Kyle & Amy Article

Amy S. Hedman, PhD, CHES
Dawn Larsen, PhD, CHES
Steve Bohnenblust, PhD
Abstract: This research study assessed the scope of comprehensive sexuality education (CSE)
offered to high school students, using 39 topics defined by SIECUS’s Guidelines for CSE, and
determined if a correlation existed between number of topics emphasized and the corresponding
county’s teenage pregnancy rate, for a sample of 10 Minnesotan counties. A survey was sent
to 104 educators within 10 counties. A mean of 24 topics were reportedly emphasized. No
significant correlation r(7) = 0.50, p = .915 was found between pregnancy rates and number
of topics reportedly emphasized. Results showed that CSE was not correlated with lower teenage
pregnancy rates.
Teen pregnancy rates have steadily declined since
1950. As a nation, the birth rate among females aged
15-19 years declined 20.1% during 1991 and 1998
(National Campaign, 2000). Despite these trends,
the U.S. still has one of the highest teen pregnancy
rates among developed countries (Jordan, Price, &
Fitzgerald, 2000). In 2002, 757,000 pregnancies
occurred among females aged 15-19 years, resulting
in 425,000 births, 215,000 induced abortions,
and 117,000 fetal losses (Ventura, Abma, Mosher,
Henshaw, n.d.). Nationally, 46.8% of students have
had sexual intercourse, with 14.3% reporting four or
more partners during their lifetime (CDC, 2006).
Among the new 15 million cases of sexually transmitted
diseases (STDs) each year in the U.S., 25%
occurred among teens (CDC, 2000). Many teens are
sexually active despite the fact that they may not be
cognitively, emotionally, or financially prepared for
the consequences of their behaviors.
Teen pregnancy rates have shown a steady decline,
however the National Campaign to Prevent
Teen and Unplanned Pregnancy (2008) reported
that “between 2005 and 2006, the national teen
birth rate increased three percent-the first increase
in fifteen years” (p. 1). Numerous studies have been
conducted in an attempt to determine the most effective
way to educate youth about sexuality, personal
responsibility, and pregnancy prevention. Comprehensive
sexuality education (CSE) is advocated to
be most effective in teaching teens about the knowledge,
skills, and values related to their sexual health
(Moore & Rienzo, 2000), however such programs
have received insufficient support and funding from
the federal government thereby limiting schools’
ability to implement comprehensive sexuality education
(National Campaign, 2008). Research is
limited on the extent to which CSE is implemented
in public schools’ sex education curricula and what
relationship, if any, exists between teen pregnancy
rates and the CSE offered to students. CSE is a valuable
component of sex education curricula. In order
to advocate for its inclusion in all curricula, it would
be beneficial to know if CSE is negatively correlated
with teen pregnancy, especially since the U.S.’s teen
birth rates have recently risen. Such findings would
support efforts to ensure all students receive comprehensive
education regarding sexual health and
pregnancy prevention.
The purpose of this study was to measure the
sexuality topics emphasized in a sample of public
high school sex education classes, and to assess
whether the level of CSE was related to the counties’
teen pregnancy rates. By investigating CSE, the
school health discipline will learn more about teachers’
attitudes and beliefs as well as perceived barriers
to teaching CSE. Examining the relationship
between CSE and teen pregnancy may help identify
deficiencies that exist in school-based sex education.
This study aimed to answer the following questions:
1. What is the teen (15-19 years) pregnancy
rate in each of the counties surveyed?
Amy S. Hedman, PhD, CHES, is an Assistant Professor in the Department of Health Science, Minnesota
State University. Dawn Larsen, PhD, CHES, is a Professor in the Department of Health Science, Minnesota
State University. Steve Bohnenblust, PhD, is a Professor in the Department of Health Science, Minnesota
State University. Please address all correspondence to Amy Hedman, 213 Highland Center North, Mankato,
MN 56001. Phone: (507) 389-5382, Fax: (507) 389-2985, Email: ude.usnm|namdeh.yma#ude.usnm|namdeh.yma.
American Journal of Health Studies: 23(4) 2008
2. What sexuality topics, as defined by
SIECUS’s Guidelines for Comprehensive Sexuality
Education, taught in public high schools commonly
receive major emphasis, minor emphasis, or no emphasis?
3. Is there a negative correlation between the
scope of sexuality topics emphasized in high school
sex education and the pregnancy rate for the county?
4. Is there a correlation between the amount
of time spent on sex education during 9-12th grade
and the teen pregnancy rate among the 10 counties?
5. What are frequently reported barriers to
teaching sex education to high school students, as
reported by sexuality educators?
