Moving towards a more comprehensive standard for sex education: A latent class analysis and examination of young adult sexual health

Abstract

While sex education has been linked to adolescent health, few studies have examined how comprehensiveness of school-based sex education may promote young adult sexual wellbeing. The current study used latent class analysis to examine patterns in the comprehensiveness of topics included in sex education among a national sample of young adults (N=676). Many participants had not received sex education (40%) or had received sex education that was focused on abstinence (20%) or sexual risks (25%). Only 15% had received comprehensive sex education (likely to cover a range of topics including: condoms/contraception, sexual communication, gender, sexual orientation, pleasure, consent, etc.). Analyses examined how class membership related to sexual health. Compared to all other groups, young adults that had received the most comprehensive sex education were more likely to use condoms and communicate with their partners about STIs. They were also more likely to have had an STI test (compared to those who received other types of sex education) and reported greater sexual satisfaction (compared to those who received no sex education). Those that received the most comprehensive sex education reported their sex education to be more inclusive, preparative, and empowering but less comfortable. Implications for research and practice are discussed.

National statistics show that by age 17, around 40% of young people have had sex and by age 20, 75% of young people have had sex – illustrating the developmental normativity of sexual activity during adolescence and young adulthood (Abma & Martinez, 2017). Thus, sexual health is a critical component of adolescent and young adult well-being. Sexual health includes both the absence of illness (e.g., STIs/HIV) and other negative outcomes (e.g., unplanned pregnancy) as well as the “possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence” (World Health Organization, 2024).

When youth hold healthy beliefs about relationships and engage in safe sexual behaviors, they are more likely to experience positive health outcomes. For example, youth that use condoms/contraception are less likely to experience an unplanned pregnancy or STIs/HIV (Centers for Disease Control and Prevention, 2018, 2021), and youth that communicate with medical professionals about their sexual health and get tested for STIs are able to seek treatment for themselves and prevent the transmission of STIs to their sexual partners (Fisher et al., 2018; Tabaac et al., 2022). Additionally, partner sexual communication is linked to greater sexual satisfaction, and sexual satisfaction is related to both condom/contraception use and overall wellbeing (Carcedo et al., 2020; Randolph et al., 2007). Finally, youth who are less accepting of traditional gender norms and rape myths are less likely to perpetrate sexual or relationship violence and more likely to intervene if they are a bystander to such violence (Karlsson et al., 2016; Mouilso & Calhoun, 2013; Reyes et al., 2016; Rothman et al., 2019). What can be done to promote these critical healthy beliefs and behaviors?

School-based sex education

School-based sex education aims to teach adolescents the information and skills they may need to promote their sexual health and/or to prevent poor sexual health outcomes. However, programming to educate adolescents on sex and relationships varies greatly in the topics that are covered. Abstinence-only programs focus on messages related to refraining from sexual activity or waiting until marriage to have sex (Santelli et al., 2017). Abstinence-only programs may mention condoms/contraception but typically only in terms of their failure rates or risks of contraception use – which are often exaggerated (Advocates for Youth, 2009; Guttmacher Institute, 2021; Kaiser Family Foundation, 2018).

Comprehensive sex education can include discussion of a broader set of topics related to gender (e.g., gender roles, societal norms), sexual and reproductive health (e.g., how to use condoms and contraception, STI/HIV prevention and treatment), sexual rights and citizenship (e.g., consent, diversity in sexual identities and experiences, how to access resources), pleasure (e.g., understanding that sex should be enjoyable, masturbation), violence (e.g., gender-based violence, rights and laws), diversity (e.g., types of diversity, discrimination), and relationships (e.g., recognizing healthy and unhealthy relationships (Future of Sex Education Initiative, 2020; International Planned Parenthood Federation, 2010). Importantly, the term “comprehensive” has been used to refer to a spectrum of sex education programs that can cover a range of topics. For example, abstinence-plus programs are sometimes referred to as a form of comprehensive sex education given that they do not solely focus on promoting abstinence and also include medically-accurate information on safe sex practices to prevent STI/HIV contraction and unplanned pregnancy (e.g., condom/contraceptive use (Bleakley et al., 2006; Underhill et al., 2007). However, health researchers and advocacy groups often assert that truly comprehensive sex education should go further and also help youth develop important skills (e.g., communication skills, ability to use condoms) and foster positive beliefs (e.g., respect for others, open-mindedness, positive attitudes towards one’s own sexuality (American Academy of Pediatrics, 2024). Truly comprehensive sex education takes a rights-based approach that focuses on youth’s rights to access sex education and information, as well as youth’s empowerment and decision-making (Berglas et al., 2014; Constantine et al., 2015).

Decades of research have attempted to explicate the relationship between various approaches to sex education and youths’ sexual and relationship health outcomes (Goldfarb & Lieberman, 2021). Reviews of this literature point towards overwhelming evidence that comprehensive sex education programs are effective at promoting positive outcomes among adolescents (compared to abstinence-only sex education or no sex education (Goldfarb & Lieberman, 2021). Adolescents that receive comprehensive sex education are less likely to experience an unplanned pregnancy, are more likely to practice safer sex behaviors, including condom use, have greater healthy relationship cognitions, are less likely to perpetrate intimate partner violence, and are less homophobic (Bordogna et al., 2023; Goldfarb & Lieberman, 2021). A review highlighted the benefits of comprehensive sex education programs, specifically those that go beyond pregnancy and STI prevention and include topics related to social justice and equity, gender norms, domestic violence and healthy relationships, and communication skills (Goldfarb & Lieberman, 2021). Conversely, research has highlighted the ineffectiveness, and sometimes harmfulness, of abstinence-only sex education. There is no consistent evidence linking abstinence-only sex education programs to positive adolescent outcomes—with some studies demonstrating no relationship between abstinence-only sex education and sexual health behaviors (Trenholm et al., 2008) and other studies finding that abstinence-only sex education is related to worse outcomes for adolescents, e.g., greater teen pregnancy rates, fewer safer sex behaviors (Chin et al., 2012; Kirby, 2008; Stanger-Hall & Hall, 2011).

