The Associations of Sex Education with Sexual Activity, Use of Condoms, and Sexually Transmitted Infections Among High School Students during 2003 – 2017

I-Shin "Jasmine" Su

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Background: Adolescents are highly susceptible to sexually transmitted infections (STI), compared to other age groups, and condom use is effective in preventing STI transmission. In Massachusetts, schools are not required to teach sex education, and schools that teach sex education do not need to include content on condom use or STI prevention. This study aimed to understand the prevalence of sex education, sexual activity, condom use, and STI rates among adolescents in Massachusetts over time. The secondary aim was to understand the associations between sex education and three outcomes over time: sexual activity, condom use, and STI/HIV diagnosis. The third aim was to examine whether gender modified the associations.

Methods: This study used eight years of data from the Massachusetts Youth Risk Behavior Survey (YRBS), collected biennially from 2003 to 2017. The survey sampled public high school students (n = 24,837). Descriptive statistics were used to understand time trends of students’ sexual behavior. Logistic regression was used, after adjusting for YRBS’ sampling method, to evaluate the associations between sex education and the three outcomes (i.e., sexual activity, condom use, and STI/HIV diagnosis). Stratified analysis was conducted to understand the modifying effect of gender.

Results: The percentage of students taught about condom use, ways to prevent STI/HIV, or both, dropped from 93% in 2003 to 83% in 2017. Consistently, approximately half of the students received sex education on condom use. Receiving sex education was associated with lower odds of having sex with four or more people (pooled OR, 0.80; 95% CI, 0.68–0.94). Receiving sex education also increased a student’s odds of using condoms during sex (pooled OR, 1.39; 95% CI, 1.10–1.76) and reduced the odds of contracting STI or HIV (pooled OR, 0.53; 95% CI, 0.35–0.81). Effects of sex education were stronger for male than female students.

Conclusion: Findings showed that sex education was consistently associated with health and behavioral benefits for over a decade in Massachusetts. The study provides strong incentives for the state government to mandate contraception and STI/HIV education in schools.