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April 15, 2020

Reforming Health Classes in Public High Schools

An Issue Brief

Brianna Mitchell
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Introduction
In 2005, a 13-year-old girl from Nebraska was impregnated by a 22-year-old man i. When the girl’s
family found out that their daughter was pregnant, they took her and the man to Kansas to marry them
because under Kansas law it is permittable for children 12 or older to get married with parental consent ii.
Even though Nebraska law does not permit marriage for children 16 years old and younger, the state still
has to legally recognize valid marriages from other states iii. The man in this story, Matthew Koso, got
sentenced to 18-30 months which stunned and upset both families. After Koso got released from prison, he
returned to live with the then 15-year-old girliv.
In 2018, the American Psychological Association (APA)
published their first-ever guidelines for practice with boys and v. In this
report, the APA cites that at first glance, men are living a pretty luxurious
life. With men occupying 95.2% of chief operating officers at Fortune 500
companies and 81% of seats in congress, they are the gold standard for
human achievement vivii. They are also 3.5 times more likely than
women to fall victim to suicide and their life expectancy is 4.9 shorter
than womenviiiix.
It might be hard to see the correlation between these two accounts.
Where the first one deals with statutory rape, the second covers how the
pressure of hegemonic masculinity is placed on boys and is one of the root
causes for their mental health issues. The link between them is the fact that the current way we are
socializing children is doing more harm than good. One of the ways that society is failing young kids is
through the inconsistency of health education classes. The lack of streamlining for all health education
classes, since there is no current universal curriculum, in the United States is one of the catalysts for the
problems described in the previous two paragraphs. In the case of sexual health, today there is a divide in
the nation regarding whether it should be taught in schools or, if it is, in what capacity. Because of this,
some school districts are enforcing the notion that sexual activity is exclusive to marriage, which creates
loopholes and excuses for crimes like statutory rape. Moreover, mental health is just now being
implemented into some school districts. However, the dialogue surrounding mental health is often held only
in reference to how it affects white women. While the APA issued their guidelines for Psychological
Practice with Girls and Women in 2007, the issue for boys came out two years ago. The conversation is just
beginning to include the fact that men struggle with mental health just as much as women do. Ronald F.
Levant, EdD, characterized the situation by saying “though men benefit from the patriarchy, they are also
impinged upon by patriarchy”x.
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Although there are many factors in this conversation, such as parental attitudes towards their own
children regarding mental and sexual health, this issue brief primarily advocates for a federally mandated
curriculum for health education in public schools in the United States. The lack of regulation and oversight
on current health education allows for ideological and religious beliefs to dictate which information is
censored from kids. The information that is often omitted is some of the most critical regarding children’s
health: sexual and mental health. Because of this, some students are not receiving the necessary life skills
they need which can cause severe damage to not only themselves, but to their relationships to others, as
well.