Students have their own perceptions of experiences taking part in sex education programming at schools such as their feelings of comfort and whether the content was relevant and/or accurate. The acceptability of health education among young people is critical given that more acceptable programs are more likely to be adopted and sustained; and, thus, will be more successful at promoting healthy behaviors (Proctor, 2011). Generally, research in this area suggests that young people would prefer sex education that is more comprehensive. For example, young adults who received abstinence-only sex education highlight that this education did not have much influence on their lives and instead voice support for sex education that is comprehensive and focused on topics outside of the potential negative consequences of sex (Gardner, 2015). And, young adults who report learning about reproductive anatomy, puberty, abstinence, STIs, and contraceptives when they were in high school often report that the content was out-of-date, not relatable, and/or inaccurate (Astle et al., 2021; Gardner, 2015). In addition to providing content that is updated and accurate, adolescents’ suggestions for improving sex education taught in high school included adding discussions of psychological, relational, and emotional aspects of sex as well as diverse sexual behaviors and identities (Astle et al., 2021). Finally, it is critical that sex education is inclusive of students of all gender and sexual identities, yet LGBTQ+ youth highlight that their sex education was often not comprehensive enough – lacking representation and topics relevant to LGBTQ+ youth (Hobaica, 2024).

While there is a wealth of research to demonstrate that abstinence-only sex education is ineffective and more comprehensive programs are both effective and preferred by adolescents and young adults, there are notable gaps that remain in research on the association between sex education and sexual and relationship health outcomes. First, there are a wide range of programs that have been considered “comprehensive” and whether they differ in their effectiveness is unclear. Whereas some comprehensive sex education may focus mostly on topics related to STI/HIV and unplanned pregnancy prevention, other comprehensive sex education also addresses a number of other topics related to violence prevention, relationship health, communication, pleasure, sexual and gender identity, and health equity. With the addition of these topics, it is possible that the most comprehensive sex education programs would be more likely to impact a broader array of critical health outcomes for youth, beyond just abstinence and condom and contraception use (e.g., sexual communication, STI testing, gender norms, and sexual satisfaction). Further, with the addition of these topics, we might also expect more comprehensive programs to have a greater influence on condom/contraception use given links between pleasure and greater partner communication with more consistent condom use (Randolph et al., 2007; Widman, Noar, et al., 2014). Unfortunately, we have not identified any studies that have examined how comprehensive sex education programs covering a range of different topic areas may differ from each other in their association with sexual health outcomes. However, this information is critical as it would help to shape more specific priorities for what must be covered in school-based sex education to maximize benefits for adolescent and young adult wellbeing.

Additionally, the vast majority of research on outcomes associated with sex education is focused on short-term outcomes experienced among adolescents that are still in high school. Only a handful of studies have examined how sex education during high school may influence outcomes during the transition to adulthood (Evans et al., 2020; Grasso & Trumbull, 2021; Walcott et al., 2011). In a 2011 study, young adults that received middle and high school sex education that discussed condoms/contraception had greater safer sex knowledge and more positive attitudes towards safer sex when compared to young adults that received abstinence-only sex education (Walcott et al., 2011). And, those that received sex education that addressed condom use negotiation and peer pressure, were more likely to use condoms (Walcott et al., 2011). More recently in a sample of young adults, Grasso and Trumbull (2021) compared participants who received middle and high school sex education that was either abstinence-only or that taught about condoms/contraception. Findings revealed that students who participated in the abstinence-only programs were more likely to delay the initiation of sex; however, they were less likely to communicate with their partners about what to do in the event of an unwanted pregnancy (Grasso & Trumbull, 2021). There were no differences across groups in condom/contraceptive use or other types of partner sexual communication (Grasso & Trumbull, 2021). Another more recent study found that, for heterosexual young adults, more comprehensive middle and high school sex education (as opposed to abstinence-only) was related to greater sexual satisfaction (Evans et al., 2020). Results from these studies are mixed but provide preliminary evidence to expect that sex education during high school could impact outcomes beyond the high school years. If there is a link between comprehensiveness of school-based sex education and health outcomes among young adults, this would further strengthen the argument for delivering high-quality, comprehensive sex education in adolescence given that this education has the potential to impact youth not only in the short term but also in the long-term, during their transition to college. Importantly, many young adults become sexually active during the transition to college and are at risk for failing to engage in safe sex practices upon sexual initiation (Abma & Martinez, 2017). Thus, efforts to provide them with the tools to engage in healthy sexual decision-making during this high-risk time are critical.

Finally, most studies examining the longer-term influence of high school sex education on young adult sexual health have focused narrowly on sexual risk reduction – including outcomes such as abstinence and condom use – with just one previous study examining young adult sexual communication (Grasso & Trumbull, 2021) and one additional study examining sexual satisfaction (Evans et al., 2020). However, sexual health is multifaceted – with components related to STI and unplanned pregnancy prevention, relationship health promotion, sexual violence prevention, sexual health care utilization, and overall satisfaction. Truly comprehensive sex education may be poised to influence all of these dynamic and interrelated components of young adult sexual health; however, more research is needed in this area.

Current Study

The current study is positioned to fill these gaps and, thus, strengthen the body of research investigating the longer-term influence of sex education on young adult sexual and relationship health. The goal of this study is to examine whether and how comprehensiveness of sex education during adolescence is related to multifaceted sexual and relationship health outcomes among young adults attending community college. To address this goal, we first used latent class analysis (LCA) of young adults’ retrospective reports of the topics covered in their previous school-based sex education to determine whether there are distinct, interpretable latent classes of sex education, based upon the probabilities of covering each topic. Employing the LCA procedure allows us to use a data-driven method for classifying the types of sex education that adolescents received, instead of relying on a priori assumptions about content in types of sex education (for examples of other applications of LCA to evaluate educational methods, see: Hewawitharana, 2023; McMahon, 2019). LCA is an exploratory method by nature; thus, we did not have specific predictions regarding the number of sex education classifications that we would find.

Next, we examined whether latent class membership was associated with differences in sexual and relationship health outcomes in young adulthood, with post-hoc comparisons specified between the sex education classification that included the most topics and all other identified classifications. Outcomes included sexual and relationship beliefs that are tied to sexual and relationship violence during young adulthood – i.e., gender role norm acceptance; rape myth acceptance; bystander efficacy and intent (Haberland, 2015; Santana et al., 2006; Yapp, 2018). In addition, we assessed self-efficacy for condom use and condom/contraception use behaviors – outcomes related to the prevention of STIs and unplanned pregnancy (Abma & Martinez, 2023; Centers for Disease Control and Prevention, 2024). Outcomes also included self-efficacy for sexual health communication with partners and medical professionals as well as sexual health communication and STI testing behaviors. Partner sexual communication is related to healthier relationships and condom use and communication with medical professionals and STI testing is linked to STI prevention and treatment (Fisher et al., 2018; Tabaac et al., 2022; Widman, Noar, et al., 2014). Sexual satisfaction was also included as an outcome given links between sexual satisfaction and physical and relationship wellbeing throughout the lifespan (Fisher et al., 2015; Fortenberry, 2013; Mallory, 2022).

