Tech: Sex Ed for All, Sex Problems for Some

Teens, Digital Devices, and Sexual ProblemsThe holidays are over and young people are diving headlong into use of their brand new digital devices. In addition to video games and social media, some kids, especially adolescents, are using their freshly acquired laptops, pads, smartphones, and the like as a gateway for sexual exploration, experimenting with pornography, sexting, video chat, “friend finder” apps, and more. Unfortunately, for some kids these online sexual behaviors can escalate over time in both frequency and intensity to the point where they begin to cause problems.

Once upon a time, of course, compulsivity and consequences related to sexual behaviors in adolescents were much less likely than today, mostly thanks to a lack of accessibility. For instance, in the pre-Internet era finding porn was somewhat difficult, and the pool of potential sex partners was limited to other kids (and maybe a few adults) in the immediate vicinity. So the odds of a typical teen struggling related to his/her sexual activity were minimal. The lack of access prevented potential problems.

Well, those days are gone. Today, any kid with a digital device has access to an unending array of online sexuality. And the vast majority of young people take advantage of this fact. Especially boys. In fact, in the digital era boys almost universally experiment with online sex, especially porn.i And most of the time they do this sooner rather than later. (Current estimates place the average age of first porn use at 11.ii) Girls also experiment with online sexuality, but, as with adult females, their behaviors tend to focus more on romantic fulfillment than purely sexual gratification. As such, girls tend to explore on social media and chat sites rather than porn sites.

Adolescent Sexual Behaviors: Normal or Problematic?

Because adolescents are naturally hyper-obsessed with sex, it is sometimes difficult to differentiate between “normal” kids and kids with sexual problems. That said, a small percentage of young people do have serious sexual issues. In fact, there isn’t a week that goes by when I don’t get at least a few calls or emails from people seeking help for an adolescent who is sexually acting out in an abusive and/or compulsive way. And that last bit – abusive and/or compulsive – is the primary difference between healthy adolescent sexual exploration and a behavioral disorder.

To further understand this difference, consider a boy who masturbates to pornography several nights per week before going to bed who is maintaining his grades, his social life, and other important aspects of life. This boy probably does not have a sexual problem, even though his parents might be somewhat disturbed by his behavior. Now consider a boy who looks at and masturbates to pornography multiple hours nightly, whose grades have fallen off a cliff, who has lost interest in normal teenaged social activities, and whose self-esteem is in the toilet. In all likelihood, this boy does have an issue that needs to be addressed.

If/when young people experience problems with online sexual activity, it is typically because they’ve become compulsive with porn use, sexting, hookup apps, sexualized video chat, and/or sexualized use of social media. Often they will spend hours per day involved in these activities (and in hiding evidence of these behaviors from their caregivers). Common warning signs that an adolescent may be experiencing problems with digitally-driven sexual behaviors include:

• Diminished interest in and/or ability to socialize with peers (i.e., social withdrawal)
• Excessive interest (or a total lack of interest) in typical adolescent dating activities
• Mood problems that are ongoing (not situational)
• Decreased interest in and/or declining performance in school and extracurricular activities
• Secretiveness around computer and smartphone usage – wiping browser histories, clearing texts and phone logs, password protecting devices, owning and using devices in secret, etc.
• Lying to parents or others about the nature and/or the amount of online activity
• Secrecy in general, such as spending large amounts of time alone in a room with the door locked
• Sexual aggression, incest, age-inappropriate relationships, etc.
• A demonstrated lack of empathy toward other individuals involved (either directly or indirectly) in the child’s sexual behavior

In general, young people who become compulsive with online sexuality suffer stunted emotional and psychological growth. (This is also true with adolescent substance abusers.) In short, if a 12-year-old with no sexual or romantic experience is suddenly exposed to and becomes compulsive with hardcore pornography, that’s what his or her view of adult relationships is likely to become, which will almost certainly create difficultly if/when he or she attempts to have a real world romantic relationship later in life. Other common short- and long-term consequences include:

• Erectile dysfunction (generally linked to excessive porn use)
• Physical harm to genitalia (caused by excessive masturbation)
• Loss of self-esteem
• Social isolation and loneliness
• Depression
• Anxiety
• Trouble in school
• Relationship problems – with friends, girlfriends/boyfriends, parents, siblings, teachers, coaches, etc.
• Drug and/or alcohol use/abuse/addiction in conjunction with sexual acting out
• Sexually transmitted diseases
• Sexual addiction

Many of these consequences will dissipate if/when the child stops compulsively using his or her digital device in sexualized ways. For instance, porn related erectile dysfunction tends to stop after porn use stops. (Essentially, compulsive porn users become conditioned to the hyper-stimulation of porn, which makes it difficult to become aroused under normal sexual circumstances. However, their brains readjust and things go back to normal after a month, or maybe a few months, of porn abstinence.)

Among the most serious potential consequences is the last item on the list: sexual addiction. For the most part, the same kids who are at risk for substance addictions are at risk for sexual addiction, usually thanks to a witch’s brew of genetic predisposition and unresolved early-life trauma issues.iii That said, even kids who aren’t at risk can become sexually addicted, particularly if they begin their use of porn, sexting, and other sexual activities at an early age. (This is also true with alcohol and drug addiction, where numerous studies find a direct correlation between age of first use and an increased likelihood of later-life addiction.iv) So the fact that most kids are experimenting with porn by age 11 suddenly looks a bit more ominous.

Should We Blame Technology?

Young people are usually able to express their sexual selves online with no more consequences than they experience related to real-world sexual experimentation. This does not mean that teens don’t occasionally experience problems related to digitally driven sexual behaviors, because they do. For the most part, however, these issues arise thanks to typical adolescent impulsivity more than anything else. In short, technology doesn’t push these kids into bad behavior, it simply provides a new venue for it.

Nevertheless, many adults, parents and professionals alike, want to put the onus on digital devices. Essentially, they choose to pathologize digital age adolescent sexuality because it looks different than their own pre-Internet sexual exploration. Basically, adults, fearing the unfamiliar, decide that technology is the problem and they respond to that in kind – usually by trying to take away digital devices. This DOES NOT WORK. Kids are not going to stop using digital devices any more than adults stopped drinking during prohibition.

The simple truth is adults need to understand that new is not necessarily bad. It’s just different. In other words, even though a technology and related behaviors may look entirely foreign (and frightening) to adults, these things are perfectly natural and normal for kids. For instance, the idea of teen sexting scares the daylights out of most grown-ups, but research suggests that for adolescents it’s simply part of the new normal.v So adults can scream and yell and pathologize this behavior all they want, but kids are going to do it anyway. Because for them it’s part of the normal adolescent sexual process.

What Can You Do?

