A Group Randomized Trial Evaluating High School FLASH, a Comprehensive Sexual Health Curriculum



      To evaluate the effectiveness of a school-based comprehensive sexual health curriculum (FLASH) on high-school students’ sexual behavior and related outcomes.


      A cohort of 1,597 9th and 10th grade students representing 20 schools from two regions in the U.S. (Midwest and South) were enrolled and completed the baseline survey. Following baseline, the 20 schools were randomly assigned to receive FLASH (n = 10 schools, five per region) or a knowledge-based sexual health curriculum (n = 10 schools, five per region). Follow-up surveys were administered at 3 months and 12 months after the instruction period.


      There were no statistically significant differences between conditions for the overall sample on rates of vaginal sex in the past 3 months or the rates of vaginal sex without a condom or other birth control. In supplementary subgroup analyses of students who were not sexually experienced at baseline, FLASH showed a statistically significant protective impact at the 3-month follow-up on vaginal sex without a condom or birth control (p = .04). FLASH also showed statistically significant gains in psychosocial outcomes, such as refusal and condom use self-efficacy, attitudes toward birth control and condoms, and perceived norms.


      FLASH demonstrated consistent short-term and long-term impacts on key behavioral determinants. It also showed a significant impact on vaginal sex without a condom or other birth control for the subgroup of students who were not sexually experienced at baseline. Behavioral impacts were not evident for the entire study population.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and CDC Winnable Battles
        Teen pregnancy.
        2017 (Available at:)
        • Kann L.
        • McManus T.
        • Harris W.A.
        • et al.
        Youth risk behavior surveillance—United States, 2017.
        MMWR Surveill Summ. 2018; 67: 1
        • Centers for Disease Control and Prevention
        Sexually transmitted disease surveillance 2015. 2016.
        U.S. Department of Health and Human Services, Atlanta, GA2017
        • Davis J.W.
        • Bauman K.
        School enrollment in the United States: 2008. Population characteristics.
        U.S. Census Bureau, 2011 (Available at:)
        • Kantor L.
        • Levitz N.
        Parents’ views on sex education in schools: How much do Democrats and Republicans agree?.
        PLoS One. 2017; 12: e0180250
        • Kohler P.K.
        • Manhart L.E.
        • Lafferty W.E.
        Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy.
        J Adolesc Health. 2008; 42: 344-351
        • Mueller T.E.
        • Gavin L.E.
        • Kulkarni A.
        The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex.
        J Adolesc Health. 2008; 42: 89-96
        • Goesling B.
        • Colman S.
        • Trenholm C.
        • et al.
        Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: A systematic review.
        J Adolesc Health. 2014; 54: 499-507
        • Coyle K.
        • Anderson P.
        • Laris B.A.
        • et al.
        Schools and sexuality education.
        in: Evidence-based approaches to sexuality education. Routledge, New York and London2015: 170-192
        • Denford S.
        • Abraham C.
        • Campbell R.
        • Busse H.
        A comprehensive review of reviews of school-based interventions to improve sexual-health.
        Health Psychol Rev. 2017; 11: 33-52
        • Chin H.B.
        • Sipe T.A.
        • Elder R.
        • et al.
        The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services.
        Am J Prev Med. 2012; 42: 272-294
      1. Harm reduction: An approach to reducing risky health behaviours in adolescents.
        Paediatr Child Health. 2008; 13: 53-56
        • Ajzen I.
        The theory of planned behavior.
        Organ Behav Hum Decis Process. 1991; 50: 179-211
        • Benjamini Y.
        • Hochberg Y.
        Controlling the false discovery rate: A practical and powerful approach to multiple testing.
        J R Stat Soc Series B Methodol. 1995; 57: 289-300
        • Kirby D.C.
        • Coyle K.
        • Alton K.
        • et al.
        Reducing adolescent sexual risk: A theoretical guide for developing and adapting curriculum-based programmes.
        ETR Associates, Scotts Valley, CA2011
        • Kirby D.
        • Lepore G.
        Sexual risk and protective factors summary: Factors affecting teen sexual behavior, pregnancy, childbearing and sexually transmitted disease: Which are important? Which can you change?.
        National Campaign to Prevent Teen Pregnancy, Washington, DC2007
        • Baumler E.
        • Glassman J.
        • Tortolero S.
        • et al.
        Examination of the relationship between psychosocial mediators and intervention effects in it’s your game: An effective HIV/STI/pregnancy prevention intervention for middle school students.
        AIDS Res Treat. 2012; 2012
        • O’Leary A.
        • Jemmott L.S.
        • Jemmott III, J.B.
        Mediation analysis of an effective sexual risk-reduction intervention for women: The importance of self-efficacy.
        Health Psychol. 2008; 27: S180
        • Guzzo K.B.
        • Hayford S.R.
        Adolescent reproductive and contraceptive knowledge and attitudes and adult contraceptive behavior.
        Matern Child Health J. 2018; 22: 32-40
        • Martin-Smith H.A.
        • Okpo E.A.
        • Bull E.R.
        Exploring psychosocial predictors of STI testing in university students.
        BMC Public Health. 2018; 18: 664
        • Huebner A.J.
        • Howell L.W.
        Examining the relationship between adolescent sexual risk-taking and perceptions of monitoring, communication, and parenting styles.
        J Adolesc Health. 2003; 33: 71-78
        • Parker J.S.
        • Benson M.J.
        Parent-adolescent relations and adolescent functioning: Self-esteem, substance abuse, and delinquency.
        Adolescence. 2004; 39
        • Widman L.
        • Choukas-Bradley S.
        • Noar S.M.
        • et al.
        Parent-adolescent sexual communication and adolescent safer sex behavior: A meta-analysis.
        JAMA Pediatr. 2016; 170: 52-61
        • Centers for Disease Control and Prevention
        Youth risk behavior survey—data summary & trends report: 2007–2017. Youth risk behavior survey.
        • Šimkovic M.
        • Träuble B.
        Robustness of statistical methods when measure is affected by ceiling and/or floor effect.
        PLoS One. 2019; 14: e0220889

      Linked Article

      • Opportunities and Challenges in Implementing and Evaluating School-Based Sex Education Programs
        Journal of Adolescent HealthVol. 68Issue 4
        • Preview
          Despite recent declines, teen birth rates in the U.S. remain higher than in other industrialized nations [1]. Three quarters of teen pregnancies are unintended [2], and disparities persist between racial and ethnic groups [1]. There is evidence that sex education can reduce the risk of unintended pregnancy by delaying sexual activity and increasing the use of contraception [3]. While federal efforts have identified multiple evidence-based teen pregnancy prevention programs with impacts on sexual risk behaviors or reproductive health outcomes [3], it remains important to evaluate new programs with promising or innovative approaches to pregnancy prevention and update existing evidence-based programming to better align with the current needs of adolescents.
        • Full-Text
        • PDF