Finally, we examined whether latent class membership was associated with differences in students’ evaluation of their school-based sex education experiences. We posited the following hypotheses about the association of sex education classification with sexual and relationship health outcomes and students’ evaluation of their school-based sex education experiences:

H1: Students that received the most comprehensive sex education will have healthier sexual and relationship beliefs (i.e., lower gender role norm acceptance; lower rape myth acceptance; more bystander efficacy and intent) when compared to students in other classifications.

H2: Students that received the most comprehensive sex education will have greater self-efficacy for condom use and healthier condom and contraception use behaviors (e.g., more frequent condom use) when compared to students in other classifications.

H3: Students that received the most comprehensive sex education will have greater self-efficacy for sexual health communication with partners and medical professionals and more frequent sexual health communication and STI testing when compared to students in other classifications.

H4: Students that received the most comprehensive sex education will have greater sexual satisfaction than students in other classifications.

H5: Students that received the most comprehensive sex education will report their experiences with sex education to be more positive (i.e., comfortable, inclusive, preparative, and empowering) when compared to students in other classifications that received some form of sex education.

Method

Participants

This study was conducted using data from the Community College Health Study – a randomized controlled trial (RCT) focused on evaluating the efficacy of a web-based sexual health program with young adults attending community college (Scull et al., 2022). Participants were recruited from 23 community college campuses across the United States. Campuses were diverse with respect to geographic location and racial-ethnic composition of the student body. To be eligible, all participants had to be 18 or 19 years old, have an email address and internet access to receive study materials, and be fluent in English. All participants were required to verify that they were a student enrolled at one of the college campuses from which we were recruiting (e.g., by submitting a photo of their college ID or verifying their student email). High school students who were dual enrolled in high school and community college were not eligible to participate. The final sample included 676 community college students. Demographic characteristics of the sample are included in Table 1.

Table 1.

Characteristics of the sample of young U.S. community college students (N = 676)

Characteristic	Percentage of sample (%)
Age (years)
18	51.04
19	48.96
Gender
Women	63.91
Men	31.07
Nonbinary	5.03
Race
White	56.21
Black	12.57
Asian	12.13
Other race	10.21
Multiracial	8.88
Hispanic/Latino	28.99
In a relationship	43.79
Has had sex	58.43
Sexual orientation
Heterosexual	64.79
Gay or Lesbian	4.88
Bisexual	13.17
Pansexual	3.99
Queer	2.07
Asexual	2.96
Questioning	4.59
Prefer to self-describe	2.22

Procedure

The innovation Research & Training Institutional Review Board approved the methods and measures used in this study (approval number: 20–007-1-EFF). Eligible students had to provide online consent prior to being enrolled in the study. As part of the larger RCT, participants were asked to complete web-based questionnaires and review a web-based sexual health program. Students completed a baseline questionnaire, followed by a web-based sexual health program and feedback questionnaire (with all activities occurring within about one month). Data for the current study on participants’ sexual health cognitions and behaviors came from the baseline questionnaire (collected prior to completing the sexual health program associated with the larger RCT) and data regarding students’ previous school-based sex education came from the feedback questionnaire (collected after completing the sexual health program associated with the larger RCT). For more information about the larger study design and methods, see the trial protocol paper (Scull et al., 2022).

Measures

Sample characteristics

The following characteristics were assessed: age, gender, race, ethnicity, sexual orientation. Participants selected their gender from three answer options: woman, man, or nonbinary. Participants also selected one of the following answer options to indicate their sexual orientation: heterosexual, gay or lesbian, bisexual, pansexual, queer, asexual, questioning, prefer to self-describe (if selected, participants could write-in their sexual orientation). Participants were asked whether they were in a relationship and whether they were sexually active (i.e., had ever had oral, anal, or vaginal sex). Of note, “relationship” was not directly defined for participants. Race and ethnicity were assessed in this study to monitor the diversity of the sample during and after recruitment. Answer options provided to participants to assess race and ethnicity were determined in accordance with NIH reporting policies.

Sex education

Receipt of sex education.

Participants were asked if they received sex education at school since the 9th grade by answering yes or no. All participants were instructed not to consider the sexual health program they reviewed for the RCT when answering this question.

Content of sex education.

Participants who indicated that they received sex education at school were asked which topics they recalled being included in their education (yes/no; see Table 2). Again, all participants were instructed not to consider the sexual health program they reviewed for the RCT when answering these questions. The 25 sex education topics included were based on the Centers for Disease Control and Prevention School Health Profiles (Centers for Disease Control and Prevention, 2019).

Table 2.

Sexual health education topics and frequencies

Sexual health topic	Nyes	% of whole sample	% of those who received sex ed
1. Benefits of abstaining from sex (abstinence)	341	50.44%	83.58%
2. Goal-setting and decision-making skills related to preventing HIV and other STDs	261	38.61%	63.97%
3. Goal-setting and decision-making skills related to prevent pregnancy	279	41.27%	68.38%
4. Importance of using a condom at the same time as another form of contraception to prevent both STDs and pregnancy	326	48.22%	79.90%
5. How people get HIV and other STDs	310	45.86%	75.98%
6. How to correctly use a condom	214	31.66%	52.45%
7. How to access valid and reliable health information, products, and services related to HIV, other STDs, and pregnancy	203	30.03%	49.75%
8. How to help and support your friends/peers to avoid risky sexual behaviors	206	30.47%	50.49%
9. How to create and sustain healthy and respectful relationships	216	31.95%	52.94%
10. Health consequences of HIV, other STDs and teen pregnancy	320	47.34%	78.43%
11. Methods of contraception other than condoms	276	40.83%	67.65%
12. Influences of family and peers on decisions about sex	196	28.99%	48.04%
13. Influences of media and/or technology on decisions about sex	221	32.69%	54.17%
14. The relationship between alcohol and other drug use and risky sexual behaviors	263	38.91%	64.46%
15. Importance of limiting the number of sexual partners	230	34.02%	56.37%
16. Efficacy of condoms (how well condoms work and do not work)	286	42.31%	70.10%
17. Sexual orientations	157	23.22%	38.48%
18. Communication and negotiation skills related to preventing HIV and other STDs	211	31.21%	51.72%
19. Communication and negotiation skills related to preventing pregnancy	236	34.91%	57.84%
20. Importance of using condoms consistently and correctly	300	44.38%	73.53%
21. Preventive care for reproductive and sexual health (e.g., medical visits)	249	36.83%	61.03%
22. How to obtain condoms	254	37.57%	62.25%
23. Gender roles, gender identity, or gender expression	166	24.56%	40.69%
24. Sexual consent	318	47.04%	77.94%
25. Sexual pleasure	123	18.20%	30.15%

Student perceptions of sex education.