If you are worried about a child’s online sexual behavior, consider using an Internet filtering and monitoring software. (For more information, see this article.) In this way you can limit the child’s online access to sexual content and contacts, much as laws that govern the purchase and consumption of alcohol and tobacco limit your child’s access to those potentially problematic substances. Typically these software products offer varying levels of filtering and monitoring, allowing parents to set them at an age-appropriate level. Of course, even with the help of a top-tier protective software adults can’t completely shield children from the online world. After all, what a kid can’t access on his or her own digital devices can be accessed on a friend’s device, at the library, or on a digital device that he or she purchases and uses in secret.

As such, much as it is with drugs and alcohol, the best thing adults can do, if they’re worried about a child’s sexual behavior (online or real world), is to talk to that child in a nonjudgmental way, encouraging an open and honest discussion about all aspects of adolescent sexuality, including the use of online pornography, chat rooms, hookup apps, social media, sexting, and the like. It is incredibly important that adults work through any strong feelings they have about these issues before initiating this conversation, eliminating (or at least significantly reducing) any fear or anger based reactions that might drive away a potentially valuable growth and learning opportunity.

Having done that, adults should then try to learn the extent and purpose of the child’s online sexual activity. If the behavior seems extreme (multiple times daily, for hours at a time, etc.) or if it’s being engaged in as an escape/avoidance mechanism (the child seems isolated, the child is avoiding social/dating settings), then it might be wise to seek the help of an adolescent sexual addiction treatment specialist. The International Institute of Trauma and Addiction Professionals (IITAP) offers referrals to certified sex addiction therapists.


source by : http://blogs.psychcentral.com/sex/2016/01/teens-digital-devices-and-sexual-problems/

Their target: Your Health Today, a sex-ed book published by McGraw Hill. It offers the traditional advice and awkward diagrams plus some considerably more modern tips: a how-to for asking partners if they’ve been tested for STDs, a debate on legalizing prostitution. And then there was this: “[One] kind of sex game is bondage and discipline, in which restriction of movement (e.g. using handcuffs or ropes) or sensory deprivation (using blindfolds or masks) is employed for sexual enjoyment. Most sex games are safe and harmless, but partners need to openly discuss and agree beforehand on what they are comfortable doing.”

“I was just astounded,” says Fremont mom Teri Topham. “My daughter is 13. She needs to know how boys feel. I frankly don’t want her debating with other 13-year-olds how well the adult film industry is practicing safe sex.” Another parent, Asfia Ahmed, who has eight and ninth grade boys, adds: “It assumes the audience is already drinking alcohol, already doing drugs, already have multiple sexual partners…Even if they are experimenting at this age, it says atypical sexual behaviors are normal. ”

15000But school board members contend that 9th grade students have already been exposed to the contents of the book—and much, much more. They argue that even relatively modern sex ed has even not begun to reckon with what kids are now exposed to in person and online.

The singer Rihanna, for example, has legions of young fans. Her music video for the song “S&M”—viewed more than 57 million times on YouTube so far—shows the artist, pig-tied and writhing, cooing “chains and whips excite me.” It then cuts to her using a whip on men and women with mouths covered in duct tape.

“I think denying that [sex] is part of our culture in 2014 is really not serving our kids well,” says Lara Calvert-York, president of the Fremont school board, who argues that kids are already seeing hyper-sexualized content—on after school TV. “So, let’s have a frank conversation about what these things are if that’s what the kids need to talk about,” she says. “And let’s do it in classroom setting, with highly qualified, credentialed teachers, who know how to have those conversations. Because a lot of parents don’t know how to have that conversation when they’re sitting next to their kids and it comes up in a TV show. Everyone is feeling a little awkward.”

But the Fremont parents aren’t budging. “Any good parent monitors what their child has access to,” says Topham. “We don’t say, ‘they’re going to drink anyway, let’s give them a car with bigger airbags.’” The parents note that the book was actually written for college students, and refers to college-related activities like bar crawls. (While acknowledging this, the book’s author Sara L. C. Mackenzie, believes it’s appropriate for high schoolers; her children read it at 13.)

The book has been shelved, at least for this year. But the problem isn’t going away. The Fremont showdown is a local skirmish in what has become a complicated and exhausting battle that schools and parents are facing across the nation. How, when, and what to tell kids about sex today? TIME reviewed the leading research on the subject as well as currently available resources to produce the information that follows, as well as specific guides to how and when to talk to kids on individual topics.

(Read more: How—and when—to talk your kids about which subjects.)




overexposedteens

The average American young person spends over seven hours a day on media devices, often using multiple systems at once. Studies show that more than 75% of primetime TV programs contain sexual content, and the mention of sex on TV can occur up to eight to 10 times in a single hour. And that’s the soft stuff: A national sample study of 1,500 10 to 17-year-olds showed that about half of those that use the Internet had been exposed to online porn in the last year.

How do you learn appropriateness and consent in a culture where Beyoncé’s song about pleasuring a guy in a car is championed by some as feminist and others as lewd? Or where Robin Thicke’s “Blurred Lines” can refer to violent sexual acts in a music video viewed on the web at least 36 million times? Or where, in a major news story, it becomes apparent that wholesome girls from teen adventure movies send naked photos. Or where primetime TV shows—the kind you often watch with your family—not infrequently make reference to anal sex?

80Uncensored media is not harmless. Longitudinal studies suggest exposure to sexual content on TV and other media in early adolescence is linked to double the risk of early sexual intercourse, and young people whose parents limit their TV time are less likely to partake in early sexual behavior. Other studies have found that 10% of young women who had their first sexual experience in their teenage years say it was not their choice, and the younger they were, the more likely this was the case. While the vast majority of primetime programming contains sexual content, only 14% of sexual incidents mention the risks or responsibilities associated with sexual activity according to research from the American Academy of Pediatrics.

And that’s just the media teenagers consume. There’s a whole different set of issues raised by the other ways they use tools of communication.

“I was sexting and sending pictures to a guy older than me because he told me he loved me and i believed him and he showed everyone my picture and i had everyone asking me for photos and making fun of me and calling me a slut.”

“me n my girlfriend have been datin a year an almost 2months, she has sent me naked pics of her and she asked me to send her some of me naked, but i dont want too and i dont want to lose her either.”

“My girlfriend will text me good morning, if i dont respond right away she will send a question mark with a question, then a few more question marks, then call me. If i don’t respond she gets realy upset and angry. is this abuse? what do i do?”

Young people now engage in relationships increasingly via technology, which means they’re able to connect in a variety of ways and at a speed and frequency not known to prior generations. They also appear to be more comfortable showing skin. A 2014 survey published in the journal Pediatrics among over 1,000 early middle school students found 20% reporting receiving sexually explicit cell phone text or picture messages (more colloquially known as “sexts”) and 5% reporting sending them.

