What Works: Overview

Evidence-Based Strategies for Your School

what works: delivering sexual health education, increasing access to sexual health services, and promoting safe and supportive environments

The Centers for Disease Control and Prevention’s Division of Adolescent and School Health (DASH) has established an evidence-based approach schools can implement to help prevent HIV, STDs, and unintended pregnancy among adolescents. It includes delivering sexual health education, increasing access to sexual health services, and promoting safe and supportive environments. This info brief provides an overview of this approach and information to help educators, staff, and administrators as they implement HIV, STD, and unintended pregnancy prevention efforts in their schools.

What Are the Risks? A Current Snapshot of Student Health

Data from CDC’s Youth Risk Behavior Survey show that fewer high school students engage in health behaviors that put them at risk. But even though adolescents are making better decisions about their health, far too many are still at risk for human immunodeficiency virus (HIV), sexually transmitted diseases (STDs), and unintended pregnancy.

  • 46% of U.S. high school students did not use a condom the last time they had sex
  • More than 1 in 10 female students and 1 in 28 male students have been physically forced to have sex
  • 19% of high school students have been bullied at school
  • Nearly 1 in 7 high school students misuse prescription opioids
  • More than 47% of lesbian, gay, or bisexual students have considered suicide
  • Some youth engage in multiple and serious risk behaviors like high-risk substance use* and sex without condoms, and go through harmful experiences such as being a victim of violence.
  • Youth who engage in these behaviors or who have these harmful experiences are more at risk for a variety of negative health outcomes including HIV and STDs.
  • These risks are more common among some youth—including lesbian, gay, bisexual, and transgender youth, who are more likely to experience stigma, discrimination, family disapproval, social rejection, and violence. As a result, they are more likely to have poor health.
*High-risk substance use is any use by adolescents of substances with a high risk of adverse outcomes (i.e., injury, criminal justice involvement, school dropout, loss of life). This includes misuse of prescription drugs, use of illicit drugs (i.e., cocaine, heroin, methamphetamines, inhalants, hallucinogens, or ecstasy), and use of injection drugs (i.e., drugs that have a high risk of infection transmission of blood-borne diseases such as HIV and hepatitis).

What Works? CDC’s Approach to School-Based HIV and STD Prevention

Why Are Schools Important for Promoting Student Health?

Schools offer valuable opportunities for improving adolescent health.

  • They have direct contact with millions of students for at least six hours a day.
  • Students generally attend school throughout much of their social, physical, and intellectual development.
  • Many schools have staff with the knowledge to address critical health risk and protective behaviors.
  • Many schools have the infrastructure to support a varied set of evidence-based approaches and interventions.

CDC’s Division of Adolescent and School Health (DASH) has established an evidence-based approach to school-based HIV and STD prevention. It includes providing quality sexual health education, connecting students to sexual health services, and establishing safe and supportive school environments. These evidence-based strategies benefit all students. Further, activities related to health education and health services can be tailored to address health outcomes other than sexual behaviors, including high-risk substance use, violence victimization, and mental health. Promoting safe and supportive environments can address all of these health outcomes.

Sexual Health Education

Benefits of providing SHE to students:
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  • Knowledge to reduce sexual risk
  • Condom negotiation skills
  • Self-efficacy to delay sexual activity

Quality sexual health education (SHE) is a systematic approach to preparing students with the knowledge and skills needed to make informed health decisions to prevent HIV, STDs, and unintended pregnancy.

  • Sexual health education includes planned, progressive learning objectives and outcomes across grade levels (K–12).
  • Sexual health education addresses knowledge and skills students need before risk behaviors and health issues emerge.
  • Effective SHE programs:
    • Are taught by qualified and trained teachers
    • Connect students to health services
    • Engage parents and community partners
    • Foster positive relationships between students and trusted adults.

Students who receive evidence-based SHE can reduce health risk behaviors and experiences and may improve their academic performance in school.

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Sexual Health Services

Benefits of connecting students to SHS:
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  • Risk-reduction counseling
  • HIV and STD testing
  • Contraceptive use

Sexual health services (SHS) give students access to preventive health care, such as STD testing, HIV testing, contraception, and condoms, and referrals to appropriate treatment, if needed.

  • Through SHS, students can gain access to broad preventive health services, such as sexual risk assessments and counseling on healthy decision making and protective behaviors.
  • Schools can connect students to SHS by providing the services on site or by referring students to youth-friendly health care providers in the community.

These services can provide students with information, education, support, referrals, and counseling for a broad range of health behaviors and experiences that can affect healthy development.

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Safe and Supportive Environments

Benefits of promoting SSE:
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  • School connectedness
  • Parental monitoring
  • Parent-adolescent communication

Creating safe and supportive environments (SSE) emphasizes aspects of school settings and family relationships that can protect adolescents and reduce their risk for HIV, STDs, and unintended pregnancy.

  • These protective factors include school connectedness, parental monitoring, and parent-adolescent communication (both generally and specifically
    about sex).
  • Safe and supportive environments connect adolescents to a network of caring peers and adults, including parents, other primary caregivers, and teachers.
  • Improving environments can have a broad and lasting positive impact on health. It also establishes a context for sexual health education and sexual health services to be effective.

Creating SSE involves schools, communities, families, and youth working together to protect students’ health and improve academic performance.

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For More Information

Schools provide students with the opportunity to learn the importance of behaviors and skills needed to engage in a healthy lifestyle now and into adulthood.

Learn more about CDC’s school-based approach to HIV and STD prevention in the Program Guidance.

  1. CDC, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Youth Risk Behavior Survey Data Summary & Trends Report, 2007–2017. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office of Infectious Diseases, NCHHSTP; 2018.
  2. Braxton J, Davis DW, Grey J, et al. Sexually Transmitted Disease Surveillance 2016. Published September 2017.
  3. Centers for Disease Control and Prevention. Diagnoses of HIV Infection in the United States and Dependent Areas, 2016; vol. 28. Published November 2017
  4. Johns MM, Lowry R, Andrzejewski J, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students — 19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep 2019;68:67–71.
  5. Kann L, Olsen EO, McManus T, et al. Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9–12 — United States and selected sites, 2015. MMWR Surveill Summ 2016;65(No. SS-9):1-202.
  6. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance—United States, 2017.MMWR Surveill Summ. 2018;67(8):1-114.
  7. National Center for Education Statistics. Fast Facts: Back to School Statistics. US Department of Education. Washington, DC.
  8. National Center for Education Statistics. The Condition of Education: Elementary and Secondary Enrollment. Updated May 2018.
  9. Centers for Disease Control and Prevention. PS18-1807 Program Guidance: Guidance for School-based HIV/STD Prevention (Component 2) Recipients of PS18-1807. Atlanta, GA: U.S. Department of Health and Human Services; 2019.
  10. DiClemente RJ, Salazar LF, Crosby RA, Rosenthal SL. Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective–a commentary. Pub Health. 2005;119(9):825-836.
  11. Markham CM, Lormand D, Gloppen KM, et al. Connectedness as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health. 2010;46(3 Suppl):S23-41.
  12. Dittus PJ, Michael SL, Becasen JS, Gloppen KM, McCarthy K, Guilamo-Ramos V. Parental monitoring and its associations with adolescent sexual risk behavior: A meta-analysis. Pediatrics. 2015;136(6):e1587- 1599.
  13. Frieden TR. A framework for public health action: the health impact pyramid. Am J Pub Health. 2010;100(4):590-595.