The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior

  • Douglas B. KirbyEmail author
Special Issue Article


In an effort to reduce unintended pregnancy and sexually transmitted disease (STD) in adolescents, both abstinence and comprehensive sex and STD/HIV education programs have been proffered. Based on specified criteria, the author searched for and reviewed 56 studies that assessed the impact of such curricula (8 that evaluated 9 abstinence programs and 48 that evaluated comprehensive programs) on adolescents’ sexual behavior. Study results indicated that most abstinence programs did not delay initiation of sex and only 3 of 9 had any significant positive effects on any sexual behavior. In contrast, about two thirds of comprehensive programs showed strong evidence that they positively affected young people’s sexual behavior, including both delaying initiation of sex and increasing condom and contraceptive use among important groups of youth. Based on this review, abstinence programs have little evidence to warrant their widespread replication; conversely, strong evidence suggests that some comprehensive programs should be disseminated widely.

Key words

teen pregnancy sexually transmitted disease curriculum-based programs teens 


  1. Aarons, S. J., Jenkins, R. R., Raine, T. R., El-Khorazaty, M. N., Woodward, K. M., Williams, R. L., et al. (2000). Postponing sexual intercourse among urban junior high school students—A randomized controlled evaluation. Journal of Adolescent Health, 27, 236–247.CrossRefPubMedGoogle Scholar
  2. Bearman P. S., & Bruckner, H. (2001). Promising the future: Virginity pledges and the transition to first intercourse. American Journal of Sociology, 106, 859–912.CrossRefGoogle Scholar
  3. Blake, S. M., Ledsky, R., Lohrmann, D., Bechhofer, L., Nichols, P., Windsor, R., et al. (2000). Overall and differential impact of an HIV/STD prevention curriculumfor adolescents. Washington, DC: Academy for Educational Development.Google Scholar
  4. Borawski, E. A., Trapl, E. S., Goodwin, M., Adams-Tufts, K., Hayman, L., Cole, M. L., et al. (2005, March). Taking Be Proud! Be Responsible! to the suburbs: A replication study. Paper presented at the Psychosocial Workshop of the Population Association of America Annual Meeting, Philadelphia, PA.Google Scholar
  5. Borawski, E., Trapl, E., Lovegreen, L., Colabianchi, N., & Block, T. (2005). Effectiveness of abstinence-only intervention in middle school teens. American Journal of Health Behavior, 29, 423–434.PubMedGoogle Scholar
  6. Boyer, C., Shafer, M., Shaffer, R., Brodine, S., Pollack, L., Betsinger, K., et al. (2005). Evaluation of a cognitivebehavioral, group, randomized controlled intervention trial to prevent sexually transmitted infections and unintended pregnancies in young women. Preventive Medicine, 40, 420–431.CrossRefPubMedGoogle Scholar
  7. Boyer, C., Shafer, M., & Tschann, J. (1997). Evaluation of a knowledge- and cognitivebehavioral skills-building intervention to prevent STDs and HIV infection in high school students. Adolescence, 32, 25–42.PubMedGoogle Scholar
  8. Clark, M. A., Trenholm, C., Devaney, B., Wheeler, J., & Quay, L. (2007). Impacts of the Heritage Keepers Life Skills Education component. Princeton, NJ: Mathematica Policy Research.Google Scholar
  9. Coyle, K. K., Basen-Enquist, K. M., Kirby, D. B., Parcel, G. S., Banspach, S. W., Collins, J. L., et al. (2001). Safer Choices: Reducing teen pregnancy, HIV and STDs. Public Health Reports, 1, 82–93.CrossRefGoogle Scholar
  10. Coyle, K. K., Kirby, D. B., Marin, B., Gomez, C., & Gregorich, S. (2004). Draw the Line/Respect the Line: A randomized trial of a middle school intervention to reduce sexual risk behaviors. American Journal of Public Health, 94, 843–851.CrossRefPubMedGoogle Scholar
  11. Coyle, K. K., Kirby, D. B., Robin, L. E., Banspach, S. W., Baumler, E., & Glassman, J. R. (2006). All4You! A randomized trial of an HIV, other STDs and pregnancy prevention intervention for alternative school students. AIDS Education and Prevention, 18, 187–203.CrossRefPubMedGoogle Scholar
  12. Denny, G., & Young, M. (2006). An evaluation of an abstinence-only sex education curriculum: An 18-month follow-up. Journal of School Health, 76, 414–422.CrossRefPubMedGoogle Scholar
