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HIV, Other STD and Pregnancy Prevention Education in Public Secondary Schools -- 45 States, 2008-2010

By Laura Kann, Ph.D., Nancy Brener, Ph.D., Timothy McManus, M.S., and Howell Wechsler, Ed.D.

April 6, 2012

In the United States, 46% of high school students have had sexual intercourse and potentially are at risk for human immunodeficiency virus (HIV) infection, other sexually transmitted diseases (STDs), and pregnancy.1 The National HIV/AIDS Strategy for the United States recommends educating young persons about HIV before they begin engaging in behaviors that place them at risk for HIV infection.2 The Community Preventive Services Task Force (CPSTF) also recommends risk reduction interventions to prevent HIV, other STDs, and pregnancy among adolescents.3 To estimate changes in the percentage of secondary schools that teach specific HIV, other STD, and pregnancy risk reduction topics, a key intervention consistent with those supported by the National HIV/AIDS Strategy and CPSTF,2,3 CDC analyzed 2008 and 2010 School Health Profiles data for public secondary schools in 45 states. This report summarizes the results of those analyses, which indicated that in 2010, compared with 2008, the percentage of secondary schools teaching 11 topics on HIV, other STD, and pregnancy prevention in a required course in grades 6, 7, or 8 was significantly lower in 11 states and significantly higher in none; the percentage of secondary schools teaching eight topics in a required course in grades 9, 10, 11, or 12 was significantly lower in one state and significantly higher in two states; and the percentage of secondary schools teaching three condom-related topics in a required course in grades 9, 10, 11, or 12 was significantly lower in eight states and significantly higher in three states. Secondary schools can increase efforts to teach all age-appropriate HIV, other STD, and pregnancy prevention topics to help reduce risk behaviors among students.

School Health Profiles surveys have been conducted biennially since 1996 to assess school health practices in the United States.* States, territories, large urban school districts, and tribal governments participate in the surveys, either selecting systematic, equal-probability samples of their secondary schools (middle schools, junior high schools, and high schools with one or more of grades 6-12), or selecting all public secondary schools within their jurisdiction.§ Self-administered questionnaires are sent to the principal and lead health education teacher at each selected school and returned to the agency conducting the survey. Lead health education teachers are asked questions regarding the content of required instruction related to HIV, other STD, and pregnancy prevention. Data are included in this report only if the state provided appropriate documentation of methods and had a school response rate ≥70% for both the 2008 and 2010 surveys. Across states included in this report, school response rates ranged from 70% to 93% (median: 73%) in 2008 and from 70% to 86% (median: 73%) in 2010. The number of lead health education teachers who participated, by state, ranged from 71 to 472 (median: 245) in 2008 and from 65 to 677 (median: 249) in 2010. Participation in School Health Profiles is confidential and voluntary. Follow-up telephone calls, e-mails, and written reminders are used to encourage participation. For states that use a sample-based method, results are weighted to reflect the likelihood of schools being selected and to adjust for differing patterns of nonresponse. For states that conduct a census, results are weighted to adjust for differing patterns of nonresponse.

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This report includes data from 45 states that provided weighted School Health Profiles data in 2008 and 2010.** For each of these states, three composite measures were created to determine the percentage of schools that taught 1) all 11 topics listed in the questionnaire in a required course in grades 6, 7, or 8; 2) all eight topics listed in the questionnaire in a required course in grades 9, 10, 11, or 12; and 3) all three condom-related topics listed in the questionnaire in a required course in grades 9, 10, 11, or 12. These topics reflect the knowledge and skills that are the focus of interventions shown to be effective in reducing risk that CPSTF and others use as a basis for their recommendations about interventions for adolescents.3-6 For each state, the percentages of schools that taught individual topics and the composite measurements are reported. Significant (p<0.05) differences between results from 2008 and 2010 were determined by t-test. Statistical software was used to account for the sample design and unequal weights.

Compared with 2008, the percentage of schools in 2010 in which all 11 topics were taught in a required course in grades 6-8 was significantly lower in 11 states and significantly higher in no state (Table 1). The percentage of schools in which all eight topics were taught in a required course in grades 9-12 was significantly lower in one state and significantly higher in two states (Table 2). Additionally, the percentage of schools in which all three condom-related topics were taught in a required course in grades 9-12 was significantly lower in eight states and significantly higher in three states (Table 3). Among the 45 states in 2010, the percentage of schools that taught all 11 topics in grades 6, 7, or 8 ranged from 12.6% (Arizona) to 66.3% (New York) (median: 43.3%), the percentage of schools that taught all eight topics in grades 9-12 ranged from 45.3% (Alaska) to 96.4% (New Jersey) (median: 80.3%), and the percentage of schools that taught all three condom-related topics in grades 9-12 ranged from 11.3% (Utah) to 93.1% (Delaware) (median: 58.1%).

