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Sex education: A review of its effects

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Archives of Sexual Behavior, Vol. 10, No.2, 1981

Sex Education: A Review of Its Effects

Peter R. Kilmann,Ph.D., Richard L. Wanlass,
1.2 B.A., 1

Robert F. Sabalis, Ph.D., and Bernard Sullivan,

1 B.A.

This paper reviewed 33 empirical studies which assessed the effectiveness of

sex education. Methodological issues were considered within six sections:
(a) populations, (b) instructors, (c) program formats, (d) time format, (e)
program goals, and (f) outcome measures. College students were the most
frequently assessed population, followed by educators and counselors, and
then medical-school populations. Most investigators did not include control
subjects. In the studies which included them, they were usually nonequiva-
lent to the experimental subjects. The results were almost exclusively
dependent upon questionnaire data. Only a few studies included a follow-
up. In general, the subjects reported gains in sexual knowledge and shifts
toward more tolerant and liberal sexual attitudes. However, it was not clear
whether or to what extent these changes affected the subjects' behavior. The
surprising lack of studies evaluating the effects of sex education on ele-
mentary, junior high, and high school students-was noted in light of the
controversy surrounding the presentation of sex-related information to
these populations. In addition to the recommendation that sex education
presented to "normal" students who are below the college level should be
evaluated, suggestions for future research included the use of equivalent
experimental and control subjects, the reporting of instructor character-
istics, the specification of program goals, and the inclusion of follow-up
evaluations.

KEY WORDS: sex education; college students; educators; counselors; medical school popula-
tions; human sexuality.

'University of South Carolina, Columbia, South Carolina.

'All correspondence should be sent to Peter R. Kilmann, Department of Psychology, Univer-
sity of South Carolina, Columbia, South Carolina 29208.

177
0004-0002/81/0400-0177$03.00/0 © 1981 Plenum Publishing Corporation
178 Kilmann, Wanlass, Sabalis, and Sullivan

The topic of sex education historically has generated considerable contro-

versy and emotion. For example, despite the dearth of empirical evidence /;:,~..
that sex education is dangerous or that it fosters sexual acting-out, radical ~
conservative groups, religious fundamentalists, and uninformed parents
have offered anti-sex-education opinions. Many of these people believe that
sex education fosters sexual curiosity and a resultant increase in sexual
experimentation (Libby et al., 1974). On the other side of the issue are those
who believe that sex education should be a vital aspect of the educational
process (e.g., Burleson, 1976; Hayman, 1970; Levine, 1962).
To date, the issues of whether, when, and how information about sex
should be communicated have not been satisfactorily resolved. The
continuing controversy surrounding the topic of sex education highlighted
the importance of conducting a comprehensive, up-to-date literature review
with the purpose of determining its effects. Kirkendall and Miles (1968)
reviewed the early sex-education literature. However, a number of studies
have examined the effects of sex education since this review was completed.
Voss (1980) evaluated some of these more recent studies. However, a sub-
stantial portion of the studies included in her review did not attempt a
formal assessment of program effectiveness. In addition, neither of these
reviews included a comprehensive methodological evaluation of the
literature.
This paper reviewed the studies which have assessed the impact of
various sex-education formats using at least a pre/post-experimental design
with statistical analyses. Strict adherence to this criterion resulted in the
exclusion of studies within four categories: (a) studies that described a sex-
education program but did not evaluate its effects (Kleinerman et al., 1971);
(b) studies that presented sex education to sexually dysfunctional males and
females but did not isolate the effects of this intervention on treatment out-
come (see Kilmann, 1978; Kilmann and Auerbach, 1979; Sotile and
Kilmann, 1977); (c) studies that merely administered questionnaires to
subjects at one time period (e.g., Gough, 1974; Richards, 1978; Spanier,
1976); (d) studies that did not conduct a statistical analysis of the data (e.g.,
Golden and Liston, 1972; Rees and Zimmerman, 1974). Sex education was
defined as any attempt to communicate sex-related information as part of
an educational format.
From a literature review conducted in March 1980, only 33 studies that
met the criteria for inclusion stated above were found. The first part of this
paper evaluates the methodological characteristics of these studies within
six sections: (a) populations, (b) instructors, (c) program format, (d) time
format, (e) program goals, and (f) outcome measures. Next, the studies are
reviewed and summarized within four main headings, which refer to the
populations that have received sex education: medical school populations,

/
 Sex Education 179

college students, educators and counselors, and miscellaneous populations.

r: Subsequently, conclusions and implications of the review for future
research are discussed.

METHODOLOGICAL EVALUATION

Populations

The table shows that the most frequently assessed population in this
review was college students (e.g., Vennewitz, 1975), followed by educators
and counselors from varied occupational settings (e.g., Flatter, 1975;
Richardson, 1976), and medical-school populations (e.g., Marcotte, 1973).
Overall, only a small number of studies randomly assigned subjects to ex-
perimental and control conditions (Dykstra, 1978; Krizmis, 1978; Nagy,
1978; Orlovick, 1979; Vennewitz, 1975; Voss and McKillip, 1979). Only one
study attempted to match subjects on relevant variables (Marcotte and
Logan, 1977). Data were frequently incomplete because both responding to
questionnaires and attendance at 'sex-education programs often were
voluntary (Garrard et al., 1972; Marcotte and Logan, 1977; Mims et al.,
1974).
Student motivation was not systematically investigated although it
may be an important element in the success of the course. Attendance at
some courses was voluntary (Barnum, 1974), whereas at others it was man-
datory (Mims et al., 1976). Courses were graded in some studies (Krizmis,
1978) but not in others (Reichelt and Werley, 1975). Students in a course
that is mandatory and/or graded may learn differently from students
who are in an elective and/or ungraded course. Only a few studies
attempted to control for informal or nonspecific learning of sexual
material and/or motivational factors (e.g., Karas and Elliott, 1972; Zucker-
man et al., 1976). No study systematically evaluated subject variables in the
determination of the relative effectiveness of programs for specific popula-
tions.

