What Works: Sexual Health Education
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 quality health education, systems that connect students to health services, and safer and more supportive school environments. This info brief focuses on delivering quality sexual health education—a systematic, effective way schools can provide adolescents the essential knowledge and critical skills needed to decrease sexual risk behaviors.
Quality sexual health education (SHE) provides students with the knowledge and skills to help them be healthy and avoid human immunodeficiency virus (HIV), sexually transmitted diseases (STD), and unintended pregnancy. A SHE curriculum includes medically accurate, developmentally appropriate, and culturally relevant content and skills that target key behavioral outcomes and promote healthy sexual development. The curriculum is age-appropriate and planned across grade levels to provide information about health risk behaviors and experiences. Sexual health education should be consistent with scientific research and best practices; reflect the diversity of student experiences and identities; and align with school, family, and community priorities.
Across states, fewer than half of high schools (43%) and less than one-fifth of middle schools (18%) teach key CDC topics for sexual health education.
Quality sexual health education programs share many characteristics. These programs:
- Are taught by well-qualified and highly-trained teachers and school staff
- Use strategies that are relevant and engaging for all students
- Address the health needs of all students, including the needs of lesbian, gay, bisexual, transgender, and questioning youth
- Connect students to sexual health and other health services at school or in the community
- Engage parents, families, and community partners in school programs
- Foster positive relationships between adolescents andimportant adults.
A school health education program that includes a quality SHE curriculum targets the development of critical knowledge and skills needed to promote healthy behaviors and avoid risks. It is important that SHE explicitly incorporate skill development. Giving students time to practice, assess, and reflect on skills taught in the curriculum helps move them toward independence, critical thinking, and problem solving to avoid HIV, STDs, and unintended pregnancy.
Broward County Public Schools in Florida has used CDC’s Health Education Curriculum Analysis Tool (HECAT) to improve their health education curricula.
We compared our current curriculum with HECAT and made changes and modifications and enhancements based on what we analyzed.
Quality sexual health education programs teach students how to:
- Analyze family, peer, and media influences that impact health
- Access valid and reliable health information, products, and services (e.g., HIV/STD testing)
- Communicate with family, peers, and teachers about issues that affect health
- Make informed and thoughtful decisions about their health
- Take responsibility for themselves and others to improve their health.
Promoting and implementing well-designed SHE programs positively impacts student health in a variety of ways. Students who participate in these programs are more likely to:
- Delay initiation of sexual intercourse
- Have fewer sex partners
- Have fewer experiences of unprotected sex
- Increase their use of protection, specifically condoms
- Improve their academic performance.
In addition to providing knowledge and skills to address sexual behavior, quality SHE programs can be tailored to include information on high-risk substance use*, suicide prevention, and how to keep students from committing or being victims of violence—behaviors and experiences that place youth at risk for poor health and academic outcomes.
To successfully put quality SHE into practice, schools need supportive policies, appropriate content, trained staff, and engaged parents and communities. Schools can put these four elements in place to support SHE.
- Identify existing state, district, and school policies on health education and SHE for all students.
- Establish a skills-based health education course requirement—which includes SHE content—for all middle and high school students.
- Develop a SHE scope and sequence document† that identifies behavioral and learning outcomes for all middle and high school students.
- Develop or select a SHE curriculum—consistent with the approved scope and sequence—that includes instructional lessons, student activities, resources, and assessment strategies. CDC’s Health Education Curriculum Analysis Tool (HECAT) is a great resource to develop, select, and revise curricula.
- Promote the use of teaching tools and resources—for example, pacing guides or specific lesson plans—to continuously improve SHE content and delivery.
- Seek feedback from teachers, staff, students, and administrators within the school about what critical knowledge and skills are needed to effectively deliver SHE.
- Identify a set of instructional competencies—the essential knowledge and teaching skills—that those delivering SHE should know and be able to demonstrate during instruction.
- Use the identified instructional competencies to design, implement, and evaluate teacher and staff professional development and training. These trainings can improve teachers’ knowledge and comfort with the subject matter and use of effective teaching skills needed for SHE.
- Create School Health Advisory Councils (SHACs), or similar committees, that regularly provide district-level guidance on the school health program for students and staff. Within SHE, a SHAC can make valuable recommendations to strengthen curriculum or professional development and training opportunities for staff.
- Use strategies to actively engage families and communities in school health programs, explicitly gaining their feedback on SHE curricula through participation on the SHACs.
Include enough time during professional development and training for teachers to practice and reflect on what they learned (essential knowledge and skills) to support their sexual health education instruction.
By law, if your school district or school is receiving federal HIV prevention funding, you will need an HIV Materials Review Panel (HIV MRP) to review all HIV-related educational and informational materials. This review panel can include members from your School Health Advisory Councils, as shared expertise can strengthen material review and decision making.
Learn more about delivering quality sexual health education in the Program Guidance.
Check out CDC’s tools and resources below to develop, select, or revise SHE curricula.
- Health Education Curriculum Analysis Tool (HECAT). This tool helps school and community leaders conduct clear, complete, and consistent analyses of health education curricula across a wide variety of topics (e.g., nutrition, tobacco, mental/emotional health).
- Health Education Curriculum Analysis Tool (HECAT), Module 6: Sexual Health pdf icon[PDF – 70 pages]. This module within CDC’s HECAT includes the knowledge, skills, and health behavior outcomes specifically aligned to sexual health education. School and community leaders can use this module to develop, select, or revise SHE curricula and instruction.
- Developing a Scope and Sequence for Sexual Health Education pdf icon[PDF – 17 pages]. This resource provides an 11-step process to help schools outline the key sexual health topics and concepts (scope), and the logical progression of essential health knowledge, skills, and behaviors to be addressed at each grade level (sequence) from pre-kindergarten through the 12th grade. A developmental scope and sequence is essential to developing, selecting, or revising SHE curricula.
- CDC. PS18-1807 Program Guidance: Guidance for School-Based HIV/STD Prevention (Component 2) Recipients of PS18-1807 pdf icon[PDF – 120 pages]. Atlanta, GA: U.S. Department of Health and Human Services; 2019.
- National Health Education Standards. CDC Division of Adolescent and School Health website. Accessed December 20, 2019.
- Chin HB, Sipe TA, Elder R. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. Am J Prev Med 2012;42(3):272–94.
- Mavedzenge SN, Luecke E, Ross DA. Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: A systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014;66:S154–69.
- Basch CE. Healthier students are better learners: A missing link in school reforms to close the achievement gap. J Sch Health 2011;81(10):593–8.
- CDC. Health-related behaviors and academic achievement among high school students—United States, 2015. MMWR 2017;66(35):921–927.
- CDC. Developing a Scope and Sequence for Sexual Health Education [PDF – 17 pages]. Atlanta, GA: U.S. Department of Health and Human Services; 2016. .
- CDC. Program guidance on the review of HIV-related educational and informational materials for CDC assistance programs pdf icon[PDF – 4 pages]. Atlanta, GA: U.S. Department of Health and Human Services; 2016.
- CDC. Health Education Curriculum Analysis Tool (HECAT). Atlanta, GA: U.S. Department of Health and Human Services; 2012.