The United States has the highest rates of teenage pregnancy and sexually transmitted diseases (STDs) among developed countries-but the appropriate response has been contested because of debate over how sex education should be taught. Some federal laws promote an abstinence-only approach. Such legislation provides funds for abstinence-based programs and prohibits most programs from providing information about contraception or safer-sex practices. A recent study, however, has found that not only does that approach to sex education fail to prevent teenage pregnancies, it's positively correlated with increases in teenage pregnancies and births.

Figure. Sex education teacher Shayna Knowles talks to students at St. Andrew's Episcopal Church in Lake Worth, Florida, where for a little more than a year the federal government has been funding sex education programs that aren't based solely on abstinence. Photo by Alan Diaz / Associated Press.

The sex education laws and policies in each of the 48 states studied were analyzed to determine the extent to which the state emphasized abstinence in its sex education program. (North Dakota and Wyoming were excluded, as they had no state law or policy regarding sex or STD and HIV education as of 2005.) States were assigned ordinal values from 0 to 3 in four categories of emphasis: no provision (0), abstinence covered (1), abstinence promoted (2), and abstinence stressed (3). The most recent data available from national reports on teenage pregnancy, teenage births, and abortion rates among teens 15 to 19 years of age were from 2005.

Data analysis showed that the more abstinence was stressed, the higher were the rates of teen pregnancy and births. Of the four approaches, the most effective was level 1, which included comprehensive sex or HIV education (or both) and covered contraception, condom use, and abstinence.

Anne Teitelman, assistant professor of nursing at the University of Pennsylvania, responded to the study by saying that with this additional evidence, NPs in family planning, adolescent health, and school nursing can be confident that providing comprehensive sexual health information to youths is appropriate and effective. "Practicing nurses can also reassure parents," she added, "that talking with their teenagers about sex and contraception will not encourage sexual activity and will result in lessening the chance that young people will experience unintended pregnancy or sexually transmitted infections."

Barbara Huberman, a nurse and director of education and outreach for Advocates for Youth, noted that a major initiative, the Future of Sex Education, created new National Sexuality Education Standards, which were released in January (to read the standards, go to http://bit.ly/zbbN8R). "Among developed countries, we're the last to create national standards for minimum, essential core content and skills in sex education," Huberman says. "School nurses are the most trusted by parents to deliver sex education," she adds, and should be trained as sexuality educators and in providing "leadership in their school to adopt comprehensive sex education."-David Carter

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