Source:

Jennifer M. Grossman, Allison J. Tracy, Linda Charmaraman, Ineke Ceder, and Sumru Erkut, “Protective Effects of Middle School Comprehensive Sex Education with Family Involvement,” Journal of School Health (November 2014)

Description:

Researchers followed more than 2,400 middle school students in 24 Boston-area schools over three years, to compare the behavioral impact of the sexual health education program Get Real with the impact of attending the routine sexual health education programming already available in those schools. Get Real: Comprehensive Sex Education That Works is a 27-session program (9 sessions per year in grades 6, 7, and 8) intended to delay vaginal intercourse among middle school students. Of the 24 middle schools involved in the study, 2 were private schools, 9 were publically-funded charter schools, and 13 were traditional public schools. The researchers took special interest in the role of Get Real’s family involvement components in the program’s overall effectiveness.

Key Findings:

• 11% of boys and 4% of girls reported having had vaginal intercourse by the start of 6^th grade, prior to the start of the program.
• In schools where Get Real was taught, 16% fewer boys and 15% fewer girls reported having vaginal intercourse by the end of 8^th grade in contrast with boys and girls at comparison schools.
• Completing the family involvement activities had the most effect in delaying age of first sexual intercourse for boys.

Analysis:

This study provides evidence that a middle-school sexuality education program, with 9 lessons per year (and more comprehensive than what many schools provide), can delay the age of first vaginal intercourse among students of all genders.

Get Real: Comprehensive Sex Education That Workswas developed by Planned Parenthood League of Massachusetts. The program identifies parents as the primary sexuality educators of their children and incorporates 8 family activities in each grade to strengthen parent/guardian involvement in their child’s sexuality education. Family activities include answering true/false questions about HIV/AIDS, talking about images of sexuality in popular media, practicing how to say “no” and set boundaries, and discussing what makes relationships healthy or unhealthy.

The results of the 3-year study indicate that for boys in particular, the family activities increase the effect of the program – perhaps because they encourage parents and guardians to talk as much with sons as they typically do, by default, with daughters.

Several aspects of the study pose challenges for future researchers. The key measure of sexual activity, a yes/no question that asks students, “Have you ever had sex? Having sex means when a boy puts his penis inside a girl’s vagina,” reinforces longstanding popular beliefs that ‘real’ sex is only penis-vagina intercourse.[1] The effect of this is to remove from consideration many other forms of sexual contact that might be more likely to have occurred among youth in grades 6, 7, and 8. If Get Real also helped students to delay these other sexual behaviors, it is not possible to know from the data in this study. Additionally, in contrast to the students in the comparison group who did not receive Get Real, the students in the Get Real schools were more likely to be white (31% in Get Real schools, 14% in comparison schools) and middle class (median household income $57, 964 in Get Real schools, $46,416 in comparison schools). Finally, the researchers faced high percentages of student turnover – leaving early or joining late – which made it challenging to track the effects of the program over three years. All these concerns would be important for future researchers to consider when designing additional studies on the effects of Get Real.

The researchers offered the following response to this critique:

“While we agree that aspects of this study pose challenges, in our study analyses we addressed concerns about 1) demographic differences in intervention and comparison groups, and 2) high rates of student mobility. We addressed differences in race/ethnicity and household income in the intervention and comparison groups by statistically controlling for these factors in study analyses. This allowed us to consider differences in sexual behavior across students from similar racial/ethnic and social class backgrounds in intervention and comparison groups.

“We also statistically addressed high rates of student mobility in our analyses in both the intervention and comparison groups. By using established missing data modeling strategies, we were able to keep teens in the sample who either dropped out of the study (e.g. took the survey in 6^th and 7^th grade, but not in 8^th grade) or came into the sample partway through the study (e.g., only took the survey in 7^th and 8^th grades). By including these teens in the analysis, we reduced the bias of study findings, because it allowed us to assess whether the intervention was effective in delaying sex for the teens who were most at risk.

“We do acknowledge however that statistical approaches do not fully address group differences, either between intervention and comparison groups or between those who completed the full study and those who did not, with respect to characteristics we did not measure.

“In addition, as stated in the evaluation paper, using vaginal sex as the only indicator of sexual behavior limited our understanding of the effects of the intervention on teens who engage in non-vaginal sex. While the Get Real intervention addressed other sexual behaviors, school and parental limitations on data collection among middle school students limited our capacity to measure these outcomes in the evaluation.”[2]

In the era of Evidence-Based Interventions, or EBIs, sexuality education programs that come with data to demonstrate effects on sexual risk behavior have the best chance of being funded and implemented. Because most EBIs were not designed for schools, Get Real provides school-based sexuality educators with an opportunity to try replicating a program designed with classroom settings in mind.