While many parents think that explaining the consequences of sending out explicit images will get teens to stop, they may be missing the point. “There’s a pressure that people feel to send a sext as a digital currency of trust,” says Emily Weinstein a Harvard University doctoral student who collected the texts above from an online forum run by MTV, for a study on the digital stress of adolescence. “It’s a way to say to someone, here is a thing that could destroy me, I trust that you won’t use it.”



sexedisnotkeepingup

On paper, the United States is checking all the right boxes of managing teen sexual behavior. The national pregnancy rate is at a record low and it appears teens are waiting longer to have sex, and those that are sexually active are using birth control more than previous years. But these numbers only tell a tiny snippet of the story.

“Sex education in the U.S. has only gotten worse,” says Victor Strasburger, an adolescent medicine expert and distinguished professor of pediatrics at the University of New Mexico School of Medicine. “Most of the time they don’t talk about contraception, they don’t talk about risk of pregnancy, STIs [sexually transmitted infections]—certainly not abortion. At some point you would think adults would come to their senses and say hey we have to counteract this.”

(Read more: Sex Education, From ‘Social Hygiene’ to ‘The Porn Factor’)

Strasburger says the U.S. shouldn’t base success on its teen pregnancy numbers: “Everyone else’s teen pregnancy rate has gone down too. Before we pat ourselves on the back, we should acknowledge that we still have the highest rate in the Western World.”

Not only does sex education still virtually not exist in some areas of the country, but school programs that do teach kids about what used to be called the facts of life start too late. A recent CDC study showed that among teens ages 15-17 who have had sex, nearly 80% did not receive any formal sex education before they lost their virginity. Or, if they did, it was only to discourage them from being sexually active. “Parents and legislators fail to understand that although they may favor abstinence-only sex education (despite the lack of any evidence of its effectiveness), the media are decidedly not abstinence only,” reads a 2010 American Academy of Pediatrics policy statement.

“I had sex with my older boyfriend at 16,” says Ashley Jones, 22, a young Georgia woman. “Suddenly my dad wanted to talk about the birds and the bees. I was like, what? It’s too late!” (The Kinsey institute puts the average age that kids have first have sex at 16.9 for boys and 17.4 for girls.)

Current sex education, where it does exist, often teaches the basic plumbing, but it’s not answering the questions young people really have when it comes to sexuality: What should I do when my girlfriend/boyfriend is pressuring me to have sex? What on earth was happening in that video I probably shouldn’t have clicked online? What do I do when my best friend tells me they’re gay—or I think I am?

School-wide sex education largely ignores gay men and women. “I think the Internet is one of the most commonly used sources for young LGBT folks to gain information,” says Adrian Nava, 19, who says his question about same sex relationships in his Colorado high school sex ed class that was shot down by the teacher. “In some ways it’s great because online forums tend to be supportive and positive. But there’s so much misinformation that reinforces negative feelings.”

(Read more: How to Talk to Your Gay Teen About Sex)

Sex ed courses tends to hyper-focus on the girls. “Girls are the ones who have babies,” says Victoria Jennings, director of the Institute for Reproductive Health at Georgetown University, whose research has shown there are globally more programs developed to help young girls navigate their sexuality than to help boys. Given the fact that recent CDC literature shows 43.9% of women have experienced some form of unwanted sexual violence that was not rape, and 23.4% of men have experienced the same, public health experts agree both sexes need education on appropriate behavior.

It doesn’t help that the two groups are getting quite different messages. “The way we talk to boys is antiquated and stereotypical,” says Rosalind Wiseman, educator and author of Queen Bees and Wannabes, about teen girls and Masterminds and Wingmen, on boys. “There’s an assumption that they’re insensitive, sex-crazed, hormone-crazed. It’s no surprise that so many boys disengage from so many conversations about sex ed.”

We teach girls how to protect themselves, adds Wiseman, and their rights to say yes and no to sexual behaviors. But we don’t teach boys the complexities of these situations or that they’re a part of the conversation. “We talk to them in sound bites: ‘no means no.’ Well, of course it does, but it’s really confusing when you’re a 15-year-old boy and you’re interacting with girls that are trying out their sexuality,” she adds. Data show that boys are less likely than girls to talk to their parents about birth control or “how to say no to sex,” and 46% of sexually experienced teen boys do not receive formal instruction about contraception before they first have sex compared to 33% of teen girls.

Yet completely reshaping the sex education landscape is currently almost impossible, not just because of disagreements like the one in Fremont, but because schools lack resources. There’s historically large funding for abstinence-only education, but supporters of comprehensive sex education—which deals with contraception, sexually transmitted diseases and relationships—face significant logistical and financial barriers.

Only 22 states and the District of Columbia require public schools teach sex education. Oklahoma and Alabama—two states with the highest teen pregnancy rates—don’t require any sex ed. And few states really take a critical look at sexuality in the way kids encounter it, through TV shows, movies, and yes, even pornography. It’s like taking a child to a waterpark without teaching them how to swim.

This leaves the ball in the parents’ court. A recent survey from Planned Parenthood shows that 80% of parents are willing to have “the talk” with their kids, but in order for these conversations to have real meaning, parents need to understand just how much sexual exposure their kids are getting daily and how soon. They also need to overcome the desire to lecture, and kids need to understand that the conversation is less about rules and more about guidance. All of this while having a conversation about what is usually a very private matter.

(See a gallery of vintage sex education books from the 19th Century to now: Sex Education Through the Ages.)

Some experts believe that many of the obstacles can be overcome by approaching the adolescent in his or her own habitat: using the Internet or cell phones as learning tools.

10974“Perhaps it’s time to fully embrace the power of 21st century communication and direct it toward public health goals more deliberately,” wrote Strasburger and Sarah Brown, the CEO of The National Campaign to Prevent Teen and Unplanned Pregnancy, in a July report. “Online material and social media could help to fill the gaps in sex education and support for many young people.”

Websites like Bedsider.org (developed by Brown’s group) offer easy to understand facts about contraception in an open-minded and legitimate way. As do other websites like StayTeen.org, GoAskAlice! and Sex, etc. On Scarleteen.com, educators answer questions from “How do I behave sexually without someone thinking I’m a slut?” to questions about pubic hair.

For reaching teenagers right where they gather, it’s hard to beat YouTube. Laci Green has made a name for herself by providing frank and funny videos that answer common questions young people have and dispel myths. Her approach is not for everyone; two of her more popular episodes are “You Can’t POP Your Cherry! (Hymen 101)” and “Sex Object BS.”

Texting has also proved to be a surprisingly useful tool. Some health departments and community groups in states like California and North Carolina have established services where teens can text their sex-related questions to a number and receive a texted response in 24 hours, allowing for anonymity. Planned Parenthood offers a chat/text program where teens and young adults can either live text or chat with a Planned Parenthood staffer. Since the launch in May this year, there have been a total of 393,174 conversations.

