Comprehensive risk reduction sexual education

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 (Denford 2017*, Chin 2012*, Cochrane-Underhill 2008*, 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, Cochrane-Underhill 2008*, Chin 2012*). Such programs also increase use of contraception (Cochrane-Lopez 2016a*, Chin 2012*, Campbell-Scher 2006*, Bennett 2005*).

Comprehensive risk reduction programs may reduce pregnancy (Chin 2012*, Cochrane-Underhill 2008*, Underhill 2007) and sexually transmitted infections (STIs) among adolescents (Chin 2012*). There is no evidence that providing comprehensive information regarding contraception in sexual education programs increases sexual activity or hastens initiation of sex (Cochrane-Underhill 2008*, Smoak 2006Bennett 2005*).

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 (Denford 2017*, Kirby 2007, Kirby 2000*). Effective programs are usually conducted within groups (Chin 2012*) over the course of multiple sessions with multiple activities (Cochrane-Lopez 2016a*).

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

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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.

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.

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 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.

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.

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.

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

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.

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.

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

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.

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