Britain: Limits of Teacher Delivered Sex Education: Interim Behavioral Outcomes from Randomized Trial

In Britain problems associated with young people's sexual health include high rates of teenage pregnancy, a rising incidence of sexually transmitted diseases, and unsatisfactory early heterosexual relationships. Comprehensive sex education is regarded as essential to complement the provision of sexual health services for young people.

Despite the widespread assumption that sex education delivered by teachers can reduce sexual risk taking in young people, there have been few randomized trials large enough to show this and none in the United Kingdom. A review of sexual health interventions for primary prevention found that quasi-experimental studies show that interventions work and randomized trials show that they do not. However, recent findings from the United States have been more positive. Other studies have shown that sex education is more likely to influence behavior if it is narrowly focused, has a clear behavioral message, and develops negotiation skills.

This study sought to determine whether a theoretically based sex education program for adolescents (SHARE) delivered by teachers reduced unsafe sexual intercourse compared with current practice. The SHARE intervention (Sexual Health and Relationships: Safe, Happy and Responsible) is a five-day teacher training program plus a 20-session pack: 10 sessions in the third year of secondary school (at 13-14 years) and 10 in the fourth year (at 14-15 years). It is intended to reduce unsafe sexual behaviors, reduce unwanted pregnancies, and improve the quality of sexual relationships. The program was developed and piloted in Scotland over two years in consultation with teachers, sex education specialists, and education and health promotion departments.

In a cluster-randomized trial with 8,430 students ages 13 to 15 in 25 secondary schools in east Scotland, an intervention group was compared with the conventional sex education group. Follow up occurred up two years after baseline (six months after intervention). A process evaluation investigated the delivery of sex education and broader features of each school. Measures of the study included self-reported exposure to sexually transmitted disease, use of condoms and contraceptives at first and most recent sexual intercourse, and unwanted pregnancies.

Results of the study showed no differences between groups in sexual activity or sexual risk taking by the age of 16 years. However, those in the intervention group reported less regret of first sexual intercourse with most recent partner (young men 9.9 percent difference; young women 7.7 percent difference). Pupils evaluated the intervention program more positively, and their knowledge of sexual health improved. Evaluation of tertiary effects showed that the lack of behavioral effect could not be linked to differential quality of delivery of intervention.

According to the authors, "In comparison with conventional sex education, a program specially developed to incorporate current theories on behavioral change had a limited beneficial effect on the quality of relationships but no effect on use of condoms for the third of pupils who have had sexual intercourse by the age of 16 years. These results could be interpreted as evidence of the failure of the program, the delivery, or the evaluation."

Improvements in teacher delivered whole class sex education have some beneficial effect on the quality of young people's sexual relationships but do not influence sexual behavior. Compared with conventional sex education, this specially designed intervention did not reduce sexual risk taking in adolescents.

In their discussion, the researchers emphasized that their "analysis does not suggest that the lack of impact on behavior can be attributed to quality of delivery. The results imply that the potential for teacher delivered, whole class sex education to influence sexual behavior in adolescents might have already been reached by conventional provision. If behavioral change among this age group is a central objective of school sex education then it should be further refined and other means of delivery should be rigorously evaluated. The intervention program was rated more positively by pupils than comparison programs, led to greater practical knowledge about sexual health, and did not encourage earlier sexual activity."

A longer version of the report can be found at www.msoc-mrc.gla.ac.uk/Reports/Pages/share_MAIN.html.

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