  13. DiClemente, R. J., Wingood, G. M., Harrington, K. F., Lang, D. L., Davies, S. L., Hook, E. W., et al. (2004). Efficacy of an HIV prevention intervention for African American adolescent girls: A randomized controlled trial. Journal of the American Medical Association, 292, 171–179.CrossRefGoogle Scholar
  14. Doniger A. S., Riley, J. S., Utter, C. A., & Adams, E. (2001). Impact evaluation of the “Not Me, Not Now” abstinence-oriented, adolescent pregnancy prevention communications program, Monroe County, N.Y. Journal of Health Communication, 6, 45–60.CrossRefPubMedGoogle Scholar
  15. Eisen, M., Zellman, G. L., & McAlister, A. L. (1990). Evaluating the impact of a theory-based sexuality and contraceptive education program. Family Planning Perspectives, 22, 261–271.CrossRefPubMedGoogle Scholar
  16. Ekstrand, M. L., Siegel, D. S., Nido, V., Faigeles, B., Cummings, G. A., Battle, R., et al. (1996, July). Peerled AIDS prevention delays onset of sexual activity and changes peer norms among urban junior high school students. Paper presented at XI International Conference on AIDS, Vancouver, British Columbia.Google Scholar
  17. Fisher, J., Fisher, W., Bryan, A., & Misovich, S. (2002). Information-motivation-behavioral skills modelbased HIV risk behavior change intervention for inner-city high school youth. Health Psychology, 21, 177–186.CrossRefPubMedGoogle Scholar
  18. Gillmore, M. R., Morrison, D. M., Richey, C. A., Balassone, M. L., Gutierrez, L., & Farris, M. (1997). Effects of a skill-based intervention to encourage condom use among high-risk heterosexually active adolescents. AIDS Education and Prevention, 9(Suppl. A), 22–43.PubMedGoogle Scholar
  19. Gottsegen, E., & Philliber, W. W. (2001). Impact of a sexual responsibility program on young males. Adolescence, 36, 427–433.PubMedGoogle Scholar
  20. Harrington, N. G., Giles, S. M., Hoyle, R. H., Feeney, G. J., & Yungbluth, S. C. (2001). Evaluation of the All Stars Character Education and Problem Behavior Prevention Program: Effects on mediator and outcome variables for middle school students. Health Education & Behavior, 28, 533–546.CrossRefGoogle Scholar
  21. Hoffman, S. D. (2006). By the numbers: The public costs of adolescent childbearing. Washington, DC: National Campaign to Prevent Teen Pregnancy.Google Scholar
  22. Howard, M., & McCabe, J. (1990). Helping teenagers postpone sexual involvement. Family Planning Perspectives, 22, 21–26.CrossRefPubMedGoogle Scholar
  23. Hubbard, B. M., Giese, M. L., & Rainey, J. (1998). A replication study of Reducing the Risk, a theory-based sexuality curriculum for adolescents. Journal of School Health, 68, 243–247.CrossRefPubMedGoogle Scholar
  24. Jemmott, J., III, Jemmott, L., Braverman, P., & Fong, G. T. (2005). HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic. Archives of Pediatrics & Adolescent Medicine, 159, 440–449.CrossRefGoogle Scholar
  25. Jemmott, J., III, Jemmott, L., & Fong, G. (1992). Reductions in HIV risk-associated sexual behaviors among Black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health, 82, 372–377.CrossRefPubMedGoogle Scholar
  26. Jemmott, J., III, Jemmott, L., & Fong, G. (1998). Abstinence and safer sex: HIV risk-reduction interventions for African-American adolescents: A randomized controlled trial. Journal of the American Medical Association, 279, 1529–1536.CrossRefPubMedGoogle Scholar
  27. Jemmott, J., III, Jemmott, L., Fong, G., & McCaffree, K. (1999). Reducing HIV risk-associated sexual behaviors among African American adolescents: Testing the generality of intervention effects. American Journal of Community Psychology, 27, 161–187.CrossRefPubMedGoogle Scholar
  28. Jorgensen S. R., Potts, V., & Camp, B. (1993). Project taking charge: Six-month follow-up of a pregnancy prevention program for early adolescents. Family Relations: Interdisciplinary Journal of Applied Family Studies, 42, 401–406.Google Scholar
  29. Kirby, D. (2001). Emerging answers: Research findings onprograms to reduce teen pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy.Google Scholar
  30. Kirby, D. (2007). Emerging answers 2007: Research findings onprograms to reduce the problems of teen pregnancy and sexually transmitted disease. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy.Google Scholar
  31. Kirby, D., Barth, R., Leland, N., & Fetro, J. (1991). Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives, 23, 253–263.CrossRefPubMedGoogle Scholar