SIECUS: The Guidelines for Comprehensive
Sexuality Education (The Guidelines). Sexuality Information
and Education Council of United States
(SIECUS) has developed guidelines specifically for
sex education. The Guidelines are centered upon the
following four goals:
1) Information: Sexuality education seeks
to provide accurate information about human
sexuality, including growth and development,
human reproduction, anatomy, physiology,
masturbation, family life, pregnancy, childbirth,
parenthood, sexual response, sexual orientation,
gender identity, contraception, abortion, sexual
abuse, HIV/AIDS, and other sexually transmitted
2) Attitudes, Values, and Insights: Sexuality
education seeks to provide an opportunity for
young people to question, explore, and assess
their own and their community’s attitudes about
society, gender, and sexuality. This can help
young people understand their family’s values,
develop their own values, improve critical thinking
skills, increase self-esteem and self-efficacy,
and develop insights concerning relationships
with family members, individuals of all genders,
sexual partners, and society at large. Sexuality
education can help young people understand
their obligations and responsibilities to their
families and society.
3) Relationships and Interpersonal Skills:
Sexuality education seeks to help young people
develop interpersonal skills, including communication,
decision-making, assertiveness, and
peer refusal skills, as well as the ability to create
reciprocal and satisfying relationships. Sexuality
education programs should prepare students to
understand sexuality effectively and creatively in
adult roles. This includes helping young people
develop the capacity for caring, supportive, noncoercive,
and mutually pleasurable intimate and
sexual relationships.
4) Responsibility: Sexuality education seeks
to help young people exercise responsibility regarding
sexual relationships by addressing such
issues as abstinence, how to resist pressures to
become involved in unwanted or early sexual intercourse,
and the use of contraception and other
sexual health measures (SIECUS, 2004, p. 19).
In addition to the goals mentioned above, The
Guidelines include six key concepts and corresponding
topics. The Guidelines include the following:
Key Concept 1: Human Development. Topics
include: Reproductive and Sexual Anatomy
and Physiology, Puberty, Reproduction, Body
Image, Sexual Orientation, and Gender Identity.
Key Concept 2: Relationships. Topics include:
Families, Friendship, Love, Romantic
Relationships and Dating, Marriage and Lifetime
Commitments, and Raising Children.
Key Concept 3: Personal Skills. Topics include:
Values, Decision-making, Communication,
Assertiveness, Negotiation, and Looking
for Help.
Key Concept 4: Sexual Behavior. Topics
include: Sexuality Throughout Life, Masturbation,
Shared Sexual Behavior, Sexual Abstinence,
Human Sexual Response, Sexual Fantasy, and
Sexual Dysfunction.
Key Concept 5: Sexual Health. Topics
include: Reproductive Health, Contraception,
Pregnancy and Prenatal Care, Abortion, Sexually
Transmitted Diseases, HIV and AIDS, and
Sexual Abuse, Assault, Violence and Harassment.
Key Concept 6: Society and Culture. Topics
include: Sexuality and Society, Gender Roles,
Sexuality and the Law, Sexuality and Religion,
Diversity, Sexuality and the Media, and Sexuality
and the Arts (SIECUS, 2004, p. 15-18).
To date, research on the scope of CSE is limited.
To measure sex education effectiveness, Klein,
Goodson, Serrins, Edmundson, and Evans (1994)
conducted a content analysis of 10 nationally known
sex education curricula using SIECUS’s Guidelines as
criteria for assessment. Of the 10 curricula analyzed,
only six curricula addressed at least one-half of the
36 topics recommended by SIECUS. One limitation
to their study was that only the number of topics
addressed was measured, not the extent to which
topics were covered (Klein et al. 1994).
Moore and Rienzo (2000) looked at sex education
offered in public high schools and assessed
the relationship between the number of topics (in
the Guidelines) taught and the level of importance
that the teachers assigned to the topics. Moore and
Rienzo found a mean of 25 of the 36 topics were reportedly
taught by the teachers surveyed. Common
topics taught were “abstinence, decision-making,
STDs/HIV, communication, values and finding
help;” neglected topics included: “abortion, sexuality
and religion, sexuality and the law, shared sexual
behavior, diversity, masturbation, fantasy, sexual
dysfunction, and sexuality and the arts” (Moore &
Rienzo, 2000, p. 59).
CSE offered to children throughout their education
provides students with essential information.