Origins of Health Education in Public Schools

Health education in public schools has come a long way. Health education today covers a plethora
of topics, but the focus here is on the history of how, and when, the inclusion of mental and sexual health
came to fruition. The initial sense of urgency for the inclusion of health programs in the United States’
public school system arrived in 1850xi. In that year, the Sanitary Commission of Massachusetts produced a
report in which they enclosed that there is a need to teach students how to take care of someone’s physical
health and how to prevent themselves from becoming ill. From then on, each consecutive year produced
more evidence that pushed for further expansion of health education xii. Starting in the 1920’s, health
education had been mandated to cover more topics such as nutrition, disease, alcohol, tobacco, and family
relationshipsxiii.
In the 1960s and 1970s, the platform that the Great Society and War on Poverty presented brought
an increased sense of awareness and funding for health in public education systems, although many of these
programs were directed at disadvantaged areas xiv. Thus, some scholars argue that this created a false
sentiment that health education was necessary only for certain populations that were associated with low
socioeconomic backgroundsxv. Around the same time, the conversation was beginning to advance as sexual
health started to be considered as a public health concern. Before this, the dialogue surrounding sexual
health was ignored because of the predominant societal ideals of “social hygiene” and “moral purity” which
created narrow goals such as eliminating sexually transmitted infections, masturbation, prostitution, and
sexual expressionxvi.
Following the 1960s, there was an increasing consensus surrounding the inclusion of sexual health
in schools. But, in the 1980’s, the conversation drifted from the addition of sexual health in health classes to
how sexual health should be discussed in the classroom xvii. Even today, states and politicians are pretty
evenly split between whether sexual education should be discussed in the classroom and, if it is, whether it
should be a comprehensive or abstinence-only based curriculum. In short, abstinence-only programs
promote ideals of refraining from any sexual activity until marriage while withholding medical information
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and endorsing negative stereotypes when it comes to sexuality and gender xviii. Whereas, on the other hand,
the American College of Obstetricians and Gynecologists define comprehensive sex education as medically
accurate, evidence-based information that includes the benefits of delaying intercourse, while providing
information about reproductive development, contraception, and sexually transmitted infections. xix
Also, another big discussion that is happening right now is whether or not mental health should be
covered in health education. It was only in 2018 when New York and Virginia became the first two states
that required mental health education in their schools xx. As of 2019, ten states require a mental health
curriculum by law and at least twenty states, along with the District of Columbia, include mental health in
their health or education standardsxxi. However, more than a dozen states do not explicitly require mental
health in their law or their standards. This increase in public discourse among states is derived from the
myriad scientific studies that show that our children, at a dangerously increasing rate, are being diagnosed
with mental illnesses as well as contributing to the staggering suicide rate xxii.
Reviewing the evolution of health education allows us to understand that schools have previously
been called on by the government to play a huge role in educating their students on important lifestyle
decisions. Also, the progression of what was incorporated into health class curriculums shows that each
issue that was previously proposed by governments (e.g., poor sanitation) was once deemed controversial
by multiple school districts. Today, the groundwork has been laid by past legislation but, now, school
districts are faced with battling against their respective local and state governments when they are being
asked to include mental and sexual health into their health classes.

What Do Health Classes Look Like Today?

What do experts say?

