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

## TL;DR

This study examines how and when sexual education is taught in U.S. middle and high schools, comparing rural and urban settings.

## Contribution

The study provides insights into the timing and comprehensiveness of sexual education in secondary schools, emphasizing the need for reform and inclusivity.

## Key findings

- Most participants received sexual education in middle school at ages 10 to 14.
- Contraceptive education was more frequent in high school, with significant differences in condom and oral contraceptive discussions.
- Rural middle schools taught anatomy and physiology less frequently than urban ones.

## 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.