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IMPORTANCE OF SEX EDUCATION ESSAY

Custom StudentMr. TeacherENG 1001-041 May 2016

Importance of Sex Education

Abstract

Sex education is an important aspect for adolescents and crucial for their development. It is
crucial for youths to learn about their sexuality and be able to make better decisions about sex.
The sources confirmed that the topic of sex education is a highly debated when it comes to
whether or not sex education should be added to the curriculum that is taught in schools. The
controversy stems from parents that oppose sex education in schools due to their religious or
personal opinions. According to the CDC there has been a decline in teen pregnancy due to the
efforts towards prevention of pregnancy and STDs. The United States has the highest rate of
sexually transmitted diseases and teenage pregnancy among developed countries, (Carter, 2012).

Studies will show that teen pregnancy, STDs, and the initiation of sex remain a risk and
controversial topic in the United States and that teens is less likely to become pregnant if they
receive some type of comprehensive sex education compared teens that received no sex
education, (Kohler et al., 2008). Sex education is not only about giving youths the facts, it is
about teaching young people knowledge they can to use to live a safe and healthier life.

Importance of Sex Education

The lack of adolescents sexual knowledge during an adolescent multiple developmental changes,
can increase their use of self selected media, abstract thinking, or increase time spent with peers.
It has been found of students in their first year at least 56 percent have experience genital
fondling, (Byers et al., 2011). Adolescents sexuality becomes prominent and their sexual
feelings and interest is heightened during their middle school years, including their opportunity
for sexual exploration and sexual knowledge. A study shows that before a girl 20th birthday that
three out of ten girls will at least become pregnant one time. A survey done by the Center of
Disease Control in 2011 indicated that among high school students that over 47 percent of them
have already had sex and at least 15 percent of students have had sex with four or more different
partners, (Institute, 2014).

Between 1995 and 2002 there was a major decline of about 86% in teen pregnancy rate due to
the dramatic improvements in teens using contraceptions and the decreased in sexual
activity.owe Providing adolescents with skill and knowledge is a human right and helps improve
their sexual health, even though some suggest that sex education increases sexual activity, (Ross,
2008).

Review of Literature

There has been a continued debate about how sex education is taught. Controversy stems from
parents that oppose sex education in schools due to their religious or personal opinions. A study
that was recently done showed teens that received parental guidance from their parents about
sex, STDs, and birth control was more likely to use protection than the teens that had not talked
frequently about sex with their parents. Some sources dispute the fact that sex education
provokes youths into having sex once schools begin teaching sex education. The topic of sex is
barely discussed with parents and adolescents feel sexual topics have little importance to their
parents compared to a parent perception. Communication between youth and parents can help the
youths to make healthy decisions. Parents sometimes find it difficult to communicate with their
youths about topics they wants to know about, including abstinence and how to prevent STDs
and HIV, (Whittaker, 2009).

Depending on the content, its harder to assess teenagers behavior when it comes to sex
education, which can lead to risky behavior among sexually experienced teenagers. Parents
communication about sex education is delayed when it comes to sexual initiation and birth
control methods. Adolescents should be educated on a wide range of sexual topics according to
teachers, high school students, and parents by middle school or earlier. Sex education in home or
school is important for adolescents and crucial for their development, (Martinez et al., 2010). A
study on sexual health education shows that students believe that comprehensive school based
sexual health education is important and has positive views than the sex education they receive
from their parents. Some studies show that the comprehensive sex education provides a higher
quality and is more comfortable for students to frequently ask questions, (Byers et al., 2011).

There was a study conducted by the Ripple trial that shows that effectiveness of a long term
evaluation about peer led sex education programs compared to the teacher led sex education
programs. Out of twenty seven secondary schools randomly selected, studies shows that among
students the peer led programs were more popular than the teacher led programs, (Ross, 2008).
There have been little epidemiologic evaluations done on a population level that shows the
effectiveness of these programs, despite a few systematic reviews, (Kohler et al., 2008). The rate
of teen pregnancy in the United States is still higher than it is in Europe even though with
comprehensive sex education in the states has a lower teen pregnancy rate. Data has suggested
that the formal comprehensive sex education programs help reduce the risk for unplanned
pregnancy without provoking youths to engage in sex. Randomized results confirm that
abstinence only programs have very little effect on risky sexual behavior, (Kohler et al., 2008).
Sex education is widely implemented even though that there is evidence of weakness of the
effectiveness of sex education.

