Appraisal of Sexual Education Curriculum in Secondary Schools With Inclusion of Practical Implications and Evaluation, Based on Rural-Urban Residence

Abstract

Introduction The primary objective of this study was to review the comprehensibility of sexual education content and the age at which this curriculum was received by participants within middle and high school through a descriptive study on osteopathic medical students. The secondary objective involves a comparison of sexual education content within middle and high schools based on rural-urban residence. Methods An IRB-approved survey was created utilizing Qualtrics software and was administered to school-issued email accounts of Alabama osteopathic medical students within the classes of 2023 through 2026. Responses were recorded over a six-month time frame with a collection of 140 responses. Statistical analyses were completed utilizing Prism 10 software. Fisher exact testing was performed given the small sample size of survey respondents. Results Survey respondents attended middle and high schools throughout the United States. Most participants attended an urban middle school (87.14%; N=122) and an urban high school (90.00%; N=126). Most participants received sexual education and information about contraception within the ninth grade (44.29%; N=62) and during middle school at ages 10 to 14 (78.57%; N=110), respectively. A little over half of students (57.45%; N=80) indicated that they thought the sexual education provided to them within middle and/or high school was presented to them at an early enough age. The most common contraceptives that were discussed involved information about the usage, safety, and/or effectiveness of condoms (40.00%; N=56 in middle school and 55.00%; N=77 in high school; p=0.0165) and oral contraceptives (OCPs) (17.86%; N=25 in middle school and 32.86%; N=46 in high school; p=0.0058). All contraceptive methods were taught more frequently in high school as opposed to middle school. A lower percentage of students received instruction regarding male and female anatomy and physiology within middle school in rural vs urban areas (33.33%; N=6 in rural areas and 62.30%; N=76 in urban areas; p=0.0378). Students received most sexual education information from online websites (17.86%), during college (17.14%), or during high school (16.43%). Top additional comments mentioned that sexual education programs should be more comprehensive (50.00%) and need continuity (29.17%). Conclusion As supported by prior literature, despite participants' high education level, we can assume that comprehensive sexual education reform is necessary and may be initiated within middle school with continuation into high school. Efforts should be made to incorporate online resources into future formal secondary sexual education programs. Special attention should be made to ensure greater inclusivity along with language modifications to create safe spaces for adolescents to discuss sexual health. There was no statistically significant difference in contraception education between rural and urban areas. Consequently, there can be no conclusions made suggesting that contraceptive education is lacking for those individuals living in rural vs urban regions. Future studies should aim to expand the number of survey participants across the United States within a setting other than medical school, such as within large undergraduate institutions. These institutions can gather individuals from diverse rural-urban residences and include students who are closer in time to their formal secondary school sexual education instruction.

Keywords: adolescents; comprehensive sexual education; contraception; curriculum; high school; middle school; rural; sexual health; urban.

Figure 1. Regional middle and high school attendance of survey respondents.

Most respondents attended middle and high school within the South (72%), predominantly within Florida and Alabama. Fewer participants were educated within the Northeast (9%), Midwest (8%) and West (11%). Percentages accompanying each region are depicted as averages of middle and high school attendance rounded to the nearest whole percent.

Figure 2. (A-B) Grade and age in which surveyed students received instruction regarding sexual education and contraception methods.

Most surveyed students received information regarding sexual education in seventh, eighth, and ninth grade (A), while most received education pertaining to various contraception methods within middle school (10-14 years old) corresponding to grades five through nine (B).

Figure 3. Student’s evaluation of the age of sexual education instruction.

Among the students, 57.45% stated sexual education was provided to them early enough in the curriculum and 42.55% stated that sexual education was provided too late in the curriculum. Of a total of 59 respondents who stated they believed their sexual education was provided too late, 44.07% suggested early exposure around age 12.

Figure 4. Primary sources of sexual education and contraceptive information.

Students received most sexual education information from online websites, within college, or during high school. Fewer students stated that they obtained sexual education information via social media and middle school. Surveyed students who listed, “Other,” indicated that their parents taught them information relating to sexual education or that they learned this information from medical school, sexual partners/friends, a single seminar/class, or within 5th grade.

Figure 5. Additional comments of survey respondents provided at the conclusion of the survey.

Based on response content, a total of 24 comments were evaluated and separated into one of five categories including sexual education programs should be more comprehensive (50.00%), sexual education programs need continuity (29.17%), parents should provide additional sexual education (4.17%), sexual education is seen as a taboo subject (12.50%), and online resources should be implemented into sexual education curriculums (4.17%).