HIV, Other STD, and Pregnancy Prevention Education in Public Secondary Schools

45 States, 2008-2010

Laura Kann, PhD; Nancy Brener, PhD; Timothy McManus, MS; Howell Wechsler, EdD

Disclosures

Morbidity and Mortality Weekly Report. 2012;61(13):222-228. 

In This Article

Abstract and Introduction

Introduction

In the United States, 46% of high school students have had sexual intercourse and potentially are at risk for human immunodeficiency virus (HIV) infection, other sexually transmitted diseases (STDs), and pregnancy.[1] The National HIV/AIDS Strategy for the United States recommends educating young persons about HIV before they begin engaging in behaviors that place them at risk for HIV infection.[2] The Community Preventive Services Task Force (CPSTF) also recommends risk reduction interventions to prevent HIV, other STDs, and pregnancy among adolescents.[3] To estimate changes in the percentage of secondary schools that teach specific HIV, other STD, and pregnancy risk reduction topics, a key intervention consistent with those supported by the National HIV/AIDS Strategy and CPSTF,[2,3] CDC analyzed 2008 and 2010 School Health Profiles data for public secondary schools in 45 states. This report summarizes the results of those analyses, which indicated that in 2010, compared with 2008, the percentage of secondary schools teaching 11 topics on HIV, other STD, and pregnancy prevention in a required course in grades 6, 7, or 8 was significantly lower in 11 states and significantly higher in none; the percentage of secondary schools teaching eight topics in a required course in grades 9, 10, 11, or 12 was significantly lower in one state and significantly higher in two states; and the percentage of secondary schools teaching three condom-related topics in a required course in grades 9, 10, 11, or 12 was significantly lower in eight states and significantly higher in three states. Secondary schools can increase efforts to teach all age-appropriate HIV, other STD, and pregnancy prevention topics to help reduce risk behaviors among students.

School Health Profiles surveys have been conducted biennially since 1996 to assess school health practices in the United States.* States, territories, large urban school districts, and tribal governments participate in the surveys, either selecting systematic, equal-probability samples of their secondary schools (middle schools, junior high schools, and high schools with one or more of grades 6–12), or selecting all public secondary schools within their jurisdiction.§ Self-administered questionnaires are sent to the principal and lead health education teacher at each selected school and returned to the agency conducting the survey. Lead health education teachers are asked questions regarding the content of required instruction related to HIV, other STD, and pregnancy prevention. Data are included in this report only if the state provided appropriate documentation of methods and had a school response rate ≥70% for both the 2008 and 2010 surveys. Across states included in this report, school response rates ranged from 70% to 93% (median: 73%) in 2008 and from 70% to 86% (median: 73%) in 2010. The number of lead health education teachers who participated, by state, ranged from 71 to 472 (median: 245) in 2008 and from 65 to 677 (median: 249) in 2010. Participation in School Health Profiles is confidential and voluntary. Follow-up telephone calls, e-mails, and written reminders are used to encourage participation. For states that use a sample-based method, results are weighted to reflect the likelihood of schools being selected and to adjust for differing patterns of nonresponse. For states that conduct a census, results are weighted to adjust for differing patterns of nonresponse.

This report includes data from 45 states that provided weighted School Health Profiles data in 2008 and 2010.** For each of these states, three composite measures were created to determine the percentage of schools that taught 1) all 11 topics listed in the questionnaire in a required course in grades 6, 7, or 8; 2) all eight topics listed in the questionnaire in a required course in grades 9, 10, 11, or 12; and 3) all three condom-related topics listed in the questionnaire in a required course in grades 9, 10, 11, or 12. These topics reflect the knowledge and skills that are the focus of interventions shown to be effective in reducing risk that CPSTF and others use as a basis for their recommendations about interventions for adolescents.[3–6] For each state, the percentages of schools that taught individual topics and the composite measurements are reported. Significant (p<0.05) differences between results from 2008 and 2010 were determined by t-test. Statistical software was used to account for the sample design and unequal weights.

Compared with 2008, the percentage of schools in 2010 in which all 11 topics were taught in a required course in grades 6–8 was significantly lower in 11 states and significantly higher in no state (Table 1). The percentage of schools in which all eight topics were taught in a required course in grades 9–12 was significantly lower in one state and significantly higher in two states (Table 2). Additionally, the percentage of schools in which all three condom-related topics were taught in a required course in grades 9–12 was significantly lower in eight states and significantly higher in three states (Table 3). Among the 45 states in 2010, the percentage of schools that taught all 11 topics in grades 6, 7, or 8 ranged from 12.6% (Arizona) to 66.3% (New York) (median: 43.3%), the percentage of schools that taught all eight topics in grades 9–12 ranged from 45.3% (Alaska) to 96.4% (New Jersey) (median: 80.3%), and the percentage of schools that taught all three condom-related topics in grades 9–12 ranged from 11.3% (Utah) to 93.1% (Delaware) (median: 58.1%).

For five of the 11 topics (Table 1), the percentage of schools teaching the topic in a required course in grades 6–8 increased significantly in no state, and for the remaining six topics, the percentage increased significantly in one state. Conversely, the percentage of schools teaching any one topic decreased significantly in one to 10 states. The percentage of schools teaching how HIV and other STDs are diagnosed and treated decreased significantly in 10 states, as did the percentage teaching health consequences of HIV, other STDs, and pregnancy. The percentage of schools teaching how to prevent HIV, other STDs, and pregnancy decreased significantly in nine states.

For five of the eight topics (Table 2), the percentage of schools teaching the topic in a required course in grades 9–12 increased significantly in no state; for two topics, the percentage increased significantly in one state; and for the remaining two topics, the percentage increased significantly in two states. Conversely, the percentage of schools teaching any one topic decreased significantly in one to four states. The relationship among HIV, other STDs, and pregnancy was the one topic that showed significant decreases in the percentage of schools teaching it in four states. No state showed a significant increase, and one to seven states showed a significant decrease in the percentage of schools teaching any of the three condom-related topics in any of grades 9–12 (Table 3). The percentage of schools teaching how to obtain condoms decreased significantly in seven states.

* Additional information and questionnaires are available at http://www.cdc.gov/healthyyouth/profiles.
Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Florida, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Virginia, Washington, West Virginia, and Wisconsin.
§ Delaware, Hawaii, Idaho, Maine, Massachusetts, Montana, Nevada, New Hampshire, Rhode Island, South Carolina, Utah, Vermont, and Wyoming.
In 2008, lead health education teachers were asked, "During this school year, did teachers in this school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in any of grades 6, 7, or 8?" for a list of 11 topics (Table 1) (e.g., how HIV and other STDs are diagnosed and treated; how to prevent HIV, other STDs, and pregnancy; and the benefits of being sexually abstinent). Respondents were instructed to mark "yes" or "no" for each topic or "not applicable" if their school did not include grades 6, 7, or 8. Teachers also were asked the same question for grades 9–12 for a list of eight topics (Table 2) that repeated some of the 11 topics and added others (e.g., the relationship between alcohol and other drug use and risk for HIV, other STDs, and pregnancy), and three condom-related topics (Table 3). In 2010, lead health education teachers were asked, "During this school year, did teachers in your school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in each of the grade spans below?" The topics, grade spans, and possible responses were the same as those specified in 2008.
** Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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