Participants who indicated that they received sex education at school were asked about their perceptions of the sex education. Using a 5-point Likert scale (1 = not at all; 5 = extremely), they answered the following questions: 1) “How comfortable did you feel learning about sex from sex education at school?”; 2) “How inclusive of many sexual orientations, gender identities, and gender expression was sex education at school?”; 3) “To what extent did sex education at school make you feel prepared to make informed decisions about sex?”; 4) “To what extent did sex education at school make you feel empowered to make sexual decisions that are right for you?”

Sexual and relationship health outcomes

Gender role norms.

A 6-item measure was used to assess participants’ acceptance of traditional gender role norms (adapted from Foshee et al., 2005). Items such as, “Raising children is primarily a woman’s responsibility,” were rated on a 4-point Likert-type scale from 1 = strongly disagree to 4 = strongly agree (α = 0.78). Higher scores indicate greater acceptance of traditional gender roles.

Rape myth acceptance.

Three subscales (“she asked for it,” “it wasn’t really rape,” and “he didn’t mean to”), with a total of 13 items, from the Illinois Rape Myth Acceptance – Short Form were used to assess participants’ attitudes toward rape myths (McMahon & Farmer, 2011). Items such as, “If a girl is raped while she is drunk, she is at least somewhat responsible for letting things get out of hand,” were rated on a scale from 1 = strongly disagree to 4 = strongly agree (α = 0.89). Higher scores indicate greater rape myth acceptance.

Bystander efficacy.

Five items (e.g., “I could talk to a friend who I suspected is in an abusive relationship”) were used to assess efficacy to intervene as a bystander to abusive relationships or non-consensual sexual activity (Banyard et al., 2005). Participants rated their confidence that they could do the action on a scale from 0–100 (α = 0.74) with higher scores indicative of greater perceived ability to intervene as a bystander.

Bystander intent.

A 4-item scale was used to assess intentions to intervene as a bystander to abusive relationships or non-consensual sexual activity (Banyard & Cross, 2008). The question stem prompted participants to rate the likelihood on a 4-point Likert-type scale from 1 = not at all likely to 4 = extremely likely that they would engage in four behaviors (e.g., “Approach a friend if I thought they were in an abusive relationship and let them know that I am here to help”; α = 0.82). Higher scores indicate greater intentions to intervene as a bystander.

Self-efficacy to use a condom.

Participants rated their perceived ability to use a condom correctly. They rated one item (“I can use a condom correctly or explain to my partner how to use a condom correctly”) on a 4-point Likert-type scale from 1 = strongly disagree to 4 = strongly agree (Soet et al., 1999). Higher scores indicated greater self-efficacy to use a condom.

Frequency of condom use during vaginal sex.

One item was used to assess frequency of condom use during vaginal sex [“In the past month, how often did you or your partner(s) use a condom when having vaginal sex?”]. The item was rated on a 4-point Likert-type scale from 1 = never to 4 = always with higher scores indicating more frequent condom use. This variable was only assessed among participants that indicated they had had vaginal sex.

Dual contraception use at last vaginal sex.

Participants who had had vaginal sex, indicated whether they used dual contraception the last time they had vaginal sex by answering yes, no, or unsure to the following question: “Did you or your partner use another form of birth control in addition to a condom the last time you had vaginal sex?” Responses of “unsure” were coded as missing data.

Condom use at last vaginal sex.

Participants who had had vaginal sex indicated whether they used a condom the last time they had vaginal sex by answering yes, no, or unsure to the following question: “Did you or your partner use a condom the last time you had vaginal sex?” Responses of “unsure” were coded as missing data.

Self-efficacy to communicate with partners about sex.

Participants rated three items about their perceived ability to communicate with sexual partners about sex (Soet et al., 1999). Items such as, “I can discuss preventing STIs with my partner,” were rated on a 4-point Likert-type scale from 1 = strongly disagree to 4 = strongly agree (α = 0.80). Higher scores indicate greater self-efficacy to communicate with partners.

Self-efficacy to communicate with medical professionals about sex.

Participants rated their perceived ability to communicate with medical professionals about sex. They rated one item (“I can talk to a doctor or health professional if I had a question or was concerned about sex.”) on a 4-point Likert-type scale from 1 = strongly disagree to 4 = strongly agree (Soet et al., 1999). Higher scores indicate greater self-efficacy to communicate with medical professionals.

Communication with partners about using protection.

Participants who had had sex (i.e., oral, anal, or vaginal) rated their frequency of communication with their partners before engaging in sexual activity related to using condoms and/or other forms of contraception on a 4-point Likert-type scale from 1 = never to 4 = always. Higher scores indicated more frequent communication with partners about protection.

Communication with partners about sexually transmitted infections.

Participants who had had sex (i.e., oral, anal, or vaginal) rated their frequency of communication with their partners before engaging in sexual activity related to sexually transmitted infections (STIs) on a 4-point Likert-type scale from 1 = never to 4 = always. Higher scores indicated more frequent communication with partners about STIs.

Communication with a medical professional about sexual health.

Participants indicated whether they have ever talked with a medical professional about sexual health by answering yes or no to the following question: “Have you talked to a doctor or other medical professional about sex, contraception, and/or relationships?”

STI testing.

Participants indicated whether they have ever been tested for an STI by answering yes, no, or unsure to the following question: “Have you ever been tested for an STI?” Responses of “unsure” were coded as missing data.

Sexual satisfaction.

Participants reported on their satisfaction with their sex life by rating one item (i.e., “Overall, how satisfied are you with your sex life?”) using a 5-point Likert scale from 1 = not at all satisfied to 5 = completely satisfied (Perry & Whitehead, 2019). Higher scores indicated more sexual satisfaction.

Data analytic plan

LCA was conducted to identify classes of sex education in this sample. LCA is an empirically driven procedure that defines taxonomies or profiles of individuals based on common characteristics. LCA uses all observations of categorical dependent variables to define these classes via maximum likelihood estimation. The probability that an individual was properly classified, which ensures each individual to be placed into the best-fitting class, is estimated simultaneously with the overall model. Models are estimated with classes added sequentially to determine which model best fits the data (Masyn, 2013). For the current study, the use of LCA offers distinct advantages given that this method allows us to use a data-driven approach to identifying types of sex education that students recall receiving rather than simply relying on preconceived assumptions about content and types of sex education.

Analyses were conducted using the Mplus program (version 8.10 (Muthén & Muthén, 1998–2017), with full information maximum likelihood estimation to account for missing data. Binary yes/no (1/0) responses to the sex education topics were entered into the LCA analyses. Some individuals in the sample reported that they did not receive sex education; thus, they did not respond to questions about the topics included in their sex education and were instead automatically assigned a “0” for all topics. During the LCA estimation, these individuals were identified and constrained to an additional class in the model. Thus, all models have at least two classes: one “no sex education” class and additional classes for individuals who had sex education in school.

