Support Materials for Applicants for ESHE

Support Materials for Applicants to CDC-RFA-PS13-1308:
Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance

Exemplary Sexual Health Education (ESHE)
Rationale:
Just as schools are critical to preparing students academically and socially, they are also vital partners
in helping young people take responsibility for their health and adopt health-enhancing attitudes and
behaviors that can last a lifetime. Health education is integral to the primary mission of schools, and
provides young people with the knowledge and skills they need to become successful learners and
healthy and productive adults. Increasing the number of schools that provide health education on key
health problems, such as HIV, other STD, and pregnancy, is a critical objective for improving our
nation’s health.1,2
Thirty-three states currently mandate HIV education; of those, 20 mandate additional sexual education
(e.g., programs that describe sexual development, provide skills to establish healthy relationships and
prevent behaviors that increase the risk of HIV, other STD, and unintended pregnancy).3 Regardless of
the emphasis in content, sexual health education programs should be medically accurate; consistent
with scientific evidence; tailored to students’ contexts and the needs and educational practices of
communities; and should use effective classroom instructional methods. Sexual health education
should allow students to develop and demonstrate developmentally appropriate sexual risk avoidance
and reduction-related knowledge, attitudes, skills, and practices.
Independent reviews of the scientific evidence show that well-designed and well-implemented
HIV/STD prevention programs are effective in decreasing sexual risk behaviors among youth.4,5
Specific outcomes include:
6-9
• Delaying first sexual intercourse
9-12
• Reducing the number of sex partners
13-15
• Decreasing the number of times students have unprotected sex
14,16,17
• Increasing condom use
Notably, the HIV prevention programs were not shown to hasten initiation of sexual intercourse among
adolescents, even when those curricula encouraged sexually active young people to use condoms.18,19
In addition, effective HIV/STD prevention programs can be cost-effective. An economic analysis of one
school-based sexual risk reduction program found that for every dollar invested in the program, $2.65
was saved in medical costs and lost productivity.20 Other studies have found similar savings for HIV
prevention programs focusing on youth who are at disproportionate risk for HIV, including young gay
and bisexual men21,22 and urban African American male adolescents.23
Definitions:
1. Evidence-Based Interventions (EBI): A program that has been (i) proven effective on the basis
of rigorous scientific research and evaluation and (ii) identified through a systematic
independent review. This funding opportunity announcement (FOA) is specifically interested in
those EBIs that show effectiveness in changing behavior associated with the risk factors for HIV/

CDC-RFA-PS13-1308 Applicant Support Materials

STD infection and/or unintended pregnancy among youth; these behaviors may include
delaying sexual activity, reducing the frequency of sex, reducing the number of sexual partners,
and/or increasing condom or contraceptive use.
2. Evidence-Informed Programs (EI): “A program that is informed by scientific research and
effective practice. Such a program replicates evidence-based programs or substantially
incorporates elements of effective programs. The program shows some evidence of
effectiveness, although it has not undergone enough rigorous evaluation to be proven
effective”.24
3. Exemplary25 Sexual Health Education (ESHE): A systematic, evidence-informed approach to
sexual health education that includes the use of grade-specific, evidence-based interventions,
but also emphasizes sequential learning across elementary, middle, and high school grade
levels. ESHE provides adolescents the essential knowledge and critical skills needed to avoid
HIV, other STD, and unintended pregnancy. ESHE is delivered by well-qualified and trained
teachers, uses strategies that are relevant and engaging, and consists of elements that are
medically accurate, developmentally and culturally appropriate, and consistent with the
scientific research on effective sexual health education. For more information:
www.cdc.gov/healthyyouth/sher/characteristics/index.htm and
www.cdc.gov/healthyyouth/hecat/pdf/HECAT_Module_SH.pdf.
Resources:
•

Characteristics of an effective health education curriculum
http://www.cdc.gov/healthyyouth/sher/characteristics/index.htm

•

Analysis of health education curriculum
http://www.cdc.gov/healthyyouth/HECAT/

•

Federal registries of evidence-based programs for youth
http://www.cdc.gov/healthyyouth/AdolescentHealth/registries.htm

•

Selecting and implementing evidence-based sexual health education programs
http://www.cdc.gov/TeenPregnancy/PDF/LittlePSBA-GTO.pdf
http://www.nrepp.samhsa.gov/Courses/Implementations/NREPP_0101_0010.html

•

Adapting sexual health education curriculum
http://www.acf.hhs.gov/sites/default/files/fysb/prep-making-adaptations-ts.pdf

References:
1.

2.

The White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington,
DC: White House; 2010. Available at http://aids.gov/federal-resources/national-hiv-aids-strategy/nhas.pdf.
U.S. Department of Health and Human Services. Healthy People 2020. U.S. Department of Health and Human
Services Web site. Available at http://www.healthypeople.gov/2020/default.aspx.

CDC-RFA-PS13-1308 Applicant Support Materials
3.
4.

5.

6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

17.
18.
19.
20.
21.
22.
23.

