Advocacy Report

Advocacy Report

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  Sex Education inthe U.S. 1 A Call for Improvement in U.S. Sexuality Education for Adolescents Samantha Beardslee CHHS 302 Section 2 Professor Natasha Oehlman December 16, 2013
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  Sex Education inthe U.S. 2 Table of Contents Overview of Sexuality Education in the U.S...............................................................3 The Root Causes of Poor Sexual Health Among Teens...........................................3 U.S. Approaches to Sex and Relationship Education................................................. ......4 Abstinence-only education...................................................................................................................4 The rise of comprehensive sexuality education..........................................................................6 Outcomes of Current Sexuality Education Policy............................................... .....7 How to Improve Teen Sexual Health through Policy..............................................8 Foreign Approaches to Sex and Relationship Education...............................................8 Improving Adolescent Sexual Health Through Policy....................................................9 A Final Summary and Call to Action...........................................................................10 References..........................................................................................................................11 Appendix.............................................................................................................................14
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  Sex Education inthe U.S. 3 Overview of Sexuality Education in the U.S. Education is paramount because it provides the foundation for individual and community growth. However, one might be educated yet not have the necessary knowledge or wisdom for preventing STI transmission and early, unintended pregnancy. It is imperative to open political discussion regarding why the teen pregnancy rates are so much higher in the United States than in many other industrialized nations. In the UnitedStates,a simple Internet search would reveal that age-appropriate sexuality education is a constant, controversial issue debated thoroughly among politicians, social scientists, psychologists, medical doctors, educators, sexual health professionals, religious leaders, and parents. There is no greater stakeholder, however, than the adolescent population, although they are the least heard voices in public discussion on sexuality education. Additionally, statistical research shows that the U.S. falls drastically behind many other industrialized nations in teen pregnancy and STI transmission rates (World Bank, 2009). The limits set in place for acceptable curricula in youth sexuality education exemplify U.S. cultural attitudes toward sexuality, and show a need not only for advocating new limits, but also for seeking out alternative ways to teach the next generations to develop healthier relationships and sexual habits. Inadequate sexuality education leads to substandard sexual health among teens, butby taking queues from other nations, re-appropriating funds,and creating incentives for comprehensive sexuality education, we can provide healthier outcomes for our nation’s youth. The Root Causes of Poor Sexual Health among Teens One may ask what it means to be sexually healthy or unhealthy. An obvious reaction to this question would be whether or not a person has a sexually transmitted infection (STI/STD). In the case of teenagers, many would agree that pregnancy and child rearing in U.S. culture could also be damaging to their emotional, mental, and physical health. According to Steinberg (2005), “When faced with an immediate personal decision, adolescents will rely less on intellectual capabilities and more on feelings. Nevertheless, when reasoning about a hypothetical, moral dilemma, the adolescent will rely more on logical information” (as cited in Casey, Jones & Hare, 2008, conclusions, para. 6). In other words, teens can make rational decisions, but they are still developing the aptitude for making optimal choices in the heat of a moment. Still, Steinberg also showed that the emotional significance of a decision and its environmental context are very influential to an adolescent (as cited in Casey et al.
