State-level school-based sex education policies on sexual ...

State-level school-based sex education policies on sexual orientation are associated with changes in teaching about HIV prevention Tuesday, July 25, 2017 Ashley Grosso, PhD Dayana Bermudez, CHES Mary Ann Chiasson, DrPH Public Health Solutions #IAS2017 | @IAS_Conference #IAS2017 | @IAS_conferenc Conflict of Interest No conflicts of interest to declare.

#IAS2017 | @IAS_conferenc Acknowledgements Support for this research was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation. #IAS2017 | @IAS_conferenc Outline Sex education laws related to

lesbian, gay, bisexual and transgender (LGBT) individuals Methods Data sources: Policies and implementation Panel data analysis Results Discussion: Next steps in research #IAS2017 | @IAS_conferenc States with LGBT-biased sex education laws in 2016

#IAS2017 | @IAS_conferenc No Promo Homo or Dont Say Gay laws, 2016 Alabama: Classes must emphasize, in a factual manner and from a public health perspective, that homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under the laws of the state. Alabama State Code 16-40A-2(c)(8). Arizona: No district shall include in its course of study instruction which(1) promotes a homosexual life-style(2) portrays homosexuality as a positive alternative life-style(3) suggests that some methods of sex are safe methods of homosexual sex. AZ Rev. Stat. 15-716(c). Florida: If this instruction is included, it must: a. Teach abstinence from sexual activity outside of marriage as the expected standard for all school-age students, while teaching the benefits of monogamous, heterosexual marriage Illinois: When sex education is taught, honor and respect for monogamous heterosexual marriage must be taught. Illinois School

Code Louisiana: No sex education course offered in the public schools of the state shall utilize any sexually explicit materials depicting male or female homosexual activity . . . La. R.S. 17:281 Mississippi: Must teach the current state law related to sexual conduct, including forcible rape, statutory rape, paternity establishment, child support and homosexual activity Section 37-13-171 of the Mississippi Code of 1972 North Carolina: Requires teaching that a mutually faithful monogamous heterosexual relationship in the context of marriage is the best lifelong means of avoiding sexually transmitted diseases, including HIV/AIDS General Statutes 115C-81 Oklahoma: AIDS prevention education shall specifically teach students that: 1. engaging in homosexual activity, promiscuous sexual activity, intravenous drug use or contact with contaminated blood products is now known to be primarily responsible for contact with the AIDS virus; 2. avoiding the activities specified in paragraph 1 of this subsection is the only method of preventing the spread of the virus. 70 Okla. Stat. 11-103.3 South Carolina: The program of instruction provided for in this section may not include a discussion of alternate sexual lifestyles from heterosexual relationships including, but not limited to, homosexual relationships except in the context of instruction concerning sexually transmitted diseases. S.C. Stat. 59-32-30(5).

Texas: The materials in the education programs intended for persons younger than 18 years of age must: (1) emphasize sexual abstinence before marriage and fidelity in marriage as the expected standard . . . and (2) state that homosexual conduct is not an acceptable lifestyle and is a criminal offense under Section 21.06, Penal Code. Tex. Health & Safety Code 85.007. Course materials and instruction relating to sexual education or sexually transmitted diseases should include: emphasis, provided in a factual manner and from a public health perspective, that homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under Section 21.06, Penal Code. Tex. Health & Safety Code 163.002 #IAS2017 | @IAS_conferenc Media coverage #IAS2017 | @IAS_conferenc How sex education policies might

work or fail Laws Funding Implementation Behaviors Outcomes #IAS2017 | @IAS_conferenc

Research question What is the relationship between state policies on sexual orientation in sex education and schools teaching about HIV prevention, human sexuality and sexually transmitted disease (STD) prevention? #IAS2017 | @IAS_conferenc Methods Data sources Policies: Sexuality Information and Education

Council of the United States (SIECUS) Implementation: Centers for Disease Control and Prevention (CDC) School Health Profiles Control variables (Cavazos-Rehg et al) Level of religiosity: Pew Research Center Abortion laws for minors: Guttmacher Institute Political ideology: Berry et al Child poverty: Census

Racial/ethnic composition: Census #IAS2017 | @IAS_conferenc Methods Panel data 2006-2014 Changes within a year between states Changes within states over time Linear regression analyses in Stata 14 State and year fixed effects Sensitivity analysis: Lagged variable #IAS2017 | @IAS_conferenc

Policies NOT significantly related to the percentage of schools teaching about HIV prevention, human sexuality or STD prevention Mandatory to Teach sex or HIV education Cover/stress abstinence Cover contraception Promote marriage #IAS2017 | @IAS_conferenc Number of states with anti-LGBT sex

education policies and teaching by year #IAS2017 | @IAS_conferenc 90% % of schools teaching about each topic by whether the state sex education policy is anti-LGBT, 20062014 85% 80%

75% 70% 65% HIV prevention State sex education law is anti-LGBT Human sexuality No Yes

STD prevention #IAS2017 | @IAS_conferenc Results Having a state sex education policy that was anti-LGBT was associated with decreases in the % of schools that taught HIV prevention: 17.4% Human sexuality: 21.7% STD prevention: 16.3% #IAS2017 | @IAS_conferenc

Results Correlation with teaching HIV prevention Coefficient Human sexuality Coefficient STD prevention Coefficient

LGBT-biased sex education law -17.4* -21.7* -16.3* 95% confidence interval -30.0 to -4.7 -33.2 to -10.1

-24.3 to -8.4 Regression constant 85.1 78.2 80.8 Observations 174

*p<0.05 R-squared Within-state ranged from 0.10 to 0.17 Between-state ranged from 0.11 to 0.13 Overall ranged from 0.07 to 0.11 #IAS2017 | @IAS_conferenc Discussion State LGBT-related sex education laws may increase reluctance of teachers to try to teach sex

education topics in general Expect a decrease in teaching these topics in 2016 CDC data????? #IAS2017 | @IAS_conferenc Limitations Missing data School health profile data are selfreported SIECUS data differs from other categorizations (e.g. Guttmacher Institute) Multiple comparisons

#IAS2017 | @IAS_conferenc Next steps Anti-LGBT sex education laws and Teen health outcomes Youth risk behaviors #IAS2017 | @IAS_conferenc References Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Iguchi M, Schootman M, Cottler L, Grucza RA, Bierut LJ. Associations between sexuality education in schools and adolescent birthrates: a state-level

longitudinal model. Archives of pediatrics & adolescent medicine. 2012 Feb 6;166(2):134-40. Berry WD, Fording RC, Ringquist EJ, Hanson RL, Klarner CE. Measuring citizen and government ideology in the US states: A re-appraisal. State Politics & Policy Quarterly. 2010 Jun;10(2):117-35. #IAS2017 | @IAS_conferenc Thank you! Questions? [email protected]