BACKGROUND: Many racial, socioeconomic, and geographic disparities exist in rates of teen birth and sexually transmitted infections. Increasing access to comprehensive sex education is one risk reduction strategy for these outcomes, yet access to and quality of sex education in schools often falls far below recommended standards, particularly in Texas. The current exploratory study examines barriers to effectively delivering sex education in West Texas schools and identifies strategies to help overcome these barriers. METHODS: In-depth interviews with school leaders and health education professionals (n=4) were conducted to understand teen sexual health needs in West Texas. Interviews were analyzed using descriptive coding, memoing, and quote matrices to interpret the data. RESULTS: Participants identified a number of policy-, organizational-, and interpersonal-level barriers to delivering sex education in public schools. School personnel experienced intense time pressures, a lack of institutional support, and tension with parents. Many expressed a desire to work more collaboratively with parents and participants acknowledged the important role of school health advisory councils (SHACs). CONCLUSIONS: School personnel face complex challenges at multiple levels when attempting to deliver sex education in public schools. Despite these challenges, SHACs represent a valuable opportunity for communities to work collaboratively to improve sex education in public schools.

Key Take Away Points

  • School settings represent a key opportunity for delivering sex education in light of declining sexual and reproductive health services in Texas
  • School leaders and health education professionals in West Texas face several interpersonal, organizational, and policy level barriers that significantly impair their ability to effectively deliver sex education in school settings
  • These barriers can be addressed in part through greater collaboration between families and school personnel through School Health Advisory Councils, as well as by strengthening local sex education policies and regulations.

Author Biography

Cristina Leos, PhD, MSPH, is a behavioral scientist and entrepreneur who received her public health training at the UNC Gillings School of Global Public Health in the Department of Health Behavior. Her research focuses on adolescent development, with emphasis on Latino youth mental and sexual health outcomes. Cristina’s expertise centers on finding innovative ways to improve adolescent health and reduce disparities, specifically by leveraging behavioral science and digital health innovation. She is co-founder and officer of MyHealthEd, Inc., a nonprofit dedicated to improving youth health education through technology and human-centered design, where she developed an Office of Population Affairs funded mobile sexual health intervention for middle school students. Cristina’s work has been generously recognized by the American Public Health Association, National Public Radio, and Forbes 30 Under 30. David Wiley, PhD, Professor of Health Education at Texas State University and is a lifelong health educator who has focused his professional life on addressing health issues of adolescents. Dr. Wiley has authored/co-authored over 40 peer-reviewed articles and has presented over 150 keynote addresses and workshops across the United States on the role of schools in creating healthy children and healthy communities. He is the founder the Texas Campaign to Prevent Teen Pregnancy in January of 2009 and continues to serve as Board Vice-Chair. He is also the co-author of “Just Say Don’t kNOw: The Status of Sexuality Education in Texas Public Schools” which is the most comprehensive study conducted on the teaching of sexuality education in Texas. In 2017, he published “The Conspiracy of Silence: The Status of Sex Education in Texas Public Schools.”


Data for this analysis came from a project funded by the Institute for Emerging Issues out of North Carolina State University and the State Employee Credit Union Foundation. No direct support was received from this award for this analysis.