Should parents really cede sex education to the digital realm? Given that an incredibly high number of young people go to the Internet for information on sex anyway, directing them to quality material that appeals to their age range may be the one of the better ways to circumvent poor education at school. Showing kids a reliable website can’t replace a good conversation, but it can complement one.

In Fremont, parents are supplementing their children’s sex education in different ways. “I don’t just rely on the school to teach sex ed to my children,” says Topham. “I told my kids about [sex] when they are in third grade, and open up the dialogue at that point. When we are watching movies together or discussing current events that may touch on this topic, we talk about it.”

Not all parents are prepared to go as far as Topham: Her five kids did not get a smartphone until they were 18 and they can’t have TVs or computers in their bedrooms. “You can be the best kid possible but we don’t want you to have porn in your pocket,” she says. To some her views may seem extreme, but when it comes to sex ed, Topham’s decided it’s better to take no chances. In the age of Innocence vs. the Internet, some parents won’t go down without a fight.

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Sex Ed Books Through the Ages SHARE
More than 100 years of trying to teach kids the facts of life

SEX ED BOOKS THROUGH THE AGES
“Those who look at our bodily dwelling can gain a very good idea of what we are... The care of our body, then, adds to our value,” advised Barbara Wood-Allen in  1897's  "Self and Series: What a Young Girl Ought to Know."
"When the organs peculiar to woman are displaced or disordered ...pangs shoot through her like winged piercing arrows or darting needlepoints" wrote mail order doctor Lydia Pinkham in 1907.
Published by the Christian Education Service, of Nashville, Tennessee, during the 60s, it was written by one of the founders of SIECUS
"When the natural God-designed and God-honored sex instinct is perverted and base desire supplants love, in the choice of a companion, the home instinct is degraded, love dethroned and inharmony prevails," wrote Thomas Washington Shannon in 1913.

“Those who look at our bodily dwelling can gain a very good idea of what we are... The care of our body, then, adds to our value,” advised Barbara Wood-Allen in 1897's "Self and Series: What a Young Girl Ought to Know."
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How I Learned About Sex SHARE

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How to Talk to Your Gay Teen About Sex SHARE
Advice from Dannielle Owens-Reid and Kristin Russo, co-authors of This Is a Book For Parents of Gay Kids

I never learned how to have safe sex. I am sure that I had a few health classes that talked about condoms and rattled off a lot of facts about scary diseases I might get if I did the wrong thing with the wrong person—but no one ever mentioned what to do if I wasn’t having sex with a boy. I didn’t know if I was supposed to protect myself and, if I was, I had never heard of any ways in which I could do so. My parents didn’t know that I was gay until after I was sexually active, and I don’t think they ever even considered talking to me about having safe “gay” sex. —Kristin

If your kid has recently come out to you as lesbian, gay, bisexual, transgender, or queer, there is a chance that you might feel a bit like a deer in headlights when it comes to approaching them with tips on safe sex. Between 1991 and 2010, the average age of coming out dropped dramatically from 25 to 16, which means many young people are already out by the time parents would start talking with them about sex.

Finding out how to talk to your LGBTQ kid about safe sex is much, much easier than you think. The more you know, the more open you can be with your child and the more open you can be about sex, the easier it becomes for your kid to talk to you about their questions and concerns. Here are the three main points to remember:

Be Open to Questions

The earlier you start talking to your kids, the easier things will be for you later in the game, according to globally recognized sex expert Dr. Justine Shuey. “The most important thing you can accomplish is to become an askable parent,” she says. This does not mean you have to have all of the answers, or that you need to be comfortable talking to your child about everything (or telling them what you do sexually) — just that you are approachable. If you don’t know an answer, research it together, or look for reliable and factually accurate sources with your child.

“When I teach educators, I teach them to first say ‘Good question,’ ” Shuey explains. “That is your moment to think about your answer before you laugh or blurt out something silly or negative.”

Educate Yourself

Before you start looking for resources to answer your questions, it’s helpful to address the many misconceptions surrounding the LGBTQ community. First, your child isn’t going to have any more sex than their classmates — our identities do not shape our personalities or our interest in sex. Second, they face the same risks; fluids are fluids are fluids, and sexually transmitted infections can happen to any sexually active human being on this planet.

Lastly, there’s no such thing as “gay” sex acts—there are sexual acts that are shared between people of all genders, and the way we keep ourselves safe is always the same. Inform yourself about ways to be safe when engaging in oral sex, anal sex and sex with toys. Newsflash: these are sexual acts that any person may engage in, so even if your kid doesn’t identify as LGBT, they still need to be informed.

Learn What Works for Your Kid

We all have our own relationships to sex, and we also all have our own relationships to our children. You know your kid, and you also know yourself, so don’t feel as though there’s only one way to exchange this important information. The “sex talk” doesn’t—and most likely shouldn’t—have to be one long conversation held at the dinner table. It can be something that evolves over time, perhaps in a letter or over the course of several smaller discussions. Prepare yourself with information, and communicate in the way that you think will bring the highest level of comfort to both you and your child.

Sometimes that means having a talk without actually talking. Oluremi, an out 18-year-old whom we spoke to while researching our book, said her mother took a different route than most when approaching safe sex.

“Luckily, my mom understood that I wasn’t really one for talking, but knew I would read anything put in front of me,” she said. Oluremi’s mom communicated most of her thoughts on safe sex with her daughter through e-mail, which she knew would make the exchange of information easier.

Just like Oluremi’s mom, you can send your kid an email if that’s easier. Or hand them a copy of This is a Book for Parents of Gay Kids with the safe sex chapter bookmarked (shameless plug alert!). Or talk to them about your feelings on sex as much as you are both comfortable and then tell them to check out some of the websites listed in the main story. You can even make them read this article. The point is, you have options in how you approach this topic with your kid.

When all is said and done, familiarizing yourself with the resources available and making them available to your kid is the critical piece of this sex-talk puzzle. Be prepared in case your kid does feel comfortable enough to ask you questions, even if that means just knowing where to point them when you don’t have the answers. Many teens say that they listen to their parents more than anyone else when it comes to practicing safe sex. What you say matters, and what you don’t say can matter even more.

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Resources and Guidelines SHARE
How to talk to your kids about sex, intimacy and other awkward subjects. Plus reliable, relatable sites to send them for more information.