Abortion and pregnancy have been mostly depended on studies on self reported behavioral
outcomes, (Ross, 2008). According to the authors of, Demographic differences in adolescents
sexual attitudes and behaviors, parent communication about sex, and school sex education,
(2011) the most important demographic variables that are influencing risky sexual behaviors is
the maturity levels of the adolescents. The older adolescents seem to have a promiscuous attitude
about sex and receive more sexual communication proving that age is a major factor when it
comes to adolescent sexual behavior. This study was to show the demographic differences and
similarities that dealt with gender and age that affect adolescent sexual behaviors. The research
confirms that the gender differences in adolescent sexual behavior and a heterosexual male will
engage more regularly in sexual behaviors than heterosexual females.

Adolescent males seem to engage in inconsistent condom use and many short-term monogamous
relationships than females, (Anagurthi et al., 2011). Adolescents sexual behaviors and sexual
behavior patterns for gender and age are clear but vary when it comes to ethnicity. Studies done
by authors, (Anagurthi et al., 2011) suggests that African American adolescents have more sex at
an early age than the Caucasian adolescents and have more sex partners than any other racial
minority. Research done on African American college students in the United States focused on
sexually transmitted diseases, sexual decision making, teen pregnancy, and sexual experiences
from living in poor urban areas. Factors such as religion, parents involvement, and education
had a part in influencing African American sexual decision making, (Barnes et al., 2010).
HIV/AIDS cases among African American females show a disproportionate percentage
according to the CDC in 2004. African American females with HIV/AIDS are sometimes treated
in biased ways by society along with limited healthcare.

The fact still remains that premarital sexual activities among youths are growing along with the
epidemic of HIV/AIDS. Roughly every year in the United States, there are at least nine million
new cases of STDs reported among young adults and teens, (Institute, 2012). A study reported by
Alexandra McManus and Lipi Dhar shows that the increased rates of HIV (Human
Immunodeficiency Virus) and STIs (Sexually Transmitted Infections) was caused by the risky
sexual behavior of youths and biological factors. The report showed that 32 percent of the cases
of AIDS (acquired immunodeficiency syndrome) were among young people between the ages of
15-29 and twice as much among young women, (McManus et al., 2008). Alarming proportions
estimated that there are about 3 percent of people living in the United States among the 35
million people living with HIV worldwide and the population that are vulnerable continue to be
young adults.

A study done among college students suggest for prevention against STDs and HIV/AIDS there
are two important aspects, a monogamous relationship along with correct and consistent condom
use, (Kanekar et al., 2010). Out of the 48 states that have the sex education policies and laws,
there were studies done to determine and analyze the extent that states focus on abstinence as
part of their sex education program, (Carter, 2012). The CDC officials from the Center for
Disease Control states that there has been a decline of teen births due to the pregnancy
prevention efforts since they began tracking in the 1940s. Reports also show that abstinence
only programs had little impact on teen pregnancy and that sixty percent of teens that received
some type of comprehensive sex education would less likely to get someone pregnant or become
pregnant, (Beadle, 2012).