Today, there is a ton of variation of what a typical health class looks like in public schools. As of
right now, there are national standards, but what actually gets implemented is often based on the discretion
of individual schools’ districts. The Centers for Disease Control and Prevention (CDC) provides the
National Health Education Standards and Healthy Schools. The National Health Education Standards
outline 8 suggestions for what public schools should be including in their health classes xxiii. A lot of these
standards focus on physical health and relationship building with one’s family and friends. For example,
Standard 4 aims for students to “demonstrate the ability to use interpersonal communication skills to
enhance health and avoid or reduce health risks”. xxiv Though this standard could possibly be connected to
one’s mental health, there is no explicit reference to mental health. Moreover, in the Healthy Schools
standards, the CDC offers suggestions on teaching students nutrition, physical education and activity, out of
school time, sleep and health, and social and emotional climate xxv. In the social and emotional climate
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section of Healthy Schools, the emphasis placed here is on reducing bullying and increasing communication
between students and their peers and familiesxxvi. Although the National Health Education Standards is a
nationally recognized reference for health education and Healthy Schools serves as a supplement to this,
both of these resources do not include specific mental and sexual health curriculum.
However, though sexual health and mental health are not included in national standards provided by
the CDC, the CDC does have standards listed on their website, but they are not utilized nationally. In 2006,
the CDC did a State-by-State Summary for the School Health Policies and Programs Study xxvii. In this
summary paper, the CDC points out which states actually follow all of the recommended policies on their
website beyond the National Health Education Standards and Healthy Schools. The CDC found that despite
44 out of the 50 states requiring public schools to follow national or state physical education standards,
fewer than half of high schools and only a fifth of middle schools teach all sixteen topics recommended by
the CDC as essential components of sexual education xxviii.
Because of this inability to conform to one universal curriculum for sexual health in public schools,
some school districts are adopting any of abstinence-only, comprehensive, or no sex education program.
Abstinence-only education, which originated in the passage of the Adolescent Family Life Act in 1981, is
defined by teaching the “social, psychological, and health” improvements one can gain from abstaining
from sexual activityxxix. Within this education system, educators promote, among many other standards, that
abstinence is the only way to avoid sexually transmitted diseases xxx. Also, a popular trope used in these
programs is that sexual activity outside the context of marriage can lead to detrimental psychological
effects. Over the years, the federal government has contributed a lot of money to fund abstinence-only
education in public schools which includes the George W. Bush administration , which contributed over
$1.75 billionxxxi. However, many studies have been done on abstinence-only education and reported that the
information taught is not always the most beneficial. In a 2007 study conducted by Christopher Trenholm,
he collected data from teenagers four to six years after they attended four similar abstinence programsxxxii.
He concluded that none of the programs aided teenagers from abstaining from sex any longer than average
teenagers, raised the age for their first intercourse, reduced the number of sex partners, or reduced use of
drugsxxxiii. Also, Trenholm noted that the teenagers in these programs were less likely than others to agree
that condoms are an effective way to avoid infection xxxiv. On the other side, some public schools have been
utilizing comprehensive sex education. This type of education provides information about, but not limited
to, human sexuality, anatomy, reproduction, family life, sexual orientation, gender identity, abortion, and
HIV/AIDSxxxv. This education also includes dialogue about healthy and consensual relationships, decision-
making, discussing safe sex practices which includes abstinence as an option. Comprehensive sex education
has also had a lot of studies done on it and has received resounding results xxxvi. In Douglas Kirby’s report in
2007, he stated that of the comprehensive sex education programs he studied, he found that they improved
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sexual health outcomes for teenagers by delaying first intercourse, reducing the number of sexual partners,
and increasing the use of contraceptivesxxxvii. Because of this, for the first time ever from a federal power, the
Obama administration in 2009 redistributed funds from Comprehensive-based Abstinence Education
Programs, and set aside $190 million in new funding for two new initiatives: the Teen Pregnancy
Prevention Program (TPPP) and the Personal Responsibility Education Program (PREP) which aimed to
produce strategies, technical assistance, evaluation, and program support xxxviii. In 2015, 81 programs
received grants through TPPP, in order to build and improve comprehensive sex education programs, which
were predicted to reach over 290,000 youth annuallyxxxix.
And, when it came to mental health, there was a lot of incomplete data from the CDC when they
tried to find out which states mandated the inclusion of mental health into their curriculum and having
relevant personnel employed in public schools. However, one of the most sobering pieces of data that the
CDC collected was that only 18 out of 50 states require that their public high schools have one full-time
counselor that is trained in mental healthxl. Beyond this, the number of states that include mental health in
their curriculum decreases tremendously. However, it is noted that in recent years, more states have begun
to have conversations about integrating mental health in their education systems.

The Role of the State Government

Since the CDC has limited powers over what individual school districts do and there is no current
federal legislation mandating the inclusion of sex or mental education in health class curriculum, the power
currently lies in states to oversee and dictate what their school districts are actually teaching in their health
classes.
In regard to sexual health education, the CDC reported in 2010 that more than 95% of all teenagers
in U.S schools, churches, or community centers receive some “formal” sexuality education before they turn
18xli. However, the quality or density of the information they are receiving varies drastically depending on
where they are living. From the CDC report, the National Survey of Family Growth analyzed the same data
but through the lens of gender and topic. They found a major decline in adolescents’ receipt of formal
sexual education from 2006 to 2013, particularly concentrated in nonmetropolitan areas xlii. This decline was
significant in terms of what information adolescent females were receiving. For example, the number of
females receiving education about birth control dropped from 70% to 60% and their education about
consensual sex dropped from 89% to 82%xliii. And, while females were learning less about sexual health, so
were males. In the same period as females not learning about birth control, men were also learning less
about birth control, as the percentage for males dropped from 61% to 55% xliv.
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In a more recent study done by the Guttmacher Institute, which has been updated this month, the
Institute continually notates which states have specific content requirements for sex education and also
investigates which states incorporate HIV/AIDS education into their curriculum. Some highlights from that
study were:

- 39 states, and the District of Columbia, mandate sex education and/or HIV education. Of those 39
states, 27 states and D.C. mandate both sex education and HIV education, 2 states only mandate sex
education, and 10 states only mandate HIV educationxlv.
- When it comes to the content of sex and HIV education: 17 states require program content to be
medically accurate, 26 states and D.C. require instruction to be appropriate for the students’ age, 9
states require the that the content is not biased against any race, sex, or ethnicity; and 3 states
prohibit from promoting religionxlvi
- 20 states and D.C require information on contraceptives xlvii
- 39 states and D.C. require information on abstinence and 29 of those states require that abstinence
be stressedxlviii
- 19 states require instruction on the importance that sexual activity be exclusive to marriage xlix
- 10 states and D.C. require inclusive content to be integrated on homosexuality and/or positive
emphasis on heterosexualityl
- 7 states solely require only negative information to be included on homosexuality and/or positive
emphasis on heterosexualityli

So, the obvious lack of cohesion among states in regard to sexual health education is apparent from
these studies. However, despite these trends, there is overwhelming evidence that parents from the United
States, 95%, believe that sex education programs in high school, along with 90% believing it should be
extended to middle school, should be provided and cover areas such as HIV, healthy relationships, birth
control, and abstinencelii. Moreover, more studies have proven that parental opinions on sex education are
similar despite whether their state majority endorses abstinence-only or comprehensive sexual education. In
2006, a survey of parents in North Carolina, a state which enforced abstinence-only education, showed that
91% of parents support sex education in schools and 89% support comprehensive sex education liii. Then, in
2007, a similar study done in California, revealed that 90% of parents claimed to believe their children
should have comprehensive sex educationliv. And, in 2011, a study of parents in Harris Country, Texas,
revealed that a majority of them supported sex education that would include abstinence messaging, as well
as medically accurate information about the human body, condoms, and contraception lv. However, despite
this consensus among parents, almost all Texas schools’ districts have abstinence programs with no proven
evidence of effectivenesslvi. These studies prove that the policymakers in these states are not as progressive
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as their neighbors in their sex education policies, and cannot blame their constituents as the majority of
parents in these districts want their children to have a full
education about sexual health.
As stated before, when it comes to mental health,
there are at least nine states that require mental health
education and at least 20 states, along with D.C., that
include mental health in their standardslvii. This is
tremendous progress because as of 2017, no states
required mental health in their curriculum. However,
more than a dozen states have not acted on incorporating
mental health into their education, nor incorporated
them into their standards.

Who is Affected?

This lack of inclusion of mental health and sex education into national standards has been the root
of myriad problems. A pressing argument for those who do not want sexual or mental health education in
schools is that parents should be able to choose what information they want their children to know. For sex
education, the debate over what information is being provided to students presents a huge problem because
schools may be a child’s only resource for receiving accurate information. In 2012, a survey of a nationally
representative group of 1,046 parents and 1,046 teenagers, found that though about 85% of parents are
talking to their children about relationships and when sex should take place, fewer parents are touching on
rather critical issueslviii. Only 74% of parents are teaching their kids about consensual sex and only 60% of
parents are speaking to their children about birth control options lix. Moreover, there are seemingly
incongruent results when parents are asked about what they are talking to their teenagers about and what
teenagers report what they talk to their parents about. According to the same study above, where 41% of
parents report that they have discussed how to say “no” to sex, only 27% of their teenagers’ report that they
have had this discussionlx. And, when 50% of parents have said they have discussed what a healthy and
unhealthy relationship looks like, only 32% of teenagers responded that they engaged in this conversation
with their parentslxi. So, it is apparent that if education is up to the discretion of parents nationally, there is
no uniform guarantee of what information the children will receive.
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Moreover, unchecked curriculum in