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  Sex Education inthe U.S. 4 2008), so there is hope if teens are taught to make at least some of their decisions in advance and through building positive habits. Bringing a baby into the world during this stage of life could only add to the stress of developing into a well-adjusted adult. In the words of Wellings, Collumbien, Slaymaker, Singh, Hodges, Patel, and Bajos (2006), "The ability of individuals or couples to pursue a fulfilling and safe sex life is central to achievement of sexual health” (p. 1706).Teen pregnancy and STI transmission are common indicators of unsafe sexual activity, and based on these indicators, the sexual health of U.S. teenagers is in jeopardy. The critical issue is that the U.S. falls behind many other countries, especially Western European and Scandinavian countries, in unintended teen pregnancy rates as well as in STI screening and transmission (Darroch, Singh, and Frost, 2001). According to the National Surveillance Data published by the CDC in 2008, “The largest number of reported cases of both chlamydia and gonorrhea . . . was among girls between 15 and 19 years of age” (p.1). Also, data from the World Bank (2009) shows the U.S. to have a higher birth rate among teens age 15-19 than many other developed countries, including Australia, Belgium, Canada, China, Denmark, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Japan, North and South Korea, the Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Russia, Saudi Arabia, Singapore, Spain, Sweden, Switzerland, and the U.K. Based on this concern, the high STI transmission and unintended pregnancy rates among teens in the U.S. warrant examination of current sexuality education policies. There is no doubt culture takes an important role in determining how sexual wellness and relationship education is approached in any given country. Regardless of who has attempted to address the reproductive health problems of adolescents, all agree on the critical issues presented by the statistics. The point of disagreement is primarily how to best resolve the issues. Some countries, such as the Netherlands and France, look at teen sexuality realistically by acknowledging not only that many teens are sexually active, but also that there is little variation in age at first intercourse across the nations (Weaver et al., 2005). Weaver et al. (2005) also suggested, “A deeply entrenched and ongoing tension exists between those who accept or tolerate sex between young people and those who do not.” This passage continues to say that while some people think the cause of poor sexual health is primarily sexual activity itself among youth, others claim the cause is a lack of education and guidance in making healthy sexual choices. There are also those who believe that the root of the problem is pre-marital sex. This belief takes a moral approach to the problem, posing that the correct response is to encourage young people to abstain from sex until marriage (Weaver et al., 2005). While abstinence is a well-intended approach, the conclusion from one study published in 2001 indicated, “Data on contraceptive use are more important than
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  Sex Education inthe U.S. 5 the data on sexual activity in explaining variation in levels of adolescent pregnancy and childbearing among the five developed countries; however, the higher level of multiple sexual partnership among American teenagers may help explain their higher STD rates” (Darroch, Singh, and Frost, 2001, abstract). Although the origin of these particular behaviors and attitudes toward multiple partnerships is unknown, an examination of the origin of current U.S. sexuality education policies may prove helpful in understanding the root causes of unhealthy sexual practices among teens. U.S. Approaches to Sex and Relationship Education Abstinence-only education.Although U.S. culture is an amalgamation of various traditions and religious beliefs, the most influential value system stems from the New England settlers, especially Puritans, Edwardsian Calvinists, and Revivalists. An article in the journal William and Mary Quarterly cited two historians, Henry F. May and Perry Miller, who described the religious history of America (Cohen, 1997). Cohen explained the spread of Puritan concepts of sin and redemption to the South and West from New England. He wrote, “By the Revolution, the New England mind had become America’s (p. 696).” Among the New England settlers’ values was that of abstinence from sex until marriage. Pre-marital sex and extra-marital sex have been taboos consistent in many cultures throughout the world, but the central beliefs of the New England Puritans were based on the following Bible passage (Romans 13:12-14): “The night is far spent, the day is at hand; not in carousing and drunkenness, not in debauchery and lust, not in strife and jealousy. But put ye on the Lord Jesus Christ, and make no provision for the flesh, to fulfill the lusts thereof (as cited in Campbell, 2010).” Essentially, all sexual activity was considered shameful and sinful. This Puritan worldview became so ingrained in American society that written information regarding contraception was considered obscene material under the Comstock Laws in the late 1800s (Comstock Act, 2012). Contraception was not legalized for use by all citizens of the United States until 1976, when the Supreme Court declared it unconstitutional to deny sales of contraceptives to people under the age of 16 (“History and Successes,” 2012). Abstinence was and continues to be considered the most moral and widely accepted form of birth control in the United States.As stated by Santelli, Ott, Lyon, Rogers, Summers, and Schleifer (2006), “There is broad support for abstinence as a necessary and appropriate part of sexuality education. Controversy arises when abstinence is provided to adolescents as a sole choice and where health information on other choices is restricted or misrepresented.” Furthermore, they pointed out the heavy influence of politicians in promoting abstinence-only education, acknowledging that since 1996, the federal government has been funding community-based programs that teach only abstinence and restrict other information; grants are directly sent to the organizations running the programs, thus bypassing the course of state approval (Santelli, et al. 2006).