It is important for states to work toward training teachers and reducing the high rates of teen
pregnancy by teaching comprehensive sex education in schools and for teens to learn safe sex
practices, human reproduction, prevention of sexual transmitted diseases, unplanned
pregnancies, as well the right time to learn sex education, (Stranger-Hall et al., 2011). The United
States policies and laws can only provide guidelines for school boards that do decide to teach sex
education and is not really required to teach STD and sex education. The states that dont have
sex education laws have some type of policy that deal with STD and HIV education, (Stranger-
Hall et al., 2011). Due to the problem that researchers have gaining access to students and
schools, the public will never know what is being taught in sex education in the classrooms. The
insight into how policies on sex education affect students in private and public schools in the
United States is due to social inequality and sex education, (Kendall, 2010).
Sex education in schools can play a major developmental role towards sexual behaviors and
attitudes for adolescents even though the context of the adolescents developmental comes
primary from the parents. Schools can help promote safe sex and healthy sexual development for
the adolescents that are already sexually active There were an increase in school performance
and attachment to schools, reduce in risky sexual behaviors and sexual attitudes, and a decrease
in school dropout rates due to the effectiveness of some of the school programs in a review that
was done on over 60 studies. Other studies that indicated that sex education programs had no
effect toward sex before marriage among adolescents or how frequent they engaged in sex.
Unprepared adolescents with sexual behavior can become vulnerable to emotional problems and
stress. A continue effort on sex education programs is important to help focus on which features
of the programs that can effectively help reduce risky sexual behavior, (Anagurthi et al., 2011).

The family planning advocates and health educators indicated that the web would be a good and
accurate source for teens that are looking for information about sexuality topics and
contraception when other sensitive may be limited. The availability of the web and the use of
multimedia for teenagers have led to the discussion by the author, Freya Lund Sonenstein (2012)
on whether the information on the web dealing with sexual topics needs to be more accurate and
complete. Providing sex education and information about contraception is prohibited in public
schools in many states. The indication is that the web cannot replace life skills that schools and
family can teach on sexually transmitted diseases and prevention of unplanned pregnancy,
(Sonenstein, 2012).

Teenagers spend less time on the internet than the older populations searching health information
and visiting health information sites. In the United States qualitative data indicated that teens
doesnt trust the sexual health information on the web. The rate of teen pregnancy and sexual
transmitted diseases does not decrease by sheltering adolescents from sex education but instead it
increases the chance of unprotected sex. Even though the internet is capable of providing
information on prevention of teen pregnancy and STDs, teenagers seems to be cautious about the
sexual health information on the web and do not rely on it, (Sonenstein, 2012).

Explicit sexual activities and messages can be confusing for adolescents and school-age children
and can be detrimental to their well-being and health. Katherine Bowman and Lynn Rew discuss
in their article Protecting Youth from Early and Abusive Sexual Experiences (2008), about the
many American children that are at risk of abusive sexual experiences and how nurses can
provide guidance to assist children in protecting themselves. Our nation is second in the
industrialized world for sexual transmitted diseases and adolescent pregnancy that is contributed
to the conflicting information about sexuality, (Bowman et al., 2008).
While our American children and adolescents are being exposed to real life experiences,
conflicting messages on sexual values and behavior, and sexually explicit media, many are still
being prevented from receiving sex education in school. Sexual abuse in the United States
among adolescents and children are experienced within the home and within the community
including schools and churches. One type of sexual abuse sometimes involves children of the
same age being forced to engage in sexual acts. According to Katherine Bowman and Lynn Rew
(2008) sexually abused children will likely experience vulnerability to more sexual victimization
during their adolescent years.

Conclusion

Increasing children knowledge about human sexuality can help protect adolescents and children.
When children do not receive answers to questions concerning sex, they can be forced to access
the internet or turn to their friends. Sex education along with parents, schools, and community
health can focus on methods that can help children and adolescents avoid STDs and teen
pregnancy. Because of the positions that community and public health nurses have, they are able
to implement a plan through the community programs that can help protect children against the
risk of sexual abuse and early sexual experiences, (Bowman et al., 2008). Programs such as
youth development, curricular sex education, and HIV and puberty need to be implemented in
schools. Ethnicity and gender differences should not be ignored.

Adolescents are trying to find ways to understand their own sexual identities, feel good about
their decision making, and becoming young adults. A lot of work needs to be done in order for
the internet to be a vehicle for educating teenagers on complete and accurate information about
contraceptive options. Sites with search engine problems and that are committed to helping
teenagers make inform choices need to address the issues so that the teenagers that are motivated
can access the sites readily when seeking health information, (Sonenstein, 2012). This issue is
evident and important in helping adolescents gain knowledge on sex education.