For five of the 11 topics (Table 1), the percentage of schools teaching the topic in a required course in grades 6-8 increased significantly in no state, and for the remaining six topics, the percentage increased significantly in one state. Conversely, the percentage of schools teaching any one topic decreased significantly in one to 10 states. The percentage of schools teaching how HIV and other STDs are diagnosed and treated decreased significantly in 10 states, as did the percentage teaching health consequences of HIV, other STDs, and pregnancy. The percentage of schools teaching how to prevent HIV, other STDs, and pregnancy decreased significantly in nine states.

For five of the eight topics (Table 2), the percentage of schools teaching the topic in a required course in grades 9-12 increased significantly in no state; for two topics, the percentage increased significantly in one state; and for the remaining two topics, the percentage increased significantly in two states. Conversely, the percentage of schools teaching any one topic decreased significantly in one to four states. The relationship among HIV, other STDs, and pregnancy was the one topic that showed significant decreases in the percentage of schools teaching it in four states. No state showed a significant increase, and one to seven states showed a significant decrease in the percentage of schools teaching any of the three condom-related topics in any of grades 9-12 (Table 3). The percentage of schools teaching how to obtain condoms decreased significantly in seven states.

Reported by: Laura Kann, Ph.D., Nancy Brener, Ph.D., Timothy McManus, M.S., Howell Wechsler, Ed.D., Div of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Laura Kann, lkk1@cdc.gov, 770-488-6181.

Editorial Note

CPSTF recommends group-based comprehensive risk reduction interventions delivered to adolescents, in schools or communities, to promote behaviors that prevent or reduce the risk for HIV, other STDs, and pregnancy. This recommendation is based on evidence of effectiveness in reducing engagement in any sexual activity, frequency of sexual activity, number of partners, and frequency of unprotected sexual activity, and in increasing the self-reported use of protection against STDs and pregnancy.3

Although a median of 90% of all public secondary schools across the 45 states in this report taught HIV prevention in a required course during 2010,7 the findings indicate that little progress was made in increasing the number of specific topics covered as part of HIV, other STD, and pregnancy prevention education during 2008-2010. The percentage of secondary schools that taught all HIV, other STD, and pregnancy prevention topics in a required course also varied widely across states. Further research is needed to understand determinants of the number of specific HIV, other STD, and pregnancy prevention topics taught in secondary schools.

HIV, other STD, and pregnancy prevention education in grades 6-8 is particularly important because most students in those grades are not yet sexually active.1,2 HIV, other STD, and pregnancy prevention education that is taught before most young persons engage in risk behaviors, and that includes information on the benefits of abstinence and delaying or limiting sexual activity, can prevent behaviors that might lead to HIV infection, other STDs, and pregnancy.2

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Because many students become sexually active during high school,1 HIV, other STD, and pregnancy prevention education in these grades also is critically important.2 HIV, other STD, and pregnancy prevention education that includes information on condom efficacy, the importance of using condoms consistently and correctly, and how to obtain condoms taught to those who might decide to be or are sexually active also can prevent behaviors that might lead to HIV infection, other STDs, and pregnancy.4-6

HIV prevention education also can address misconceptions about how HIV is transmitted.2 A 2011 public opinion poll indicated that 20% of persons aged 18-29 years believe incorrectly that a person can become infected with HIV by sharing a drinking glass, or are unsure whether the statement is true or false.8

The findings in this report are subject to at least three limitations. First, these data apply only to public secondary schools and, therefore, do not reflect practices at private schools or elementary schools. Second, these data were self-reported by lead health education teachers or their designees, and the accuracy of their description of the HIV, other STD, and pregnancy prevention topics taught in required courses was not verified by other sources. Finally, the effect of changes between 2008 and 2010 in the percentage of secondary schools in a state that taught HIV, other STD, and pregnancy prevention topics varies by the number of students attending public schools in the state during those years. States with fewer students would have less of a nationwide impact.

HIV prevention education supports strategies required to achieve the National HIV/AIDS Strategy goal of lowering the annual number of new HIV infections by 25% by 2015.2 Families, the media, and community organizations, including faith-based organizations, can play a role in providing HIV, other STD, and pregnancy prevention education. However, schools are in a unique position to provide HIV, other STD, and pregnancy prevention education to young persons because almost all school-aged youths in the United States attend school.9 School policies can provide critical support for implementation of comprehensive HIV, other STD, and pregnancy prevention education in secondary schools.10


Acknowledgment

State School Health Profiles coordinators.


