National Partnership for Women & Families

Monthly Women's Health Research Review

Rights-Based Sexual Health Curriculum May Improve Sexual Health Outcomes in Adolescents, Study Finds

Summary of "A Rights-Based Sexuality Education Curriculum for Adolescents: 1-Year Outcomes From a Cluster-Randomized Trial," Rohrbach et al., Journal of Adolescent Health, July 2.

"One emerging framework [in sexuality education] is the rights-based approach, which seeks to integrate discussions of sexuality, human rights, and gender equality and is driven by recognition of adolescents' fundamental rights to sexual health information and services, self-determination, and nondiscrimination," according to Louise Rohrbach of the Department of Preventive Medicine at University of Southern California's Keck School of Medicine and colleagues.

However, they noted that while "conceptually similar interventions" to a rights-based sexuality education curriculum "have shown encouraging results through randomized trials, a rigorous evaluation of a rights-based sexuality education intervention with adolescents in the United States has not been conducted." For their study, Rohrbach and colleagues aimed "to evaluate the effectiveness of a rights-based classroom curriculum" and "to determine the effectiveness of the multicomponent intervention consisting of the rights-based classroom curriculum plus three school-wide intervention components (parent education workshops, afterschool peer advocate program, and clinical sexual health services)."

Study Design

For the study, Rohrbach and colleagues recruited "ninth-grade students at 10 public charter schools affiliated with a large urban school district." According to the researchers, "The schools were recruited as five pairs that were matched on school-level demographic characteristics."

The study took place over two school years and involved two "levels of randomization," one at the school level and one at the classroom level.

The school-level assessment aimed to determine the effectiveness of the full multicomponent intervention. Within each matched pair of schools, schools were randomly assigned to either all or none of three school-wide intervention components, including parent education, peer advocacy and sexual health services. However, by the end of the study period, all schools had the sexual health services component.

The classroom-level assessment aimed to determine the effectiveness of the rights-based curriculum. Ninth-grade classrooms in each school were randomly assigned to receive either a "three-session control curriculum" or a "12-session rights-based intervention curriculum."

Methods

According to the researchers, the rights-based curriculum, called the Sexuality Education Initiative, was developed by Planned Parenthood Los Angeles to improve "the sexual health of low-income high school-aged youth, including reducing the risk of pregnancy and [sexually transmitted infections], and improving students' ability to manage their sexuality respectfully." The intervention used international and national best practices to "address gender norms and power dynamics in relationships, use a rights-based framework, and contextualize sexual health messages through an ecological model."

The SEI curriculum consisted of 12 sessions designed to educate ninth-grade students on "sexual and reproductive anatomy, pregnancy, STIs/[HIV], and contraception." According to the researchers, the curriculum "was taught over an average span of 53 days by PPLA staff who had received two days of training." Meanwhile, the three-session control curriculum addressed anatomy, pregnancy and STIs, as well as other "basic sexual health" issues. It "was taught over an average span of 9 days by PPLA volunteer educators who received 1 day of training."

For the study, researchers observed 220 intervention sessions and 43 control sessions of the two-year timeframe, which accounted for 50% of all sessions provided in the first year and 25% of all sessions provided in the second year.

The researchers surveyed a final sample of participants that included 1,447 students in 91 classrooms, composed of:

  • "769 students (48 classrooms) [who] received the SEI curriculum"; and
  • "678 students (43 classrooms) [who] received the control curriculum."

According to the researchers, the surveys were administered before any sexuality education classes were taken and then again one year after "delivery of the curriculum." The dependent variables assessed via the surveys included students' primary behavioral outcomes, such as pregnancy risk and STI risk; secondary behavioral outcomes, such contraceptive use at last sex and what types of sex the student engaged in; and psychosocial outcomes, such as "attitudes about rights" in casual and steady sexual relationships and awareness of sexual health services. The survey also assessed participants' socioeconomic status.

Results

Attrition

The study found "no statistically significant differences in attrition rates for the SEI and control curriculum groups." However, according to the study, students lost to attrition were more likely than those retained through the one-year follow-up to:

  • Be born in the U.S.;
  • Be non-Hispanic;
  • Be older;
  • Have a higher household socioeconomic status;
  • Have greater acculturation; and
  • Have had sex in their lifetime and in the last three months.

Baseline Characteristics

According to the researchers, the students' mean age was 14.2 years, 88% said they were Hispanic and 81.1% were born in the U.S. The researchers also found that of the study participants:

  • "14.7% ... reported having had vaginal or anal sex";
  • "12.9% reported having had oral sex in their lifetime";
  • "6.1% reported vaginal or anal sex" in the previous three months; and
  • "5.4% reported oral sex in the previous 3 months."

Meanwhile, "less than 14% of students reported having previously used sexual health services."

Researchers found no statistically significant differences in demographic or behavioral characteristics between the SEI and control curriculum groups.

Behavioral Outcomes

Regarding primary behavioral outcomes, the only "statistically significant effec[t] of the SEI curriculum" was that "[s]tudents in the SEI curriculum group were significantly more likely to have used sexual health services than were students in the control curriculum group." Meanwhile, the researchers found that "[t]here were no statistically significant effects of the SEI curriculum for ... secondary outcomes" other than "students in the SEI curriculum group [being] significantly more likely to be carrying a condom than ... students in the control group."

Psychosocial Outcomes

Regarding psychosocial outcomes, researchers found the effects of the SEI curriculum were statistically significant for six of the nine measured outcomes, with the greatest effects found in:

  • Attitudes about relationship rights with a casual partner;
  • Protection self-efficacy; and
  • Sexual health knowledge.

According to the researchers, "students in the SEI curriculum group were more likely to report access to sexual health information and awareness of sexual health services than students in the control curriculum group."

Discussion

"The results of this study indicated a number of statistically significant, positive effects of the SEI on students' sexual health behaviors and psychosocial outcomes 1 year after participation in the curriculum intervention," the researchers wrote. They explained that many of the "positive effects on psychosocial outcomes immediately after curriculum delivery," as assessed in prior research, "were sustained at 1-year follow-up, with higher levels of sexual health knowledge, self-efficacy, communication, access to sexual health information, awareness of sexual health services, and more favorable attitudes among students in the SEI curriculum group relative to the control (basic sex education) group."

However, they noted that the curriculum had "more limited" positive effects on sexual health behaviors, pertaining only to "use of sexual health services and condom carrying." Nonetheless, they wrote that these behavior changes "are important," as they "might be considered indicators of intentions regarding future sexual behaviors."

The researchers concluded, "[T]his study offers evidence that a rights-based sexuality education curriculum can have positive effects on young adolescents' psychosocial outcomes 1 year after participation and thus may be a good strategy for promoting healthy sexual development." However, urging further research, the researchers noted that "it might not be sufficient to produce measurable changes in these behaviors at 1-year follow-up among younger adolescents, most of whom are not sexually active."