References
Anagurthi, C., Hillman, S. B., Somers, C. L., & Tobey, J. (2011). Demographic differences in
adolescents sexual attitudes and behaviors, parent communication about sex, and school sex
education. Electronic Journal of Human Sexuality, 14. Retrieved from
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9a883a3c8a9e6 Barnes, S. L., & Bynum, M. S. (2010). An examination of the sexual behavior of
middle-class African American female college freshmen. Black Women, Gender & Families,
4(2), 1. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE
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 a140aaf9b38df Beadle, A. P. (2012, April 10). Teen Pregnancies Highest In States With
Abstinence-Only Policies. Retrieved from Think Progress:
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& Rew, L. (2008). Protecting youth from early and abusive sexual experiences. Pediatric
Nursing, 34(1), 19. Retrieved from Retrieved from
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91daca9171b5a Byers, E. S., Foster, L. R., & Sears, H. A. (2011). Middle school students
perceptions of the quality of the sexual health education received from their parents . The
Canadian Journal of Human Sexuality, 55. Retrieved from http://go.galegroup.com/ps/i.do?
id=GALE
%7CA276516861&v=2.1&u=oran95108&it=r&p=AONE&sw=w&asid=814f1aefc986d63381bd
d5c7a8f20682 Carter, D. (2012). Comprehensive Sex Education for Teens Is More Effective than
Abstinence. AJN, American Journal of Nursing: Volume 112, Issue 3, 15. Retrieved from
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ns_Is_More.5.as%20%20px Institute, G. (2012, February). Facts on American Teens Sources of
Information About Sex. Retrieved from Guttmacher Institute:
http://www.guttmacher.org/pubs/FB-Teen-Sex-Ed.html Institute, G. (2014, 11 July). State
Policies on Sex Education in Schools . Retrieved from NCSL:
http://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx Kanekar, A.,
& Manoj, S. (2010). Interventions for safer sex behaviors among college students. American
Journal of Health Studies, 25(3), 138. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE
%7CA308741511&v=2.1&u=oran95108&it=r&p=AONE&sw=w&asid=76328310c0ede21ea91f
749caad3556e Kendall, N. (2010, December). Risky Lessons: Sex Education and Social
Inequality. Social Forces, 89(2), 714. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE
%7CA247339536&v=2.1&u=oran95108&it=r&p=AONE&sw=w&asid=bc4a9d58495b53e793b
f5f8f974a117b Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-Only and
Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy. Journal
of Adolescent Health, Volume 42, Issue 4, 344-351. Martinez, G., Abma, J., & Copen, C. (2010).
Educating Teenagers About Sex in the United States. NCHS Data Brief, Number 44. Retrieved
from http://www.cdc.gov/nchs/data/databriefs/db44.htm McManus, A., & Dhar, L. (2008, July
23). Study of knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex
and sex education: (A cross sectional survey of urban adolescent school girls in South Delhi,
India). BMC Womens Health, 12. Retrieved from
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%7CA181965652&v=2.1&u=oran95108&it=r&p=AONE&sw=w&asid=c9ca6c75bc7197b0fc08
92a1e6fe5f62 Ross, D. (2008). Approaches to sex education: peer-led or teacher-led? . PLoS
 Medicine, 1536+ .Retrieved from: http://go.galegroup.com/ps/i.do?id=GALE
%7CA202254703&v=2.1&u=oran95108&it=r&p=AONE&sw=w&asid=e309362c426934a7a75
b01743a20b9a3 Sonenstein, F. L. (2012, September 24). The internet, teenagers, and sexual
health information: a cautionary tale,1. Israel Journal of Health Policy Research, 39. Retrieved
from http://go.galegroup.com/ps/i.do?id=GALE
%7CA307926629&v=2.1&u=oran95108&it=r&p=AONE&sw=w&asid=fb0f9b5127ee8a729ff4
c3bf5b0bb9a4 Stanger-Hall, K., & Hall, D. W. (2011). Abstinence-Only Education and Teen
Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S . PlosOne. Whittaker,
A. (2009, August). Parent-Child Communication: Promoting Sexually Healthy Youth . Retrieved
from Advocates for Youth: Retrieved from.http://www.advocatesforyouth.org/the-facts-parent-
child-communication
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Abstract
The thesis examines Sex Education lessons integrated to the fourth
and fifth year core curriculum of a mixed comprehensive school. It
studies their stated objectives, contents and implementation in the
classroom and analyses how pupils interpret curricular meanings
with regard to their gender expectations from sexuality, employment
and domesticity. A variety of qualitative methods - in particular,
participant observation and informal interviews - has been used.
The first chapter argues that sexual and gender socialisations
must be understood from a materialist position and that the Sex
Education curriculum may be structured by the fundamental functions
of schooling in a gender - and class - divided society. The second
chapter locates the marginal position of Sex Education within the
Health Education course of the deeply divided school. Strategies
for control over curriculum and classroom social relations developed
by both Sex Education teachers and pupils constitute the theme of
the third chapter with illustrations from the lesson on childbirth
and pregnancy. Contraception, sexual intercourse and marriage are
discussed in the next three chapters which follow the same pattern.
Each considers the selection of curricular meanings, their transmission
in the class and boys' and girls' perceptions of these
topics.
The last chapter underlines the dominance of traditional views
on sexuality, gender and marriage in teachers' and pupils' perceptions
alongside a liberal reformist theme. Both dominant and negotiated
meanings form the ideology of personal relationships which blends
objective information with commonsense knowledge of sexual and
gender conflicts. Consistent with the social democratic views of
education, this ideology serves to negotiate the fundamental
contradiction between the socialisation of pupils to ascribed
positions (sexual, familial and occupational) and individuals'
self-determination with regard to these. By and large, pupils'
accommodative strategies based on conflicting sexual - and gender - interests validate this ideology
but also give them some limited
control over definitions of appropriate behaviour

