Cautious optimism is emerging among those concerned about adolescent sexuality. The rate of sexual intercourse among teenagers has declined, and teen contraception-use rates, particularly for condom use, have increased. As a result, teen birth rates have declined for the past seven years (Kann et al., 2000; Ventura, Mathews, & Curtin, 1999).
Support for sexuality education is also at an all-time high. A recent poll conducted by the Sexuality Information and Education Council of the United States (SIECUS) and Advocates for Youth showed that 93 percent of adults supported teaching sexuality education in high school and 84 percent supported teaching sexuality education in middle school. And although 90 percent of Americans believe that abstinence should be a topic in sexuality education, 70 percent oppose the provision of federal law that allocates funding for abstinence-only-until-marriage education but prohibits use of the funds for information on contraception for the prevention of unintended pregnancy and disease. The poll and subsequent focus groups clearly demonstrate that parents in the United States don't see any inconsistency in providing information about both abstinence and contraception in sexuality-education programs. For parents, it is not a matter of either/or—they want both (Haffner & Wagoner, 1999).
These trends are promising, but we cannot afford to be complacent. In spite of recent declines, the birth rates among African American and Latina women ages 15 to 19 are still significantly higher than the overall birth rate in this age group (Ventura, Mathews, & Curtin, 1999). The rates of intercourse, pregnancy, and sexually transmitted diseases (STDs) are still much higher in the United States than in other industrialized countries (Advocates for Youth, 1999). And despite the lack of scientific evidence of the effectiveness of abstinence-only programs for delaying the initiation of sexual intercourse, the federal government has allocated tens of millions of dollars to support abstinence-only-until-marriage programs.
Whether we agree with young people's actions or not, we cannot ignore the fact that millions of teenagers in the United States are engaging in a range of sexual behaviors. From the perspective of public health, some of these behaviors are less risky in terms of pregnancy or transmission of STDs, whereas others carry a greater risk. For these reasons, all young people in the United States need the information, skills, and access to services to make and carry out informed, responsible decisions about their sexuality.
As a society, the United States has a long way to go to become sexually healthy. Americans hold confused and contradictory attitudes about sexuality. Although we are generally accepting enough to participate in sexual behaviors, we are not accepting enough of these behaviors to avoid guilt or shame. More important, we lack commitment to the prevention of disease and unintended pregnancies. This cultural confusion about sexuality is especially profound when we consider how adults deal with adolescent sexuality and sexual behaviors.
In our society, adults do not model sexual health for young people. In fact, teenagers often behave more responsibly than adults. For example, 75 percent of unintended pregnancies in the United States occur to adult women (Brown & Eisenberg, 1995). Never-married teens use birth control more consistently than never-married young adults in their twenties, and adolescents are much more likely to use condoms than older couples (Alan Guttmacher Institute, 1990). Sexual intercourse with adult males is the cause of 60 percent of all teen births and nearly all sexually transmitted HIV infection among both male and female teens (Males, 1996).
Discussions about adolescent sexuality often focus on adults' perceptions of how "things should be" rather than a realistic understanding of the dynamics of adolescents' lives. During adolescence, young people develop the knowledge, attitudes, and skills that become the foundation for their healthy adulthood. Recognizing that nearly all Americans eventually become sexually active, we need to ensure that young people have the information and skills to make responsible decisions about their sexuality—whether they make those decisions as adolescents or adults. Ensuring that young people have access to comprehensive sexuality education is one step that we can take toward helping them achieve a sexually healthy adulthood.
Comprehensive, school-based sexuality education that is appropriate to students' ages, developmental levels, and cultural backgrounds should be an important part of the education program at every grade. A comprehensive sexuality-education program respects the diversity of values and beliefs represented in the community and complements and augments the sexuality education children receive from their families, religious and community groups, and health care professionals (SIECUS, 1996). The National Guidelines Task Force convened by SIECUS has produced Guidelines for Comprehensive Sexuality Education: Kindergarten–12th Grade (1996) to help educators formulate such programs.
Work on the path to sexual health has begun. As professionals who care for and about young people, we can take specific steps to make sexual health a reality.
Support Parents
Parents and families play a major role in ensuring adolescent sexual health. Parents are, and ought to be, the primary sexuality educators of their children. They educate both by what they say and don't say, as well as by how they behave. Research indicates that young people who are able to talk to their parents about sexuality often behave more responsibly (Council of Economic Advisers, 2000; Whitaker, Miller, May, & Levin, 1999).
With open communication, young people are more likely to turn to their parents for help and support. Some parents have difficulty communicating with their children about sexuality, particularly because many of their parents also had difficulty with communication. To overcome this difficulty, educators must provide parents with accurate, honest, and developmentally appropriate sexuality information to share with their children, and educators must encourage parents to express their values about sexuality to their children. Parents and other adults need to foster responsible sexual decision-making skills and to model healthy sexual attitudes and responsible behaviors in their own lives (National Commission on Adolescent Sexual Health, 1995).
Define Comprehensive
The primary goal of comprehensive sexuality education is to promote sexual health—to help people develop a positive view of sexuality, to provide them with information and skills to take care of their sexual health, and to help them acquire skills to make decisions both now and in the future (National Guidelines Task Force, 1996).