What kids should know at what age: As a parent, it can be tricky to know when to have The Talk, and how much you should bring up to your kids at what time. The National Sexuality Education Standards suggests that by the end of second grade, kids should know the proper names for male and female body parts and know that all people have the right to tell others not to touch their body when they don’t want to be touched. By the end of fifth grade, they should be able to define the process of human reproduction, and be able to describe puberty and how friends, family, media, society and culture can influence ideas about body image. By the end of eighth grade, kids should be able to explain the health benefits, risks and effectiveness rates of various methods or contraception, including abstinence and condoms and should know how alcohol and drugs can influence sexual decisions. By the end of 12th grade, students should know how to communicate decisions about whether and when to engage in sexual behaviors and understand why using tricks, threats or coercion in a relationship is wrong. (For more detailed information, click on the NSES link above.)

Other useful and reliable websites:

For Parents

Common Sense Media
When it comes to advice and resources for healthy media and technology consumption, Common Sense Media is a one-stop shop. Parents can use the organization’s media reviews tool to look up movies, apps, TV shows, books and games and view a content breakdown of specific elements like violence, language, substance abuse, role models and sex. There are also resources to answer parental concerns related to themes like cyberbullying and social media use. For instance: “How can I help my kid avoid digital drama.”

Answer
Answer is a national organization established by the New Jersey Network for Family Life Education to offer sex ed resources to parents, teens, and advocacy groups. It publishes Sex, Etc. magazine and has a website for teens, written by teens. Especially helpful is Answer’s curated book list, organized by age appropriateness.

Planned Parenthood Federation of America
Planned Parenthood wants parents be the go-to resources for their kids and teens. The site offers advice for how to talk to young people about sex and sexuality, how to parent teens who may be sexually active, and even how to answer questions from LGBT children and teens. Planned Parenthood also offers book lists for both parents and children.

The Guttmacher Institute
For parents who are curious about trends, and want the latest data on issues like contraceptives, puberty and sexual initiation, the Guttmacher Institute offers a scholarly approach on research, education, and police. It publishes two peer-reviewed journals and collects data on topics like adolescents, contraceptives, abortion and STIs.

The National Campaign to Prevent Teen and Unplanned Pregnancy
The National Campaign’s goal is to prevent teen and unplanned pregnancy, especially among single, young adults. The site offers resources to parents and runs several spin off websites like StayTeen.org and Bedsider.org that target young people at different ages and stages in their sexuality.

The Sexuality Information and Education Council of the United States (SIECUS)
SIECUS educates and advocates for better sex ed in the United States. Along with other groups that advocate comprehensive sex ed, it developed “The Future of Sex Education,” an initiative to spur discussion about the future of sex education and to encourage implementing comprehensive sexuality education in public schools.

Sexual Health at the U.S. Centers for Disease Control and Prevention (CDC)
For the most frank and up to date information about sexual health, check out the CDC’s resources on all topics from sexual violence prevention to healthy pregnancies.

For Kids

KidsHealth
Developed by the Nemours Foundation, a non-profit organization focused on children’s health, the site provides health resources for parents, kids and teens. The kids’ site has information about topics like puberty as well as explainers on how all parts of the body work, from the brain to the kidney.

It’s My Life
Run by the Corporation for Public Broadcasting, It’s My Life provides kid-friendly information on everything from dating to puberty to eating disorders and money. The site also offers games that help kids navigate issues like gossiping and cheating on school work.

For Teens

Bedsider
Bedsider is an online birth control support network for women 18-29. The site talks to teens like a best friend, and prides itself on being unbiased: It’s not funded by pharmaceutical companies or the government.

Answer
(see above) Answer’s Sex, Etc. magazine and website offer teens advice about gender and talking to parents about sex, plus forums where Answer’s experts answer questions.

Stay Teen
The goal of Stay Teen, a site sponsored by the nonprofit organization National Campaign to Prevent Teen and Unplanned Pregnancy, is to encourage young people to enjoy their teen years and avoid the responsibilities that come with a too-early pregnancy. It provides resources and advice for how to say no to situations young people are not ready for.

Planned Parenthood
Planned Parenthood has easy to use chat and text sex education programs that allow young people to chat in realtime with a Planned Parenthood staffer about everything from STD to morning-after pill question. The organization also has an Awkward or Not app that takes young people through an online quiz that gives them the chance to send their parents a text to start a conversation about dating and sex.

Go Ask Alice!
Go Ask Alice! is the health question and answer site produced by Alice! Health Promotion at Columbia University. Users can get answers to their questions from how to use a condom properly to urinary problems.

I Wanna Know
Run by the American Sexual Health Association (ASHA), I Wanna Know offers sexual health information for teens and young adults. There’s in-depth information on topics like STDs, relationships and myths. Common Sense says I Wanna Know is appropriate for ages 13 and up.

Laci Green
Laci Green is a sexual health educator who creates fun and flashy videos to answer sex-related questions people are often too embarrassed to ask. Green has over one million subscribers to her YouTube channel. Her content is fun, but some parents may find it too explicit.

Scarleteen
Scarleteen is an edgy site that provides sexuality education through popular message boards and fact sheets. Data has shown young people spend almost twice as long on the site as THE AVERAGE user DOES on Facebook. It’s also more explicit than OTHER sexual health sites, but answers questions submitted by teenagers themselves. All message boards are moderated by Scarleteen staff and volunteers.

Center for Young Women’s Health
Young women looking for easy-to-access accurate and extensive information about all sexual and gynecological health topics can find it at the Center for Young Women’s Health. The center is developed as a partnership between the Division of Adolescent & Young Adult Medicine, the Division of Gynecology, and the Center for Congenital Anomalies of the Reproductive Tract at Boston Children’s Hospital.

Young Men’s Health
Youngmenshealthsite.org (YMH) is produced by the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital. The site provides well-researched health information to teen boys and young men. There’s sexual health information as well as explainers on other health issues from celiac disease to Ebola.

Advocates for Youth
Advocated for Youth is an organization meant to help young people make informed and responsible decisions about their reproductive and sexual health. The organization also offers support to young people who want to bring better sex education to their schools.

This review presents the findings from controlled school-based sex education interventions published in the last 15 years in the US. The effects of the interventions in promoting abstinent behavior reported in 12 controlled studies were included in the meta-analysis. The results of the analysis indicated a very small overall effect of the interventions in abstinent behavior. Moderator analysis could only be pursued partially because of limited information in primary research studies. Parental participation in the program, age of the participants, virgin-status of the sample, grade level, percentage of females, scope of the implementation and year of publication of the study were associated with variations in effect sizes for abstinent behavior in univariate tests. However, only parental participation and percentage of females were significant in the weighted least-squares regression analysis. The richness of a meta-analytic approach appears limited by the quality of the primary research. Unfortunately, most of the research does not employ designs to provide conclusive evidence of program effects. Suggestions to address this limitation are provided.