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  Sex Education inthe U.S. 6 Figure 1provides a basic depiction of the prevalence of sexuality education programs that strongly support abstinence in the U.S., by region(see Appendix for more detail). Despite the dominance of abstinence-stressed education, several studies have shown the majority of parents, students, and teachers want a more comprehensive version of sexuality education to be taught in schools Figure 1 (Dailard, 2001). The rise of comprehensive sexuality education.The widespread promotion of comprehensive sexuality education is not a recent occurrence in the United States. According to the Guttmacher Institute (2012), Americans in the 1970s supported sex education in schools due to the alarming rise in teen pregnancies and the influx of HIV/AIDS. Currently, the majority of parents, educators, and health professionals all support comprehensive sexuality education, while an aggressive public minority and many politicians push abstinenceonly education with the belief that sex among adolescents is a moral issue rather than a health issue (Berne &Huberman, 1999; Santelli, et al. 2006). In the article written by Santelli, et al. (2006), the authors discussed the sexual behaviors of youth as a health issue according to proponents of comprehensive sexuality education. Because for these proponents sexuality is a health issue, they do not believe it is ethical to withhold information regarding personal health maintenance; to do so would cause harm. Causing harm to others directly violates the common medical principle of nonmaleficence. Further, more studies have been done that validatecomprehensive sexuality education as opposed to abstinence-only education. The opposing core beliefs of sexuality as a health issue and sexuality as a moral issue polarize the discussions regarding sex education without either position offering compromise (Berne &Huberman, 1999).
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  Sex Education inthe U.S. 7 Such controversy inhibits progression toward creating policies that would cause the rates of U.S. teen pregnancy and STI transmission to decline to levels more consistent with those of other developed countries, which take much different approaches to ensuring the sexual health of their youth. Outcomes of Current Sexuality Education Policy There are two key determinants of inadequate sexuality education in the United States: Pregnancy (along with childbirth and abortion), and STI transmission. Figure 2 shows the U.S. has a significantly higher teen birth rate than several other industrialized countries. Many young women who become pregnant outside of marriage are ostracized from the conservative families in which they were raised, leaving them without financial and familial support (Saewyc, 2003). These young people are left with less access to proper health care and in turn, their babies may suffer. Figure 2 *Compiled by Associated Press 2010 The debates regarding sexuality education have not only been based on health indicators, but also based on the moral state of U.S. society. Many studies and evaluations have been done on the different types of sexuality education programs in the U.S. to determine their efficacy in delaying age of first intercourse and reducing teen pregnancy. Unlike many other developed countries, the United States has no federal requirement for sexuality education, so it is left to each state to decide their own
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  Sex Education inthe U.S. 8 policies regarding sexuality education. For example, Maine has completely refused to accept any federal funding for abstinence-only programs. Although many individual organizations have welcomed the federal incentive to teach abstinenceonly sexuality education, there is an overwhelming lack of evidence showing the efficacy of such programs (Santelli, et al., 2006). The other determinant of inadequate sexuality education is that the U.S. has seen a rise in STI transmission. Conversely, the countries that take a more pragmatic and sex-positive approach to sexuality education—acceptingadolescents as sexual beings—demonstratemore widespread and correct use of contraceptive devices, thus reducing the rate of unintended teen pregnancy and STI transmission (Byrne &Huberman, 1999). Many young people who have chlamydia, gonorrhea, and HIV are unaware of their infection due to lack of symptoms, and if left undetected and untreated, chlamydia and gonorrhea can lead to pelvic inflammatory disease, infertility, ectopic pregnancy, and in the case of HIV, death (CDC, 2008). It would be valuable to the health of U.S. teens if the U.S. federal and state governments consider and incorporate some of the examples other industrialized countries have provided. How to Improve Teen Sexual Health Foreign Approaches to Sex and Relationship Education While the United States has the highest teen pregnancy rate of all other developed countries, Switzerland and Netherlands have the lowest and second lowest, respectively (World Bank, 2009). The Netherlands has a method for sex education that is different from many other countries. The Dutch treat sexuality as a matterof-fact, natural part of humanity. Weaver, et al. (2005) discussed the sex education policies of the Netherlands as well as those of France and Australia. Since 1993, schools in the Netherlands have been required to include sexuality education in their curriculum, although no specific curriculum is enforced. Teachers are free to incorporate the necessary topics into their other courses as they choose (p. 174). The Dutch highly value education and believe it is important that students direct class discussions through asking questions; the goal is more to talk about sexual health rather than simply teach it, and all the teachers receive training in sexual health (Byrne &Huberman, 1999). The French, on the other hand, do mandate a national curriculum for sexuality education for youth aged 13, believing that by this age, the information provided on this topic is necessary for maintaining personal and public health, and parents are not permitted to remove their teenagers from the sexuality education program (Byrne &Huberman, 1999, p. 175). In Australia, sexuality education has been a part of school policies in all the states since the 1970s, although reforming how it was taught became apparent with the
