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Comprehensive risk reduction sexual education

Health Factors: Sexual Activity
Decision Makers: Educators Local Government State Government Federal Government Nonprofit Leaders
Evidence Rating: Scientifically Supported
Population Reach: 10-19% of WI's population
Impact on Disparities: No impact on disparities likely

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Comprehensive risk reduction programs provide information regarding contraception and protection against sexually transmitted infections (STIs). Sometimes called abstinence-plus programs, many efforts emphasize abstinence and delayed initiation of sex in addition to broader risk reduction components. Such programs can take place in schools (e.g., as part of the health curriculum) or in community settings; program components vary by implementer and specific model. 

Expected Beneficial Outcomes

Reduced risky sexual behavior
Increased condom use
Increased use of contraception
Reduced sexual activity
Reduced teen pregnancy
Reduced incidence of STIs

Evidence of Effectiveness

There is strong evidence that comprehensive risk reduction programs decrease sexual risk behaviors among adolescents in both the short-term and the long-term (Denford 2017, Chin 2012, Cochrane-Underhill 2008, Kirby 2007).

Comprehensive risk reduction programs have been shown to reduce risk behaviors such as engagement in sexual activity, frequency of sexual activity, number of partners, and frequency of unprotected sexual activity (Underhill 2007, Cochrane-Underhill 2008, Chin 2012). Such programs also increase use of contraception (Cochrane-Lopez 2016a, Chin 2012, Campbell-Scher 2006, Bennett 2005).

Comprehensive risk reduction programs may reduce pregnancy (Chin 2012, Cochrane-Underhill 2008, Underhill 2007) and sexually transmitted infections (STIs) among adolescents (Chin 2012). There is no evidence that providing comprehensive information regarding contraception in sexual education programs increases sexual activity or hastens initiation of sex (Cochrane-Underhill 2008, Smoak 2006Bennett 2005).

Research suggests that effective comprehensive risk reduction programs focus on specific behaviors, provide basic and accurate information regarding the risks and methods of protection, and include opportunities to address peer norms and practice communication, negotiation and refusal skills within the program (Denford 2017, Kirby 2007, Kirby 2000). Effective programs are usually conducted within groups (Chin 2012) over the course of multiple sessions with multiple activities (Cochrane-Lopez 2016a).


United States

Legislation regarding sex education varies from state to state. As of 2017, 24 states and the District of Columbia mandate sexual education in public schools, 34 states and the District of Columbia mandate HIV education, and 13 states require medically accurate sexual education (Guttmacher-Sex and HIV education).


Wisconsin does not require sexual education in public schools. Per Wisconsin statute 118.019, a school board may provide an instructional program in human growth and development in grades kindergarten to 12; the statute includes a recommended instructional program for school board consideration. When HIV or sex education is presented in Wisconsin public schools, instruction must include and stress abstinence as the only reliable way to avoid pregnancy and sexually transmitted infection. Sex education must also include information on the importance of sex only within marriage (Guttmacher-Sex and HIV education).

Implementation Resources

Alford 2012 - Alford S. Science and success, 3rd edition: Sex education and other programs that work to prevent teen pregnancy, HIV and sexually transmitted infections. Washington, DC: Advocates for Youth; 2012. Accessed on May 15, 2017
Kirby 2007 - Kirby D. Emerging answers 2007: Research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; 2007. Accessed on May 15, 2017
NCSL-Sex ed - National Conference of State Legislatures (NCSL). State policies on sex education in schools. Accessed on March 22, 2017

Citations - Evidence

Bennett 2005* - Bennett SE, Assefi NP. School-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials. Journal of Adolescent Health. 2005;36(1):72–81. Accessed on March 22, 2017
Campbell-Scher 2006* - Scher L, Maynard RA, Stagner M. Interventions intended to reduce pregnancy-related outcomes among adolescents. Campbell Systematic Reviews. 2006:12. Accessed on March 22, 2017
Chin 2012* - Chin HB, Sipe TA, Elder R, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, Human Immunodeficiency Virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. American Journal of Preventive Medicine. 2012;42(3):272-94. Accessed on March 22, 2017
Cochrane-Lopez 2016a* - Lopez LM, Bernholc A, Chen M, Tolley EE. School-based interventions for improving contraceptive use in adolescents. Cochrane Database of Systematic Reviews. 2016;(6):CD012249. Accessed on March 30, 2017
Cochrane-Underhill 2008* - Underhill K, Montgomery P, Operario D. Abstinence-plus programs for HIV infection prevention in high-income countries. Cochrane Database of Systematic Reviews. 2008;(1):CD007006. Accessed on March 22, 2017
Denford 2017* - Denford S, Abraham C, Campbell R, Busse H. A comprehensive review of reviews of school-based interventions to improve sexual-health. Health Psychology Review. 2017;11(1):33-52. Accessed on March 30, 2017
Kirby 2000* - Kirby D. What does the research say about sexuality education? Educational Leadership. 2000;58(2):72-6. Accessed on March 22, 2017
Kirby 2007 - Kirby D. Emerging answers 2007: Research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; 2007. Accessed on May 15, 2017
Smoak 2006 - Smoak N, Scott-Sheldon LA, Johnson BT, et al . Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual behavior: A meta-analysis of 174 studies with 116,735 participants. Journal of Acquired Immune Deficiency Syndromes. 2006;41(3):374–84. Accessed on March 22, 2017
Underhill 2007 - Underhill K, Operario D, Montgomery P. Systematic review of abstinence-plus HIV prevention programs in high-income countries. PLoS Medicine. 2007;4(9):e275. Accessed on March 22, 2017

Citations - Implementation

Guttmacher-Sex and HIV education - Guttmacher Institute. Sex and HIV education. New York: Guttmacher Institute. Accessed on March 22, 2017

Page Last Updated

March 30, 2017

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