Instructors

The instructors were varied in terms of professional identity, affilia-

tion with the agency sponsoring the program, age, sex, and previous educa-
tion and training (see Table I). Instructors included psychology professors
(Zuckerman et aI., 1976), nursing instructors (Woods and Mandetta,
1975a), physicians (Garrard et al., 1972), doctoral students (Dykstra, 1978),
 Table I. Methodological Summary of Sex-Education Studies •...
00
0
Program Time Program Outcome
Study Population instructors format format goals measures
Barnum 64 teachers Not reported Process-oriented 18 Y, hours over To train teachers I. Sex knowledge
(1973) and education sex education one weekend to deal with the 2. Attitude toward premarital
students who workshop cognitive and af- sexual behavior
volunteered to fective aspects of 3. Attitudes toward sexual be-
participate in a teaching sex havior and ways of express-
sex education education ing sexuality
workshop 4. Attitudes toward their own
sexual behavior

Bernard 275 undergrad- Different 24 lectures and Semester-long Not reported 1. Sex Knowledge Question-
(1973) uates (experi- specialists in the weekly discus- course naire
mental group), area of sex sion groups 2. Attitude Survey
93 undergrad- served as lee- 3. Personal History Question-
uates (first con- turers-trained naire (Measure of Sexual
trol group), 48 student volun- Behavior)
undergraduates teers served as 4. Sex Guilt Inventory
randomly chosen discussion-
from university group leaders ~
population (see-
ond control
.,
3'
=
?
group)
.=,
~
Bloom 34 emotionally Not reported Course in sex 12 weeks To impart 1. Sex Knowledge Inventory or
(1969) disturbed and 31 education knowledge, de- 2. Information Test on .'"'"
physically dis-
abled l lth- and
velop adoles- Human Reproduction .,or
00

cents' under- 3. IP AT Anxiety Scale !:?

l Zth-grade
students
standing of
themselves as
4. Taylor Manifest
Anxiety Scale .,
c;;.

sexual beings, 5. Mooney Problem Check =

Co
00
and reduce List §:
anxiety
.,=
~.

u
 rJJ
Brantlinger 109 residential- Not reported Workshops on I-day workshop Encourage resi- I. Sexuality and the Mentally ••><
(1979) care staff for the the sexual needs dential-care staff Retarded Attitude t'1
c.
mentally re- and rights of the to allow for nor- Inventory
tarded mentally re- mal sexual devel-
=
(")

~
tarded opment and ex- o·
pression by the =
mentally retarded

Byrd (1978) 100 under- 4 instructors Human sexuality I college semes- Not reported I. Sex Knowledge inventory
graduates (each teaching course-eight see- ter 2. Measure of Sexual Guilt
one experimen- tions-identical 3. Measure of Sexual Attitudes
tal and one con- in content except 4. Measure of Sexual Behavior
trol group) that sexually ex-
plicit films shown
in half and audio
tapes covering the
sametopics played
in the other half

Davidow 22 university Not reported Lectures, films, 14 4-hour ses- Not reported 1. Sex Information Test
(1976) students outside speakers, sions over a pe- 2. Sex Attitude Questionnaire
and small-group riod of 2V, 3. Sex Behavior Questionnaire
discussions weeks

Doyle (1976) 45 male and Not reported 1. Panel discus- 7 5-hour sessions I. Pre- and posttreatment interview
female graduate sions among 2. SKAT
students with course instruc- 3. Test of Diagnostic Awareness for Sexual Prob-
professional ex- tors lems
perience in 2. Large-group 4. Self-rating of confidence during interview
counseling discussions
3. Small-group
discussions
with struc-
tured experi-
ences, such as •..
counseling
role-play
•..
00
 -
00
N

Table I. Continued

Program Time Program Outcome

Study Population Instructors format format goals measures

Dykstra (1978) Experimental Small-group 9 lectures each 2 weekends Not reported I. SKAT
group-54 in- leaders were 5 followed by 2. Schiller Inventory
structors who doctoral stu- small-group
elected to take dents in counsel- discussions
the course; con-
trol group-12
students in a
graduate educa-
tion course

Elwood 26 institutional- I. Lecture 2 hours To reduce anxi- I. SKAT

(1978) ized, physically 2. Films ety and change 2. IPAT Anxiety Scale
~
disabled males
(18 spinal in-
3. Group discus-
sions
sexual attitudes 3. Self-Actualizing Love Scale
.,
3"
jured and 8 =
?
others with
various physical .,~
injuries) =;.;-
'"
:!'
.,~
tr:

~
u;.
Flatter
(1975)
341 educators
(teachers and
Guest speakers
considered
I. Lectures
2. Small-group
6-day intensive
workshops
To increase tol-
erance of sexual
l. Research Questionnaire
on Sex .,
counselors) knowledgable discussions attitudes and be- =
Co.
tr:
about sexual haviors that dif-
~
fer from one's
own .,
::;.
=
 IJJ
72 medical Not reported I. Films 2-day intensive I. SKAT
Garrard et al.,
(1972) students 143 2. Slides programs
I. Demytholo-
gize sexual be- 2. Adjective Checklist
••"
t'l
Q,
others 3. Large and havior 3. Attitude Rating Scale c
....
small-group 2. Desensitize to
discussions sexual stimuli
ao·
3. Increase un- =
derstanding
of sexuality of
self and others

Garrard, 205 male med- Not reported I. Films 2-day seminar To develop toI- l. SKAT
et al., (I 976) ical students 2. Slides and 18 hours erance and un- 2. Attitude Questionnaire
3. Large and (over 2 weeks) derstanding of
small group of diadactic pre- one's own and
discussions sentation others' sexuality
4. Lectures
5. Counseling
demonstra-
tions

Iverson (I973) 135 middle-class Sex-education Not reported Not reported I. Sexual Liberalism Conser-
suburban adoles- course offered vatism Scale
cents by Unitarian 2. Omnibus Personality In-
churches ventory (Complexity and
Autonomy Scales)
3. Measure of Sex-Role
Stereotyping