To determine the optimal number of classes for the data, fit statistics were calculated for latent models containing two through six classes (with one class always representing “no sex education”) and compared. Two primary statistics, Vuong-Lo-Mendell-Rubin Likelihood Ratio Test (VLMRT) and the Bayesian information criteria (BIC), drove the decision-making process for determining the number of latent classes (Fraley & Raftery, 1998; Lo et al., 2001). The VLMRT compares the fit of the target model to a comparison model with one fewer class to establish whether adding a class significantly improves model fit. The BIC is a descriptive fit index, and lower relative values suggest better model fit. In addition to these indices, each model was evaluated on interpretability to determine whether the classes ultimately represent different categories, rather than being an artifact of a non-normal distribution (Masyn, 2013). It also has been suggested that small classes (containing less than 5% of the sample) are typically considered spurious classes, therefore class size was also considered when deciding on the optimal number of classes (Hipp & Bauer, 2006).

After identifying the best-fitting classification, correlates of class membership (i.e., associations between class membership and outcomes) were examined using the BCH approach (Bolck et al., 2004). Correlates of class membership examined were sexual and relationship health outcomes and student perceptions of sex education (see measures for details). Asparouhov and Muthen (2014) recommend the BCH procedure to examine means and probabilities across classes for outcomes of interest while controlling for other covariates. The BCH method uses group specific weights for each observation that are computed during the latent class model estimation and has been shown to outperform other auxiliary analyses (Asparouhov & Muthén, 2014). Specifically, the BCH approach involves first estimating the latent classes, then assigning observations to latent classes, and finally testing weighted differences across classes in standing on the outcome variable, assigning weights to reflect the measurement error of the latent class variable (Asparouhov & Muthén, 2014). This procedure was employed and produced a test of the overall model for each outcome variable of interest. If this overall test was significant, then tests of differences on the outcome variable between latent classes of interest were conducted (i.e., post-hoc comparisons). Contrasts of interest were chosen in an a priori manner and included the latent class with the most comprehensive inclusion of sex education topics compared to every other class. For continuous outcomes, means were compared across classes and for categorical outcomes, probabilities were compared across classes using a probit link, which uses the inverse normal distribution to transform categorical outcomes. All comparisons control for participant gender and relationship status, which were effect coded to provide marginal means, accounting for all levels of gender and relationship status. Standard errors were adjusted to account for non-independence due to nesting (students within community college campus). In post hoc analyses, religiosity was added to the model as a covariate as well; however, the pattern of results did not change, so the more parsimonious model was selected for inclusion in this manuscript (Wright, 2021).

Results

Preliminary analysis

Table 2 includes frequencies of reception for all sex education topics. Only 60.2% of the sample reported receiving school-based sex education since the 9^th grade. Among students that received school-based sex education, the most common topics covered were benefits of abstaining from sex (83.6%), importance of using a condom at the same time as another form of contraception to prevent both STDs and pregnancy (79.9%), and health consequences of HIV, other STDs, and teen pregnancy (78.4%). The topics addressed least in school-based sex education were sexual pleasure (30.2%), sexual orientations (38.5%), and gender roles, gender identity, or gender expression (40.7%).

Latent class analysis

Statistics for class enumeration for estimating two through six classes are in Table 3. The p-value for VLMRT suggested a three-class solution as optimal and the reduction in BIC suggested a four- or five-class optimal solution. The three-, four-, and five-class solutions were investigated and based on interpretability and prior research, we found the four-class solution to be most optimal. In addition, the BIC for the four-class solution was substantially smaller than that of the three-class solution. Though the BIC estimate was smaller still for the five-class solution, the five-class solution resulted in small or uninterpretable classes.

Table 3:

Model fit across classes

Classes	Number of parameters	Log Likelihood	BIC	VLMRT p-value
2	26	−6780.43	13730.27	<.001
3	52	−5663.91	11666.66	0.002
4	78	−5418.38	11345.02	0.3345
5	104	−5322.68	11323.05	0.3384
6	130	−5261.47	11370.05	0.8404

The probabilities of class members receiving each sex education topic in the four-class solution is plotted in Figure 1. Probabilities were fixed to 0 for Class 1 members (N = 269), as participants who reported that they did not receive sex education were not asked about reception of individual topics. Class 1 is labeled No Sex Education (NO). Members in Class 2 (N = 135) had the second lowest probabilities of receiving each topic in their school-based sex education. Within Class 2, members had the highest probability of receiving content related to abstinence [probability p(x) = 0.741] and the lowest probabilities of receiving content related to sexual pleasure [p(x) = 0.077], how to access valid and reliable health information [p(x) = 0.088], and sexual orientations [p(x) = 0.109]. Class 2 is labeled Abstinence-Only (ABS). Members in Class 3 (N = 167) had the second highest probabilities of receiving each topic in their school-based sex education. Within Class 3, members had the highest probabilities of receiving content related to health consequences of HIV, other STDS, and teen pregnancy [p(x) = 0.881], and importance of condom use [p(x) = 0.866], and the lowest probabilities of receiving content related to sexual pleasure [p(x) = 0.217] and sexual orientation [p(x) = 0.334]. Class 3 is labeled Abstinence Plus (ABS+). Finally, members in Class 4 (N = 105) had the highest probabilities for sex education content items; probabilities were above 0.9 for 22 of the 25 topics. Therefore, Class 4 is labeled Comprehensive (COMP).

Figure 1:

Plot of probabilities for the four latent class solution

Notably, all three classes that received previous school-based sex education had high probabilities of covering content related to abstinence. Classes 3 and 4 (ABS+ and COMP) had high probabilities of receiving content related to the importance of condom use [p(x)_ABS+ = 0.866; p(x)_COMP = 0.992], efficacy of condoms [p(x)_ABS+ = 0.839; p(x)_COMP = 1.000], and the importance of using another form of contraception in addition to condoms [p(x)_ABS+ = 0.852; p(x)_COMP = 0.971]. The groups differentiate, however, on more practical issues related to condom use. COMP has a higher probability of receiving content related to how to get condoms [p(x)_ABS+ = 0.690; p(x)_COMP = 0.962] and how to use a condom [p(x)_ABS+ = 0.493; p(x)_COMP = 0.929].

