SEX EDUCATION IN THE 21ST CENTURY

Controversies about the proper content of school-based
sex education continue, but in some fundamental sense
they have been matched by—perhaps even overtaken
by—other pressing realities. For example, there are
increasing demands that school resources be dedicated
to teaching the basics of reading, writing, and math
and to upgrading the attention given to science
education. Many communities find that meeting these
legitimate demands places substantial pressure on
school hours and budgets, often at the expense of such
areas as art and physical education as well as health
education, which often includes sex education.
Moreover, limited budgets can also decrease the
amount of training made available to sex education
teachers.
This situation is particularly distressing because during
the last decade, increasing numbers of programs have
become available that can help teens delay having sex,
increase their use of contraception when they do have
sex, and potentially help reduce the incidence of teen
pregnancy. Some of these programs are based in
schools, some are in community settings, and some
span both. The US Department of Health and
Human Services’ Office of Adolescent Health lists 31
such programs that have evidence of effect, and the
list has played a major role in shaping the funding
priorities of the Teen Pregnancy Prevention Program
administered by that office.
Numerous schools and communities welcome these
evidence-based programs, and funding through the
Office of Adolescent Health and the Family and Youth
Services Bureau has supported many such programs
nationwide and also has increased the amount of
attention given to using and replicating effective
programs. Even so, many sexually experienced teens
(46% of males and 33% of females) report that they
had not received any instruction about contraception
before they began having sex, and states like
Oklahoma and Alabama—with 2 of the highest rates of
teen pregnancy in the country—do not require any sex
education in school at all. Moreover, in some
communities the “sex ed wars” (ie, the intense and
vocal controversy over sex education in schools) persist
as they have for decades.
Such developments suggest a need to rethink the way
in which sex education is offered to young people. In
the age of smartphones, texting, Twitter, Instagram,
and Facebook, sex education should evolve to fit the
21st century and the media-saturated lives of young
people today. A strong case can be made that in the
United States, the media are already the de facto sex
educators (the average teenager sees 15 000 sexual
references on television alone each year). Perhaps it is
time to fully embrace the power of 21st-century
communication and direct it toward public health goals
more deliberately. Online material and social media
could help to fill the gaps in sex education and support
for many young people.
Sex education materials and conversations provided
through digital and social media could be useful
adjuncts to classes and programs that may be offered
in a community or school system; in areas where no
such programs exist, they may help to fill serious gaps.
Two increasingly popular sites sponsored by The
National Campaign to Prevent Teen and Unplanned
Pregnancy, StayTeen.org and Bedsider.org , and other
engaging sites such as Go Ask Alice! and Scarleteen,
are expanding understanding of how digital media can
help. These sites provide information in an accurate
and appealing way. An amusing video on Bedsider.org ,
for example, shows a young adult woman explaining
her initial reluctance to use a contraceptive vaginal ring
and how she mastered the method, and funny “Fact or
Fiction” cartoons that include physician commentaries
debunk common myths in a relaxed but accurate way.
In addition, some community groups and local health
departments around the country (in California, New
Mexico, and North Carolina, for example) have
established digital services to which teens can text their
sex-related questions. These emerging sites and
systems may appeal in particular to teens who are
more comfortable obtaining sexual information
anonymously than they are in a coed sex education
class or asking their parents for information. Unlike
many community or school-based sex education
classes, Internet-based sex information can be
available throughout a teenager’s adolescence.
Questions may change, new situations arise, and new
treatments or scientific information sometimes develop;
the Internet can be a good repository for updated,
ongoing sex information that any teenager can access
anytime. In a recent survey of more than 1200
Australian teenagers, for example, the most common
source of information about sex actually was the
Internet (85%). Misinformation on the Internet does
exist, but professional oversight may help direct teens
to reputable, accurate sites. In addition, “good” sexual
content may help to drown out “bad” sexual content
(Gresham’s corollary). In any event, sex education
should not miss out on the worldwide move to use
online systems to improve health.
Sex education in the 21st century merits time, attention,
innovation, and, in particular, research to assess
possible benefit. For example, 4 issues might be
addressed. First, can online sex education systems help
young people learn some of the key skills increasingly
seen as central to risk reduction, such as negotiating
skills and a strong sense of agency and self-efficacy?
Or is the main value of these online sites more likely to
be in the somewhat less difficult task of providing
information? The research base here is weak at best,
although one study of sexual health promotion on
Facebook has demonstrated that young people will at
least access this information. In addition, methods of
assessing the effect of online interventions on behavior
are currently an emerging topic in research design.
Second, is there a way for online sex education to be
presented in the voice and tone of teens to reflect their
concerns yet also provide accurate and credible
information? Adults and professionals could lead the
way, but a site that feels like it is the product of a
lecturing, authoritarian, adult group may well be
unpopular. Involvement of teens in the development of
sites will likely be needed for success, and teen-
appropriate humor and perspective could be especially
attractive. One site currently has been developed and is
administered solely by teens; its motto is “by teens, for
teens.”
Third, might there be a way for professional groups like
the American Academy of Pediatrics, the Society for
Adolescent Health and Medicine, the American Academy
of Family Physicians, and the National PTA to create a
standardized but fully teen-centric core set of materials,
lessons, and interactive components that could then be
“localized” by community groups? Detailed information
on adolescent-centered services and where to go for
what types of help, including information on
confidentiality, cost issues, and privacy, would be
particularly useful for teens. Fourth, how can online
systems support and amplify evidence-based programs
already in use? Are there some instances in which the
online platform is preferable?
Given the controversies about sex education that have
limited the full use of well-designed, evidence-based
programs, the acceptance and use of online sex
education and support remain to be determined.
However, because the Internet is essentially
unregulated, there is no need to secure anyone’s
particular approval for any site or its content, improving
access of teens to sex information without school board
approval. In addition, although not all teens are in
school, odds are that they are online. The Internet is
already a major source of sex information, some of it
inaccurate, so why not encourage development of
responsible, relevant sex information that would appeal
to teens and be easy to use? It may be an idea for
which the time has come.