Although teen sexual activity is influenced by a
variety of factors, providing sexuality information
to students is crucial in educating students about
protecting their sexual health and reducing risk of
pregnancy and STDs including HIV. This study attempted
to determine the extent to which specific
sexuality topics (as recommended by SIECUS) were
emphasized in sex education classes and whether or
not a relationship existed between county teen pregnancy
rates and CSE offered in schools.
Prior to data collection, approval from the university’s
Institutional Review Board was obtained.
From the population of all public high school sex
educators in MN, the participants of this study represented
the sex educators of 10 randomly selected
counties. All Minnesota counties were identified
and pooled. The first 10 counties drawn from the
pool were selected for this study.
All public high schools within each selected
county were identified through the MN Department
of Education (Districts by County Contact Listing,
n.d.). For each of the 10 counties, every public
school serving grades 9-12 was contacted by telephone.
The educators’ names and specific disciplines
were collected. Educators representing Health,
Physical Education, Family Consumer Science,
Home Economics, Child Development and Family
Life were included in the sample. An online search
was also conducted to further identify current sex
educators. Educators representing the disciplines
mentioned above received a cover letter, the Sexuality
Educator Survey (SES), and a postage-paid, self-addressed
return envelope. The cover letter described
the study’s purpose and listed the participating counties.
The envelopes were coded to track returns and
provide information on who should receive a followup
Teen pregnancy rates were taken from the
Center for Health Statistics, MN Department of
Health. The teen pregnancy rate represented the
number of pregnancies per 1,000 females aged 15-
19 years, for a three-year period (2003-2005) within
each of the 10 counties. Data for this study was
collected using the SES, a survey designed to assess
the level of emphasis placed upon each of the 39
sexuality topics (Guidelines) during sex education
classes. Information regarding the teachers’ qualifications,
training, and experience teaching sexuality was
obtained. In addition, participants were asked about
perceived barriers of teaching sexuality and personal
beliefs regarding sex education. Data was collected
Spring 2007.
A 26-item survey was developed based on a
comprehensive literature review and SIECUS’s
Guidelines. The survey was designed with reference
to Moore and Rienzo’s (2000) study that used the
Guidelines to “access the scope of sexuality education
topics taught by teachers” and their “rated importance
of these topics in public high school” (p. 57).
The content and format of Moore and Rienzo’s survey
was taken from the “Survey of School Sexuality
Education,” developed by Yarber, Torabi and Haffner
(1997). Moore and Rienzo’s survey assessed topics
taught and teachers’ ratings of importance for
each topic. For this study, participants were asked
the level of emphasis that each of the sexuality topics
received, rather than the teachers’ perceptions of
importance. The topics were listed randomly, in no
particular order.
Assessing content validity for the survey involved
two stages: Developmental Stage and Judgment-
Quantification Stage (Lynn, 1986). A thorough
review of literature and item selection took place
during the Developmental Stage. The Judgment-
Quantification Stage involved asking professional
experts to review the SES for content validity. The
SES was sent to a panel (convenience sample) of
experts within the field of sex education (n=6) for
content validity. Based on the suggestions given,
the final version of the SES consisted of 26 items.
Results of a reliability analysis were .869 Cronbach
alpha for the topic items and .835 Cronbach alpha
for the teaching barrier items.
Demographic questions included gender,
ethnicity, and age. Additional items included
teachers’education and certification attained, and
experience teaching sex education. Participants were
asked to rate their level of confidence in teaching sex
education. Participants were asked to estimate the
total number of weeks that 9th-12th graders in their
school received sex education.
Participants were instructed to read five statements
and indicate whether or not they agreed with
each statement. The questions related to personal
beliefs regarding the qualities of effective sex education.
Next, using a table format, participants were
asked to indicate the biggest barrier to teaching each
of the following: abstinence, HIV/AIDS, assertive-
Hedman, Larsen & Bohnenblust
American Journal of Health Studies: 23(4) 2008
ness skills, contraception, abortion, teen parents,
sexual orientation, body image, and decision making
skills. Finally, participants were asked to indicate the
level of emphasis that each of the 39 sexuality topics
experienced during their sex education course.
Analyses were conducted separately, according
to county. Data was documented and analyzed using
SPSS. Descriptive statistics were used to describe the
demographical results as well as the background and
beliefs of the participants. Pearson product-moment
correlation coefficient was used to measure the degree
of relationship between the teen pregnancy rate
and total number of sexuality topics emphasized, as
well as the relationship between teen pregnancy rate
and average time spent on sex education during high
school. The level of significance used for this study
was p <.05.
This study measured the extent to which CSE
was reportedly offered in MN public high schools
and assessed whether there was a correlation between
the extent of CSE offered and teen pregnancy rates.