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  Sex Education inthe U.S. 9 influx of AIDS in the 1980s. Since then, Australia has developed national policy guidelines for promoting adolescent sexual health through comprehensive sexuality education (p. 176). The United States can stand to learn from these other industrialized nations and reform sexuality education. Improving Adolescent Sexual Health through Policy As stated in Weaver, Smith, and Kippax (2005), “Sex education policies are generally considered ‘public policy.’” Thus, it is the politicians who have the most influence on policies, and are provided with research and support from social media and a variety of professional sources. In 1981, Congress instated the Adolescent Family Life program (AFL) (Dailard, 2001, p. 9), which was a well-intended step toward caring for adolescent reproductive health. This program helped fund organizations providing assistance to pregnant adolescents in order to help them carry out healthy pregnancies and births, and funding increased for AFL in 1996 with the new welfare reform (Dailard, 2001, p.9). The purpose of AFL is to prevent abortions by ameliorating some of the negative consequences of having children at such a young age (Department of Health and Human Services, 2012). These negative consequences may include financial stress, lack of medical care and lack of familial support; the AFL provides services to relieve some of these stresses and to ensure a healthier birth. The AFL, now called the Pregnancy Assistance Fund under the Patient Protection and Affordable Care Act of 2010, continues to provide assistance to pregnant teens in order to minimize abortion rates and continues to focus sexuality education efforts on the value of abstinence. A new policy is needed to ensure the sexual health and safety of non-pregnant adolescents as well. The most valuable step toward improving teen sexual health in the U.S. would be for Congress to create a policy that acknowledges and addresses the reality of teen sexual behavior. The reality is the following: Teens have sex despite abstinence-only education o Alabama and Mississippi have the highest teen pregnancy rates, respectively, both of which stress abstinence in their state sex education policies (Guttmacher Institute, 2012; Office of Adolescent Health, 2013). Teens have greater numbers of reported STI cases. The Internet is a valuable resource for spreading health information among teens (Web Watch: Update teen knowledge with Internet resources, 2005). A policy is needed that would support programs that promote the delay of first intercourse as well as provide the knowledge necessary for adolescents to make healthier and wiser choices in their relationships and sexual behaviors. This is not to say that abstinence and morals are useless when taught in schools, but that these
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  Sex Education inthe U.S. 10 values should be taught as supplemental to the truth about sexual health and sexual diversity, knowing that the United States is home to citizens from hundreds of different cultural backgrounds, each with their own values and the innate human desire to ensure the health of one’s offspring. As such, parents should be allowed to opt out of a school-based sexuality education program, provided they agree to review the school’s literature for any helpful information and they agree to discuss sexuality-related topics of their choosing with their children. An effective sex education policy should: Encourage parent-child discussions on sexual health, Stress a necessity for including rhetorically relevant sexual health topics, Expand the website of the Office of Adolescent Health (a division of the Department of Health and Human Services) to include sections aimed specifically at educating schools, parents and/or teens on currentsexual health research, And provide a requirement that all state sexuality education policies be regularly evaluated based on the efficacy of programs developed under these policies. Federal funds originally allocated to grants for abstinence-only education should be re-appropriated for the most successful comprehensive sexuality education programs in each state. This re-appropriation of funding would be more cost efficient than the current policy, since using the grants as incentive to be more successful in reducing teen pregnancies and STI transmission would create competition among the programs within each state, and the number of programs eligible to receive federal funding would be much fewer. A Final Summary and Call to Action It is clear there are stout core morals and values diffused into United States culture since the time of early colonization. These mores do not have to conflict with an agenda for creating a sexually healthier society. While there are many psychological benefits for beginning one’s sexual experiences within a loving and committed relationship, our government cannot ignore the negative health results caused by withholding information vital for its young people to have the ability to make conscientious and responsible choices within the context of sexual behavior. Congress members, please create a policy that: Addresses STI prevention and contraception, and recognizes that teens do engage in sexual behaviors, Provides information to parents about sexual health and sexual health communication within the family.