ABSTRACT

Half of all new human immunodeficiency virus (HIV) infections in the United States and two thirds of all
sexually transmitted diseases (STD) occur among young people under the age of 25. It is estimated that by
the end of high school, nearly two thirds of American youth are sexually active, and one in five has had four
or more sexual partners. Despite these alarming statistics, less than half of all public schools in the United
States offer information on how to obtain contraceptives and most schools increasingly teach abstinence-
only-until-marriage (or "abstinence-only") education. There is little evidence that abstinence-only programs
are successful in encouraging teenagers from delaying sexuality activity until marriage, and consequently,
avoiding pregnancy, or STD or HIV infection. Comprehensive sex education, which emphasizes the benefits
of abstinence while also teaching about contraception and disease-prevention methods, has been proven to
reduce rates of teen pregnancy and STD infection.

Abstract

Recommendations from official sources highlight a number of key principles which areessential for effective sex

education within schools. These relate to the planning and teaching of the topic, in-service training of teachers, and

the establishment of links between schools and parents.

Models of practice in the teaching of sex education vary between schools throughoutEngland; also the wide variations

in quality and quantity of provision indicate considerable scope for improvement.

Government, despite its key role in shaping provision of sex education in schools, does not appear to be consistently

supportive.

This paper examines and assesses the impact of a number of key policies, including those related to the 1993

Education Act, which will change the legal framework for the teaching of sex education within schools. It makes a

series of practical recommendations for purchasers of health promotion services, with the intention of supporting and

furthering the development of sex education in schools.

Abstract

It is widely debated among mental health professionals, among whom I include myself; the
fact that not only teenagers who come to our clinics need good sex education, but that
parents and/or legal guardians, often also it would be beneficial. I do not mean much to the
sexual practice itself; the mechanics or completion of the act, as well as the training that is
not received, when dealing with certain issues with young adolescents. Why can cost both
accept that, well before age 17, have already fully developed sexuality? The answer could
be as simple as saying that, it's not on focusing on the "do" but, from the "feel" and the latter
field seems to be much more muddy and complex than the first. The management process
of sexual development of our children and teens, begins when we are ready to grow
ourselves in this respect, to overcome conflicts, needs, fears and insecurities of their own.
Only then, when we will be able to become true and effective sexual educators and
counselors of the young

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The effectiveness of school-based sex education programs in the promotion of

abstinent behavior: a meta-analysis

Mnica Silva

Health Educ Res (2002) 17 (4): 471-481. DOI: https://doi.org/10.1093/her/17.4.471

Published: 01 August 2002 Article history

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Abstract

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.