states has serious health effects on the youth.
In Massachusetts alone, even though people
from the ages of 15 to 24 make up only a
quarter of people engaging in sexual
intercourse, they contributed to more than
two-thirds of chlamydia cases and almost
half of gonorrhea cases in 2015lxii. These
results can be traced back to the many young
people not learning about the tools that are
necessary to protect themselves because in
that same year only 52% of Massachusetts
teenagers were taught how to use condomslxiii. So, when children are not learning the importance of
consensual sex or taking precautions when having sex, this study sheds light on the fact that when states
have limited sexual education or abstinence-only education, they create higher rates of sexual assault, teen
pregnancy, and sexually transmitted infections.
Furthermore, the lack of integration of comprehensive sexual education disproportionately affects
children who identify with the LGBTQ community. The GLSEN 2013 National School Climate Survey
found that fewer than 5% of LGBT students had access to health classes that displayed positive
representations of LGBT-related topicslxiv. Furthermore, in a survey conducted in 2015, only 12% of
participants reported that their sex education classes went over same-sex relationships lxv. Due to the lack of
dialogue occurring in the classroom, many LGBTQ youth opt to seek information online or from their peers.
The danger of this is that some information online can be too mature or not medically accurate for the child
seeking it be soliciting dubious advicelxvi.
Similarly, the urgency of addressing mental health in schools is immense. There is a plethora of
statistics that show the exigence of students needing the tools to not only recognize signs of mental illness,
but also feel like they have resources to utilize if they are struggling with one. More than half of mental
illnesses begin before the age of 14 even though the average person waits 10 years after the signs of their
first symptoms before asking for helplxvii. Also, the rate of teenagers experiencing major depression surged
nearly 40% from 2005 to 2014 which makes for an approximate 2.2 million children struggling with
depressionlxviii. Also, teen suicides between the ages of 15 and 19 have spiked by a third for boys and has
doubled for girls between the years of 2007 and 2015lxix. But, this number only accounts for fatalities, as
about 9% of kids in high school reported that they attempted to commit suicide in 2015 lxx. Unfortunately,
only a narrow majority of states mandate suicide prevention training for faculty and less than a dozen states
require annual courses on suicide.
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Similar to sex education, mental health heavily effects African American or LGBTQ youth. And,
when the Trevor Project did a study this past year, they found that the intersection of black and LGBTQ
youth has more of a risk of having mental health problems than any other combination of race, gender, and
sexuality. Myeshia Price-Feeney, who is a research scientist, said that the discrimination and ostracization
that is targeted at black LGBTQ youth is astronomical because not only are they dealing with racial
microaggressions, but they are also confronted with homophobic and possibly transphobic behaviors lxxi.
And, among those who reported that they considered suicide, only half of the black LGBTQ youth reported
seeing a counselor in comparison to the 60% of nonblack LGBTQ youth . Though there is not one clear
answer, the lack of accessibility offers one, as many public schools do not have trained counselors that have
sensitivity to these types of life experiences, and mental health is not often spoken about as a problem for
the black community. Price-Feeney adds that the solution to rates of crimes in Chicago is almost always lxxii
to meet it with increased police presence. So, if public schools are not becoming more aware and
inclusive in their health education system, kids, especially those who identify with the black or LGBTQ
communities, are not getting the resources they need when grappling with life-threatening mental health
issues.
However, this is an issue that does not solely affect children. In recent years, the world has seen
multiple celebrities, such as Kate Spade, who seem to “have it all” fall victim to suicide. The lack of
resources and conversation is allowing people to feel helpless as they do not have the tools to express that
they need help. Moreover, the negative repercussions of mental health are something that affects our
national safety. In a study done by Tristian Bridges and Tara Leigh Tober, they linked how the mental
health of American men is connected to the astronomical number of mass shootings lxxiii. They cite that the
way men are raised in the United States, a nation that promotes hegemonic masculinity, stunts emotional
growth in men, which causes them resort to violence when their identity as a male is questioned or they
exhibit aggrieved entitlement. With so much societal change happening, men, who may feel threatened by
the increasing rights of their female counterparts or the acceptance of same-sex relationships, are
increasingly showing signs of mental health issueslxxiv. Because of this, there is a real need for a
comprehensive and multi-perspective mental health education program in schools.