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  Sex Education inthe U.S. 11 Teaches youth how to have healthy relationships and make wise personal decisions, and includes an emphasis on positive self-esteem. This research is applicable to parents and their children, health educators, and policy makers. Policies affect everyone within their jurisdiction, so it is the responsibility of the legislators to keep the majority of their constituents’ best interests in mind, while encouraging the constituent minority to pass cultural wisdom regarding sexuality to their children. Regulations regarding education affect a whole society and its future. Therefore, all policy makers and those impacted by their decisions should care about research that could benefit the overall health of society. Politicians and the communities they represent need to diligently work together to create laws aimed at increasing the sexual health of their posterity, and above all, to do no harm.
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  Sex Education inthe U.S. 12 References Berne, L., &Huberman, D. (1999). European approaches to adolescent sexual behavior & responsibility: Executive summary & call to action. Washington, DC: Advocates for Youth. Retrieved from http://www.advocatesforyouth.org/publications/398?task=view Boonstra, H.D. (2010). New Pregnancy Assistance Fund under health care reform: An analysis. Guttmacher Policy Review 13(4), 11-14. Retrieved from http://www.guttmacher.org/pubs/gpr/13/4/gpr130411.html Casey, B.J., Jones, R.M. & Hare, T.A. (2008).The adolescent brain.Annals of the New York Academy of Sciences, 1124, 111-126. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475802/ CDC (2008).Sexually transmitted diseases in the United States. Retrieved from http://www.cdc.gov/std/stats08/trends.htm Campbell, D.M. (2010). Puritanism in New-England. Literary Movements. Department of English, Washington State University. Retrieved from http://public.wsu.edu/~campbelld/amlit/purdef.htm Cohen, C. (1997). The post-Puritan paradigm of early American religious history.The William and Mary Quarterly, 54(4), 695-722. Retrieved from http://www.jstor.org/stable/2953879?seq=1 Comstock Act. (2012). In Encyclopedia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/130734/Comstock-Act Dailard, C. (2001). Sex education: Politicians, parents, teachers and teens. The Guttmacher Report on Public Policy, 4(1), 9-12. Retrieved from https://guttmacher.org/pubs/tgr/04/1/gr040109.pdf Darroch, J.E., Singh, S., & Frost, J.J. (2001). Differences in teenage pregnancy rates among five developed countries: The roles of sexual activity and contraceptive use. Family Planning Perspectives, 33(6), 244-250+281. Retrieved from http://www.jstor.org/stable/pdfplus/3030191.pdf?acceptTC=true Department of Health and Human Services (2012). Justification of estimates for appropriations committees – Fiscal year 2012, pages 123-124. Retrieved from http://www.hhs.gov/about/budget/fy2012/gdm_cj_fy2012.pdf Guttmacher Institute. (2012). Sex and HIV education.State Policies in Brief.Retrieved from http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf “History and Successes.” (2012). Planned Parenthood Federation of America, Inc. Retrieved from http://www.plannedparenthood.org/about-us/who-weare/history-and-successes.htm#era Kost, K., &Henshaw, S. (2013). U.S. Teenage Pregnancies, Births and Abortions, 2008: State Trends by Age, Race and Ethnicity. Retrieved from http://www.thenationalcampaign.org/state-data/statecomparisions.asp?ID=3&sID=18&sort=rank#table