Surveys were sent to 104 presumed sexuality educators
within a sample of 10 counties in MN. The
initial response rate was 33% (n=34). Of 34, 29
educators were currently teaching sex education and
therefore qualified for this study, representing a 28%
response rate.
Thirty-eight percent of the educators surveyed
were male (n=11) and 62% were female (n=18). All
respondents (n=29) were Caucasian. The mean age
of the educators surveyed was 46 years, with a range
of 29-58 years. Eighty-three percent (n=24) of the
educators reported completing a college academic
course on sexuality. Thirty-two percent of the educators
(n=9) reported that 10th grade was the grade
level at which they most frequently taught sex education.
The mean hours spent teaching sexuality within
a semester/quarter was 23.5 hours (s.d. 35.98), ranging
from 2 to 160 hours, with 85% (n=23) of educators
reporting less than 20 hours. When asked if
their sex education course was required, 59% (n=17)
reported yes and 41% (n=12) answered no.
Table 1. Total Pregnancies per 1,000 Females Aged 15-19 years
County Pregnancy Rate
Benton 42.3
Clearwater 41.7
Hubbard 29.6
Kittson Not available
Lake of the Woods Not available
Lyon 23.2
Swift 32.5
Todd 38.9
Wabasha 30.7
Watonwan 53.1
(MN County Health Tables, 2006)
Table 2. Reported Topics Most Commonly Receiving Major Emphasis, All Counties
Topic Percentage Number
Communication 62% (n=18)
STDs 62% (n=18)
Sexual Abstinence 59% (n=17)
Values 41% (n=12)
Pregnancy & Prenatal Care 41% (n=12)
Love 41% (n=12)
Sexual Abuse, Assault, Violence & Harassment 41% (n=12)
Educators reported a mean of 15.54 years experience
teaching sex education, with a range of 4 to
34 years. Overall, 86% (n=25) of the educators felt
confident or very confident teaching sexuality, with
7% (n=2) of the educators reported feeling unconfident.
Educators were asked how committed their
school was in providing CSE, using a scale of one to
10 with 10 being most committed; the mean score
was 6.6. Eighteen percent (n=5) of the educators
stated that they used a standardized sex education
curriculum, versus 27% (n=7) who used an abstinence-
only curriculum.
To answer the first research question, teen pregnancy
rates of the 10 counties selected were taken
from MN Department of Health (MN County
Health Tables, 2006). Rates represented pregnancies
per 1,000 females aged 15-19 years old during 2003-
2005. Teen pregnancy rates for the 10 counties are
displayed in Table 1.
To assess the second research question, a frequency
table was used to tally the total of sexuality
topics receiving major, minor, and no emphasis.
The extent of emphasis for each topic was assessed
for each county in order to evaluate if a correlation
existed between the number of total topics emphasized
and the county teen pregnancy rate. Of the
39 topics listed in the Guidelines, a mean number
of 12.6 topics received minor emphasis, 11.6 topics
received major emphasis, and 9.9 topics received no
Table 2 highlights the topics most frequently
reported to receive major emphasis, these include
decision-making at 66% (n=19), communication at
62% (n=18), STDs at 62% (n=18), and sexual abstinence
at 59% (n=17). Topics most likely to receive
no emphasis included sexual fantasy, masturbation,
sexuality and religion, human sexual response, and
sexual orientation. Table 3 displays the topics most
likely to receive no emphasis.
Table 4 displays the number of educators that
reported major, minor, or no emphasis for each of
the 39 topics included in the Guidelines. The topics
are displayed by key concept. Tests of significance
of binomial proportions were conducted to determine
if significant differences were observed among
the key concept categories (Human Development,
Relationships, Personal Skills, Sexual Behavior,
Sexual Health, and Society and Culture) reportedly
receiving major emphasis compared to those receiving
minor/no emphasis. For all categories, the observed
proportion of major emphasis was significantly
different that the observed proportion of minor/
no emphasis at the 0.05 level (2 tailed). See Table 5
for further details.
The third research question sought to determine
if a correlation existed between the average number
of topics emphasized during sex education and the
teen pregnancy rate for each of the counties. Using
Pearson product-moment correlation coefficient,
no significant correlation r(7) = 0.50, p = .915 was
found between pregnancy rates and the average
number of sexuality topics reported to receive emphasis
in class.
