This has been a problem too for other reviewers in the field Franklin et al. 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. Studies had to be published in a peer-reviewed journal. Suggestions to address this limitation are provided. 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. Patterns and correlates of parental and formal sexual and reproductive health communication for adolescent women in the United States, — Changes in formal sex education: 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. No significant effect was associated to the type of intervention:
The Future of Sex Education Given the insufficient state of sex education in the United States in , existing gaps are opportunities for more ambitious, forward-thinking strategies that cross-cut levels to translate an expanded evidence base into best practices and policies. 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. 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. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: 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. To date, too few studies have reported success in involving parents in sex education programs. Ultimately, expanded, integrated, multilevel approaches that reach beyond the classroom and capitalize on cutting-edge, youth-friendly technologies are warranted to shift cultural paradigms of sexual health, advance the state of sex education, and improve sexual and reproductive health outcomes for adolescents in the United States. 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 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 process evaluation of the FaceSpace Project. 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, Even considering only published studies, it may be difficult to detect duplication. As adolescents turn increasingly to the Internet for their sex education, perhaps school-based settings can better serve other unmet needs, such as for comprehensive sexual and reproductive health care, including the full range of contraceptive methods and STI testing and treatment services. The most exciting studies have found programs with rights-based content, positive, youth-centered messages, and use of interactive, participatory learning and skill building are effective in empowering adolescents with the knowledge and tools required for healthy sexual decision-making and behaviors [ 4 , 11 — 14 , 27 — 29 ]. The results of the analysis indicated a very small overall effect of the interventions in abstinent behavior. 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. Studies had to be published between January and July This is not to say that all conference papers are defective or all journal articles are free of weaknesses. The publisher's final edited version of this article is available at J Adolesc Health See other articles in PMC that cite the published article. Emerging trends in evidence and practice. 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. Moreover, the study highlights several additional new concerns. 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. 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. Branching from the bibliographies and reference lists in articles located through the original search provided another source for locating studies. 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. Paradoxically, the declines in formal sex education from to have coincided with sizeable declines in adolescent birth rates and improved rates of contraceptive method use in the United States from to [ 20 , 21 ].
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