-....
00
 Table I. Continued 0-
00

Program Time Program Outcome ""

Study Population Instructors format format goals measures

Karas and Teachers (29 in Not reported I. Sensitivity- 6 weeks To impart I. Sex Knowledge Inventory
Elliot (1972) experimental group training knowledge for 2. Attitude Scale Toward Sex
group, 20 in con- 2. Interdis- teaching sex edu- 3. Semantic Differential Tests
trol group) ciplinary in- cation in kinder-
struction in garten through
human sexual- 9th grade
ity
3. Guidance with
curriculum de-
velopment and
syllabus prep-
aration
4. Practical ex-
perience

Krizmis (\ 978) Experimental Not reported I. Sexually ex- I academic term To dispel myths, I. SKAT
group-13 males plicit films taboos, and ste- 2. Sexual Adjustment Inven-
and 17 females and slides reotypical beliefs tory
z::
enrolled in hu- 2. Lectures by related to sexual 3. Sexuality Comfort Scale 3
~
man sexuality authorities in behavior and to =
-=
course; control the field facilitate normal
group-1O males 3. Small-group adjustment
~
~
and II females discussions ;=-
V>
enrolled in other ~
psychology ~
[I)

courses e:r
!2.
;;;.
Lamberti and 138 medical Medical faculty I. Lectures 2-day intensive I. Impart know 1- I. SKAT ~
Chapel (1977) students, and male and fe- 2. Films program edge 0 f sexual =
Co
[I)
spouses, and male small-group 3. Slides behavior §:
faculty cofacilitators 4. Panel discus- 2. Modify atti- :;;.
sions tudes ~
=

"
 [IJ
5. Small-group 3. Develop to
><
discussions skills in deal- t"l
0.
ing with sex-
,.,
::
ual dysfunc- ~
tions o·
:s
Mandetta 23 undergradu- Nursing faculty I. Lectures I semester I . Increase sex- I. Human Sexuality Knowl-
and Woods ates 2. Small-group ual knowledge edge and Attitude Inventory
(1974); Woods discussions 2. Increase
and Mandetta 3. Independent awareness of
(1975a) study projects ones' own feel-
study projects ings, attitudes,
and values
about sex
3. To increase
tolerance and
understand-
ing of others'
sexuality

Marcotte and Medical students Not reported I. Elective course 22 hours I. To increase I. SKAT
Kilpatrick enrolled in 2 utilizing films, tolerance and
(1974) courses: (a) one videotapes, acceptance 0 f
elective; (b) one lectures, and the sexual at-
required group discus- titudes of
sions others
2. Required 2. To impart
course util- sexual knowl-
izing chiefly edge
a lecture for-
mat with
sparse audio-
visual aid and

-
group discus-
sion
..,.
00
 Table I. Continued
-
00
0-

Program Time Program Outcome

Study Population Instructors format format goals measures

Marcotte and 240 2nd-year Not reported Lectures, discus- 3-day intensive I. To present I. Sexual Attitude and Behav-
Logan (1977) medical students sions, films program factual infor- ior Scale
mation 2. Attitudes Toward Women
Scale
2. Expose stu- 3. Rokeach D-Scale
dents to differ-
ing sexual atti-
tudes and
3. Provide prac-
tice in skills
such as sexual-
history taking

Mims, eta!. 70 medical stu- Interdisciplinary Lectures, role- 5-day intensive I. Increase sex- I. SKAT
(1974) dents, 37 nursing playing, films, program ual knowledge
students, 14 videotapes, 2. Desensitize to ~
others slides, live inter- sexual stimuli .,
3"
views, and small-
group discus-
3. Broaden
understanding
=
?
sions of self and .,
~
others =
iO
'"
Nagy (1978) Undergraduates:
experimental
Not reported Human sexual-
ity course
10 weeks Not reported I. Mosher Forced Choice
Guilt Inventory
.,
::'
tr:
a-
group-70 stu- 2. Sex Guilt Subscale a
dents in human 3. Bern Sex-Role Inventory .,
,Pl"
sexuality course;
control group-
4. Attitude Measure of Sexual =
Q,
tr:
Behaviors
§:
67 students in
other courses .,~.
=

"
 00
Orlovick 50 adults who re- Not reported Lectures fol- Weekend semi- I. Mosher Forced-Choice to
(1979) gistered to take lowed by related nar Guilt Inventory "
r"!l
Q.
part in the study: sexually explicit 2. SKAT ..,
e
experimental films followed 3. Mood List ~
group-31; con- by small-group 4. Sexual Self-Disclosure s
trolgroup-19 discussions Questionnaire =

Poinsett 20 school per- Not reported Experimental Not reported Not reported I. Inventory of Sexual Atti-
(1976) sonnel involved workshops on tudes
in the education "Promoting Po- 2. Self-report of involvement
of handicapped sitive Social-Sex- in teaching sex education
children ual Functioning to the handicapped
in Handicapped
Children"

Reichelt and 367 females Young staff "Rap sessions" I meeting To provide sex I. Questionnaire of Sex
Werley (1975) under 18 years members information to Knowledge
of age coming to adolescents
Teen Center for
birth control pills

Richardson Health-care pro- "Qualified Workshop deal- Not reported To meet the edu- Attitude and cognitive tests
(1976) fessionals faculty" ing with sexual cational needs of
dysfunction re- the workshop
suiting from dis- population
abilities, diseases,
alcohol, drugs,
aging, and homo-
sexuality (con-
tent based on re-
sults of a needs-
assessment ques-
tionnaire)
-
00
-..j
 Table I. Continued -
00
00