The fourth research question asked if a correlation
existed between the amount of time spent
on sex education during 9th-12th grades and the
teen pregnancy rate among the 10 counties. Using
Pearson product-moment correlation coefficient,
no significant correlation r(7) = .001, p = .998 was
found between the pregnancy rates of the 10 counties
and the mean total weeks reportedly spent on
sex education during grades 9-12. Therefore, for
Table 3. Reported Topics Most Commonly Receiving No Emphasis, All Counties
Topic Percentage Number
Sexual Fantasy 76% (n=22)
Masturbation 66% (n=19)
Sexuality & Religion 48% (n=14)
Human Sexual Response 48% (n=14)
Sexual Orientation 48% (n=14)
Negotiation 41% (n=12)
Abortion 41% (n=12)
Gender Identity 41% (n=12)
Sexuality & the Law 38% (n=11)
Hedman, Larsen & Bohnenblust
American Journal of Health Studies: 23(4) 2008
Table 4. Total Number of Educators That Reported Major, Minor, or No Emphasis n=29
Topic Major Emphasis Minor Emphasis No Emphasis
Human Development
Reproductive Sexual Anatomy &Physiology 11 (38%) 9 (31%) 1 (3%)
Reproduction 13 (45%) 9 (31%) 0
Puberty 10 (34%) 8 (28%) 3 (10%)
Body Image 7 (24%) 11 (38%) 4 (14%)
Sexual Orientation 1 (3%) 8 (28%) 14 (48%)
Gender Identity 1 (3%) 10 (34%) 12 (41%)
Total 43 (33%) 55 (42%) 34 (26%)
Families 10 (34%) 9 (31%) 3 (10%)
Friendship 9 (31%) 11 (38%) 2 (7%)
Romantic Relationships & Dating 11 (38%) 8 (28%) 3 (10%)
Love 12 (41%) 7 (24%) 4 (14%)
Marriage & Lifetime Commitments 9 (31%) 12 (41%) 2 (7%)
Raising Children 9 (31%) 9 (31%) 4 (14%)
Total 60 (45%) 56 (42%) 18 (13%)
Personal Skills
Values 12 (41%) 11 (38%) 0
Decision-making 19 (66%) 5 (17%) 0
Communication 18 (62%) 5 (17%) 0
Assertiveness 9 (31%) 11 (38%) 2 (7%)
Negotiation 3 (10%) 6 (21%) 12 (41%)
Looking for Help 6 (21%) 6 (21%) 9 (31%)
Total 67 (50%) 44 (33%) 23 (17%)
Sexual Behavior
Sexuality Throughout Life 4 (14%) 7 (24%) 12 (41%)
Masturbation 0 3 (10%) 19 (66%)
Shared Sexual Behavior 4 (14%) 8 (28%) 10 (34%)
Sexual Abstinence 17 (59%) 7 (24%) 0
Human Sexual Response 0 8 (28%) 14 (48%)
Sexual Fantasy 0 0 22 (76%)
Sexual Dysfunction 0 4 (14%) 18 (62%)
Total 25 (16%) 37 (24%) 95 (61%)
Sexual Health
Contraception 9 (31%) 11 (38%) 2 (7%)
Abortion 1 (3%) 9 (31%) 12 (41%)
Pregnancy & Prenatal Care 12 (41%) 7 (24%) 4 (14%)
STDs 18 (62%) 4 (14%) 1 (3%)
HIV & AIDS 14 (48%) 9 (31%) 1 (3%)
Sexual Abuse, Assault, Violence & Harass. 12 (41%) 8 (28%) 3 (10%)
Reproductive Health 8 (28%) 13 (45%) 1 (3%)
this study, there was no relationship between teen
pregnancy rates and amount of time spent on sex
education during grades 9-12.
The fifth research question was in regards to the
most frequently reported barriers in teaching certain
sexuality topics. Educators were asked to indicate the
biggest barrier for teaching the following topics: abstinence,
HIV/AIDS, assertiveness skills, contraception,
abortion, teen parents, sexual orientation, body
image, and decision-making skills. Overall, the most
reported barriers to providing sex education included
lack of time, lack of materials, topic not included
in required curriculum, and topic uncomfortable for
students. Sexual orientation 79% (n=23), abortion
62% (n=18), HIV 55% (n=16), and contraceptives
55% (n=16) were most often reported to have barriers.
Sex educators were also asked whether or not
they agreed with five different statements related to
sex education. Twenty-four percent (n=7) of educators
agreed with the statement that if a teacher is
generally an effective teacher, he or she will make
an effective sex educator. Fifty-nine percent (n=17)
disagreed with the statement that providing contraceptive
information to students may promote early
sexual involvement. Seventy-five percent (n=21)
educators disagreed that abstinence-only programs
were the best approach. Forty-six percent (n=13)
agreed that emphasizing negative outcomes (STDs,
pregnancy, etc.) of sexual involvement was an effective
way to promote abstinence. Ninety-six percent
of educators agreed that continuing education was
important, yet only 28% (n=7) reported continuing
education within the past 12 months.