Guttmacher Institute. State Policies in Brief: Sex and HIV Education (As of January 1, 2013). Guttmacher Institute
Web site. Available at http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf.
Mathematica Policy Research and Child Trends. Identifying Programs That Impact Teen Pregnancy, Sexually
Transmitted Infections, and Associated Sexual Risk Behaviors: Review Protocol 2.0. U.S. Department of Health and
Human Services/Adolescent School Health Web site. Available at http://www.hhs.gov/ash/oah/oahinitiatives/tpp/eb-programs-review-v2.pdf.
Chin HB, Sipe TA, Elder R, Mercer SL, Chattopadhyay SK, Jacob V, et al. The effectiveness of group-based
comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent
pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the
Guide to Community Preventive Services. American Journal of Preventive Medicine 2012;42(3):272‒294.
Tortolero S, Markham C, Peskin M, Shegog R, Addy R, Escobar-Chavez L, et al. It’s your game: keep it real: delaying
sexual behavior with an effective middle school program. Journal of Adolescent Health 2010;46(2):169–179.
Coyle K, Kirby D, Marín B, Gómez C, Gregorich S. Draw the line/respect the line: a randomized trial of a middle
school intervention to reduce sexual risk behaviors. American Journal of Public Health 2004;94(5):843–851.
Sikkema K, Anderson E, Kelly J, Winett R, Gore-Felton C, Roffman R, et al. Outcomes of a randomized, controlled
community-level HIV prevention intervention for adolescents in low-income housing developments. AIDS
2005;19(14):1509–1516.
Jemmott J, Jemmott L, Fong G. Efficacy of a theory-based abstinence-only intervention over 24 months: a
randomized controlled trial with young adolescents. Archives of Pediatrics & Adolescent Medicine
2010;164(2):152–159.
Villarruel A, Jemmott J , Jemmott L. A randomized controlled trial testing an HIV prevention intervention for Latino
youth. Archives of Pediatrics & Adolescent Medicine 2006;160(8):772–777.
Koniak-Griffin D, Lesser J, Nyamathi A, Uman G, Stein J, Cumberland W. Project CHARM: an HIV prevention
program for adolescent mothers. Family & Community Health 2003;26(2):94–107.
Shrier L, Ancheta R, Goodman E, Chiou V, Lyden M, Emans J. Randomized controlled trial of a safer sex
intervention for high-risk adolescent girls. Archives of Pediatrics & Adolescent Medicine 2001;155:73–79.
Markham CM, Tortolero SR, Peskin MF, Shegog R, Thiel M, Baumler ER, et al. Sexual risk avoidance and sexual risk
reduction interventions for middle school youth: a randomized controlled trial. Journal of Adolescent Health 2012;
50(3):279–288.
Coyle K, Kirby D, Robin L, Banspach S, Baumler E, Glassman J. All4You! A randomized trial of an HIV, other STDs,
and pregnancy prevention intervention for alternative school students. AIDS Education and Prevention
2006;18(3):187–203.
Jemmott J, Jemmott L, Braverman P, Fong G. HIV/STD risk reduction interventions for African American and Latino
adolescent girls at an adolescent medicine clinic: a randomized controlled trial. Archives of Pediatrics & Adolescent
Medicine 2005;159:440–449.
DiClemente R, Wingood G, Rose E, Sales E, Lang D, Caliendo A, et al. Efficacy of sexually transmitted
disease/human immunodeficiency virus sexual risk-reduction intervention for African American adolescent
females seeking sexual health services: a randomized controlled trial. Archives of Pediatric & Adolescent Medicine
2009;163(12):1112–1121.
DiClemente R, Wingood G, Harrington K, Lang D, Davies S, Hook E III, et al. Efficacy of an HIV prevention
intervention for African American adolescent girls: a randomized controlled trial. Journal of the American Medical
Association 2004;292:171–179.
Kirby D. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually
Transmitted Diseases. Washington, DC: National Campaign to Prevent Teen Pregnancy;2007.
Kirby D. The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual
behavior. Sexuality Research & Social Policy 2008;5(3):18–27.
Wang L, Davis M, Robin L, Collins J, Coyle K. Economic evaluation of Safer Choices: a school-based HIV/STD and
pregnancy prevention program. Archives of Pediatrics & Adolescent Medicine 2000;154(10):1017–1024.
Tao G, Remafedi G. Economic evaluation of an HIV prevention intervention for gay and bisexual male adolescents.
Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;83–90.
Kahn J, Kegeles S, Hays R, Beltzer N. Cost-effectiveness of the Mpowerment project, a community-level
intervention for young gay men. Journal of Acquired Immune Deficiency Syndrome 2001;27(5):482–491.
Pinkerton S, Holtgrave D, Jemmott J. Economic evaluation of HIV risk reduction intervention in African-American
male adolescents. Journal of Acquired Immune Deficiency Syndrome 2000;25(2):164–172.

CDC-RFA-PS13-1308 Applicant Support Materials
24. Djamba YK, Davidson TC, Aga MG. Sexual Health of Young People in the U.S. South: Challenges and Opportunities.
Montgomery, Alabama: Center for Demographic Research. March 2012. Available at
http://www.demographics.aum.edu/uploadedfile/CDR_SexualHealth_6-1.pdf.
25. CDC. Indicators for School Health Programs. HIV Prevention: State Education Agencies. 2011. Available at
http://www.cdc.gov/healthyyouth/evaluation/indicators/pdf/questionnaires/quest_hivsea_2012.pdf.