The probabilities for all topics are comparatively low for ABS, with only five topics with a 0.50 probability or above [p(abstinence) = 0.741; p(importance of using another form of contraception in addition to condoms) = 0.620; p(consent) = 0.566; p(health consequences of HIV, STDs, and teen pregnancy) = 0.528; p(how people get HIV) = 0.513]. The COMP group, however, has comparatively high probabilities of receiving education on gender roles, gender identity, or gender expression [p(x)_COMP = 0.850; p(x)_ABS = 0.118; p(x)_ABS+ = 0.377], sexual orientations [p(x)_COMP = 0.841; p(x)_ABS = 0.109; p(x)_ABS+ = 0.334], and sexual pleasure [p(x)_COMP = 0.744; p(x)_ABS = 0.077; p(x)_ABS+ = 0.217].

Associations with sexual and relationship health outcomes

Analyses were conducted to determine whether latent class membership is associated with differences in young adults’ sexual and relationship health outcomes and perceptions of sex education, with post-hoc comparisons specified between the most comprehensive sex education class and all other identified classes. Marginal means (for continuous outcomes), marginal probabilities (for categorical outcomes), and class contrasts are included in Table 4.

Table 4:

Marginal means and tests of means (continuous) and marginal probabilities and tests of probabilities (categorical) across classes

	Class 1: NO	Class 2: ABS	Class 3: ABS+	Class 4: COMP	Overall p-value	1 vs. 4	2 vs. 4	3 vs. 4
Gender role norms	1.40	1.36	1.35	1.39	0.231
Rape myth acceptance	1.46	1.40	1.43	1.44	0.424
Bystander efficacy	81.78	77.82	83.12	82.91	0.106
Bystander intent	3.45	3.48	3.50	3.48	0.720
Efficacy for condom use	3.41	3.47	3.43	3.62	0.155
Frequency of condom use during vaginal sexa	2.59	2.63	2.52	2.91	0.020*	0.012*	0.093	0.007**
Condom use at last vaginal sexa, c	0.42	0.50	0.43	0.69	<.001***	<.001***	0.007**	0.011*
Dual contraception use at last vaginal sexa, c	0.34	0.42	0.44	0.51	0.055
Efficacy for sexual health communication with partners	3.44	3.57	3.51	3.51	0.183
Efficacy for sexual health communication with medical professional	3.37	3.31	3.44	3.47	0.334
Partner communication about using protectionb	3.07	3.09	3.14	3.34	0.226
Partner communication about preventing STIsb	2.52	2.37	2.66	2.95	0.003**	0.001**	0.001**	0.035*
Communication with a medical professionalc	0.61	0.59	0.67	0.65	0.395
STI testingc	0.43	0.35	0.34	0.49	0.042*	0.366	0.042*	0.032*
Sexual satisfaction	3.72	3.78	3.97	3.96	0.007**	0.044*	0.132	0.993
Perceptions of comfort	1.00	2.06	2.53	0.97	<.001***	NA	<.001***	0.001**
Perceptions of inclusiveness	1.00	1.61	2.23	2.77	<.001***	NA	<.001***	0.001**
Perceptions of preparedness	1.00	1.82	2.75	3.27	<.001***	NA	<.001***	0.003**
Perceptions of empowerment	1.00	1.76	2.66	3.11	<.001***	NA	<.001***	0.007**

Note: Outcomes are on a continuous scale, unless noted. Class 1 (NO) means are fixed for sex education evaluation items (e.g., perceptions of comfort) and specific contrasts were not calculated (NA) because this group reported not having sex education to evaluate. Asterisks indicate significant differences between groups:

^*p < .05,

^**p < .01,

^***p < .001

^aAmong participants that have had vaginal sex.

^bAmong participants that have had vaginal, anal, or oral sex.

^cOutcome is on categorical scale

Hypothesis 1 predicted that students who received the most comprehensive sex education would have healthier sexual and relationship beliefs when compared to students in all other classes. This hypothesis was not supported. There were no overall significant differences between classes for normative beliefs about traditional gender roles (p = 0.231); rape myth acceptance (p = 0.424); bystander efficacy (p = 0.106); or bystander intent (p = 0.720).

Hypothesis 2 predicted that students who received the most comprehensive sex education would have greater self-efficacy for condom use and healthier condom and contraception use behaviors when compared to students in all other classes. Hypothesis 2 was mostly supported. The means for frequency of condom use during vaginal sex differed significantly between classes (p = 0.020). Students in the COMP class reported significantly higher frequency of condom usage than students in the NO class (p = 0.012) and students in the ABS+ class (p = 0.007). Students in the COMP class reported more frequent condom use than the ABS class, but not significantly so (p = 0.093). In addition, there was a significant difference in the probability of using a condom at last sex (p < .001). Students in the COMP class were significantly more likely to use a condom at last sex compared to students in the NO class (p < .001), the ABS class (p = 0.011), and the ABS+ class (p = 0.007). The means for self-efficacy for condom use during vaginal sex did not differ significantly between classes (p = 0.155). In addition, the means for dual contraception use at last sex did not differ significantly between classes (p = 0.055).

Hypothesis 3 predicted that students who received the most comprehensive sex education would have greater self-efficacy for sexual health communication with partners and medical professionals and more frequent sexual health communication and STI testing when compared to students in all other classes. Hypothesis 3 was partially supported. The means for frequency of communication with a partner about STIs significantly differed between classes (p = 0.003). Students in the COMP class reported significantly higher frequency of communication about STIs than students in the NO class (p = 0.001), students in the ABS class (p = 0.001), and students in the ABS+ class (p = 0.035). In addition, there was a significant difference between classes in the probability of getting tested for STIs (p = 0.042). Students in the COMP class were significantly more likely to ever have been tested for an STI compared to students in the ABS class (p = 0.032), and the ABS+ class (p = 0.042). Students in the COMP class were more likely to report ever having an STI test than students in the NO class, but not significantly so (p = 0.366). However, the means did not differ between classes for self-efficacy for sexual health communication with their partners (p = 0.183) or medical professionals (p = 0.334), communication with their partners about using protection (p = 0.226), or communication with a medical professional about sexual health (p = 0.395).

Hypothesis 4 predicted that students who received the most comprehensive sex education would have greater sexual satisfaction than students in all other classes. Hypothesis 4 was partially supported. Students in the COMP class had significantly higher levels of sexual satisfaction compared to students in the NO class (p = 0.044), but not compared to students in the ABS or ABS+ classes.

Hypothesis 5 predicted that students who received the most comprehensive sex education would report their experiences with sex education to be more positive than students in all other classes. Hypothesis 5 was mostly supported. Among classes that received school-based sex education (i.e., ABS, ABS+, COMP), there were significant differences in their reported ratings of the inclusiveness, preparedness, empowerment, and comfort of their previous sexual education (p < .001). Students in the COMP class reported the highest ratings of inclusiveness, preparedness, and empowerment and were significantly higher than students in both the ABS class (p < .001) and the ABS+ class (p < .001) on all these ratings. However, students in the COMP class reported the lowest ratings of comfort and were significantly lower than students in the ABS class (p < .001) or the ABS+ class (p < .001).