Program Time Program Outcome

Study Population Instructors format format goals measures

Shofer (1973) College students Not reported Lectures, guest I semester Not reported I. Tennessee Self-Concept
enrolled in either speakers, small- Scale
a sex-education group discus-
course or another sions
health-education
course
Story (1979) Experimental Not reported Lecture! discus- 48 hours dis- Not reported Likert-type scale reflecting
group-l27 un- sion, audiovisual distributed over attitudes about sexual be-
dergraduates en- presentations, a 4-week sum- haviors of self and others
rolled in a sex guest speakers, mer session
course; control small-group or a 16-week
group-I 14 un- discussion course
dergraduates en-
rolled in a human
communications
course
~
Vennewitz Experimental Not reported College human
3"
I academic term Not reported I. Sexual Knowledge and atti- ••
(1975) group-167 sexuality course tude Instrument-devel- .=e
undergraduates oped by the author
~
enrolled in hu- 2. Premarital Sexual Perm is- ••=
man sexuality
course; control
si veness Scale
;
group-89 under- rJl

graduates who
••
a'
!2.
had signed up for ~.
the course but ••=
denied admission Q.
rJl
because of en- §:
rollment limita- <.
tions ••=
Vorgeas College freshman Not reported Group l-en- 1 semester Not reported 1. Measure for Sex Knowl- rn
(1973) rolled in course edge and Attitudes '..,"
trl
in family life and 2. Psychophysiological mea- Q.

sex education; sures while exposed (audi- ='"

!!?.
Group 2-issued tory or visual presentation) o·
text for course to emotionally charged =
but did not at- sexual content
tend classes;
Group 3-no in-
tervention

Voss and Male and female Trained leaders Intensive work- Weekend 1. To develop Sex questionnaire with scales
McKillip volunteers from shops involving more tolerant for knowledge, attitudes, and
(1979) the university small-group dis- sexual atti- behavior.
and surrounding cussions, large- tudes
communities group activities, 2. To increase
and sexually sexual knowl-
explicit films edge
3. To increase
range of sex-
ual behaviors
to the extent
desired by the
individual

Woods and Experimental Not reported Human sexuality 1 semester 1. Increase sexual Human Sexuality Knowledge
Mandetta group-75 male course utilizing knowledge and Attitude Inventory
(1975b) and female lectures and 2. Increase
undergraduates small-group dis- awareness of
enrolled in arts cussions one's own feel-
and sciences and ings, attitudes,
nursing and values
about sex

-
00
\0
 -
ID
o

Table I. Continued

Program Time Program Outcome

Study Population Instructors format format goals measures

Zuckerman Experimental Psychology pro- Lectures, explicit 14 weeks Not reported I. Parental Attitude Scale
et al. (1976) group-321 sin- fessor movies and 2. Heterosexual Experience
gle undergrad- slides, guest Scale
uates enrolled in speakers, panel 3. Number of Heterosexual
sex course; con- discussions, Partners Scale
trol group-234 small-group dis- 4. Homosexual Experience ~
undergraduates cussions Scale .,
3"
enrolled in per-
sonality psychol-
5. Number of Homosexual
Partners Scale
==
ogy course 6. Masturbation Scale .,
~
7. Orgasmic Experience Scale =[
!f'
.,r::r
fIl

~
:;; .
.,
=
Q.
fIl
§:
.,=
:;;.

"/
 Sex Education 191

and interdisciplinary teams (Lamberti and Chapel, 1977; Mims et al., 1974).
In some cases, the instructor was a single individual, while in other cases
male-female teams were involved (Garrard et al., 1972; Lamberti and
Chapel, 1977; Marcotte, 1973). Most instructors were regular members of
institutional faculties or "volunteers" (Mims et al., 1976). In some
instances the instructors were not specified (Marcotte and Logan, 1977;
Richardson, 1976). Some investigators reported that the instructors received
some type of training as preparation for teaching sex education (Mims et
al., 1976), but in most cases the preparation of the instructors was not
specified. Thus, it was not possible to determine the impact of the
instructor's knowledge or background on outcome. Only one study
(Dykstra, 1978) assessed the effect of instructor characteristics on program
effectiveness.

Program Format

The majority of sex-education programs were multimodal in approach

(see Table I), consisting of some combination of group discussion, lecture,
audio-visual aids, panel discussions by "experts," and guest speakers (e.g.,
Lamberti and Chapel, 1977; Mims et al., 1976). Some courses also incor-
porated role-playing experiences and live interviews as a part of the learning
process (Mims et al., 1974). Sensitivity group training was sometimes used
as the primary mode of instruction (Karas and Elliot, 1972). While the value
of small-group discussion frequently was stressed, no study contrasted the
effects of this intervention with other education components. Only one
study (Byrd, 1978) attempted to separate the influence of specific program
components.

Time Format

Table I shows that program formats varied substantially in spacing

and sequencing. Some programs met regularly over the course of a semester
(Byrd, 1978), while others occurred in massed intervals of 2 days (Garrard
et al., 1972; Lamberti and Chapel, 1977), 3 days (Mims et al., 1976), or 5
days (Mims et al., 1974). One study investigated a program which
consisted of a 2-day concentrated seminar with a 2-week didactic pro-
gram (Garrard et al., 1976). While opinions have been offered that the
shorter, more concentrated programs are superior to longer ones in that
interest does not lag and interdisciplinary staffs can be assembled (Mims et
01., 1974), this notion has not yet been tested.
Only a few studies conducted a follow-up evaluation of outcome. For
example, Richardson (1976) evaluated behavior change as a result of attend-
ing a sexuality workshop 11 weeks after the workshop. Garrard et al. (1976)
192 Kilmann, Wanlass, Sabalis, and Sullivan

attempted to evaluate long-term results at both 6 months and 1 year after

the program. However, because of insufficient methodological controls it is
impossible to discern whether changes in knowledge and attitude
(particularly in the semester-long programs) were attributable to program
participation or to maturational factors. Thus, the data mainly provide
information on shortterm effects.

Program Goals

The goals of the sex-education programs were varied and often not
operationalized (see Table I). For example, Marcotte and Kilpatrick (1974)
described two sex-education programs for medical students, one designed
"to impart intellectual knowledge about sexuality to participants," the
other "to promote the acceptance of others' differing sexual attitudes."
The authors stated that "changes in students' personal sexual attitudes are
not considered to be essential." Other program goals included extinguishing
sexual anxiety (Marcotte, 1973), preparing teachers of sex-education
courses (Karas and Elliot, 1972), and promoting greater interest in sex edu-
cation for target populations (Brantlinger, 1979; Poinsett, 1976). Since
similar programs were designed for different purposes, it was not possible
to assess the relationship of goals and methods of presentation.

