General Articles

Middle School Sexual Health Programs: Are Their Effects Still Evident at Grade 10?

By Kendall Karr, SIECUS Federal Policy Intern
Christine M. Markham, Ph.D., et al., “Behavioral and Psychosocial Effects of Two Middle School Sexual Health Education Programs at Tenth-Grade Follow-Up,” Journal of Adolescent Health (February 2014).
To determine whether the behavioral and psychological effects of two middle school sexual health education programs extended into 10th grade, researchers compared a risk-avoidance version (i.e. abstinence-only) and a risk-reduction version of the program It’s Your Game, Keep It Real alongside a control group in fifteen middle schools in a large, urban, south-central U.S. school district.The abstinence-only version promoted the benefits of abstinence until marriage and incorporated elements of future orientation and character development. The risk-reduction version encouraged responsibility, self-respect, and abstinence until older. The control group intervention was the school district’s regular sexual health education, which covered puberty, reproduction, and HIV/STI transmission, but not abstinence-until-marriage or condoms and contraception.
The researchers analyzed data from 1,187 10th graders who participated in these three groups starting in 7th grade, and examined how different student subgroups processed and applied the sexual health education messages they received in middle school. The researchers predicted that students who participated in either the risk-reduction or abstinence-only version of It’s Your Game would significantly delay any sexual initiation into 10th grade (and report fewer unsafe sexual behaviors) compared with students in the control group.This is one of only a few studies to evaluate the continued impact of middle school sexual health education programs into 10th grade and beyond.
Key Findings:
  • By 10th grade, students in both the abstinence-only and risk-reduction groups were significantly less likely than their control-group peers to have initiated anal sex.
  • By 10th grade, students in the middle school abstinence-only groups were less likely than their control-group peers to engage in unprotected sex at last vaginal intercourse, either by abstaining from vaginal intercourse or by using a condom.
  • By 10th grade, there was no difference in the number of recent vaginal sex partners between students in the control group and students who received at least four lessons in either the risk-reduction or abstinence-only group. “Although both programs delayed anal sex initiation into 10th grade, effects on the delayed initiation of oral and vaginal sex were not sustained.”[1]
The study delivered highly mixed results, and raised more questions than it answered. Neither version of It’s Your Game: Keep It Real proved decisive at changing youth sexual risk behaviors three years after implementation with 7th graders.
Relatively few studies explore the longer-term impacts of middle school sexual health interventions to determine their effects upon delayed sexual initiation and other risk-reduction behaviors into the high school years. Many sexuality education professionals believe that a contiguous, middle-through-high-school sexual health education program would be best for ensuring adolescent sexual health throughout the high school years. However, this belief is informed more by conviction than by actual data. While the researchers have contributed additional data with this study, the results are not especially definitive, and more studies, involving more programs, will be needed.
The results of this study do make a case for enhancing middle school sexual health programs with lessons that directly address the health risks of unprotected sexual contact with multiple partners.This study should inspire sexuality education program planners to cover topics in middle school beyond anatomy and puberty 101. Those basic lessons typically fail to address risk behaviors and risk-reduction skills (including, but not limited, to abstinence) that middle schoolers need to understand.Given the weak impact of both versions of It’s Your Game on students’ long-term oral and vaginal sexual risk behaviors, sexuality education stakeholders should keep working for the support of multi-year programs that begin by middle school, and continue well past it.

[1] Markham CM, Peskin MF, Shegog R, Baumler ER, Addy RC, Thiel M, Escobar-Chaves SL, Robin L, Tortolero SR (2014). Behavioral and psychosocial effects of two middle school sexual health education programs at tenth-grade follow-up.  Journal of Adolescent Health. February:  54(2): 154-159, accessed March 6, 2014 at