  32. Kirby, D., Korpi, M., Adivi, C., & Weissman, J. (1997). An impact evaluation of Project SNAPP: An AIDS and pregnancy prevention middle school program. AIDS Education and Prevention, 9(Suppl. A), 44–61.PubMedGoogle Scholar
  33. Kirby, D., Korpi, M., Barth, R. P., & Cagampang, H. H. (1997). The impact of the Postponing Sexual Involvement curriculum among youths in California. Family Planning Perspectives, 29, 100–108.CrossRefPubMedGoogle Scholar
  34. Koniak-Griffin, D., Lesser, J., Nyamathi, A., Uman, G., Stein, J., & Cumberland, W. (2003). Project CHARM: An HIV prevention program for adolescent mothers. Family & Community Health, 26, 94–107.Google Scholar
  35. LaChausse, R. (2006). Evaluation of the Positive Prevention HIV/STD curriculum for students grades 9–12. American Journal of Health Education, 37, 203–209.Google Scholar
  36. Landry, D. J., Kaeser, L., & Richards, C. L. (1999). Abstinence promotion and the provision of information about contraception in public school district sexuality education policies. Family Planning Perspectives, 31, 280–286.CrossRefPubMedGoogle Scholar
  37. Levy, S. R., Perhats, C., Weeks, K., Handler, A., Zhu, C., & Flay, B. R. (1995). Impact of a school-based AIDS prevention program on risk and protective behavior for newly sexually active students. Journal of School Health, 65, 145–151.CrossRefPubMedGoogle Scholar
  38. Lieberman, L. D., Gray, H., Wier, M., Fiorentino, R., & Maloney, P. (2000). Long-term outcomes of an abstinence-based, small-group pregnancy prevention program in New York City schools. Family Planning Perspectives, 32, 237–245.CrossRefPubMedGoogle Scholar
  39. Little, C. B., & Rankin, A. (2001). An evaluation of the Postponing Sexual Involvement curriculum among upstate New York eighth graders. Unpublished manuscript, State University of New York, Cortland.Google Scholar
  40. Magura, S., Kang, S., & Shapiro, J. L. (1994). Outcomes of intensive AIDS education for male adolescent drug users in jail. Journal of Adolescent Health, 15, 457–463.CrossRefPubMedGoogle Scholar
  41. Main, D. S., Iverson, D. C., McGloin, J., Banspach, S. W., Collins, K., Rugg, D., et al. (1994). Preventing HIV infection among adolescents: Evaluation of a schoolbased education program. Preventive Medicine, 23, 409–417.CrossRefPubMedGoogle Scholar
  42. Middlestadt, S. E., Kaiser, J., Santelli, J. S., Hirsch, L., Simkin, L., Radosh, A., et al. (1998, June–July). Impact of an HIV/STD prevention intervention on urban, middle school students. Paper presented at the XII International AIDS Conference, Geneva, Switzerland.Google Scholar
  43. Morrison, D. M., Hoppe, M. J., Wells, E. A., Beadnell, B. A., Wilsdon, A., Higa, D., et al. (2007). Replicating a teen HIV/STD preventive intervention in a multicultural city. AIDS Education and Prevention, 19, 258–273.CrossRefPubMedGoogle Scholar
  44. Nicholson, H. J., & Postrado, L. T. (1991). Girls Incorporated preventing adolescent pregnancy: A program development and research project. New York: Girls Incorporated.Google Scholar
  45. Rector, R. E. (2002). The effectiveness of abstinence education programs in reducing sexual activity among youth. Washington, DC: Heritage Foundation.Google Scholar
  46. Rotheram-Borus, M., Gwadz, M., Fernandez, M., & Srinivasan, S. (1998). Timing of HIV interventions on reductions in sexual risk among adolescents. American Journal of Community Psychology, 26, 73–96.CrossRefPubMedGoogle Scholar
  47. Rotheram-Borus, M. J., Koopman, C., Haigners, C., & Davies, M. (1991). Reducing HIV sexual risk behaviors among runaway adolescents. Journal of the American Medical Association, 266, 1237–1241.CrossRefPubMedGoogle Scholar
  48. Rue, L. A., & Weed, S. E. (2005, November). Primary prevention of adolescent sexual risk taking: A schoolbased model. Paper presented at the Abstinence Education Evaluation Conference: Strengthening Programs Through Scientific Evaluation, Baltimore, MD.Google Scholar
  49. Siegel, D., Aten, M., & Enaharo, M. (2001). Long-term effects of a middle school- and high school-based human immunodeficiency virus sexual risk prevention intervention. Archives of Pediatrics & Adolescent Medicine, 155, 1117–1126.Google Scholar
  50. Siegel, D., DiClemente, R., Durbin, M., Krasnovsky, F., & Saliba, P. (1995). Change in junior high school students’ AIDS-related knowledge, misconceptions, attitudes, and HIV-prevention behaviors: Effects of a school-based intervention. AIDS Education and Prevention, 7, 534–543.PubMedGoogle Scholar