Outcome Measures

Table I shows that a variety of outcome measures were used. The Sex
Knowledge and Attitude Test (SKAT) was used most frequently (e.g., Lam-
berti and Chapel, 1977). Other measures included questionnaires that
assessed sexual behavior (e.g., Zuckerman et al., 1976), or sexual attitudes
(e.g., Garrard et al., 1972). All of the attitude measures depended upon the
subjects' self-reports and were thus susceptible to social desirability and
expectancy factors. The reliability and validity of many of these measures
were not reported.

REVIEW

Medical-School Populations

Seven studies investigated the effects of sex education in medical

school settings. Mims et at. (1974) reported on a 5-day human sexuality pro-
Sex Education 193

gram for medical and nursing students. The course was required for some
of the students and optional for others. The participants showed increased
sexual knowledge and more liberal sexual attitudes (except about abortion).
In a subsequent study of a more concentrated, 3-day program, Mims et at.
(1976) found similar results: knowledge scores increased significantly, and
there was a significant shift toward more liberal attitudes (except about
abortion).
Marcotte and Kilpatrick (1974) investigated the impact of a 22-hour
elective sexuality course. Knowledge of sexuality increased significantly and
sexual attitudes showed a significant shift in the liberal direction. In this
same article, Marcotte and Kilpatrick reported on a required 22-hour sex
education course developed simultaneously at the same medical school. No
significant changes in knowledge or attitudes were found.
Marcotte and Logan (1977) studied the effects of a 3-day sex-educa-
tion course. A matched sample of 41 students (a) increased their tolerance
of others' sexual behavior and fantasy, (b) became more tolerant of their
own sexual fantasies although no effect on their sexual behavior was noted,
and (c) showed less dogmatism in nonsexual opinions. Rather inexplicably,
they also showed less tolerance for women in nontraditional roles. Since
responding to the measures was optional, the results for the students who
chose to complete test batteries cannot be considered representative of the
group as a whole.
Garrard et at. (1972) investigated the effects of a 2-day voluntary
human sexuality course and found a significant change in the direction of
more tolerant attitudes, a significant increase in sexual knowledge, and sig-
nificantly greater acceptance of the varied sexual behavior of others. A sub-
sequent study included follow-up data (Garrard et al., 1976). As part of
their required curriculum, 205 male medical students participated in a 2-day
program. Sharp increases in the direction of more tolerant attitudes and a
greater amount of knowledge were found. Scores decreased somewhat from
their post-course peak during a follow-up, but scores at the 12-month point
were still significantly higher than those at pretesting. Participants in this
study and a related one (Rosenberg and Chilgren, 1973) almost uniformly
reported the sex-education course to be personally beneficial and indicated
that as a result of the experience they were able to discuss sex more freely
with others. The inclusion of a I-year follow-up in this study is noteworthy.
Lamberti and Chapel (1977) assessed the effects of a sex-education
course that was also open to spouses and faculty. The course was attended
on an optional basis by approximately 90070of the first-year medical
students. The results showed a statistically significant shift toward more
liberal attitudes (except about abortion) and significant increases in sexual
knowledge.
194 Kilmann, Wanlass, Sabalis, and Sullivan

Summary

Sex education in the seven studies in this section typically consisted of

some combination of lectures, discussions, films, slides, role-plays and
patient demonstrations. Length of training ranged from semester-long
courses to shorter (2-3 days), more intensive programs, with the latter being
more common. In most cases, students were administered pre- and post-
training questionnaires designed to assess sexual knowledge and/or
attitudes. The studies were generally consistent in reporting gains in sexual
knowledge and shifts toward more tolerant, liberal attitudes about sexual
issues (e.g., Garrard et a/., 1972; Lamberti and Chapel, 1977; Mims et a/.,
1976). In three of these studies, however, attitudes about abortion did not
change (Lamberti and Chapel, 1977; Mims et al., 1974; Mims et al., 1976).
The study by Marcotte and Logan (1977) showed a shift toward less dog-
matic opinions on nonsexual issues. Students reported greater freedom in
discussing sexual topics (Garrard et al., 1976). The one study that assessed
sexual behaviors of the students reported no differences as a result of train-
ing (Marcotte and Logan, 1977). None of the studies made attempts to
isolate the contributions of the program components, and few conducted
follow-ups.

College Students

Twelve studies assessed the effects of sex education on college

students. Two papers (Mandetta and Woods, 1974; Woods and Mandetta,
1975a) reported on the same study of the effects of an elective under-
graduate sexuality course. Results showed significant increases in sexual
knowledge, although attitudes about sex did not change. In a later study
(Woods and Mandetta, 1975b), these investigators used the same format
and outcome measures with a larger experimental group and added a
control group. Results showed that both the 75 experimental-group under-
graduates and the 17 control-group nursing students made significant
increases in their sexual knowledge; however, the experimental group
gained significantly more knowledge than did the control group. As in the
previous studies (Mandetta and Woods, 1974; Woods and Mandetta,
1975a), attitudes toward sex did not change.
Davidow (1976) investigated the effects of a university sex-education
course. Results showed that students significantly increased their sex know-
ledge, and held significantly more accepting attitudes towards the concepts
of female masturbation, engaged individuals having premarital intercourse,
and oneself engaging in oral-genital activity. Behavior measures showed a
significant increase in masturbation frequency.
Sex Education 195

