Socio-Ecological Factors Associated With Students' Perceived Impact of an Evidence-Based Sexual Health Education Curriculum

Christine M. Markham, Melissa F. Peskin, Elizabeth R. Baumler, Robert C. Addy, Melanie A. Thiel, B. A. Laris, Kimberly Baker, Belinda Hernandez, Ross Shegog, Karin Coyle, Susan Tortolero Emery

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Although schools often implement evidence-based sexual health education programs to address sexual and reproductive health disparities, multiple factors may influence program effectiveness. METHODS: Using student-reported perceived impact measures as a proxy for program effectiveness, we employed a socio-ecological approach to examine student, teacher, school, and district factors associated with greater perceived impact of It's Your Game (IYG), an evidence-based middle school sexual health education program. The student sample was 58.7% female, 51.8% Hispanic, mean age 13.2 years, from 73 middle schools. We assessed students' (N = 4531) perceived impact of IYG on healthy decision-making (α = 0.75) and sexual communication (α = 0.71); satisfaction with IYG activities and teacher; and demographics. We assessed teachers' (N = 56) self-efficacy to teach IYG, perceived administrative support, implementation barriers, and demographics. School and district data were abstracted from state records. We used multilevel logistic regression to estimate associations between independent variables and student-reported perceived impact. RESULTS: In final multivariate models, students' demographics (sex, β = 0.06, SE = 0.015), satisfaction with IYG (β = 0.21, SE = 0.012), and their IYG teacher (β = 0.18, SE = 0.013) (all p =.000) were significantly associated with perceived impact on healthy decision-making. Similar findings resulted for sexual communication. No other variables were significantly associated with perceived impact. CONCLUSIONS: Helping schools select age-appropriate, culturally relevant programs, and facilitate supportive learning environments may enhance the perceived impact of sexual health education programs.

Original languageEnglish (US)
Pages (from-to)604-617
Number of pages14
JournalJournal of School Health
Issue number8
StatePublished - Aug 1 2020


  • child & adolescent health
  • health education curriculum
  • instructional programs
  • school health research
  • sex education
  • sexual health

ASJC Scopus subject areas

  • Education
  • Philosophy
  • Public Health, Environmental and Occupational Health


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