The Effect of Comprehensive Sex Education on Contraceptive Use Behaviors Open Access

Abstract

Abstract
The Effect of Comprehensive Sex Education on Contraceptive Use Behaviors
By Maris Perlman
The recent increase in teen pregnancy rates has brought prevention programs to the forefront of public policy in the United States. With a historical new emphasis on evidence-based models of pregnancy prevention programs, a better understanding the effects of comprehensive sex education programs is needed. This study uses a novel outcome variable of contraceptive effectiveness to evaluate the relationship between comprehensive programs and contraceptive behaviors among 1,980 sexually active respondents of the National Survey of Family Growth. Our results demonstrate that individuals who receive instruction on both abstinence and birth control methods not only use contraceptives at a higher rate than those not receiving comprehensive sex education, but also use more effective methods of contraceptives. Yet, this relationship is not as straightforward for segments of the population already at risk for poor contraceptive use. These results indicate that comprehensive sex education is successful at improving contraceptive behaviors in ways that have not previously been explicitly considered. However, more research is needed to determine how prevention programs may better serve these at-risk populations.

The Effect of Comprehensive Sex Education on Contraceptive Use Behaviors
By
Maris Perlman
BA
Stanford University
2009
Thesis Committee Chair: Laura M. Gaydos, PhD
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements for the degree of
Master of Science in Public Health
in Health Policy and Health Services Research
2011

Table of Contents

Table of Contents

LIST OF TABLES...ix
LIST OF FIGURES...x
LIST OF ABBREVIATIONS...xi
INTRODUCTION...1
LITERATURE REVIEW...4

Sexual Health Outcome Trends Among Teens in the U.S....4
Behavioral Determinants of Outcomes...6
Sex Education Curriculum...7
Common Components of Effective Sex-Education Programs...9
Absence of Contraceptive Effectiveness as an Outcome Measure...10
Absence of Timing of Exposure as a Consideration in Evaluations of Effectiveness...11
History of Sex Education Policy and Offerings...12
Risk and Protective Factors For Sexual Health Behaviors...16
Determinants of Behavioral Trends...18
Future Direction of Sex Education...19

METHODOLOGY...21

Dataset...21
Sample...23
Dependent Variables...24
Primary Independent Variables...26
Secondary Independent Variables...27
Analysis...28

RESULTS...32

Descriptive Statistics...32
Contraceptive Use at First Sex...35
Contraceptive Use at Last Sex...38
Contraceptive Effectiveness at First Sex...40
Contraceptive Effectiveness at Last Sex...44

DISCUSSION...47

Key Findings...47
Study Implications...49
Limitations...52
Future Research...54

CONCLUSION...55
APPENDIX...56
BIBLIOGRAPHY...64

LIST OF TABLES
Table 1: Contraceptive method effectiveness, by typical use failure rates...10
Table 2: State Sex and STD/HIV Education Policy...14
Table 3: Contraceptive method effectiveness groupings...25
Table 4: Sex education classification distribution in the sexually-active study sample...26
Table 5: Sex education timing classification distribution in the study sample...27
Table 6: Secondary independent variables included in the analysis...28
Table 7: Sample characteristics by CSE classification...32
Table 8: Contraceptive use behaviors by CSE classification...33
Table 9: Contraceptive use behaviors for at-risk populations...34
Table 10: Probit model with contraceptive use at first sex as dependent variable...36
Table 11: Probit model with contraceptive use at last sex as dependent variable...39
Table 12: Ordered probit model with contraceptive use effectiveness at first sex as dependent variable among general population...41
Table 13: Ordered probit model with contraceptive use effectiveness at first sex as dependent variable among at-risk children of teen mothers population...43
Table 14: Ordered probit model with contraceptive use effectiveness at last sex as dependent variable among general population...45

LIST OF FIGURES
Figure 1. U.S. teen pregnancy rates (per 1,000) 1986-2006, by race/ethnicity...5
Figure 2. Antecedents to contraceptive use...19

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Education Health Sciences, Public Health
Keyword	sex education teen pregnancy
Committee Chair / Thesis Advisor	Gaydos, Laura, Emory University
Committee Members	Blake, Sarah, Emory University Florence II, Curtis S, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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