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  Sex Education inthe U.S. 13 Office of Adolescent Health (2013).National and State Facts.Department of Health and Human Services. Available from http://www.hhs.gov/ash/oah/resources-and-publications/facts/ Saewyc, E.M. (2003). Influential life contexts and environments for out-of-home pregnant adolescents.Journal of Holistic Nursing, 21(4), 343-367. Retrieved from http://jhn.sagepub.com.library2.csumb.edu:2048/content/21/4/343.full.pdf +html Santelli, J., Ott, M.A., Lyon, M., Rogers, J., Summers, D., &Schleifer, R. (2006). Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health 38(1), 72-81. Retrieved from http://www.sciencedirect.com/science/article/pii/S1054139X05004672 Weaver, H., Smith, G.,&Kippax, S. (2005). School-based sex education policies and indicators of sexual health among young people: A comparison of the Netherlands, France, Australia and the United States. Sex Education. 5(2), 171-188.Doi: 10.1080/14681810500038889 Web Watch: Update teen knowledge with Internet resources. (2005, August 1). Contraceptive Technology Update. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA193852802&v=2.1&u=csum b_main&it=r&p=AONE&sw=w&asid=c05629dc1deaf230f73a53772b098797 Wellings, K., Collumbien, M., Slaymaker, E., Singh, S., Hodges, Z., Patel, D., &Bajos, N. (2006). Sexual behaviour in context: A global perspective. The Lancet, 368(9548), 1706-1728. Retrieved from http://www.sciencedirect.com/science/article/pii/S0140673606694798 World Bank (2009).Adolescent fertility rate (Births per 1,000 women ages 15-19). Retrieved from http://data.worldbank.org/indicator/SP.ADO.TFRT/countries/1W?display= default
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  Sex Education inthe U.S. 14 Appendix The following table is a breakdown of all U.S. states’ policy requirements for sexuality education, taken from the Guttmacher Institute’s (2012), State Policies in Brief, found at http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf. Content Requirements for Sex* and HIV Education When Provided, HIV Education Must When Provided, Sex Education Must Include Information on: Include Life Skills for: Include Information on: Condoms Abstinence X Stress Contraception Abstinence Importance of Sex Only W/in Marriage Sexual Orientation Negative Outcomes Of TeenSex Avoiding Coercion X Stress X Negative X X X X STATE Alabama Arizona Stress Arkansas Stress California X X X Stress D.C. Stress Stress Stress Delaware Family Communic ation X Cover Colorado HealthyD ecisionmaking Inclusive X X X X X X Inclusive X X X Cover Stress X Stress X Florida Stress X X Stress Georgia Stress X X Cover Hawaii X Cover X Illinois Stress X Indiana Stress X X Stress X Iowa X Stress Stress Inclusive Kentucky Cover Louisiana Stress Maine X X X Stress Cover Michigan Stress Minnesota X Missouri ** X X Stress X Cover X X X X Stress X X X Cover Cover Mississippi Cover X Stress Maryland X Stress X X X Stress X X X Stress X Stress
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  Sex Education inthe U.S. 15 Montana Cover Cover New Hampshire Cover New Jersey X Stress Inclusive New Mexico X Cover X Inclusive X X New York N. Carolina X Stress N. Dakota Stress Oklahoma X X X Stress X Stress Stress X Stress Cover Ohio X Stress X X X Oregon X X X Stress X Stress Inclusive X X X Cover X Stress Pennsylvania Stress Rhode Island X Stress S. Carolina X Stress X Tennessee Stress X Texas Stress X Utah Stress X Vermont X X Cover Washington X X Cover Wisconsin X Stress TOTAL 18+DC X X Negative Stress Stress X X X X X Negative X X X X Stress W. Virginia X X X X Cover X X Cover X X Stress X Cover Stress Cover Virginia Inclusive X X Inclusive X X X 12 X 13 Stress Stress X X X Inclusive 18 Stress X X X 20+DC 20 11 20 *Sex education typically includes discussion of STIs ** Localities may omit state-required topics, but may not include material that “contradicts the required components.” Information on contraception may only be provided with prior approval from the Department of Education. State also prohibits teachers from responding to students’ spontaneous questions in ways that conflict with the law’s requirements.