Discussion

Previous research has demonstrated that, compared to abstinence-only sex education or no sex education, comprehensive sex education programs are effective at promoting positive outcomes among adolescents. However, the comprehensive label has been used by educators and researchers to refer to a spectrum of sex education programs that can cover a range of topics, and there have been limited systematic examinations of how the comprehensiveness of topics in sex education programs may relate to sexual health outcomes. Additionally, most of the research on the impacts of sex education is focused on short-term outcomes experienced among adolescents or on a narrow set of young adult health outcomes. The goal of this study was to address these research gaps by identifying types of sex education received in adolescence through classifying the comprehensiveness of the topics covered (as reported by participants) and investigating whether the most comprehensive programming is related to young adult sexual and relationship health more broadly – including components of sexual health linked to sexual violence prevention, sexual risk reduction, and sex-positive wellbeing. Results from this study provide evidence that highly comprehensive sex education in adolescence is linked to some more positive health outcomes for young adults.

Using a novel application of latent class analysis, we identified four classes of sex education that community college students in our sample were likely to receive as adolescents: 1) no sex education; 2) abstinence-only sex education; 3) abstinence-plus sex education (i.e., sex education mostly focused on topics related to risks of sexual activity); and 4) comprehensive sex education (i.e., sex education likely to cover a range of topics including how to use condoms, sexual communication, gender, sexual orientation, pleasure, sexual consent, the influence of media, family, and peers on sexuality, and many other topics). A strength of this methodology was that it allowed for the assignation of comprehensiveness to be data-driven, based on the sex education experiences of young adults in our sample. These analyses revealed: almost 40% of students in the sample reported that they did not receive any formal sex education since 9th grade. Another 20% of students received programming with an emphasis on abstinence. And, 25% of students received programming that addressed the importance of condom use but primarily emphasized health consequences of sex (e.g., HIV/STIs, unplanned pregnancy). Unfortunately, this means that approximately 85% of the sample was not likely to have learned about important topics related to safe sex (e.g., how to use a condom, how to access valid and reliable health information); creating and sustaining healthy relationships; sexual orientation; gender; and sexual pleasure. Therefore, based on these findings it may be concluded that many young adults entering community college are likely not equipped with the information and skills they may need to navigate relationships and sex as they transition to a new phase of life.

Our second set of analyses sought to disentangle the associations between comprehensiveness of sex education and young adult sexual and relationship health outcomes. We found no differences in sexual and relationship beliefs (i.e., gender role norm acceptance, rape myth acceptance, bystander efficacy, and bystander intentions) when we compared students that received comprehensive sex education to students in other classifications. Importantly, previous research indicates that youth who are less accepting of gender roles and rape myths are less likely to perpetrate sexual or relationship violence (Mouilso & Calhoun, 2013; Reyes et al., 2016). And, college students who have greater self-efficacy and intentions to intervene as a bystander are more likely to intervene if they are a bystander to sexual violence (McMahon et al., 2015). Notably, school-based sex education programs typically target adolescents at the individual-level – aiming to foster changes in their knowledge, cognitions, and/or skills. However, other environmental factors may be especially influential with respect to cognitions about gender, rape myths, and bystander intervention. For example, adolescents are more likely to endorse traditional gender norms if their parents hold traditional gender norms (Epstein & Ward, 2011; Yang et al., 2021). And, people are more likely to intervene as a bystander to sexual violence if they believe their peers support this type of intervention (Mainwaring et al., 2023). Thus, approaches to sex education that include people in these spheres of influence (e.g., parent-based or peer-led programs) may be more effective at promoting healthy cognitions about gender, rape myths, and bystander intervention. Our analyses could have also been impacted by floor and ceiling effects given that the vast majority of participants reported low values on measures of gender role and rape myth acceptance and high values on the measures of bystander efficacy and intentions – illustrating a lack of variance in these outcomes. Future studies could investigate the influence of comprehensiveness of sex education on these cognitions among a sample of young adults that are at higher risk for sexual violence perpetration or bystander nonintervention.

Students who received comprehensive sex education were more likely than all other groups to have used a condom the last time they had vaginal sex, and they reported more consistent condom use compared to students that received abstinence-plus sex education and students that received no sex education. This may be explained by our LCA findings which suggest that there are distinct differences in the way the sex education classified as abstinence-only, abstinence-plus, and comprehensive approach instruction on condoms. As evident in Figure 1, discussion of condoms in abstinence-only sex education is quite limited. And, while students in the abstinence-plus and comprehensive sex education classifications were likely to have received instruction on the importance of condom use and efficacy of condoms, students in the comprehensive classification were more likely to have received education on how to get condoms and/or how to use condoms. Thus, this finding supports the teaching of skills (not just information) that may help overcome behavioral barriers to consistent condom use. Together with previous research this finding also highlights how the ultimate goal of comprehensive sex education (i.e., to promote better relationships, satisfaction, and overall wellbeing) includes the promotion of behaviors that reduce sexual risk.

Relatedly, students in the comprehensive classification were more likely than other groups to have received education on sexual health communication and preventative sexual health care and, thus, it is perhaps unsurprising that they were also more likely to report having communicated with their partners about STIs prior to engaging in sexual activity and more likely to have been tested for STIs. Partner sexual communication is an essential component of healthy sexual decision making as people who communicate are more likely to experience a range of more positive outcomes – including, more consistent condom use (Widman, Choukas-Bradley, et al., 2014; Widman et al., 2022). Additionally, there are a number of other topics – such as, pleasure, media influence, gender, alcohol and drug use during sexual activity – that were more likely to have been discussed in the sex education of the comprehensive class and that are also related to condom use and improved partner communication practices (Evans-Paulson et al., 2024; Randolph et al., 2007; Ritchwood et al., 2015; Smith et al., 2016; Vannucci et al., 2020). It is plausible that in also addressing these topics, school-based sex education bolstered safer sex behaviors in this sample of young adults.

