June 2008

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Objective The majority of adolescents will become sexually active between the ages of 15 and 19 (1). Teens are more likely than adults to use inadequate and/or inconsistent contraception, putting them at risk for unintended pregnancies and sexually transmitted infections (STIs) (2,3). It often falls upon school-based sex education programs to provide teens with the information and skills needed to make informed, healthy decisions about sexual behavior (4). The content of school-based sex education programs varies widely. Based on funding decisions made at the federal level, the sex education programs at many schools are limited to abstinence-only messaging. Alternatively, some schools offer comprehensive, or abstinence-plus sex education, in which abstinence is promoted, but adolescents are also provided information about contraceptive options and STIs. There are few studies examining the relationship between contraceptive use at coital debut and formal sex education, yet this remains an important question in terms of health outcomes and federal spending. The primary objective of this thesis was to determine whether the use and type of contraceptive method used at coital debut among female adolescents can be explained by differences in formal sex education. We also explored the effect of formal sex education on high risk sex behavior, as represented by history of sexually transmitted infection treatment. Methods Variables related to sexual activity and contraceptive use were identified in the 2002 National Survey of Family Growth, a nationally representative weighted database collected using interviews with 7,643 women aged 15-44. All analyses were performed using SPSS version 15.0 for Windows (Chicago, Illinois) with the complex samples module to account for the complex sampling design used by the NSFG, Cycle 6. Descriptive statistics including frequency measures were generated to compare demographic and socioeconomic variables between those that received formal sex education and those that did not, as well as between formal sex education groups. Contraceptive method use at coital debut, sex behaviors, attitude towards sex, and substance use were compared between those with and without formal sex education and between formal sex education groups using chi square tests for categorical variables. The primary outcome in this analysis was contraceptive method use at coital debut and use of a reliable contraceptive method (i.e. contraceptive pills/transdermal patch/vaginal ring, injectable contraceptive, intrauterine device) at coital debut. The secondary outcome of interest was history of STI treatment. Multiple logistic regression was employed and measures of association, including odds ratios, were calculated. The effect of confounding and effect modification was explored. Results A statistically significant association was demonstrated between type of formal sex education and reliable contraceptive method use at coital debut for female adolescents age 15 to 19 who reported formal sex education prior to coital debut, and this remained true after adjusting for other factors. We found that female adolescents in the formal sex education group who received information about birth control methods only had three times the odds of reliable method use at coital debut than those in the abstinence-only sex education group (OR= 3.14, 95% CI [1.01-11.52]) and four times the odds than the comprehensive sex education group (OR= 4.28, 95% CI [1.44-12.75]). Parental discussion of sex topics also increased the use of a reliable contraceptive method at coital debut in this sample. We found no association between type of formal sex education and use of any contraceptive method at coital debut. There was no association between formal sex education and history of STI treatment. Conclusions The results of our study, based on a large representative survey of female adolescents aged 15 to 19, demonstrated that formal sex education consisting of only information about birth control methods increases the use of a reliable contraceptive method at coital debut and inclusion of abstinence-only messaging in sex education curriculum appears to reduce the likelihood of more reliable contraceptive method use at coitarche. In view of this data, current sex education programming emphasizing abstinence-only needs to be re-examined and alternate ways of educating teens about sexuality need to be developed and studied.




School of Medicine



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