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Introduction

Sexually active teenagers are a matter of serious concern. In the past decades many school-based programs have been designed for the sole purpose of delaying the initiation of sexual activity. There seems to be a growing consensus that schools can play an important role in providing youth with a knowledge base which may allow them to make informed decisions and help them shape a healthy lifestyle (St Leger, 1999). The school is the only institution in regular contact with a sizable proportion of the teenage population (Zabin and Hirsch, 1988), with virtually all youth attending it before they initiate sexual risk-taking behavior (Kirby and Coyle, 1997).

Programs that promote abstinence have become particularly popular with school systems in the US (Gilbert and Sawyer, 1994) and even with the federal government (Sexual abstinence program has a $250 million price tag, 1997). These are referred to in the literature as abstinence-only or value-based programs (Repucci and Herman, 1991). Other programs—designated in the literature as safer-sex, comprehensive, secular or abstinence-plus programs—additionally espouse the goal of increasing usage of effective contraception. Although abstinence-only and safer-sex programs differ in their underlying values and assumptions regarding the aims of sex education, both types of programs strive to foster decision-making and problem-solving skills in the belief that through adequate instruction adolescents will be better equipped to act responsibly in the heat of the moment (Repucci and Herman, 1991). Nowadays most safer-sex programs encourage abstinence as a healthy lifestyle and many abstinence only programs have evolved into `abstinence-oriented' curricula that also include some information on contraception. For most programs currently implemented in the US, a delay in the initiation of sexual activity constitutes a positive and desirable outcome, since the likelihood of responsible sexual behavior increases with age (Howard and Mitchell, 1993).

Even though abstinence is a valued outcome of school-based sex education programs, the effectiveness of such interventions in promoting abstinent behavior is still far from settled. Most of the articles published on the effectiveness of sex education programs follow the literary format of traditional narrative reviews (Quinn, 1986; Kirby, 1989, 1992; Visser and van Bilsen, 1994; Jacobs and Wolf, 1995; Kirby and Coyle, 1997). Two exceptions are the quantitative overviews by Frost and Forrest (Frost and Forrest, 1995) and Franklin et al. (Franklin et al., 1997).

In the first review (Frost and Forrest, 1995), the authors selected only five rigorously evaluated sex education programs and estimated their impact on delaying sexual initiation. They used non-standardized measures of effect sizes, calculated descriptive statistics to represent the overall effect of these programs and concluded that those selected programs delayed the initiation of sexual activity. In the second review, Franklin et al. conducted a meta-analysis of the published research of community-based and school-based adolescent pregnancy prevention programs and contrary to the conclusions forwarded by Frost and Forrest, these authors reported a non-significant effect of the programs on sexual activity (Franklin et al., 1997).

The discrepancy between these two quantitative reviews may result from the decision by Franklin et al. to include weak designs, which do not allow for reasonable causal inferences. However, given that recent evidence indicates that weaker designs yield higher estimates of intervention effects (Guyatt et al., 2000), the inclusion of weak designs should have translated into higher effects for the Franklin et al. review and not smaller. Given the discrepant results forwarded in these two recent quantitative reviews, there is a need to clarify the extent of the impact of school-based sex education in abstinent behavior and explore the specific features of the interventions that are associated to variability in effect sizes.

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Purpose of the study

The present study consisted of a meta-analytic review of the research literature on the effectiveness of school-based sex education programs in the promotion of abstinent behavior implemented in the past 15 years in the US in the wake of the AIDS epidemic. The goals were to: (1) synthesize the effects of controlled school-based sex education interventions on abstinent behavior, (2) examine the variability in effects among studies and (3) explain the variability in effects between studies in terms of selected moderator variables.

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Literature search and selection criteria

The first step was to locate as many studies conducted in the US as possible that dealt with the evaluation of sex education programs and which measured abstinent behavior subsequent to an intervention.

The primary sources for locating studies were four reference database systems: ERIC, PsychLIT, MEDLINE and the Social Science Citation Index. Branching from the bibliographies and reference lists in articles located through the original search provided another source for locating studies.

The process for the selection of studies was guided by four criteria, some of which have been employed by other authors as a way to orient and confine the search to the relevant literature (Kirby et al., 1994). The criteria to define eligibility of studies were the following.

Interventions had to be geared to normal adolescent populations attending public or private schools in the US and report on some measure of abstinent behavior: delay in the onset of intercourse, reduction in the frequency of intercourse or reduction in the number of sexual partners. Studies that reported on interventions designed for cognitively handicapped, delinquent, school dropouts, emotionally disturbed or institutionalized adolescents were excluded from the present review since they address a different population with different needs and characteristics. Community interventions which recruited participants from clinical or out-of-school populations were also eliminated for the same reasons.

Studies had to be either experimental or quasi-experimental in nature, excluding three designs that do not permit strong tests of causal hypothesis: the one group post-test-only design, the post-test-only design with non-equivalent groups and the one group pre-test–post-test design (Cook and Campbell, 1979). The presence of an independent and comparable `no intervention' control group—in demographic variables and measures of sexual activity in the baseline—was required for a study to be included in this review.

Studies had to be published between January 1985 and July 2000. A time period restriction was imposed because of cultural changes that occur in society—such as the AIDS epidemic—which might significantly impact the adolescent cohort and alter patterns of behavior and consequently the effects of sex education interventions.

Studies had to be published in a peer-reviewed journal. The reasons for this criterion are 3-fold. First, there have been many reports published in newspapers or advocacy newsletters claiming that specific sex education programs have a dramatic impact on one or more outcome variables, yet when these reports have been investigated, they often were found lacking in valid empirical evidence (Kirby et al., 1994; Frost and Forrest, 1995). Second, unpublished studies are hard to locate and the quality of unpublished research makes it doubtful whether the cost involved in undertaking retrieval procedures is worth investing. This is not to say that all conference papers are defective or all journal articles are free of weaknesses. However, regardless of varying standards of review rigor and publication criteria between journals, published articles have at least survived some form of a refereeing and editing process (Dunkin, 1996). Finally, an added advantage of including only published articles is that it helps reduce the risk of data dependence. The probability of duplication of studies is likely to be increased when including dissertation and papers presented at conferences, which often constitute previous drafts to published studies. Even considering only published studies, it may be difficult to detect duplication. The same data set, or a subset of it, may be repeatedly used in several studies, published in different journals, with different main authors, and without any reference to the original data source. Published studies which were known or suspected to have employed the same database were only included once.1

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Coding of the studies for exploration of moderators

The exploration of study characteristics or features that may be related to variations in the magnitude of effect sizes across studies is referred to as moderator analysis. A moderator variable is one that informs about the circumstances under which the magnitude of effect sizes vary (Miller and Pollock, 1994). The information retrieved from the articles for its potential inclusion as moderators in the data analysis was categorized in two domains: demographic characteristics of the participants in the sex education interventions and characteristics of the program.

