp, P.K., Donohew, L., Sionéan, C.K., Feist-Price, S., & Helme, D. (2008). Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual Reproductive Health, 40(1), 42-51. External LinksWebsites for UK & US STI rates: www.cdc.gov/std/health-disparities/age.htmwww.fpa.org.uk/media/uploads/professionals/factsheets-non-printing/teenagers-sexual-health-and-behaviour-factsheet-january-2011.pdf

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