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Comprehensive risk reduction sexual education

Evidence Rating

Scientifically Supported

Health Factors

Comprehensive risk reduction programs provide information regarding contraception and protection against sexually transmitted infections (STIs). Sometimes called abstinence-plus programs, many efforts emphasize abstinence and delayed initiation of sex in addition to broader risk reduction components. Such programs can take place in schools (e.g., as part of the health curriculum) or in community settings; program components vary by implementer and specific model. 

Expected Beneficial Outcomes (Rated)

  • Reduced risky sexual behavior

Other Potential Beneficial Outcomes

  • Increased condom use

  • Increased use of contraception

  • Reduced sexual activity

  • Reduced teen pregnancy

  • Reduced incidence of STIs

Evidence of Effectiveness

There is strong evidence that comprehensive risk reduction programs decrease sexual risk behaviors among adolescents in both the short-term and the long-term (, , , Kirby 2007).

Comprehensive risk reduction programs have been shown to reduce risk behaviors such as engagement in sexual activity, frequency of sexual activity, number of partners, and frequency of unprotected sexual activity (Underhill 2007, , ). Such programs also increase use of contraception (, , , ).

Comprehensive risk reduction programs may reduce pregnancy (, , Underhill 2007) and sexually transmitted infections (STIs) among adolescents (). There is no evidence that providing comprehensive information regarding contraception in sexual education programs increases sexual activity or hastens initiation of sex (, Smoak 2006).

Research suggests that effective comprehensive risk reduction programs focus on specific behaviors, provide basic and accurate information regarding the risks and methods of protection, and include opportunities to address peer norms and practice communication, negotiation and refusal skills within the program (, Kirby 2007, ). Effective programs are usually conducted within groups () over the course of multiple sessions with multiple activities ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

Legislation regarding sex education varies from state to state. As of 2017, 24 states and the District of Columbia mandate sexual education in public schools, 34 states and the District of Columbia mandate HIV education, and 13 states require medically accurate sexual education (Guttmacher-Sex and HIV education).

Implementation Resources

Alford 2012 - Alford S. Science and success, 3rd edition: Sex education and other programs that work to prevent teen pregnancy, HIV and sexually transmitted infections. Washington, DC: Advocates for Youth; 2012.

Kirby 2007 - Kirby D. Emerging answers 2007: Research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; 2007.

NCSL-Sex ed - National Conference of State Legislatures (NCSL). State policies on sex education in schools.

Citations - Evidence

* Journal subscription may be required for access.

Kirby 2007 - Kirby D. Emerging answers 2007: Research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; 2007.

Cochrane-Underhill 2008* - Underhill K, Montgomery P, Operario D. Abstinence-plus programs for HIV infection prevention in high-income countries. Cochrane Database of Systematic Reviews. 2008;(1):CD007006.

Kirby 2000* - Kirby D. What does the research say about sexuality education? Educational Leadership. 2000;58(2):72-6.

Underhill 2007 - Underhill K, Operario D, Montgomery P. Systematic review of abstinence-plus HIV prevention programs in high-income countries. PLoS Medicine. 2007;4(9):e275.

Chin 2012* - Chin HB, Sipe TA, Elder R, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, Human Immunodeficiency Virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. American Journal of Preventive Medicine. 2012;42(3):272-94.

Bennett 2005* - Bennett SE, Assefi NP. School-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials. Journal of Adolescent Health. 2005;36(1):72–81.

Campbell-Scher 2006* - Scher L, Maynard RA, Stagner M. Interventions intended to reduce pregnancy-related outcomes among adolescents. Campbell Systematic Reviews. 2006:12.

Smoak 2006 - Smoak N, Scott-Sheldon LA, Johnson BT, et al . Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual behavior: A meta-analysis of 174 studies with 116,735 participants. Journal of Acquired Immune Deficiency Syndromes. 2006;41(3):374–84.

Denford 2017* - Denford S, Abraham C, Campbell R, Busse H. A comprehensive review of reviews of school-based interventions to improve sexual-health. Health Psychology Review. 2017;11(1):33-52.

Cochrane-Lopez 2016a* - Lopez LM, Bernholc A, Chen M, Tolley EE. School-based interventions for improving contraceptive use in adolescents. Cochrane Database of Systematic Reviews. 2016;(6):CD012249.

Citations - Implementation Examples

* Journal subscription may be required for access.

Guttmacher-Sex and HIV education - Guttmacher Institute. Sex and HIV education. New York: Guttmacher Institute.

Date Last Updated

Mar 30, 2017