Adolescents and young adults who attended sex education classes that discussed both abstinence and contraception have better sexual health outcomes than those who received no instruction on those topics.1 In an analysis of nationally representative survey data, respondents aged 15–24 who had received information on both topics were less likely than nonrecipients to have had sex before age 20 (odds ratios, 0.5 for females and 0.4 for males) and to have had a first partner who was much younger or older than them (0.5–0.7); they were more likely than nonrecipients to have used a condom or any effective form of contraception at first sex (1.7–1.9). Young people who had learned only about abstinence had reduced odds of having had sex before age 20, but did not differ from nonrecipients on other outcomes after adjustment for age at first sex.
The researchers analyzed data on youth aged 15–24 from the 2006–2008 National Survey of Family Growth. In addition to supplying information about their social and demographic characteristics, participants reported whether they had attended sex education classes that provided information on "how to say no to sex" and "methods of birth control"; from these responses, participants were classified as having been taught about abstinence, abstinence plus contraception or neither. Finally, the youth provided their age at first sex, as well as information about 10 other sexual and reproductive health outcomes; half of the outcomes concerned their initial experience with vaginal intercourse (e.g., condom use, whether the sex was wanted), while the others measured more recent or lifetime outcomes (e.g., whether they had ever been or gotten someone pregnant).
Bivariate and multivariate regression analyses were conducted separately for males and females. Youth were excluded if data on their sex education were unavailable, they had received education on contraception but not abstinence, or they had had sex before age 10; the resulting analytic sample consisted of 2,505 females and 2,186 males. Analyses related to first sex were restricted to sexually experienced respondents for whom data on the timing of sex education were available (1,647 females and 1,360 males); analyses related to current or lifetime sexual outcomes were further restricted to never‐married respondents (1,383 females and 1,242 males).
Overall, 66% of sexually experienced females and 55% of their male counterparts had had sex education that covered both abstinence and contraception; 18% of females and 21% of males had been taught only about abstinence, and the remainder had not received information about either topic. In bivariate analyses, eight sexual and reproductive measures were associated with sex education among one or both genders; outcomes were generally worst among youth who had not received instruction on either topic. For example, 80% of young women who had been taught about both topics had used a contraceptive method at first sex, compared with 74% of those who had been taught only about abstinence and 61% of those who had had neither type of sex education.
In multivariate analyses that adjusted for social and demographic characteristics, the likelihood that a young woman had had sex for the first time before age 20 was lower among those who had had lessons on abstinence and contraception or abstinence alone than among those who had had neither type of instruction (odds ratios, 0.5 and 0.6, respectively). Reductions in odds were even greater among males (0.4 each).
Among females, five of the remaining 10 outcomes were associated with abstinence‐plus‐contraception education. After adjustment for age at first sex, four associations remained: Young women who had received instruction about both topics were more likely than those who had received information about neither to have used condoms and to have used any effective contraceptive at first sex (odds ratio, 1.7 for each); they were less likely to report that their first sex had been unwanted (0.5) or had occurred with an age‐discrepant partner (0.7). Abstinence‐plus‐contraception education was associated with eight of the 10 measures among males, although only three associations remained after adjustment for age at first sex. Compared with young men who had received instruction on neither topic, those who had received instruction on both had elevated odds of having used condoms and having used any effective contraceptive at first sex (1.9 for each), and reduced odds of having a partner who was at least three years older or younger (0.5).
Among both sexes, abstinence‐only education was not associated with any of the other 10 measures after adjustment for age at first sex. However, outcomes in the abstinence group did not differ from those in the abstinence‐plus‐contraception group either, with one exception: Compared with young women who had been taught only about abstinence, those who had received both types of instruction were more likely to have used a condom at first sex.
The researchers note that a limitation of the study was the lack of information about the content of sex education; some youth in the abstinence‐plus‐contraception group may have been taught that contraceptives are ineffective, a scenario the investigators suspect contributed to the lack of differences between the two instruction groups. The study's reliance on participants’ recall was also a limitation. Nonetheless, the findings suggest that "receipt of formal sex education before first sex, particularly that including instruction about both delaying sex and birth control methods, was associated with a range of healthier outcomes among adolescents and young adults," according to the investigators. Moreover, because both types of sex education were associated with older age at first sex, the researchers speculate that convincing adolescents to delay sexual debut may depend less on the content of conversations about sex than on having such discussions at all.—P. Doskoch