State Sexual Health Education Policies and Sexual Behaviors among Adolescents in the USA Using Nationally Representative Data.

Sexual health education varies across the USA due to nuanced state-level policy mandates. This study examined associations between sex education mandates and sexual health behaviors among public high school students, with a focus on four types of state-level policies: sexual health and HIV/STI education where abstinence alone is not stressed, abstinence-based sexual health education, abstinence-based HIV/STI education, and combined abstinence-based sexual health and HIV/STI education. Sexual health behaviors analyzed included ever having sex, sexual intercourse before age 13, history of multiple sexual partners, use of condoms or birth control pills, and HIV/STI testing. We drew health behavior data from the 2019 Youth Risk Behavior Surveillance survey. Findings from multivariable logistic regression models suggested that sexual health and HIV/STI education mandates where abstinence alone was not stressed were negatively associated with ever having sex. Combined abstinence-based sexual health and HIV/STI education mandates were negatively associated with having used a condom or birth control pills during the last sexual intercourse and having sexual intercourse before the age of 13. Abstinence-based sexual health education mandates were negatively associated with sexual intercourse before the age of 13. Abstinence-based HIV/STI education mandates were positively associated with being tested for HIV/STIs among students who reported having had sex (all ps < 0.05). These findings indicate that associations between state-level sexual health education mandates and adolescent sexual behaviors vary by policy type and outcome, highlighting the complexity of how education mandates relate to youth sexual health behaviors.