Current Proposals to Remedy

REHYA

Introduced to the House of Representatives on May 14, 2019, the Real Education for Healthy Youth
Act (REHYA) aims to fund training on sex education and provide grants for comprehensive sex education
to programs that have an influence on youth health and education or experience with training on sex
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educationlxxv. REHYA would also mandate the inclusion of LGBTQ youth in these funded programs and
withhold federal funding from programs that do not incorporate the needs of LGBTQ youth lxxvi. This piece
of legislation provides curricula that include information on prevention of unintended pregnancies, sexually
transmitted infections, sexual abuse, dating violence, bullying, and harassment lxxvii. It also encourages
healthy relationships and advocates for teenagers to be able to have access to accurate information about
sexual healthlxxviii. Finally, this legislation would get rid of federal funding for sexual risk avoidance
education programs and reallocate the money towards a new comprehensive grant program. To survey the
public opinion on this issue, the Human Right’s Campaign Foundation did an analysis of the data- which
included 96% Democrats, 89% Independents, and 86% of Republicans- and found that though 91% of US
adults believe that teenagers engaging in sex before marriage is wrong, 91% of adults still contend that sex
education in public schools should be incorporatedlxxix.

H.R.1109 - Mental Health Services for Students Act of 2019

This proposed piece of legislation, which was introduced to a House Committee on Energy and
Commerce this past February, aims to aid students regarding mental health in many ways lxxx. If passed, it
will give funding for public schools to partner with their local mental health professionals to create on-site
mental health care services for students. This piece of legislations aims to keep the cost of mental health
services low, to save lives by preventing suicide for at-risk youth, and to address mental health while kids
are young before they fall deep into a mental illness and may resort to crime or drug use lxxxi.

Drawbacks

Though both pieces of legislation create a groundwork for positive change in communities who
have not yet made accessible sex or mental health education for youths, both pieces of legislation have their
respective drawbacks. Starting with REHYA, a major problem with this piece of legislation is how it will
cause tension with people who do not believe that their children should be learning about sex due to their
religious beliefs. Because of this, politicians whose constituents are devoutly religious, who denounce sex
before marriage, are not going to pass this piece of legislation. Then, regarding the Mental Health Services
for Students Act, though this bill advocates for a lot of good, the one thing it does not address is how
implementing these counselors and educators is going to change the dialogue to be more inclusive of all
gender and sexual identities when it comes to mental health. Without explicitly incorporating this idea into
the agenda of this piece of legislation, it is possible that the lack of cognizance in addressing all perspectives
on mental health could end up allowing the states to ignore the kids who need the resources the most.
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State-level Action
At the state level, an everyday citizen can use their voting power in order to promote the
streamlining of sex and mental health education into their public schools. One of the most effecting things
they can do is to contact their state representatives. By any means one can do so, they can use their role as a
constituent in order to advocate for the passage, or the reformation, of legislation as well as the expansion of
grants for comprehensive sex programs. This is an effective way of affecting change because at the end of
the day, if a representative is not being responsive to what their constituents want, their incumbency can be
put in question as there are many other people who could better fill their role. So, if the representative is not
advocating for these pressing issues, people can rally together to vote for another representative in the next
election cycle.

Local-level Action

Something that was expressed in this issue brief was that sometimes individual school districts can
get away with not including certain standards if it is merely suggested in that state. On a local level,
whatever public-school district a citizen is affiliated with, it can be beneficial to start a conversation at either
a town hall or with the administration about the importance of the inclusion of mental health and sex
education. Beyond this, citizens can talk to other people in their respective area- whether it be parents,
students, or associations that are affiliated with their school district- to gain more support on this issue
which will, in turn, put more pressure on the individual school district to respond and act the issue.

Conclusion

Amidst the number of many contested political issues in the nation right now, the approach to
creating a more streamlined health class for all public high schools may seem insignificant. However, by
refusing kids and teenagers the access to medically accurate and useful information regarding their own
sexual and mental health, they are going to lose out on the life skills they need in order to be the most
successful they can be. It is a popular notion that older people look to the next generation to solve the
world’s problems. But, how can the next generation do so when they are struggling with historically high
suicide and mental illness rates, as well as not being taught to maintain healthy relationships in their life?
With the implementation and enforcement of a more inclusive and comprehensive health education,
children will grow up with the sentiment that they do not have to choose between their health and pursuing
their dreams because they will know how to balance both.
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i