  51. Slonim-Nevo, V., Auslander, W. F., Ozawa, M. N., & Jung, K. G. (1996). The long-term impact of AIDS-preventive interventions for delinquent and abused adolescents. Adolescence, 31, 409–421.PubMedGoogle Scholar
  52. Smith, P., Weinman, M., & Parrilli, J. (1997). The role of condom motivation education in the reduction of new and reinfection rates of sexually transmitted diseases among inner-city female adolescents. Patient Education and Counseling, 31, 77–81.CrossRefPubMedGoogle Scholar
  53. St. Lawrence, J., Crosby, R., Belcher, L., Yazdani, N., & Brasfield, T. (1999). Sexual risk reduction and anger management interventions for incarcerated male adolescents: A randomized controlled trial of two interventions. Journal of Sex Education & Therapy, 24, 9–17.Google Scholar
  54. St. Lawrence, J., Crosby, R., Brasfield, T., & O’Bannon, R., III. (2002). Reducing STD and HIV risk behavior of substance-dependent adolescents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1010–1021.CrossRefPubMedGoogle Scholar
  55. St. Lawrence, J. S., Jefferson, K. W., Alleyne, E., Brasfield, T. L., O’Bannon, R. E., III, & Shirley, A. (1995). Cognitive-behavioral intervention to reduce African American adolescents’ risk for HIV infection. Journal of Consulting and Clinical Psychology, 63, 221–237.CrossRefPubMedGoogle Scholar
  56. Stanton, B., Guo, J., Cottrell, L., Galbraith, J., Li, X., Gibson, C., et al. (2005). The complex business of adapting effective interventions to new populations: An urban to rural transfer. Journal of Adolescent Health, 37, 17–26.CrossRefGoogle Scholar
  57. Stanton, B., Li, X., Ricardo, I., Galbraith, J., Feigelman, S., & Kaljee, L. (1996). A randomized, controlled effectiveness trial of an AIDS prevention program for low-income African-American youths. Archives of Pediatrics & Adolescent Medicine, 150, 363–372.Google Scholar
  58. Title V, Section 510 (b)(2)(A-H) of the Social Security Act (P.L. 104-193).Google Scholar
  59. Trenholm, C., Devaney, B., Fortson, K., Quay, L., Wheeler, J., & Clark, M. (2007). Impacts of four Title V, Section 510 abstinence education programs. Princeton, NJ: Mathematica Policy Research.Google Scholar
  60. Villarruel, A., Jemmott, J., III, & Jemmott, L. (2006). A randomized controlled trial testing an HIV prevention intervention for Latino youth. Archives of Pediatrics & Adolescent Medicine, 160, 772–777.CrossRefGoogle Scholar
  61. Walter, H. J., & Vaughn, R. D. (1993). AIDS risk reduction among a multi-ethnic sample of urban high school students. Journal of the American Medical Association, 270, 725–730.CrossRefPubMedGoogle Scholar
  62. Weed, S. (2001). Title Veducationprograms: Phase Iinterim evaluation report to Arkansas Department of Health. Salt Lake City, UT: Institute for Research and Evaluation.Google Scholar
  63. Weed, S. E., Ericksen, I. H., & Birch, P. J. (2005). An evaluation of the Heritage Keepers abstinence education program. Salt Lake City, UT: Institute for Research and Evaluation.Google Scholar
  64. Weed, S. E., Ericksen, I. H., Lewis, A., Grant, G. E., & Wibberly, K. H. (2008). An abstinence program’s impact on cognitive mediators and sexual initiation. American Journal of Health Behavior, 32, 60–73.PubMedGoogle Scholar
  65. Weed, S. E., Olsen, J. A., DeGaston, J., & Prigmore, J. (1992). Predicting and changing teen sexual activity rates: A comparison of three Title XX programs. Washington, DC: Office of Adolescent Pregnancy Programs.Google Scholar
  66. Weed, S., Prigmore, J., & Tanas, R. (2002). The Teen Aid Family Life education project: Fifth year evaluation report. Salt Lake City, UT: Institute for Research and Evaluation.Google Scholar
  67. Zimmerman, R., Cupp, P., Donohew, L., Sionéan, C., Feist-Price, S., & Helme, D. (2008). Effects of a schoolbased, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual and Reproductive Health, 40, 41–51.CrossRefGoogle Scholar
  68. Zimmerman, R., Cupp, P., Hansen, G., Donohew, R., Roberto, A., Abner, E., et al. (n.d.). The effects of a school-based HIV and pregnancy prevention program in rural Kentucky. Unpublished manuscript, University of Kentucky, Lexington.Google Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.ETR AssociatesScotts Valley

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