Topic: least-squares analysis parent sex education

Issue Section: Original Article

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 programsdesignated in the literature as safer-sex,
comprehensive, secular or abstinence-plus programsadditionally 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.

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.

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-testpost-test design (Cook and Campbell, 1979). The presence of an
independent and comparable `no intervention' control groupin demographic
variables and measures of sexual activity in the baselinewas 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 societysuch as
the AIDS epidemicwhich 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

Five pairs of publications were detected which may have used the same database
(or two databases which were likely to contain non-independent cases) (Levy et al.,
1995/Weeks et al., 1995; Barth et al., 1992/Kirby et al., 1991/Christoper and Roosa,
1990/Roosa and Christopher, 1990 and Jorgensen, 1991/Jorgensen et al., 1993).
Only one effect size from each pair of articles was included to avoid the possibility
of data dependence.

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
participatedeither through parentyouth sessions or homework assignmentsas
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).

Decisions related to the computation of effect sizes

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

2
Alternative methods to deal with non-independent effect sizes were not employed
since these are more complex and require estimates of the covariance structure
among the correlated effect sizes. According to Matt and Cook such estimates may
be difficultif not impossibleto obtain due to missing information in primary
studies (Matt and Cook, 1994).

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, 2, 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 2 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

QE provides the test for model specification, when the number of studies is larger
than the number of predictors. Under those conditions, QE follows an approximate
2 distribution with k p 1 degrees of freedom, where k is the number of effect
sizes and p is the number of regressors (Hedges and Olkin, 1985).

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
4

An assessment of interaction effects among significant moderators could not be

explored since it would have required partitioning of the studies according to a first
variable and testing of the second within the partitioned categories. The limited
number of effect sizes precluded such analysis.

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 analysiswith 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).

Discussion

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 comprehensivethe
source of a major controversy in sex educationwas not found to be associated to
abstinent behavior. Only two moderatorsparental participation and percentage of
femalesappeared 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 sizeswhich appeared
significant both in the univariate and multivariable analysesshould 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 decadescharacterized by
an increasing acceptance of premarital sexual intercourse, a proliferation of
sexualized messages from the media and increasing opportunities for sexual
contact in adolescencewhich 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 4.530 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 researchwhich resulted in a reduced
number of studies that met the criteria for inclusion and the limitations that ensued
for conducting a thorough analysis of moderatorsthe 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.

References marked with an asterisk indicate studies included in the meta-analysis.

Table I.

Description of moderator variables

Categorical predictor Continuous predictors

Valid n Valid n Mean SD Min Max

Socioeconomic status 8 percent of females 11 54 5 40 66

low 5

middle 3

Type of program 12 percent of whites 12 39 33 1 93

comprehensive 8

abstinence-oriented 4

Type of monitor 11 age 8 14 1.5 12 16

teacher/adult 9

peer 2

Virginity status 12 length of the program 12 10 7.4 4.5 30

virgins-only 6

all (virgins + non-virgins) 6

Parental participation 12 timing of post-test 10 221 218 1 540

yes 2

no 10
Scope of the implementation 12

large scale 7

small scale 5

Table II.

Effect sizes of studies

Study Effect size (di) 95% CI for di

Lower Upper

Brown et al.(1991) 0.00 0.11 0.11

Denny et al.(1999) 0.00 0.13 0.13

Howard and McCabe (1990) 0.59 0.36 0.82

Jorgensen (1991) 0.49 0.07 0.91

Kirby et al.(1991) 0.19 0.00 0.38

Kirby et al.(1997a) 0.05 0.03 0.14

Kirby et al.(1997b) 0.0 0.10 0.10

Main et al.(1994) 0.03 0.13 0.18

O'Donnell et al. (1999) 0.21 0.02 0.40

Roosa and Christopher (1990) 0.00 0.23 0.23

Walter and Vaughan (1993) 0.05 0.21 0.11

Weeks et al.(1995) 0.00 0.09 0.09

Overall effect size (d+) 0.05 0.01 0.09

Table III.