References

  1. CDC. Youth risk behavior surveillance -- United States, 2009. MMWR 2010;59(No. SS-5).
  2. Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington, DC: The White House; 2010. Accessed December 9, 2011.
  3. CDC. Guide to community preventive services. Prevention of HIV/AIDS, other STIs and pregnancy: interventions for adolescents. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Accessed March 28, 2012.
  4. CDC. Health Education Curriculum Analysis Tool (HECAT). Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed December 13, 2011.
  5. Kirby D, Laris BA, Rolleri L. Sex and HIV education programs for youth: their impact and important characteristics. Scotts Valley, CA: ETR Associates; 2006. Accessed December 13, 2011.
  6. Kirby D, Coyle K, Alton F, Rolleri L, Robin L. Reducing adolescent sexual risk: a theoretical guide for developing and adapting curriculum-based programs. Scotts Valley, CA: ETR Associates; 2011. Accessed December 13, 2011.
  7. Brener ND, Demissie Z, Foti K, et al. School Health Profiles 2010: characteristics of health programs among secondary schools in selected U.S. sites. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Accessed December 9, 2011.
  8. Kaiser Family Foundation. HIV/AIDS at 30: a public opinion perspective. Menlo Park, CA: Kaiser Family Foundation; 2011. Accessed December 9, 2011.
  9. Snyder TD, Dillow SA. Table 7. Percentage of the population 3 to 34 years old enrolled in school, by age group: selected years, 1940 through 2009. In: Digest of education statistics 2010. Washington, DC: US Department of Education, National Center for Education Statistics, Institute of Education Sciences; 2011. Accessed December 9, 2011.
  10. National Association of State Boards of Education. Someone at school has AIDS: a complete guide to education policies concerning HIV infection. Alexandria, VA: National Association of State Boards of Education; 2001.

* Additional information and questionnaires are available at www.cdc.gov/healthyyouth/profiles.

† Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Florida, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Virginia, Washington, West Virginia, and Wisconsin.

§ Delaware, Hawaii, Idaho, Maine, Massachusetts, Montana, Nevada, New Hampshire, Rhode Island, South Carolina, Utah, Vermont, and Wyoming.

¶ In 2008, lead health education teachers were asked, "During this school year, did teachers in this school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in any of grades 6, 7, or 8?" for a list of 11 topics (Table 1) (e.g., how HIV and other STDs are diagnosed and treated; how to prevent HIV, other STDs, and pregnancy; and the benefits of being sexually abstinent). Respondents were instructed to mark "yes" or "no" for each topic or "not applicable" if their school did not include grades 6, 7, or 8. Teachers also were asked the same question for grades 9-12 for a list of eight topics (Table 2) that repeated some of the 11 topics and added others (e.g., the relationship between alcohol and other drug use and risk for HIV, other STDs, and pregnancy), and three condom-related topics (Table 3). In 2010, lead health education teachers were asked, "During this school year, did teachers in your school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in each of the grade spans below?" The topics, grade spans, and possible responses were the same as those specified in 2008.

** Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.


What is already known on this topic?

Schools provide a unique setting for reaching most youths nationwide with information they can use to prevent human immunodeficiency virus (HIV) infection, other sexually transmitted diseases, and pregnancy.

What is added by this report?

In 2010, compared with 2008, the percentage of public secondary schools in 45 states teaching specific HIV, other sexually transmitted disease (STD), and pregnancy prevention topics in required courses generally did not increase, and percentages teaching all topics varied widely across these states.

What are the implications for public health practice?

To help reduce HIV-, other STD-, and pregnancy-related risk behaviors among students, secondary schools can increase efforts to teach all age-appropriate HIV, other STD, and pregnancy prevention topics.

Table 1. Percentage of Public Secondary Schools in Which Specific Human Immunodefiency Virus (HIV), Sexually Transmitted Disease (STD), or Pregnancy Prevention Topics Were Taught in a Required Course in Grades 6, 7, or 8 -- 45 states, 2008 and 2010

Table 1. Percentage of Public Secondary Schools in Which Specific Human Immunodefiency Virus (HIV), Sexually Transmitted Disease (STD), or Pregnancy Prevention Topics Were Taught in a Required Course in Grades 6, 7, or 8 -- 45 states, 2008 and 2010


Table 2. Percentage of Public Secondary Schools in Which Specific Human Immunodefiency Virus (HIV), Sexually Transmitted Disease (STD), or Pregnancy Prevention Topics Were Taught in a Required Course in Grades 9, 10, 11, or 12 -- 45 states, 2008 and 2010

Table 2. Percentage of Public Secondary Schools in Which Specific Human Immunodefiency Virus (HIV), Sexually Transmitted Disease (STD), or Pregnancy Prevention Topics Were Taught in a Required Course in Grades 9, 10, 11, or 12 -- 45 states, 2008 and 2010


Table 3. Percentage of Public Secondary Schools in Which Specific Condom-Related Topics Were Taught in a Required Course in Grades 9, 10, 11, or 12 -- 45 states, 2008 and 2010

Table 3. Percentage of Public Secondary Schools in Which Specific Condom-Related Topics Were Taught in a Required Course in Grades 9, 10, 11, or 12 -- 45 states, 2008 and 2010




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