Lincoln Journal Star, “Bruning charges 22-year-old man married to 14-year-old girl,” available at
https://journalstar.com/news/local/bruning-charges--year-old-man-married-to--year/article_c1b22d98-517f-55e6-b003-
c6108cf47568.html (last accessed April 2020)
ii

Ibid
iii

Ibid
iv

Lincoln Journal Star, “Years after controversial marriage, Falls City couple at risk of losing children,” available at
https://journalstar.com/news/local/years-after-controversial-marriage-falls-city-couple-at-risk-of/article_16b4ea35-a638-
5d92-923c-c9d43fcb2c31.html (last accessed April 2020)
v

American Psychological Association, “APA issues first-ever guidelines for practice with men and boys”, available at
https://www.apa.org/monitor/2019/01/ce-corner (last accessed April 2020)
vi

Ibid.
vii

Ibid.
viii

Ibid.
ix

Ibid.
x

xi

National Academy of Sciences, “Defining a Comprehensive School Health Program: An Interim Statement”, available at
https://www.ncbi.nlm.nih.gov/books/NBK231148/ (last accessed April 2020)
xii

Ibid.
xiii

Ibid.
xiv

Ibid.
xv

Ibid.
xvi

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (1) (last accessed April 2020)
xvii

Ibid.
xviii

Guttmacher Institute, “New Name, Same Harm: Rebranding of Federal Abstinence-Only Programs”, available at
https://www.guttmacher.org/gpr/2018/02/new-name-same-harm-rebranding-federal-abstinence-only-programs?
gclid=Cj0KCQjwm9D0BRCMARIsAIfvfIZaWhHpskJ1qlu4CgfodyyqXO_lYTCyDgx-i7ij_Tu-
9T0nOjM689UaAgt1EALw_wcB

xix

American College of Obstetricians and Gynecologists, “Comprehensive Sexuality Education”, available at

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/11/comprehensive-sexuality-education
(last accessed April 2020)
xx

Mental Health First Aid, “New York and Virginia Pave the Way with Mental Health Education Laws”, available at
https://www.mentalhealthfirstaid.org/external/2018/06/new-york-virginia-pave-way-with-mental-health-education-laws/
(last accessed April 2020)

xxi

Today, ”Today analysis: More states requiring mental health education by law”, available at
https://www.today.com/health/today-analysis-more-states-requiring-mental-health-education-law-t162822 (last accessed
April 2020)
xxii

Ibid.
xxiii

Centers for Disease Control and Prevention, “National Health Education Standards”, available at
https://www.cdc.gov/healthyschools/sher/standards/index.htm (last accessed April 2020)
xxiv

Ibid.
xxv

Centers for Disease Control and Prevention, “Promoting Healthy Behaviors”, available at
https://www.cdc.gov/healthyschools/healthybehaviors.htm (last accessed April 2020)
xxvi

Centers for Disease Control and Prevention, “Social and Emotional Climate”, available at
https://www.cdc.gov/healthyschools/sec.htm (last accessed April 2020)

xxvii

 “State-Level School Health Policies and Practices”, Centers for Disease Control and Prevention (2006) available at,
https://www.cdc.gov/HealthyYouth/SHPPS/2006/summaries/pdf/State_Level_Summaries_SHPPS2006.pdf
xxviii

“State-Level School Health Policies and Practices”, Centers for Disease Control and Prevention (40)(2006) available at,
https://www.cdc.gov/HealthyYouth/SHPPS/2006/summaries/pdf/State_Level_Summaries_SHPPS2006.pdf ; Planned
Parenthood, “What’s the State of Sex Education In the US”, available at https://www.plannedparenthood.org/learn/for-
educators/whats-state-sex-education-us (last accessed April 2020)

xxix

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (7) (last accessed April 2020)

xxx

Ibid.
xxxi

Ibid.
xxxii

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (9) (last accessed April 2020)
xxxiii

Ibid.
xxxiv

Ibid.
xxxv

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (2) (last accessed April 2020)
xxxvi

Ibid.
xxxvii

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (10) (last accessed April 2020)
xxxviii

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (12) (last accessed April 2020)
xxxix