Tests of categorical moderators for abstinence

Variable and class Between-classes effect (QB) n Mean weighted effect

size 95% CI for di

Lower Upper Homogeneity within each class

(QW)a

*P < 0.10;**P < 0.05***; P < 0.01

aSignificance indicates rejection of hypothesis of homogeneity.

Parent participation 5.06**

yes 2 0.24 0.07 0.42 1.6

no 10 0.04 0.00 0.08 28.9***

Virginity status 3.47*

virgins-only 6 0.09 0.03 0.14 27.09***

all 6 0.01 0.04 0.07 5.03

Scope of implementation 19.16***

Small scale 5 0.26 0.16 0.36 14.71**

Large scale 7 0.01 0.03 0.05 1.73

Table IV.

Weighted least-squares regression and test of model specification

Predictor B SE

*P < 0.10; **P < 0.05; ***P < 0.01.

aParent participation: `yes' coded as 1; `no' coded 0.

bSignificance signals incorrect model specification.

Parent participationa 0.22** 0.09

Percent females 0.02** 0.01

Constant 0.89 0.47

R2 0.28

QEb 18.8**

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Essay: Importance of Sex Education

HIGH SCHOOLS MUST PROVIDE YOUNG PEOPLE WITH ADEQUATE SEX

EDUCATION BECAUSE IGNORANCE CAN BE HARMFUL

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The largest gulf of understanding still remains between the parents and the youth
especially in the area of sexuality. Sex is a natural part of life, and when questions arise,
they can be discussed in a matured way without condoning certain behavior. Relying to
that, we realize that sex education is important to be inserted in a persons life.
Therefore, sex education in high schools is very necessary for youngsters to acquire
information, form attitudes, beliefs and values about identity, relationships and intimacy.
Sex education also encompasses sexual development, affection, body image and
gender roles. In other words, it is about learning how we grow, reproduce and change
over the years. It also includes a positive view of sex and the safety involved on
sexuality. Regarding to the importance of sex education, I want to state my stand here
that I strongly agree that High schools must provide young people with adequate sex
education because ignorance can be harmful.

Sex education in high schools helps young people to be more prepared for life changes
such as puberty, menopause and aging. Sex education can develop skills and self
esteem to help students enter adolescence. It helps them in knowing that the sudden
few changes are okay and normal. For example, girls would not get shocked, panic and
afraid at their first menstruation once they already had the knowledge about it.

Young people can also learn to appreciate and recognize their own sex: bodies just as
good, beautiful and special as other Gods perfect creations. Moreover, it delivers
confidence on them to value themselves and others. Sex education helps them
understand the place of sexuality in human life and loving other people. They will learn
to enjoy their sexuality, behave responsibly within their sexual and personal
relationships.

Youngsters are usually very curious to know all new things that came up to them
especially abstract things such as sex. Despite that, sex education plays a major role in
addressing concerns and correcting the misunderstandings that the youngsters may
have gained from sources such as the media and their peers. In addition, they will learn
to make decisions that respect themselves and others by taking account the possible
consequences. For instance, youngsters will be more matured, responsible and social
ills can also be reduced. Furthermore, research had shown that children that are
subjected to sex education are more apparent to practice safer sex.

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Some people might say that sex education could influence premarital marriage, leading
to the increment of unwanted pregnancies. Conversely, a survey done in 1987 had
shown that girls who were not educated about menstruation and sexual activity were
much more likely to become pregnant during their teen years. There was also a
statement from the Government Review of National and International Research in
London that identified high school sex education as being effective in reducing teenage
pregnancies. Based on the facts given, it clearly proves that sex education does not
lead youngsters to social ills such as unwanted pregnancies. However, a slight problem
might arise since sex education might be a new subject or program in most high
schools. Therefore, the program should be planned carefully in conjunction with those
who will participate and the parents. The program instructors also ought to receive
adequate training and equipped with the required skills and knowledge to support the
personal and social development of young people through sex education.

In conclusion, we must realize the importance of sex education being taught in high
schools to students. This is to ensure the students that are our future generations will be
well prepared to stand up against all the unexpected obstacles in their future. After all,
Education does not hurt, but ignorant does.

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