This article reviews the major approaches implemented during the last two decades to reduce sexual risk-taking behaviors, examines their evidence for success, and provides several recommendations for effective programs and program evaluations. This article does not discuss more broad-based sexuality education programs which address sexuality in a broader context. Instead, this article focuses primarily on programs that educators believed would reduce unprotected sexual intercourse.
PIP: School-based sex and health education programs exist to reduce the degree of pregnancy and HIV transmission among adolescents. Programs have ranged from one-hour didactic presentations to semester-long comprehensive education programs. While professionals who work with schools have differing views on what should be the proper goals of school-based sexuality and AIDS education programs, the proper role of schools, and appropriate outcomes to evaluate, evidence nonetheless indicates that no existing program prevents most youth from having intercourse during their high school years. Programs may, however, delay first intercourse and increase contraceptive usage; programs for younger youths should emphasize the former objective, while programs for older teens should stress the latter behavior. 44 states either mandate or explicitly encourage sex education, 40 states mandate or recommend HIV/AIDS education, and 93% of schools offer sex or AIDS education generally in the ninth and tenth grades. Early sex education curricula focused on increasing knowledge and emphasizing the risk and consequences of pregnancy. Updated second generation curricula stressed knowledge, but emphasized values clarification and skills especially indecision-making and communication. In opposition, conservatives ignored the need to sue contraception against unwanted pregnancy and disease, and created programs espousing abstinence until marriage as the only acceptable behavior. Evidence shows that these programs neither delayed nor reduced the frequency of intercourse. A fourth group of HIV/AIDS education programs aimed to change adolescent sexual behavior without building upon successes and failures of earlier programs, while new programs are based on theoretical approaches with demonstrated effectiveness in other health areas. Studies suggest that curricula based on social influence approaches and social learning theory are most effective in reducing the degree of unprotected intercourse and delaying the initiation of intercourse.