Previous research indicates that comprehensive sex education programs are effective at promoting healthy sexual decision making (e.g., condom use) among adolescents and abstinence-only programs are ineffective. The current study extends this body of research in two key ways. First, by illuminating which comprehensive programs are likely to be most effective – notably, sex education may have the greatest benefit when it goes beyond discussion of condoms, sexual health consequences, and prevention and also addresses issues related to positive aspects of sexuality, including, communication, pleasure, gender identity and expression, and sexual orientation. And, second, this study adds to the limited literature on longer-term effects of school-based sex education – amplifying how this education may promote the sexual health of youth beyond the high school years and during the transition to adulthood. Taken together, previous research and the results from the current study suggest that abstinence-only, abstinence-plus, and comprehensive sex education are qualitatively different approaches – addressing topics in different ways and with different goals. And while these approaches are often all considered under the umbrella of “sex education” it is critical to note that they all have different outcomes, with previous research highlighting that abstinence-only approaches often do not lead to positive change at all and perhaps providing the groundwork to challenge whether this approach fits under the label of sex education.

Sexual satisfaction is also a critical component of wellbeing – with studies showing a relationship between sexual satisfaction and self-esteem, relationship satisfaction, and sexual communication throughout adulthood (Fisher et al., 2015; Fortenberry, 2013; Mallory, 2022). We found that students who received the most comprehensive school-based sex education report greater sexual satisfaction as young adults compared to students that did not receive any school-based sex education. This is consistent with our hypothesis – that receiving comprehensive sex education may strengthen skills in sexual communication and normalize topics related to sexual pleasure during adolescence, which in turn, would promote long-term sexual satisfaction. However, surprisingly, there were no differences between students in the comprehensive group and students that received abstinence-only and abstinence-plus sex education. Only one previous study, that we know of, has examined the relationship between school-based sex education and sexual satisfaction among young adults (Evans et al., 2020). This study found that students who received more comprehensive school-based sex education reported greater sexual satisfaction compared to students that received less comprehensive sex education but only among heterosexual young adults. And, there was no relationship between sex education and sexual satisfaction for LGB+ young adults. This may be because sex education programs are often not inclusive of the identities and experiences of LGBTQ+ youth (Evans et al., 2020; Hobaica, 2024). This underscores the importance of making sex education more inclusive and affirming of diverse youth and examining how individual and sociocultural differences – including sexual identity, gender, peer norms, and other factors – may influence the long-term effectiveness of sex education. Unfortunately, the research in this area is quite limited. Thus, more attention is needed to better understand the nuances of how sex education may differentially impact youth based on their unique identities and experiences and how educational tools can be used to position young adults to have satisfying sex lives.

The current study also examined whether students’ perceptions of their sex education differed based on their sex education classification (i.e., for students that received sex education). The burgeoning implementation science literature highlights the importance of positive perceptions of programming among end-users (i.e., acceptability) to overall program effectiveness as well as uptake and sustainability (Perski & Short, 2021; Sekhon et al., 2017). Students in the most comprehensive classification perceived their sex education to be more inclusive, preparative, and empowering than students in the other classifications. These findings, along with the existing literature, suggest that students who receive more comprehensive sex education may be more likely to engage with and learn from their sex education (Perski & Short, 2021). Unexpectedly, students in the most comprehensive classification reported that their sex education was less comfortable, compared to students in the other classifications. Importantly, students in the comprehensive classification were most likely to have received information about a number of topics that are critical to sexual health but stigmatized in some U.S. cultures (e.g., sexual pleasure, sexual orientation, gender identity (King et al., 2020; Saewyc, 2011). Thus, when they received comprehensive sex education, this may have been the first time students had ever discussed these topics in a public space, among their peers, and also educators may not have been well-prepared to address these topics. In this case, initial discomfort among students may be a natural reaction. Going forward, when implementing comprehensive sex education, it may be helpful for educators to receive professional development that trains them to discuss sensitive sexual health topics in the classroom and prepares them to respond to instances of student discomfort.

This study has limitations that frame additional directions for future research. First, the measure used to assess condom use in analyses for the current study centered on vaginal sex. Many young adults are not engaging in vaginal sex and/or are engaging in other sexual behaviors (e.g., oral sex, anal sex) that have implications for their sexual wellbeing. While protection use during oral and anal sex were assessed, issues with power and variability in this data limited our ability to examine these variables in analyses for the current study (i.e., due to the relatively low percentage of our sample that has engaged in anal sex and low frequency of protection use during oral sex). Future studies could examine how comprehensiveness of sex education is related to additional sexual health behaviors – e.g., condom use during anal sex, PrEP use. Second, the measure of sex education used in this study required college students to recall details of their high school sex education, which could have occurred up to five years before their participation in the current study and, thus, was vulnerable to recall bias. Thus, this study assessed the sex education that student recall receiving rather than what was actually provided to them. In the future, it may be helpful to examine the relationship between high school sex education and young adult health using a longitudinal design with assessments spanning the high school and college years. Also, there are topics that are important to discuss as part of sex education but were not assessed in this study (e.g., bystander intervention, PrEP, PEP). Additionally, there are other factors that may be related to sexual health outcomes (e.g., the state where students receive sex education) that could not be explored in the current study but may be of interest in future research examining the influence of sex education. Finally, this study included a large national sample of community college students – the under-studied half of the U.S. college student population. However, generalizability may be limited, and future studies are needed to examine the longer-term influence of sex education on the sexual health of other (e.g., non-college) populations of young adults.

Young people deserve empowering sex education that prepares them to confidently engage in healthy sexual and relationship behaviors. The findings from this study suggest that very few young adult community college students have received such education. It is imperative that research findings be communicated to school administrators, parents, community organizations, and policy makers so that they are aware of the benefits of truly comprehensive sex education and can advocate for change at multiple levels. Only 30 states and the District of Columbia require that sex education be taught in schools (SIECUS, 2023), and most adolescent sex education programs include negative views of sex and focus on the prevention of risk behaviors. Missing from these programs is important positive aspects of sexual health - e.g., healthy relationships; pleasure; sexual orientation (Lameiras-Fernández et al., 2021). Standards have been developed for school districts to use to guide their selection of sex education programming in an effort to promote the implementation of truly comprehensive sex education in schools. National Sex Education Standards (Future of Sex Education Initiative, 2020) provide minimum, essential content and skills for developmentally appropriate school-based sex education and include seven topics: 1) consent and healthy relationships, 2) anatomy and physiology, 3) puberty and adolescent sexual development, 4) gender identity and expression, 5) sexual orientation and identity, 6) sexual health, and 7) interpersonal violence. Despite the existing scientific evidence demonstrating the relative ineffectiveness of abstinence-only programming, federal funding for these programs (i.e., rebranded as sexual risk avoidance) was raised considerably during the latter part of the 2010s (Guttmacher Institute, 2021). Public health would be better served by redirecting these funds to other federal funding mechanisms that require sex education programming to be truly comprehensive – not just focused on abstinence and contraception/protection, but also inclusive of topics relevant to strengthening romantic relationships, LGBTQ+ youth, and sex-positivity.

Data availability statement:

The data analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.