National Partnership for Women & Families

Monthly Women's Health Research Review

Adolescents' receipt of formal sexuality education declined between 2006-2010 and 2011-2013, study finds

Summary of "Changes in adolescents' receipt of sex education, 2006-2013," Lindberg et al., Journal of Adolescent Health, Feb. 10, 2016.

While "[p]roviding adolescents with sexual health information is an important means of promoting healthy sexual development and reducing negative outcomes of sexual behaviors," previous "research has found increasing gaps in sex education," according to Laura Duberstein Lindberg of the Guttmacher Institute and colleagues.

In this study, the researchers aimed to "extend previous work monitoring national trends in sex education since 1995" by using federal data to "examin[e] recent changes in adolescents' reports of receipt of formal sex education and instruction from parents." According to the researchers, the study assessed differences in the receipt of sexuality education "by adolescents' sociodemographic characteristics and place of residence." It also "consider[ed] how formal instruction and the informal sex education provided by parents supplement each other."

Methods

For the study, the researchers assessed data from the 2006-2010 and 2011-2013 National Surveys of Family Growth (NSFG), which polled men and women ages 15 to 44.

The researchers limited their analysis to include only data on respondents ages 15 to 19, resulting in a study sample of 2,284 females and 2,378 males in the 2006-2010 survey and 1,037 females and 1,088 males in the 2011-2013 survey. The surveys asked participants about their receipt of formal and informal instruction on sexual and reproductive health.

Results

Sample characteristics

The researchers found that, "[a]mong the weighted sample of respondents aged 15-19 years in 2006-2010 and 2011-2013, the majority were non-Hispanic white, aged 15-17 years and attended religious services often when they were aged 14 years." In addition, the researchers noted that "[a]bout one-third resided in a central city, half in other metropolitan areas, and the remaining share in nonmetropolitan statistical areas."

The researchers wrote that the share of adolescents who lived in households with incomes below 200 percent of the federal poverty level increased over the time period examined.

Trends by gender for formal instruction

The researchers found that, "[b]etween 2006-2010 and 2011-2013, there were significant declines in adolescent females' reports of the receipt of formal instruction about birth control (70% to 60%), saying no to sex (89% to 82%), sexually transmitted [infections (STIs)] (... 94% to 90%), and HIV/AIDS (89% to 86%)." The percentage of male adolescents who reported receiving formal sexuality education on birth control also declined, from 61 to 55 percent, the researchers wrote. However, the researchers did find an increase in the percentage of male and female adolescents "reporting formal instruction in saying no to sex without instruction about birth control."

The researchers noted that while "there were significant gender differences in multiple topics of formal instruction ... differential declines resulted in no significant differences by gender in 2011-2013 for the same topics." Overall, according to the researchers, "By 2011-2013, receipt of instruction about [STIs] or HIV/AIDS was most common (near 90% for each gender), and adolescents were less likely to receive instruction about birth control than about saying no to sex."

Trends by demographics for formal instruction

The study found that among female adolescents, white teenagers experienced declines in instruction about birth control and saying no to sex, "with no significant changes among black or Hispanic girls." When considering age, the researchers found that only girls ages 18 to 19 saw drops in instruction about saying no to sex, STIs and HIV/AIDS, while younger teens of both genders saw declines in birth control instruction. In addition, the researchers noted that while teenagers "who reported the highest levels of religious attendance at age 14 years had significant declines in receipt of instruction about methods of birth control (both genders) and how to say no to sex (girls)," teenagers "with less or no religious attendance" experienced no changes in instruction. Regarding income, the study found that female teenagers in households with annual incomes less than 200 percent of the federal poverty level reported "declines in instruction about saying no to sex," while only girls in households with annual incomes at or above 200 percent of the federal poverty line reported "a decline in instruction about birth control."

According to the study, both male and female teenagers in nonmetropolitan areas "had significant declines" in instruction about contraceptive methods, STIs and HIV/AIDS, and how to decline sex. In comparison, "there were few declines among teens residing in central cities or other metropolitan areas" for these topics. The researchers wrote, "The consistency of these declines for teens in nonmetropolitan areas across topics of instruction and gender is noteworthy, especially given the stability across other characteristics among males."

Additional findings on formal instruction trends

Using additional data obtained from new questions in the 2011-2013 survey, the researchers found that about three-quarters of male and female teenagers received formal instruction about delaying sex until marriage, which was similar to the percentage of teenagers who reported instruction on how to decline sex. According to the researchers, female adolescents "were significantly more likely than boys to receive instruction about where to get birth control (53% vs. 38%), whereas boys were significantly more likely than girls to receive formal instruction on how to use a condom (50% females, 58% males)." The researchers noted that "about one-quarter of [all] teens reported not receiving instruction on any of these birth control topics."

Timing of formal instruction

The percentage of girls who received formal education about how to decline sex before first sex fell from 78 to 70 percent, the researchers found. The percentage of male teenagers who received formal education about contraception before first sex dropped from 52 to 43 percent. The researchers also noted that boys who had had sex were "significantly less likely" than female teenagers to have received instruction on contraception or how to access contraception before first sex.

Informal sexuality education

According to the researchers, the percentage of teenagers who received informal sexuality education from their parents did not change significantly. They noted that only the percentage of teenagers discussing condom use with their parents increased, from 37 to 45 percent for boys and from 30 to 36 percent for girls.