This study aimed to determine which sexuality
topics received major, minor or no emphasis in
high school sex education. Using the SIECUS’s
Guidelines as a standard, the participants surveyed
reported a mean of 12.6 (32%) sexuality topics
receiving minor emphasis, 11.6 (30%) topics
receiving major emphasis, and 9.9 (25%) topics
receiving no emphasis. When combining the
mean number of sexuality topics receiving major
and minor emphasis for all counties, a mean 24.3
(62%) topics were reportedly emphasized, at some
level. This finding is similar to a study conducted
by Moore and Rienzo (2000) who found a mean of
25 sexuality topics reportedly taught by educators.
The topics most commonly receiving major emphasis
included decision-making (66%), STDs (62%),
Total 74 (47%) 61 (38%) 24 (15%)
Society and Culture
Sexuality & Society 6 (21%) 14 (48%) 3 (10%)
Gender Roles 9 (31%) 11 (38%) 3 (10%)
Sexuality & the Law 2 (7%) 10 (34%) 11 (38%)
Diversity 2 (7%) 10 (34%) 10 (34%)
Sexuality & Religion 1 (3%) 6 (21%) 14 (48%)
Sexuality & the Arts 0 0 22 (76%)
Sexuality & the Media 4 (14%) 11 (38%) 7 (24%)
Total 24 (15%) 62 (40%) 70 (45%)
Table 5. Binomial proportions
Key Concept Major emphasis vs
minor/no emphasis
vs. no emphasis
Human Development .041* .038*
Relationships .043* .029*
Personal Skills .043* .033*
Sexual Behavior .029* .039*
Sexual Health .04* .028*
Society & Culture .029* .04*
*Binomial proportion significant at the 0.05 level (2-tailed).
Hedman, Larsen & Bohnenblust
American Journal of Health Studies: 23(4) 2008
abstinence (59%), communication (62%), and HIV
and AIDS (48%). In comparison, Darroch, Landry
and Singh (2000) reported that sex educators were
more likely to teach abstinence, STDs, and resisting
peer pressure. Considering that one in four sexually
active high school students has a STD (Kirby, 2001),
it is essential that prevention, detection, and treatment
of STDs and HIV infection be taught in all sex
education courses. Although abstinence was reportedly
emphasized by 83% of the educators surveyed,
only 21% reported that the sexuality topic of “finding
help” received major emphasis in their sex education
course, with 31% of the educators reportedly
placing no emphasis at all on the topic. According
to Kaiser Family Foundation research, teens stated
that they wanted more information about locating
resources regarding reporting rape, STD and HIV
testing, and how to talk to a partner about birth control
and STDs (Darroch, Landry, & Singh, 2000).
Sexual orientation is often neglected in sex
education. Telljohann, Price, Pouresiami, and
Easton (1995) found that less than one half (46%)
of sex educators addressed homosexuality. Over 10
years later, results of this study found that 48% of
educators stated that they did not emphasize sexual
orientation (which encompasses homosexuality).
For this study, 46% percent of educators agreed
that emphasizing negative outcomes (STDs, pregnancy,
etc.) of sexual involvement was an effective
way to promote abstinence among high school
students. However, researchers Wiley and Terlosky
(2000) emphasized that sexuality programs should
eliminate stereotypes, biases, and scare tactics.
Considering how common STDs are among young
people, over-emphasis on negative consequences
could foster an environment of embarrassment and
shame and actually prevent students from participation
in STD screenings and partner notification.
For this sample, the mean amount of sex education
received during grades 9-12 was 4.23. There
was no significant correlation between the mean
number of weeks spent on sex education and teen
pregnancy rates. Research is limited regarding this
relationship however it has been strongly recommended
that adequate time be designated for sex
education (Kirby, 1995). Kirby (1995) stated that
short-term sex education should not be assumed to
have a significant impact on adolescent sexual behaviors
but rather sexuality programs need to be extensive
and of substantial duration. Also, Kirby (2001)
recommended that sex education programs last a
sufficient length of time (i.e. more than a few hours).
However, the ideal amount of time designated for
total sex education as well as recommended time
spent on different topics has not yet been established.
