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Abstract

Purpose: Successful implementation of sexual health curricula in school settings is often compromised by competing academic priorities. This study explores the association between exposure to sexual health lessons (time-on-task in hours and lesson content topics) and delayed sexual initiation of middle school students at long term follow-up.

Methods: Post hoc data analysis was conducted from a RCT (n=15 middle schools) in the south-central U.S. in which grade 7 students demonstrated delayed sexual initiation (adjusted odds ratio [AOR]: 1.54, 95% CI: 1.20 to 1.99) by grade 9 follow-up after using It’s Your Game (IYG), a 24 lesson sexual health curriculum. Logistic regression was conducted on a sub-sample of 314 grade 7 and 8 students who received IYG and who were sexually inexperienced at baseline, adjusting for covariates of age, gender, and race/ethnicity to address the impact of lesson exposure variables (time-on-task in hours and type of sexual health content) on initiation of any sex by grade 9.

Results: The greatest impact of exposure on delayed sexual initiation was a duration of 13 or more lesson hours (OR = 8.40; p<0.05) and exposure to lesson content on HIV/STI and pregnancy consequences (OR = 4.93; p<0.05).

Conclusions:

Results support previous exposure studies and provide guidance on how effective sexual health curricula can meet the challenges of delivery in a reduced and competitive academic environment.

Key Take Away Points

Evidence-based sexual health curricula compete against traditional academic priorities in middle schools which may undermine adequate implementation fidelity and compromise effectiveness.

Exposure to at least 13 lesson hours sexual health education and exposure to content on HIV/STI pregnancy consequences is associated with middle school students delay of sexual initiation by high school.

This study is among the first to empirically assess the association between exposure (dose) to sexual health programs and delayed initiation of sex.

Author Biography

Ross Shegog: Dr. Shegog served as Co-Investigator on the study, contributing to the conceptualization of the intervention and study design. He drafted the initial manuscript and approved the final manuscript as submitted. Elizabeth Baumler and Robert Addy: Drs. Baumler and Addy lead the data management and data analysis conducted in the study. They critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Melissa Peskin: Dr. Peskin served as Co-Investigator on the study, contributing to the conceptualization of the intervention and study design. She critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Melanie Thiel: Ms. Thiel directed all facets of the field study, contributing to protocol manuals, training, data collection, and instrumentation. She critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Susan Tortolero: Dr. Tortolero served as Co-Principal Investigator of the study, contributing to the conceptualization of the intervention and study design and, in concert with Dr. Markham, overseeing all facets of the study. She critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Christine Markham: Dr. Markham served as Principal Investigator and oversaw all facets of the study. She critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Acknowledgements

Acknowledgments: All authors contributed to the concept and design of the study and the process of drafting and revising the manuscript. No authors have any potential conflicts of interest. This study was funded by Centers for Disease Control and Prevention Grant 5U48DP000057 and by United States Department of Health and Human Services, Adolescent Family Life, Grant 90XF0036. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. The study is registered at www.clinicaltrials.gov. The study is registered at www.clinicaltrials.gov (#U48/DP000057). The authors thank school district personnel and students for their participation.

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