What Works: Overview

Data from CDC’s Youth Risk Behavior Survey show that fewer high school students engage in health behaviors that put them at risk. But even though adolescents are making better decisions about their health, far too many are still at risk for human immunodeficiency virus (HIV), sexually transmitted diseases (STDs), and unintended pregnancy.

• 46% of U.S. high school students did not use a condom the last time they had sex
• More than 1 in 10 female students and 1 in 28 male students have been physically forced to have sex
• 19% of high school students have been bullied at school
• Nearly 1 in 7 high school students misuse prescription opioids
• More than 47% of lesbian, gay, or bisexual students have considered suicide

• Some youth engage in multiple and serious risk behaviors like high-risk substance use* and sex without condoms, and go through harmful experiences such as being a victim of violence.
• Youth who engage in these behaviors or who have these harmful experiences are more at risk for a variety of negative health outcomes including HIV and STDs.
• These risks are more common among some youth—including lesbian, gay, bisexual, and transgender youth, who are more likely to experience stigma, discrimination, family disapproval, social rejection, and violence. As a result, they are more likely to have poor health.

CDC’s Division of Adolescent and School Health (DASH) has established an evidence-based approach to school-based HIV and STD prevention. It includes providing quality sexual health education, connecting students to sexual health services, and establishing safe and supportive school environments. These evidence-based strategies benefit all students. Further, activities related to health education and health services can be tailored to address health outcomes other than sexual behaviors, including high-risk substance use, violence victimization, and mental health. Promoting safe and supportive environments can address all of these health outcomes.

Benefits of providing SHE to students:

• Knowledge to reduce sexual risk
• Condom negotiation skills
• Self-efficacy to delay sexual activity

Quality sexual health education (SHE) is a systematic approach to preparing students with the knowledge and skills needed to make informed health decisions to prevent HIV, STDs, and unintended pregnancy.

• Sexual health education includes planned, progressive learning objectives and outcomes across grade levels (K–12).
• Sexual health education addresses knowledge and skills students need before risk behaviors and health issues emerge.
• Effective SHE programs:
  • Are taught by qualified and trained teachers
  • Connect students to health services
  • Engage parents and community partners
  • Foster positive relationships between students and trusted adults.

Students who receive evidence-based SHE can reduce health risk behaviors and experiences and may improve their academic performance in school.

Benefits of connecting students to SHS:

• Risk-reduction counseling
• HIV and STD testing
• Contraceptive use

Sexual health services (SHS) give students access to preventive health care, such as STD testing, HIV testing, contraception, and condoms, and referrals to appropriate treatment, if needed.

• Through SHS, students can gain access to broad preventive health services, such as sexual risk assessments and counseling on healthy decision making and protective behaviors.
• Schools can connect students to SHS by providing the services on site or by referring students to youth-friendly health care providers in the community.

These services can provide students with information, education, support, referrals, and counseling for a broad range of health behaviors and experiences that can affect healthy development.

Benefits of promoting SSE:

• School connectedness
• Parental monitoring
• Parent-adolescent communication

Creating safe and supportive environments (SSE) emphasizes aspects of school settings and family relationships that can protect adolescents and reduce their risk for HIV, STDs, and unintended pregnancy.

• These protective factors include school connectedness, parental monitoring, and parent-adolescent communication (both generally and specifically
  about sex).
• Safe and supportive environments connect adolescents to a network of caring peers and adults, including parents, other primary caregivers, and teachers.
• Improving environments can have a broad and lasting positive impact on health. It also establishes a context for sexual health education and sexual health services to be effective.

Creating SSE involves schools, communities, families, and youth working together to protect students’ health and improve academic performance.