Five studies contrasted the results from students in a sexuality course

with students enrolled in other courses. Krizmis (1978) found that his
experimental group made significant gains in sexual knowledge in
comparison with control students who were enrolled in other psychology
courses. Nagy (1978) studies the effects of a sexuality course on under-
graduates, who were compared with control students enrolled in other
courses. Results showed a significant shift by the experimental group in the
direction of more liberal attitudes towards the sexual behaviors of others.
No effects were found for sex guilt or for psychological androgyny. Shofer
(1973) contrasted undergraduates who were enrolled in a sex course with
students enrolled in an alternate health-education course. Students in the
former group did not show more improvement in self-concept than students
in the latter group. Zuckerman et al. (1976) found that his experimental
subjects changed significantly more than the control subjects (who were
enrolled in personality courses) in the direction of more permissive
attitudes. Participation in the sex course appeared to affect the behavior of
only males. Sex-class males showed increases relative to other groups in
heterosexual, masturbatory, and orgasmic experience, and in the number of
homosexual partners. Increase in heterosexual experience appears to have
been more a function of increased experimentation with the same partner
than of an increase in the number of partners. Story (1979) found signifi-
cantly more accepting attitudes for students in a sexuality course both at the
end of the course and at the 2-year follow-up than for control students
enrolled in a human communications course.
While the inclusion of a control condition is an important feature of
the last five studies, the experimental and control subjects may not have
been equivalent on variables which may be related to the dependent mea-
sures. For example, the pretest data of the Zuckerman et al. (1976) study
indicated that students enrolling in the sex course were more sexually per-
missive and experienced than control students. Thus, students enrolled in a
sexuality course may represent a different population than students enrolled
in other courses.
Two studies (Bernard, 1973; Vennewitz, 1975) are noteworthy in that
they addressed the issue of nonequivalent comparison groups. Vennewitz
(1975) compared undergraduates who enrolled in the course with control
students who were denied admission to the course because of enrollment
limitations. The experimental subjects showed significantly greater gains in
knowledge than the control subjects and also became significantly more
liberal in their attitudes towards the sexual behaviors of nonsignificant
others. However, the experimental group did not change significantly more
on attitudes toward the sexual behaviors of self and spouse or on the Pre-
marital Sexual Permissiveness Scale.
196 Kilmann, Wanlass, Sabalis, and Sullivan

In another well-controlled study, Bernard (1973) investigated the

impact of a semester-long undergraduate sex-education course. The 275
undergraduates enrolled in the course were the experimental group. One
control group was composed of 93 undergraduates who signed up for the
course but could not enroll because of space limitations. Another control
group was composed of 48 undergraduates randomly chosen from the
university population. Results showed significant gains in sex knowledge
for the experimental group only. The experimental group also ended up
with significantly more accepting attitudes towards masturbation and
homosexuality. However, the first control group ended up more accepting
of extramarital sex. A decrease in sex guilt was found for both the experi-
mental and the first control group, suggesting that the change could not be
attributed to participation in the course. All three groups showed similar
changes in sexual behavior, suggesting that this variable was unrelated to
course participation.
Vorgeas (1973) investigated the effects of a family-life and sex-educa-
tion course on college freshman. In addition to a measure of sex knowledge
and attitudes, the study employed psychophysiological measures of
response to emotionally charged sexual stimuli (auditory and visual).
Results showed that students enrolled in the course improved more on both
types of measures than students who were simply issued the course textbook
or who received no intervention. These findings represent the first psycho-
physiological evidence of desensitization to sexual stimuli following parti-
cipation in a sex-education course. As such, they provide substantiation for
the frequently reported self-description of increased comfort with sexual
content following exposure to a sex-education program (e.g., Rosenberg
and Chilgren, 1972).
A well-controlled study by Byrd (1978) investigated the effects of
sexually explicit films on the sexual knowledge, attitudes, and behavior of
college students. As part of a semester-long human sexuality course, half of
the students were shown sexually explicit films while the other half listened
to audiotapes covering the same general topics. Contrary to expectation,
students viewing the films did not differ significantly from those hearing the
tapes on the independent variables. An important feature of this study is
that an effort was made to assess a specific intervention (i.e., visual film
material) under controlled conditions.

Summary

The sex education in the 12 studies in this section usually consisted of

some combination of lectures, discussions, guest speakers, and study
projects. Significant improvements in sexual knowledge were found in each
Sex Education 197

study that assessed this variable. Some studies (e.g., Zuckerman et al.,
1976) reported a liberalization of attitudes and increased tolerance, while
others (e.g., Mandetta and Woods, 1974; Woods and Mandetta, 1975a) did
not find changes on attitude measures. However, it is not possible to specify
the program components that led to the differential findings. The male sub-
jects of Zuckerman et at. (1976) reported an increase in sexual experiences.
Two studies reflected methodological strengths, in that they used equivalent
experimental and control conditions (Bernard, 1973; Vennewitz, 1975).
Only one study (Byrd, 1978) attempted to separate the influence of specific
program components, and only one study included a follow-up evaluation
of outcome (Story, 1979).

Educators and Counselors

Eight studies assessed the effects of a sex-education course on

educators' and counselors' sexual knowledge and/or attitudes. Four of
these studies (Doyle, 1976; Flatter, 1975; Poinsett, 1976; Richardson, 1976)
did not include a control condition. Flatter (1975) examined the effects of 6-
day intensive human sexuality workshops on the sexual liberalism of 341
teachers and counselors. Results showed that participants significantly
increased their tolerance for sexual attitudes and behaviors viewed as
different from their own.
Doyle (1976) investigated the effects of an intensive education pro-
gram on graduate student counselors' ability to deal with sex-related
problems. Each subject completed pre- and postcourse videotaped inter-
views with a coached client presenting a sexual problem. Results showed sig-
nificant improvements in rated counseling skills and reported self-con-
fidence during the interview. There were also significant gains in sex
knowledge, as measured by the SKAT, and in diagnostic accuracy for
sexual problems.
Poinsett (1976) examined the impact of a workshop on human sexual-
ity for the handicapped on school personnel. Twenty educators took part in
an experimental workshop entitled "Promoting Positive Social-Sexual
Functioning in Handicapped Children." An increased tolerance in sexual
attitudes was reported by the participants. In addition, the program seemed
to have promoted interest and involvement in teaching sex education to the
handicapped. Richardson (1976) investigated the effects of a human
sexuality workshop on health-care professionals. Following a systematic
needs assessment, a workshop was presented on sexual dysfunction result-
ing from disabilities, diseases, alcohol, drugs, aging, and homosexuality.
Participants improved significantly on a cognitive test and showed a sig-
nificant shift towards more openness about sexuality on an attitude test.
198 Kilmann, Wanlass, Sabalis, and Sullivan

