November 10, 2006 — Comprehensive sex education, teaching about prevention of sexually transmitted infections (STIs) and pregnancy through abstinence as well as other birth control methods, is preferred for public schools, according to the results of a survey of US adults aged 18 to 83 years published in the November issue of the Archives of Pediatrics & Adolescent Medicine.

"The social merits and practical efficacy of sex education in schools generate considerable debate among public health professionals and government officials," write Amy Bleakley, PhD, MPH, from the University of Pennsylvania in Philadelphia, and colleagues. "Public opinion on sex education in schools is, however, largely absent from discourse on this issue, as few studies report on what types of sex education the public supports."

This cross-sectional survey, part of the Annenberg National Health Communication Survey, was conducted from July 2005 through January 2006, using a randomly selected, nationally representative sample of 1096 US adults aged 18 to 83 years. Rates of completion of the survey ranged from 73% to 76%. Respondents were asked about their level of support for or opposition to 3 different types of sex education in schools: abstinence only, comprehensive sex education or "abstinence plus" (teaching about abstinence and other birth control methods to prevent pregnancy and STIs), and condom instruction.

Politically, 39.5% of the sample said they were moderate, 35.5% conservative, and 25% liberal. More than half of the sample attended church only a few times a year or less often.

Approximately 82% of respondents indicated support for "abstinence plus" programs teaching students about both abstinence and other methods of preventing pregnancy and STIs; and 68.5% supported teaching how to properly use condoms. Abstinence-only education programs were supported by 36% and opposed by about 50% of respondents. Conservative, liberal, and moderate respondents all supported abstinence-plus programs, although the extent of support varied significantly.

Condom instruction was also supported by more than half of all respondents grouped by religious service attendance, except in those who attended services more than once a week (37.9%), opposition to condom instruction was 52.6%.

"US adults, regardless of political ideology, favor a more balanced approach to sex education compared with the abstinence-only programs funded by the federal government," the authors write.

Study limitations include exclusion of subjects relying solely on cellular telephones, and the possibility that, because of question wording, respondents did not fully appreciate the extent of differences between abstinence-only and abstinence-plus education.

The authors have disclosed no relevant financial relationships. The authors thank the Annenberg School for Communication and the Annenberg Foundation Trust at Sunnylands for their generous support of the Annenberg National Health Communication Survey.

In an accompanying editorial, Douglas Kirby, PhD, from ETR Associates in Scotts Valley, California, notes that few abstinence-only programs have been well evaluated and found to be effective.

"If we can agree to focus on programs with strong evidence that they effectively reduce sexual risk, regardless of whether they are abstinence-only or comprehensive programs, there still remain important questions to resolve," Dr. Kirby writes. "These include: How can we make programs even more effective?... The more quickly we can resolve these issues, the more rapidly we can reduce teen pregnancy and STD [sexually transmitted disease] rates in this country."

Arch Pediatr Adolesc Med. 2006;140:1152-1156.