The seesaw effect: positive outcomes of sex education reduce over time – while condom use increases
Condom use among adolescents is likely to increase over time following sexual health education, while other positive behaviours and attitudes towards sexual activity and risk are likely to wane, a wide-ranging evidence review suggests.
A new study investigating the long-term effects of sexual health interventions in young people has found that most positive behavioural effects fade by 24 months, with only increased condom use remaining. This suggests there is a need for schools to focus on improving the long-term effectiveness of sexual health interventions.
The study provided the first analysis of the long-term effects of sexual health interventions in the last ten years. The analysis examined the effects of mainly school-based sexual health promotion, on pregnancy and rates of sexually transmitted infections (STIs). It also tracked sexual behaviours such as condom use, and individuals’ knowledge of and attitudes towards sex and sexual health risks.
The researchers compared results from 63 studies, published between 2008 and 2016, the majority of which were conducted in North or South America (66%). Of the remaining studies, research conducted in Africa made up 13%, Europe 11% and Asia 10% of those included. The mean age of participants was 15 and around 40% of participants were sexually experienced.
In the short term, sexual health promotions were found to have a positive impact on adolescents’ sexual health-related knowledge, attitudes towards HIV and methods of protection. There was also an increase in young peoples’ confidence in using condoms, with many more intending to use condoms and an increase in actual use of them.
In the medium term, defined as 12-18 months, the positive effects present in the short-term were still recorded, although each had lessened over time. All studies that evaluated condom use at this stage found interventions were more effective in this area when they did not promote sexual abstinence.
In the long term, defined as 24 months or longer, interventions were found to only significantly impact upon condom use but no longer had an impact on the other outcomes.
However, it is difficult to estimate the real benefit of adolescent sexual health interventions. A scarcity of resources for sexual health promotion aimed at adolescents in many countries means that few studies include long-term follow-ups in their evaluation.
Longer-term evaluations are the key to determine whether these interventions actually impact on STIs and unplanned pregnancies during adolescence, and consequently are reducing associated health and social costs.
Overall, these findings suggest that there is a need for interventions to focus more on long-term behaviour changes. They also suggest that, while schools provide an effective setting to promote sexual health during adolescence, more evidence is needed on the effectiveness of sexual health promotion for adolescents in other settings such as foster-care centres, health centres, and youth clubs.