Four studies (Barnum, 1973; Brantlinger, 1979; Dykstra, 1978; Karas

and Elliot, 1972) included control conditions in the experimental design. In
the study by Karas and Elliot (1972), 29 teachers took part in a 6-week
course designed to prepare them to teach sex education in kindergarten
through ninth grade. Twenty teachers who did not take part in this program
served as controls. At the posttest, the program group showed greater
increases than the control group in knowledge about sex and sexual
anatomy, and more favorable attitudes towards sex education. The results
must be viewed as only suggestive, however, since the two groups were not
randomly assigned to conditions.
Barnum (1973) investigated the effects of a process-oriented sex-
education workshop on teachers and education students. Of the 64 subjects
who volunteered to participate, half were placed in the experimental group
(workshop), and half were placed in the control group (no intervention). At
posttest and again at the 5-week follow-up, the experimental group showed
significant gains in sex knowledge as well as significantly more accepting
attitudes toward premarital sex and sexual behavior in general.
Experimental subjects' attitudes toward their own sexual behavior did not
change. The control group did not make significant changes on any
measures. It should be pointed out that, at pretest, the experimental group
differed significantly from the control group on sexual attitudes. Thus, the
two groups cannot be considered equivalent on this dimension.
Dykstra (1978) investigated the effects of a human sexuality workshop
on 54 educators. Data were obtained from the participants and from 12
control students enrolled in a graduate education course. Thus, the experi-
mental and control groups were not equivalent. Results showed significant
gains in sex knowledge and significant changes in the direction of more
tolerant sexual attitudes for the experimental group. An analysis of the
characteristics of effective small-group leaders showed that these
individuals tended to be self-actualizing, inner-directed, and time-
competent, and were more likely to make understanding, supportive, and
interpretive responses, as well as to have adequate sex knowledge.
Brantlinger (1979) investigated the effects of l-day workshops dealing
with the sexual needs and rights of the mentally retarded on residential care
staff. Two workshops were held, one for 59 group home managers, and one
for 50 members of the educational staff at a large residential institution for
the mentally retarded. Both groups showed significant shifts in the direction
of more liberal attitudes about the sexuality of the handicapped following
attendance at the workshop.

Summary

The eight studies in this section shared the goals of informing educa-
tors or counselors about human sexuality, as well as attempting to change
Sex Education 199

their attitudes about sexual matters. The intervention typically consisted of

a variety of lectures or discussions presented in a relatively brief workshop
format. The study by Doylb (1976) represented the only attempt to assess
counseling skills following sex education. Although each of the studies
reported positive gains in sexual knowledge and/or attitudinal shifts in the
predicted direction, none included an equivalent control group for a com-
parison, or a follow-up assessment of outcome. Therefore, the findings are
only suggestive.

Miscellaneous Populations

Three studies (Bloom, 1969; Iverson, 1973; Reichelt and Werley, 1975)
used adolescent populations. Reichelt and Werley (1975) reported on the
effects of a sex-information program for sexually active teenagers. Results
showed a substantial increase in knowledge of birth control. Knowledge
about venereal disease and abortion did not increase dramatically. While
the results suggest that programs such as the one reported in this study may
serve a useful function in imparting important sexual information to
sexually active teenagers, no control group was included for comparison.
Iverson (1973) examined the effects of a church-sponsored sex-educa-
tion program on 135 middle-class suburban adolescents ranging in age from
11 to 19 years. Employing a quasiexperimental design, she found that
students completing the course become more liberal in their sexual
attitudes. However, no change was found in the sexual standards used by
subjects to guide their own behavior. Adolescents coming from homes per-
ceived as extreme in sex-role stereotyping became more flexible in the
assignment of sex roles.
Bloom (1969) investigated the effects of a 12-week sex-education
course on 34 emotionally disturbed and 31 physically disabled adolescents.
The l l th- and 12th-grade subjects were all on homebound status and thus
unable to attend a regular classroom. Results showed that both groups sig-
nificantly increased their sex knowledge. The physically disabled group
showed no significant decrease in level of manifest anxiety, whereas, among
the emotionally disturbed subjects, only the 12th-grade boys showed a
decrease on this dimension.
Orlovick (1979) evaluated a human sexuality program for adults.
From a group of 50 volunteers who registered to take part in the program,
31 were placed in an experimental group (participation in a weekend
seminar), and 19 were placed in a control group (no intervention). Results
showed a significant increase in sexual knowledge for the experimental
group. This group also made significant shifts towards more liberal atti-
tudes concerning homosexual behavior and masturbation. Attitudes about
sexual myths and abortion were not affected. Among the experimental
group, there was a temporary increase in the frequency of various sexual
200 Kilmann, Wanlass, Sabalis, and Sullivan

behaviors during the week in which the seminar occurred. The use of an
equivalent control group is noteworthy.
Another study important for its use of an equivalent control group "
(Voss and McKillip, 1979) investigated the effects of an intensive weekend
"Sexual Awareness" workshop on a mixed group of university and nonuni-
versity volunteers. An experimental group of 22 participants was compared
with a control group of nine persons drawn from the overflow registration.
At posttest, participants showed significantly more liberal attitudes and
reported a significantly wider range of sexual behaviors than controls. No
significant differences in sex knowledge was found. Both the participants
and the nonparticipants acquired greater knowledge about sex, suggesting
that those who are interested enough in their sexuality to apply for a work-
shop may increase their knowledge with or without the workshop. These
results underscore the need for equivalent control groups.
Elwood (1978) studied the effects of a 2-hour sex-education program
on institutionalized, physically disabled males. Eighteen spinal injured
patients and eight patients with various other physical injuries were
randomly assigned to either a lecture, film, and group discussion sex-
education program or a placebo control group. Results showed that the pro-
gram had no effect on the anxiety level or the sexual attitudes of the partici-
pants.