Overall, the study found that 22 percent of females and 30 percent of males reported that they did not receive any instruction about sexual or reproductive health topics from their parents. According to the study, the topics that girls most commonly discussed with parents were how to decline sex, STIs and contraception and the topics boys most commonly discussed with parents were STIs and condom use. The researchers noted that girls were more likely than boys to discuss all reproductive and sexual health topics with their parents aside from condom use.

The researchers noted that rates did not vary significantly by age, location, religiosity or income levels. However, regarding race and ethnicity, the researchers found that "Hispanic males (35%) were significantly less likely than their black (48%) or white (48%) peers to talk with their parents about saying no to sex, whereas white males (36%) were less likely to talk with their parents about HIV/AIDS than Hispanic (47%) or black (50%) males."

The researchers also found that 58 percent of black male teenagers discussed condom use with their parents, compared with 50 percent of Hispanic male teenagers and 43 percent of white male teenagers. Among girls, the researchers found that "the only significant differences by race/ethnicity were higher rates of talking about how to use a condom among Hispanic (46%) and black (45%) than white teens (33%) and higher rates of talking about [STIs] among Hispanic (67%) than non-Hispanic white girls (53%)."

Combined sources of information

According to the researchers, "There was substantial variation by topic and gender in the extent to which parents and formal instruction supplemented or reinforced one another."

For example, the researchers noted, "Although many teens received instruction on specific topics from both schools and parents ... there was a substantial share of teens who reported receiving instruction on specific topics only in school." However, "relatively few teens received instruction on a topic only from a parent." The researchers added that teenagers "were most likely not to receive instruction from either source about birth control methods generally (21% females, 34% males), where to get birth control (34% females, 53% males), or how to use a condom (40% females, 30% males)."

Discussion

"The changes described in these analyses point to significant reductions in adolescents' receipt of formal sex education, across topics addressing abstinence, birth control, and the prevention of HIV/AIDS and other [STIs]," the researchers wrote, noting, "This decline in formal instruction has been concentrated among girls, particularly non-Hispanic white teens and those living in nonmetropolitan areas."

While there were fewer disparities by gender in the 2011-2013 period, it was driven by a drop in formal sexuality education among girls, "bringing them in line with the more limited instruction received by teen boys," the researchers added, noting that many teenagers -- both male and female -- did not receive instruction until after first sex.

According to the researchers, these declines are part of a long-term trend. For example, the researchers write that in 1995, 81 percent of male teens and 87 percent of female teens received formal education about contraceptive methods, compared with 55 percent of males and 60 percent of females in the 2011-2013 set of data. However, they also cited the "significant increases in receipt of formal instruction in saying no to sex without instruction about birth control, a proxy measure for abstinence-only education." Moreover, the researchers noted that while about 90 percent of teenagers reported receiving formal education on STIs, such "instruction is generally limited."

The researchers noted that the recent declines in receipt of formal sexuality education "occurred despite increases in federal funding for teen pregnancy prevention programs and shifts in federal policy away from abstinence-only-until-marriage programs toward more comprehensive programs since 2009." The researchers explained that "a relatively small number of youth are served by these federal programs" and that Congress continues to allocate significant funding -- $85 million in fiscal year 2016 -- to abstinence-only education. Similarly, "[a]t the state level, sex education requirements are still heavily weighted toward stressing abstinence until marriage," the researchers wrote. They noted, "The increase in abstinence-only education documented in this study shows the continued salience of this approach to sex education, despite criticism and concern from major public health and medical groups."

The researchers highlighted the findings showing a decline in formal sexuality education among rural teenagers, stating that it was especially "concerning as rural adolescents are a particularly vulnerable group, with higher rates of teen childbearing, lower rates of contraceptive use, and less access to sexual and reproductive health care services than their nonrural peers." They pointed out that rural schools, which might lack resources, "may be particularly vulnerable to the influence of national and state educational policies" that do not incentivize sexuality education, while schools overall might prioritize other health topics instead of sexuality education.

While formal sexuality education has declined, the researchers noted that "the NSFG data indicate that parents' involvement in their teens' sex education have not changed over the period examined," aside from an increase in discussions about condom use. They wrote, "Parents did not fill the gaps in education when formal instruction was lacking," particularly education on contraception.

Citing the "differentials in formal instruction by household poverty level, especially among young men," the researchers noted that low-income teenagers "are more likely to live in impoverished neighborhoods, with lower school quality and less access to health services, and to have higher rates of [STIs], teen childbearing and early onset of sexual activity." The researchers wrote, "Improving both formal and informal sex education requires not only increasing the share of low income teens receiving this instruction but developing approaches that are responsive to the contexts of adolescents' lives."

The researchers also noted that their finding showing declines in formal sexuality education "occurred contemporaneously with substantial declines in the teen pregnancy and birth rates in the United States." They noted that while the "underlying drivers" of those declines are unclear, "[i]t is possible that teens have turned to digital media, including the Internet and social networking sites, for information."

The researchers noted that the Internet's availability, ease of use and anonymity "make it a likely source" of information on sexual and reproductive health. However, noting that "[o]nline resources are often inaccurate" and conflicting information can be difficult to successfully evaluate, the researchers called for further research into improving "the scope and quality of online sex education." The researchers cited studies showing that formal sexuality education, and comprehensive sexuality education in particular, "is associated with healthier sexual behaviors and outcomes," concluding, "It seems unlikely that adolescents' nearly universal access to the Internet means that other sources of formal and informal instruction are no longer relevant."