Since sex education is a controversial subject,
barriers need to be overcome in order to provide
CSE. Similar to findings by Haignere et al (1996),
educators in this study’s sample reported lack of time
and lack of materials as the two most common barriers
in providing sex education. Researchers Tappe,
Galer-Unti and Bailey (1997) also reported that lack
of time was a major barrier in implementing CSE.
One possible explanation for this is that emphasis
is increasingly placed on academic courses (math,
science, etc.) within schools and often health and
physical education courses are shortened in length
or frequency. Perhaps, if schools offered truly CSE
programs, sexuality topics and issues could be integrated
into courses that do not traditionally address
sexuality. For example, a social studies class could
investigate the social impact of teen pregnancy or a
speech course could incorporate assertiveness skill
training and practice in its curriculum. Indeed,
there is limitless potential to expand the amount
of sex education offered in schools if sexuality
topics were addressed by non-health disciplines.
The limited sample size (ten counties) combined
with the low response rate (29%) limits the generalizations
that can be made from the results of this
study. A second limitation to this study relates to
the sexuality topics with which educators were asked
to indicate the amount (major, minor, or none) of
emphasis they placed on each topic. Educators were
not provided with a description of the topics and
therefore may not have understood the related issues
surrounding each topic. Another limitation that
may make it difficult to determine the exact amount
of sexuality topics emphasized in sexuality education
is the reliance of self-reports.
For this study, the mean amount of time spent
on sexuality throughout high school was 4.23 weeks,
ranging from 1 to 12 weeks. One difficulty in assessing
the total time spent on sexuality education
relates to the variety of classes that may address
sexuality. For example, some educators may teach
courses which do not address all 39 sexuality topics.
This factor may contribute to the wide range of
time reportedly spent on sexuality education among
respondents. In addition, courses other than health
or family consumer science may also address one or
more of the 39 sexuality topics throughout a child’s
education. Topics such as values, communication,
and decision-making may be implemented in other
courses and therefore it may be difficult to assess
the total amount of time spent on sexuality topics.
Centers for Disease Control and Prevention. (2000). Tracking the hidden epidemics: Trends in STDs in
the United States. Retrieved November 19, 2007, from
Centers for Disease Control and Prevention. (2006). Youth risk behavior surveillance-United States 2005.
Morbidity & Mortality Weekly Report 55(SS-5), 112 pages.
Darroch, J. E., Landry, D. J., & Singh, S. (2000). Changing emphasis in sexuality education in US public
secondary schools, 1988-1999. Family Planning Perspectives 32(5), 204-211 & 165.
Haignere, C. S., Culhane, J. F., Balsley, C. M., & Legos, P. (1996). Teachers’ receptiveness and comfort
teaching sexuality education and using non-traditional teaching strategies. Journal of School
Health, 66(4), 140-145.
Jordan, T. R., Price, J. H., & Fitzgerald, S. (2000). Rural parents’ communication with their teen-agers
about sexual issues. The Journal of School Health, 70(8), 338-344.
Kirby, D. (2001). Emerging answers research findings on programs to reduce teen pregnancy. Washington, DC:
National Campaign to Prevent Teen Pregnancy.
This study examined the relationship between
CSE and county teen pregnancy rates.
Comprehensive school-based education is advocated
by many as a necessary strategy needed to decrease
the negative, unwanted consequences associated
with teen sexuality activity. Although this study did
not find a significant relationship between CSE and
teen pregnancy rates, there is need for further study.
Identifying positive outcomes that impact society as
a result of CSE would serve a strong argument to advocate
the inclusion of CSE within public schools.
There was great variation regarding the total
amount of time that students received sex education
in grades 9-12. Such variation further calls
attention to the need for a standardized sexuality
curriculum to be implemented in public school settings.
Establishing standards related to content,
amount of time spent, and teacher qualifications
would help to ensure that all students receive a more
CSE and that adequate time is designated for such
learning. In addition, standardization and consistency
would allow a more accurate assessment of
impact and perhaps provide insight into what role
CSE may have in the prevention of teen pregnancy.
This study aimed to identify the extent at which
CSE was offered in public high schools and if the
amount of sex education was correlated to teen
pregnancy rates. Using the recommended topics
included in SIECUS’s Guidelines as a reference, no
significant correlation was found between teen pregnancy
rates and the number of sexuality topics that
received emphasis during sex education.
This study demonstrated that a mean of 24
of the 39 SIECUS Guidelines’ key sexuality topics
were addressed among the sample of high schools.
Topics that most frequently received major emphasis
included decision-making, STDs and HIV
infection, abstinence, and communication. Further
research to determine why topics such as sexuality
and the arts, sexual dysfunction and masturbation
are not as frequently addressed, is needed.