Ibid.
xl
 “State-Level School Health Policies and Practices”, Centers for Disease Control and Prevention (40)(2006) available at,
https://www.cdc.gov/HealthyYouth/SHPPS/2006/summaries/pdf/State_Level_Summaries_SHPPS2006.pdf
xli

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (11-12) (last accessed April 2020)
xlii

Ibid.
xliii

Ibid.
xliv

Ibid.
xlv

Guttmacher Institute, “Sex and HIV Education”, available at, https://www.guttmacher.org/state-policy/explore/sex-and-hiv-

education?gclid=Cj0KCQjw-Mr0BRDyARIsAKEFbeeiRX-oHJxUNguEzf3YO7OsrACN1z-
xT5_FGWmqW1r49dtV32gx2TsaAqWBEALw_wcB (last accessed April 2020)

xlvi

Ibid.
xlvii

Ibid.
xlviii

Ibid.
xlix

Ibid.
l

Ibid.
li

Ibid.
lii

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (11-12) (last accessed April 2020)
liii

Ibid.
liv

Ibid.
lv

Ibid.
lvi

Ibid.
lvii

Today, ”Today analysis: More states requiring mental health education by law”, available at
https://www.today.com/health/today-analysis-more-states-requiring-mental-health-education-law-t162822 (last accessed
April 2020)
lviii

Planned Parenthood, “History of Sex Education in the US”, available at

https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-
a446d90fd1e3/20170209_sexed_d04_1.pdf  (13-14) (last accessed April 2020)
lix

Ibid.
lx

Ibid.
lxi

Ibid.
lxii

Planned Parenthood, “The Healthy Youth Act”, available at https://www.plannedparenthoodaction.org/planned-

parenthood-advocacy-fund-massachusetts-inc/issues/healthy-youth-act (last accessed April 2020)

lxiii

Ibid.
lxiv

GLSEN. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and
transgender youth in our nation’s schools. New York: Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M.
J. (2014).
lxv

Human Rights Campaign, “A Call to Action: LGBTQ Youth Need Inclusive Sex Education”, available at
https://www.hrc.org/resources/a-call-to-action-lgbtq-youth-need-inclusive-sex-education (last accessed April 2020)

lxvi

Ibid.
lxvii

PEW Institute, “Many Recommend Teaching Mental Health in Schools. Now Two States Will Require It”, available at
https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/06/15/many-recommend-teaching-mental-health-
in-schools-now-two-states-will-require-it (last accessed April 2020).
lxviii
 Ibid.
lxix

Ibid.
lxx

Ibid.
lxxi

NBC News, “Black LGBTQ youth, despite high levels of mental health issues, receive less professional care, study says”,
available at https://www.nbcnews.com/news/nbcblk/black-lgbtq-youth-despite-high-levels-mental-health-issues-receive-
n1137741 (last accessed April 2020).
.
lxxii

Ibid.
lxxiii

Tristian Bridges and Tara Leigh Tober, “Mass Shootings Masculinity, and Gun Violence as Feminist Issues” SocArXiv
Papers (2018)
lxxiv

American Psychological Association, “The men America left behind”, available at,
https://www.apa.org/monitor/2017/02/men-left-behind (last accessed April 2020).

lxxv

Human Rights Campaign, “Real Education for Healthy Youth Act”, available at, https://www.hrc.org/resources/real-
education-for-healthy-youth-act (last accessed April 2020)
lxxvi

Ibid.
lxxvii

Ibid.
lxxviii

Ibid.
lxxix

Ibid.
lxxx

Congress.GOV, “H.R.1109- Mental Health Services for Students Act of 2019”, available at
https://www.congress.gov/bill/116th-congress/house-bill/1109/text (last accessed April 2020).
lxxxi

Ibid.

Image References (in order of appearance):

1. Warren County New York Website: https://warrencountyny.gov/healthservices/education.php
2. APA Guidelines for Psychological Practice with Boys and Men: https://www.apa.org/about/policy/boys-men-
practice-guidelines.pdf
3. Mental Health America: https://www.mhanational.org/issues/ranking-states
4. Vox.com: https://www.vox.com/2016/1/10/10738766/sex-ed-states-maps