Demographic characteristics included the following variables: the percentages of females, the percentage of whites, the virginity status of participants, mean (or median) age and a categorization of the predominant socioeconomic status of participating subjects (low or middle class) as reported by the authors of the primary study.

In terms of the characteristics of the programs, the features coded were: the type of program (whether the intervention was comprehensive/safer-sex or abstinence-oriented), the type of monitor who delivered the intervention (teacher/adult monitor or peer), the length of the program in hours, the scope of the implementation (large-scale versus small-scale trial), the time elapsed between the intervention and the post-intervention outcome measure (expressed as number of days), and whether parental participation (beyond consent) was a component of the intervention.

The type of sex education intervention was defined as abstinence-oriented if the explicit aim was to encourage abstinence as the primary method of protection against sexually transmitted diseases and pregnancy, either totally excluding units on contraceptive methods or, if including contraception, portraying it as a less effective method than abstinence. An intervention was defined as comprehensive or safer-sex if it included a strong component on the benefits of use of contraceptives as a legitimate alternative method to abstinence for avoiding pregnancy and sexually transmitted diseases.

A study was considered to be a large-scale trial if the intervention group consisted of more than 500 students.

Finally, year of publication was also analyzed to assess whether changes in the effectiveness of programs across time had occurred.

The decision to record information on all the above-mentioned variables for their potential role as moderators of effect sizes was based in part on theoretical considerations and in part on the empirical evidence of the relevance of such variables in explaining the effectiveness of educational interventions. A limitation to the coding of these and of other potentially relevant and interesting moderator variables was the scantiness of information provided by the authors of primary research. Not all studies described the features of interest for this meta-analysis. For parental participation, no missing values were present because a decision was made to code all interventions which did not specifically report that parents had participated—either through parent–youth sessions or homework assignments—as non-participation. However, for the rest of the variables, no similar assumptions seemed appropriate, and therefore if no pertinent data were reported for a given variable, it was coded as missing (see Table I).
Once the pool of studies which met the inclusion criteria was located, studies were examined in an attempt to retrieve the size of the effect associated with each intervention. Since most of the studies did not report any effect size, it had to be estimated based on the significance level and inferential statistics with formulae provided by Rosenthal (Rosenthal, 1991) and Holmes (Holmes; 1984). When provided, the exact value for the test statistic or the exact probability was used in the calculation of the effect size.

In order to avoid data dependence, a conservative strategy of including only one finding per study was employed in this review. When multiple variations of interventions were tested, the effect size was calculated for the most successful of the treatment groups. This decision rests on the assumption that should the program be implemented in the future, the most effective mode of intervention would be chosen. Similarly, to ensure the independence of the data in the case of follow-up studies when multiple measurements were reported across time a single estimate of effect size was included.2

Analyses of the effect sizes were conducted utilizing the D-STAT software (Johnson, 1989). The sample sizes used for the overall effect size analysis corresponded to the actual number used to estimate the effects of interest, which was often less than the total sample of the study. Occasionally the actual sample sizes were not provided by the authors of primary research, but could be estimated from the degrees of freedom reported for the statistical tests.

The effect sizes were calculated from means and pooled standard deviations, t-tests, χ2, significance levels or from proportions, depending on the nature of the information reported by the authors of primary research. As recommended by Rosenthal, if results were reported simply as being `non-significant' a conservative estimate of the effect size was included, assuming P = 0.50, which corresponds to an effect size of zero (Rosenthal, 1991). The overall measure of effect size reported was the corrected d statistic (Hedges and Olkin, 1985). These authors recommend this measure since it does not overestimate the population effect size, especially in the case when sample sizes are small.

The homogeneity of effect sizes was examined to determine whether the studies shared a common effect size. Testing for homogeneity required the calculation of a homogeneity statistic, Q. If all studies share the same population effect size, Q follows an asymptotic χ2 distribution with k – 1 degrees of freedom, where k is the number of effect sizes. For the purposes of this review the probability level chosen for significance testing was 0.10, due to the fact that the relatively small number of effect sizes available for the analysis limits the power to detect actual departures from homogeneity. Rejection of the hypothesis of homogeneity signals that the group of effect sizes is more variable than one would expect based on sampling variation and that one or more moderator variables may be present (Hall et al., 1994).

To examine the relationship between the study characteristics included as potential moderators and the magnitude of effect sizes, both categorical and continuous univariate tests were run. Categorical tests assess differences in effect sizes between subgroups established by dividing studies into classes based on study characteristics. Hedges and Olkin presented an extension of the Q statistic to test for homogeneity of effect sizes between classes (QB) and within classes (QW) (Hedges and Olkin, 1985). The relationship between the effect sizes and continuous predictors was assessed using a procedure described by Rosenthal and Rubin which tests for linearity between effect sizes and predictors (Rosenthal and Rubin, 1982).

A weighted least-squares regression analysis was conducted to test the joint effect of the significant moderators on the effect sizes. The results of the univariate analyses were used to select the predictors to be included in the model. Categorical predictors were included as dummy variables. All predictors were entered simultaneously. Significance of each regression coefficient was tested using a z-test where the standard errors in the output of SPSS were adjusted by a factor of the square root of the mean square error for the regression model (Hedges and Olkin, 1985). Model specification was tested using the QE goodness-of-fit statistic.3

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Results

The search for school-based sex education interventions resulted in 12 research studies that complied with the criteria to be included in the review and for which effect sizes could be estimated.

The overall effect size (d+) estimated from these studies was 0.05 and the 95% confidence interval about the mean included a lower bound of 0.01 to a high bound of 0.09, indicating a very minimal overall effect size. Table II presents the effect size of each study (di) along with its 95% confidence interval and the overall estimate of the effect size. Homogeneity testing indicated the presence of variability among effect sizes (Q(11) = 35.56; P = 0.000).
Among the set of categorical predictors studied, parental participation in the program, virginity status of the sample and scope of the implementation were statistically significant.4

Parental participation appeared to moderate the effects of sex education on abstinence as indicated by the significant Q test between groups (QB(1) = 5.06; P = 0.025), as shown in Table III. Although small in magnitude (d = 0.24), the point estimate for the mean weighted effect size associated with programs with parental participation appears substantially larger than the mean associated with those where parents did not participate (d = 0.04). The confidence interval for parent participation does not include zero, thus indicating a small but positive effect. Controlling for parental participation appears to translate into homogeneous classes of effect sizes for programs that include parents, but not for those where parents did not participate (QW(9) = 28.94; P = 0.001) meaning that the effect sizes were not homogeneous within this class.
Virginity status of the sample was also a significant predictor of the variability among effect sizes (QB(1) = 3.47; P = 0.06). The average effect size calculated for virgins-only was larger than the one calculated for virgins and non-virgins (d = 0.09 and d = 0.01, respectively). Controlling for virginity status translated into homogeneous classes for virgins and non-virgins although not for the virgins-only class (QW(5) = 27.09; P = 0.000).

