Behavioral and psychosocial effects of two middle school sexual health education programs at tenth-grade follow-up

Christine M. Markham, Melissa F. Peskin, Ross Shegog, Elizabeth R. Baumler, Robert C. Addy, Melanie Thiel, Soledad Liliana Escobar-Chaves, Leah Robin, Susan R. Tortolero

Research output: Contribution to journalArticlepeer-review


Purpose An earlier randomized controlled trial found that two middle school sexual education programs - a risk avoidance (RA) program and a risk reduction (RR) program - delayed initiation of sexual intercourse (oral, vaginal, or anal sex) and reduced other sexual risk behaviors in ninth grade. We examined whether these effects extended into 10th grade. Methods Fifteen middle schools were randomly assigned to RA, RR, or control conditions. Follow-up surveys were conducted with participating students in 10th grade (n = 1,187; 29.2% attrition). Results Participants were 60% female, 50% Hispanic, and 39% black; seventh grade mean age was 12.6 years. In 10th grade, compared with the control condition, both programs significantly delayed anal sex initiation in the total sample (RA: adjusted odds ratio [AOR],.64, 95% confidence interval [CI],.42-.99; RR: AOR,.65, 95% CI,.50-.84) and among Hispanics (RA: AOR,.53, 95% CI,.31-.91; RR: AOR,.82, 95% CI,.74-.93). Risk avoidance students were less likely to report unprotected vaginal sex, either by using a condom or by abstaining from sex (AOR:.61, 95% CI,.45-.85); RR students were less likely to report recent unprotected anal sex (AOR:.34, 95% CI,.20-.56). Both programs sustained positive impact on some psychosocial outcomes. Conclusions Although both programs delayed anal sex initiation into 10th grade, effects on the delayed initiation of oral and vaginal sex were not sustained. Additional high school sexual education may help to further delay sexual initiation and reduce other sexual risk behaviors in later high school years.

Original languageEnglish (US)
Pages (from-to)151-159
Number of pages9
JournalJournal of Adolescent Health
Issue number2
StatePublished - Feb 2014
Externally publishedYes


  • Adolescents
  • Computer-based
  • Health education
  • Intervention studies
  • Sexual behavior
  • Urban populations

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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