This study found that lack of time and lack of
materials were the two most commonly reported barriers
in providing CSE. Perhaps establishing specific
standards and guidelines for each grade level and
developing an age appropriate, universal curricula
would help to alleviate these barriers and ensure that
all students receive the necessary information to help
them protect their sexual health and relationships.
Based on results of this study, inclusion of CSE
into sex education courses was not correlated with
lower teen pregnancy rates. SIECUS recommends
that sex education courses address key topics to qualify
as comprehensive. Since there are no national
standards or curricula requirements for school-based
sex education, the amount of sex education offered
will continue to vary. Increased training for educators
as well as community advocacy for CSE is needed
to ensure that students receive sufficient information
and knowledge in order to prevent teen pregnancies.
Identifying what role sex education plays in
the prevention of teen pregnancy will provide direction
for both sex educators and community health
professionals in developing teen pregnancy prevention
strategies. Based on the findings of this study,
a future recommendation would be to use a larger
sample size. Also, it may be beneficial to use stratified
sampling according to county population size
since teenage pregnancy rates are influenced by
population size. Furthermore, research is needed to
determine the reasons why topics such as masturbation
and sexuality and the arts are often neglected in
sexuality educations courses in order to identify effective
methods to help prepare educators to provide
CSE. In addition, it may be beneficial to research
the manner in which the topics are addressed (positively
or negatively). Certain topics (i.e. masturbation,
homosexuality, etc.) may receive only negative
emphasis and although these topics are addressed in
class, the content may not be representative of CSE.
Hedman, Larsen & Bohnenblust
American Journal of Health Studies: 23(4) 2008
Kirby, D. (1995). Sex and HIV/AIDS education in schools: Have a modest but important impact on
sexual behavior. British Medical Journal, 311(7002), 403.
Klein, N. A., Goodson, P., Serrins, D. S., Edmundson, E., & Evans, A. (1994). Evaluation of sex education
curricula: Measuring up to the SIECUS guidelines. Journal of School Health, 64(8), 328-334.
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382-
Minnesota county health tables (2006). Natality table 7: Minnesota teen birth and pregnancy rates by state
and county, 2003-2005. St. Paul, MN: Minnesota Department of Health. Retrieved November
19, 2007, from
Districts by county contact listing. St. Paul, MN: Minnesota Department of Education. Retrieved
November 19, 2007, from
Moore, M. J. & Rienzo, B. A. (2000). Utilizing the SIECUS guidelines to assess sexuality education in
one state: Content scope and importance. The Journal of School Health, 70(2), 56-60.
National Campaign to Prevent Teen and Unplanned Pregnancy. (2008, November). Policy brief: Funding
to states and communities for effective teen pregnancy prevention interventions. Retrieved
November 29, 2008, from
Brief_ Funding_for_Effective_Teen_Pregnancy_Prevention_Interventions.pdf.
National Campaign to Prevent Teen and Unplanned Pregnancy. (2000, September). United States birth
rates for teens, 15-19. Retrieved February 19, 2001, from
Sexuality Information and Education Council of United States. (2004). Guidelines for comprehensive
sexuality education, Kindergarten-12th grade. (3rd ed.). Retrieved October 4, 2007, from
Sexuality Information and Education Council of United States. (2001). State mandates: Sexuality
education and HIV/AIDS/STD education. Retrieved November 9, 2001, from
Tappe, M. K., Galer-Unti, R.A., & Bailey, K. C. (1997). Evaluation of trained teachers’ implementation
of a sex education curriculum. Journal of Health Education, 28(2), 103-108.
Telljohann, S. K., Price, J. H., Poureslami, M., & Easton, A. (1995). Teaching about sexual orientation
by secondary health teachers. Journal of School Health, 65(1), 18-22.
U. S. teenage pregnancy statistics national and state trends and trends by race and ethnicity. (2006).
New York: Guttmacher Institute. Retrieved November 19, 2007, from http://www.guttmacher/org/
Ventura, S. J., Abma, J. C., Mosher, W. D., & Henshaw, S. K. (n.d.). Recent trends in teenage pregnancy
in the United States, 1990-2002. CDC: National Center for Health Statistics. Retrieved December
19, 2007, from
Wiley, D. C., & Terlosky, B. (2000). Evaluating sexuality education curriculums. Educational Leadership,
Yarber, W. L. Torabi, M. R., & Haffner, D. W. (1997). Comprehensive sexuality education in Indiana
secondary schools: Instructional topics, importance ratings, and correlates with teacher traits.
American Journal Health Studies, 13(2), 65-73.

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