The scope of the implementation also appeared to moderate the effects of the interventions on abstinent behavior. The average effect size calculated for small-scale intervention was significantly higher than that for large-scale interventions (d = 0.26 and d = 0.01, respectively). The effects corresponding to the large-scale category were homogeneous but this was not the case for the small-scale class, where heterogeneity was detected (QW(4) = 14.71; P = 0.01)

For all three significant categorical predictors, deletion of one outlier (Howard and McCabe, 1990) resulted in homogeneity among the effect sizes within classes.

Univariate tests of continuous predictors showed significant results in the case of percentage of females in the sample (z = 2.11; P = 0.04), age of participants (z = –1.67; P = 0.09), grade (z = –1.80; P = 0.07) and year of publication (z = –2.76; P = 0.006).

All significant predictors in the univariate analysis—with the exception of grade which had a very high correlation with age (r = 0.97; P = 0.000)—were entered into a weighted least-squares regression analysis. In general, the remaining set of predictors had a moderate degree of intercorrelation, although none of the coefficients were statistically significant.

In the weighted least-squares regression analysis, only parental participation and the percentage of females in the study were significant. The two-predictor model explained 28% of the variance in effect sizes. The test of model specification yielded a significant QE statistic suggesting that the two-predictor model cannot be regarded as correctly specified (see Table IV).
This review synthesized the findings from controlled sex education interventions reporting on abstinent behavior. The overall mean effect size for abstinent behavior was very small, close to zero. No significant effect was associated to the type of intervention: whether the program was abstinence-oriented or comprehensive—the source of a major controversy in sex education—was not found to be associated to abstinent behavior. Only two moderators—parental participation and percentage of females—appeared to be significant in both univariate tests and the multivariable model.

Although parental participation in interventions appeared to be associated with higher effect sizes in abstinent behavior, the link should be explored further since it is based on a very small number of studies. To date, too few studies have reported success in involving parents in sex education programs. Furthermore, the primary articles reported very limited information about the characteristics of the parents who took part in the programs. Parents who were willing to participate might differ in important demographic or lifestyle characteristics from those who did not participate. For instance, it is possible that the studies that reported success in achieving parental involvement may have been dealing with a larger percentage of intact families or with parents that espoused conservative sexual values. Therefore, at this point it is not possible to affirm that parental participation per se exerts a direct influence in the outcomes of sex education programs, although clearly this is a variable that merits further study.

Interventions appeared to be more effective when geared to groups composed of younger students, predominantly females and those who had not yet initiated sexual activity. The association between gender and effect sizes—which appeared significant both in the univariate and multivariable analyses—should be explored to understand why females seem to be more receptive to the abstinence messages of sex education interventions.

Smaller-scale interventions appeared to be more effective than large-scale programs. The larger effects associated to small-scale trials seems worth exploring. It may be the case that in large-scale studies it becomes harder to control for confounding variables that may have an adverse impact on the outcomes. For example, large-scale studies often require external agencies or contractors to deliver the program and the quality of the delivery of the contents may turn out to be less than optimal (Cagampang et al., 1997).

Interestingly there was a significant change in effect sizes across time, with effect sizes appearing to wane across the years. It is not likely that this represents a decline in the quality of sex education interventions. A possible explanation for this trend may be the expansion of mandatory sex education in the US which makes it increasingly difficult to find comparison groups that are relatively unexposed to sex education. Another possible line of explanation refers to changes in cultural mores regarding sexuality that may have occurred in the past decades—characterized by an increasing acceptance of premarital sexual intercourse, a proliferation of sexualized messages from the media and increasing opportunities for sexual contact in adolescence—which may be eroding the attainment of the goal of abstinence sought by educational interventions.

In terms of the design and implementation of sex education interventions, it is worth noting that the length of the programs was unrelated to the magnitude in effect sizes for the range of 4.5–30 h represented in these studies. Program length—which has been singled out as a potential explanation for the absence of significant behavioral effects in a large-scale evaluation of a sex education program (Kirby et al., 1997a)—does not appear to be consistently associated with abstinent behavior. The impact of lengthening currently existing programs should be evaluated in future studies.

As it has been stated, the exploration of moderator variables could be performed only partially due to lack of information on the primary research literature. This has been a problem too for other reviewers in the field (Franklin et al., 1997). The authors of primary research did not appear to control for nor report on the potentially confounding influence of numerous variables that have been indicated in the literature as influencing sexual decision making or being associated with the initiation of sexual activity in adolescence such as academic performance, career orientation, religious affiliation, romantic involvement, number of friends who are currently having sex, peer norms about sexual activity and drinking habits, among others (Herold and Goodwin, 1981; Christopher and Cate, 1984; Billy and Udry, 1985; Roche, 1986; Coker et al., 1994; Kinsman et al., 1998; Holder et al., 2000; Thomas et al., 2000). Even though randomization should take care of differences in these and other potentially confounding variables, given that studies can rarely assign students to conditions and instead assign classrooms or schools to conditions, it is advisable that more information on baseline characteristics of the sample be utilized to establish and substantiate the equivalence between the intervention and control groups in relevant demographic and lifestyle characteristics.

In terms of the communication of research findings, the richness of a meta-analytic approach will always be limited by the quality of the primary research. Unfortunately, most of the research in the area of sex education do not employ experimental or quasi-experimental designs and thus fall short of providing conclusive evidence of program effects. The limitations in the quality of research in sex education have been highlighted by several authors in the past two decades (Kirby and Baxter, 1981; Card and Reagan, 1989; Kirby, 1989; Peersman et al., 1996). Due to these deficits in the quality of research—which resulted in a reduced number of studies that met the criteria for inclusion and the limitations that ensued for conducting a thorough analysis of moderators—the findings of the present synthesis have to be considered merely tentative. Substantial variability in effect sizes remained unexplained by the present synthesis, indicating the need to include more information on a variety of potential moderating conditions that might affect the outcomes of sex education interventions.

Finally, although it is rarely the case that a meta-analysis will constitute an endpoint or final step in the investigation of a research topic, by indicating the weaknesses as well as the strengths of the existing research a meta-analysis can be a helpful aid for channeling future primary research in a direction that might improve the quality of empirical evidence and expand the theoretical understanding in a given field (Eagly and Wood, 1994). Research in sex education could be greatly improved if more efforts were directed to test interventions utilizing randomized controlled trials, measuring intervening variables and by a more careful and detailed reporting of the results. Unless efforts are made to improve on the quality of the research that is being conducted, decisions about future interventions will continue to be based on a common sense and intuitive approach as to `what might work' rather than on solid empirical evidence.

source by:http://her.oxfordjournals.org/content/17/4/471.full