In national, state, and local polls, Americans show overwhelming support for sexuality education that covers a broad range of topics. In the SIECUS/Advocates for Youth poll, for example, more than 70 percent of parents wanted information about puberty, abstinence, STDs, and HIV—and about 60 percent wanted information about love and dating, contraception, condoms, and sexual orientation—introduced in 7th and 8th grades. More than 90 percent supported teaching about all these topics in senior high school. A majority supported teaching even the most sensitive topics in schools: Three-quarters approved teaching about sexual orientation and two-thirds approved teaching about abortion by 9th grade (Haffner & Wagoner, 1999).
Unfortunately, despite this support, many schools have significant gaps in their educational efforts that leave young people unprepared to negotiate sexual situations. Too often, ideological debates—rather than scientific evidence and concerns about public health—influence decisions about sexuality education.
Also, many programs in the United States focus exclusively on "disaster prevention"—on topics such as avoiding sexual abuse, pregnancy, and STD infection. Although these goals are important, they are neither the only goals nor the only topics that educators and students should address.
The six key concepts outlined in the Guidelines for Comprehensive Sexuality Education—human relationships, human development, sexual behavior, sexual health, personal and interpersonal skills, and social and cultural environments—provide an outline for a comprehensive sexuality education that covers not only such topics as the prevention of sexual abuse, pregnancy, and STD/HIV, but also equally important topics such as body image, friendship, love, decision making, communication, abstinence, and gender roles. A comprehensive program helps students develop their values on a broad range of important life issues (National Guidelines Task Force, 1996).
Certify Teachers in Sexuality Education
Comprehensive sexuality education should be an important component of every grade in all schools. Too often, however, teachers do not have the skills, knowledge, or inclination to teach such courses. Few have received training in sexuality education, and even fewer have received certification as sexuality educators. A 1995 SIECUS study revealed that U.S. elementary and secondary school teachers at the preservice level are not adequately prepared to provide sexuality education, including HIV prevention, to their students (Rodriguez, Young, Renfro, Asencio, & Haffner, 1995). Because sexuality issues touch on so many developmental issues relating to children and youth, SIECUS has, since 1965, urged that all preservice teachers for prekindergarten through 12th grade receive at least one course in human sexuality.
Research shows that effective programs for sexuality education are taught by teachers and leaders who believe in the program and are trained to deliver it (Kirby, 1997). Yet studies reveal that teachers do not feel adequately trained to teach sexuality education. They report concern about their ability to teach personal skills and about their knowledge of HIV/AIDS and STDs (Ballard, White, & Glascoff, 1990; Levenson-Gingiss & Hamilton, 1989). Most of those teaching sexuality education report receiving their training in short workshops or seminars (Forest & Silverman, 1989).
Clearly, training for teachers is crucial to the success of these programs and the health of our children. Teachers should undergo specialized training that includes information on sexuality topics and a special focus on the philosophy and methodology of teaching sexuality education. Ideally, preservice teachers should receive this in-depth training in college or graduate courses and then complement the training with extensive inservice courses.
Although 35 states require teaching about sexuality or HIV/AIDS (NARAL, 2000), a 1995 study showed that only 12 states, the District of Columbia, and Puerto Rico required any certification for teachers of sexuality education, and only 12 states and the District of Columbia required certification for teachers of HIV-prevention education. Only six states and Puerto Rico required teacher training for sexuality educators and nine states, the District of Columbia, and Puerto Rico required training for teachers of HIV-prevention education (SIECUS, 1995). States should develop requirements that integrate sexuality education into existing requirements for health-education certification. Current credentialing and accreditation bodies should also integrate these criteria into their requirements for health educators.
Support Sexuality Education in the Community
Education professionals should become actively involved in supporting programs for sexuality education in their communities. Professionals can submit letters to editors, vote in school board elections, write supportive letters to teachers and administrators, serve on advisory committees in their communities, and belong to professional organizations that actively support comprehensive sexuality education, such as the American Association of School Administrators, the National School Boards Association, the National Association of School Psychologists, and the National Education Association Health Information Network.
Educators can also urge schools and communities to use new resources, such as the age-appropriate, unbiased sexuality information for teens available on several Internet sites—including www.iwannaknow.org, www.sexetc.org, www.teenwire.com, and www.sextalk.org.
One of the challenges for the education and health communities is to develop innovative, accessible approaches that meet the sexual-health needs of adolescents who are not in school. Out-of-school adolescents are more likely to report having had sexual intercourse and to have had four or more sexual partners (Centers for Disease Control and Prevention, 1992). Health agencies, faith communities, community-based organizations, and youth-serving agencies—such as Girls, Inc., the Urban League, and the YWCA of the U.S.A.—can be important sources of sexuality information and programs for young people. We need to strengthen our partnerships with these agencies to ensure the sexual health of all young people, particularly those most at risk.
In spite of recent efforts to limit sexuality education, the parental and scientific support for a more comprehensive approach is exceptionally strong. The challenge for educators is to ensure that schools and communities provide all young people with the information, services, and support they need to grow up to become sexually healthy adults.