Summary

The six studies in this section assessed the impact of sex education on
various adolescent and adult populations. The adolescents either were mem-
bers of a highly select group (Bloom, 1969; Reichelt and Werley, 1975), or
they received sex education through a church (Iverson, 1973). Only three
studies (Elwood, 1978; Orlovick, 1979; Voss and McKillip, 1979) included
control groups. None of the six studies included a follow-up.

CONCLUSIONS

The literature search for this paper revealed a relatively large number
of descriptive reports that provided information on the implementation of
sex-education programs (e.g., Karpen and Lipke, 1974; Scholl, 1974). Prac-
tically all of these publications stressed the importance of sex education,
although there was a lack of effort directed toward evaluating program
effectiveness. Furthermore, given the ongoing controversy about whether
sex education should be included in the school curriculum, and the fact that
many counselors and educators (e.g., Burleson, 1976; Craig and Middleton,
,- Sex Education 201

1977; McCary, 1975) believe that sex education is important, it was sur-
prising that no systematic investigations of the effectiveness of sex-educa-
tion programs in either elementary school, junior high school, or senior
high school settings were found which met the criteria for inclusion in this
paper. Thus, no study addressed the controversial issue of whether
"normal" students below the college level who are provided with sex educa-
tion at school reflect an increased incidence of promiscuous sexual
behavior, pregnancy, abortion, or venereal disease. The importance of
resolving this issue with empirical data warrants the attention of future
researchers.
A number of methodological problems were uncovered in the course
of the review. Except for the tests of sexual knowledge, the results were
almost exclusively dependent upon self-report questionnaires, which are
subject to bias. For example, reports of change in sexual behavior (e.g.,
Zuckerman et al., 1976) may reflect increased willingness to admit to sexual
activity as much as actual changes in behavior. Other methodological short-
comings included the lack of follow-up evaluations of outcome, the lack of
equivalent control groups, and the lack of specificity in reporting character-
istics of the subjects, the instructor, or the sex-education intervention.
Although many of the differences in sexual knowledge and attitudes
reported in the studies were "statistically" significant, the inclusion of a
large number of subjects in many of these studies (e.g., Bernard, 1973)
suggests that the actual pre-post differences canot necessarily be considered
materially meaningful. (See Feinstein, 1977, for a discussion of this
problem.) Overall, the methodological problems make it difficult to draw
any reliable conclusions about the effectiveness of sex-education programs.
For this reason, the findings must be viewed with caution.
In general, this review found that the subjects, regardless of popula-
tion membership, showed gains in sexual knowledge and shifts toward more
tolerant and liberal sexual attitudes. Studies were mixed in reporting
changes in sexual behavior. For example, one study (Davidow, 1976)
reported increased masturbation frequency in college students, whereas
another (Orlovick, 1979) reported that adults temporarily increased the fre-
quency of various sexual behaviors during the week of the sex-education
seminar. Zuckerman et al. (1976) found increased sexual experience for
college males but not for females. Marcotte and Logan (1977) found no
effect for medical students. It should be noted that the lack of controlled
follow-up evaluations precluded a meaningful assessment of the long-term
effects of sex education on sexual attitudes, knowledge, or behavior.
It is to be expected that over a period of time subjects, especially
students, would undergo changes in sexual attitudes and/or knowledge
regardless of a specific intervention. Indeed, Sheppe and Hain (1966) have
reported evidence that knowledge about sex increases somewhat as medical
202 Kilmann, Wanlass, Sabalis, and Sullivan

students progress through their training, even without a specific course in

sex education. Therefore, research should include a comparison group from
the same population to control for maturational and/or nonspecific educa-
tional effects, especially in the case of semester-long interventions.
Further research is needed to clarify the extent to which attitudinal
and informational changes affected the subjects' lives, particularly their
interpersonal and sexual relationships. In the case of medical school
populations, an attempt could be made to determine whether these pro-
fessionals relate differently to patients with sexual concerns following expo-
sure to a sex education program. A similar approach could be used with
educators and counselors. For example, their students or clients could be
asked to assess whether any changes in attitude and/or behavior were
evidenced following attendance at a profesisonal workshop. The profes-
sionals and their students or clients should be blind to this purpose to
correct for expectancy factors. Another approach would be to ask spouses
or partners of course participants to rate the quality of their sexual rela-
tionships before and after the course.
Some evidence was found that students who enroll in a sex course may
differ from students enrolling in other courses (Zuckerman et al., 1976).
Following the approach used by Vennewitz (1975), future research should
control for self-selection factors by making certain that the experimental
and control groups are equivalent in their motivation for acquiring sex-
related information. A suitable experimental design would be to offer a sex
course to half of a group of students expressing an interest, while randomly
assigning the other half of these students to a "waiting list" control group.
The latter group could be asked to respond to questionnaires and other
assessment devices with the assurance that they would be able to enroll in
the sex course the following semester.
Studies employing short-term, intensive interventions do not appear to
have been differently effective from those utilizing semester-long programs.
However, no study has systematically investigated the issue of whether a
longer sex-education course is more potent than a course which meets for a
shorter time period. Future studies should compare the effects of sex educa-
tion on equivalent groups assigned to programs which share instructors and
curriculum, but differ in time format.
In addition to the recommendations for future research mentioned
above, researchers should operationally define their sex-education interven-
tion and their goals for the participants. Subject attrition rate and pre-
existing sexual knowledge should be controlled across experimental and
control conditions. The effects of various program components should be
isolated so that the most effective intervention ingredients can be identified.
Efforts such as these would lead in the direction of answering important
Sex Education 203

questions, such as which format (e.g., lectures, films) is most effective for
which goals and for which population, the instructor characteristics that are
most facilitative, and the short- and long-term effects of sex education on
personal and social functioning.

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