Net Age

Controversies about the proper content of school-

based sex education continue, but in some fundamen-

tal sense they have been matched by—perhaps even

overtaken by—other pressing realities. For example,

there are increasing demands that school resources be

dedicated to teaching the basics of reading, writing, and

math and to upgrading the attention given to science

education. Many communities find that meeting these

legitimate demands places substantial pressure on

school hours and budgets, often at the expense of such

areas as art and physical education as well as health edu-

cation, which often includes sex education. Moreover,

limited budgets can also decrease the amount of train-

ing made available to sex education teachers.

This situation is particularly distressing because dur-

ing the last decade, increasing numbers of programs have

become available that can help teens delay having sex,

increase their use of contraception when they do have

sex, and potentially help reduce the incidence of teen

pregnancy.Some of these programsare based in schools,

some are in community settings, and some span both.1-3

The US Department of Health and Human Services’ Of-

fice ofAdolescentHealth lists 31 such programs that have

evidence of effect,3 and the list has played a major role

in shaping the funding priorities of the Teen Pregnancy

Prevention Program administered by that office.

Numerous schoolsand communitieswelcome these

evidence-based programs, and funding through the Of-

fice of Adolescent Health and the Family and Youth Ser-

vices Bureau has supported many such programs na-

tionwide and also has increased the amount of attention

given to using and replicating effective programs. Even

so, many sexually experienced teens (46% of males and

33% of females) report that they had not received any

instruction about contraception before they began hav-

ing sex,2 and states like Oklahoma and Alabama—with

2 of the highest rates of teen pregnancy in the coun-

try—do not require any sex education in school at all.4

Moreover, in some communities the “sex ed wars” (ie,

the intense and vocal controversy over sex education in

schools) persist as they have for decades.

Such developments suggest a need to rethink the

way in which sex education is offered to young people.

In the age of smartphones, texting, Twitter, Instagram,

and Facebook, sexeducation shouldevolve to fit the 21st

century and the media-saturated lives of young people

today. A strong case can be made that in the United

States, the media are already the de facto sex educa-

tors (the average teenager sees 15 000 sexual refer-

ences on television alone each year).1

Perhaps it is time

to fully embrace the power of 21st-century communi-

cation and direct it toward public health goals more de-

liberately. Online material and social media could help

to fill the gaps in sex education and support for many

young people.

Sex education materials and conversations pro-

vided through digital and social media could be useful

adjuncts to classes and programs that may be offered

in a community or school system; in areas where no such

programs exist, they may help to fill serious gaps. Two

increasingly popular sites sponsored by The National

Campaign to Prevent Teen and Unplanned Pregnancy,

StayTeen.org and Bedsider.org, and other engaging sites

such as Go Ask Alice!5 and Scarleteen,6 are expanding

understanding of how digitalmedia can help. These sites

provide information in an accurate and appealing way.

An amusing video on Bedsider.org, for example, shows

a young adult woman explaining her initial reluctance to

use a contraceptive vaginal ring and how she mastered

the method, and funny “Fact or Fiction”

cartoons that include physiciancommen-

taries debunk common myths in a re-

laxed but accurate way.

Inaddition, somecommunity groups

and local health departments around the

country (in California, New Mexico, and

North Carolina, for example) have estab-

lished digital services to which teens can

text their sex-related questions. These emerging sites

and systems may appeal in particular to teens who are

more comfortable obtaining sexual information anony-

mously than they are in a coed sexeducation class or ask-

ing their parents for information. Unlike many commu-

nity or school-based sex education classes, Internet-

based sex information can be available throughout a

teenager’s adolescence. Questions may change, new

situations arise, and new treatments or scientific infor-

mation sometimes develop; the Internet can be a good

repository for updated, ongoing sex information that any

teenager can access anytime. In a recent survey of more

than 1200 Australian teenagers, for example, the most

common source of information about sex actually was

theInternet (85%).7

Misinformation on theInternet does

exist, but professional oversight may help direct teens

to reputable, accurate sites. In addition, “good” sexual

content may help to drown out “bad” sexual content

(Gresham’s corollary).In anyevent, sexeducation should

not miss out on the worldwide move to use online sys-

tems to improve health.

Sex education in the 21st century merits time, at-

tention, innovation, and, in particular, research to assess possible benefit. Forexample,4 issuesmight beaddressed. First,

can online sex education systems help young people learn some of

the key skills increasingly seen as central to risk reduction, such as

negotiating skills and a strong sense of agency and self-efficacy? Or

is the main value of these online sites more likely to be in the some-

what less difficult task of providing information? The research base

here is weak at best, although one study of sexual health promo-

tion on Facebook has demonstrated that young people will at least

access this information.8 In addition, methods of assessing the ef-

fect of online interventions on behavior are currently an emerging

topic in research design.

Second, is there a way for online sex education to be pre-

sented in the voice and tone of teens to reflect their concerns yet

also provide accurate and credible information? Adults and profes-

sionals could lead the way, but a site that feels like it is the product

of a lecturing, authoritarian, adult group may well be unpopular. In-

volvement of teens in the development of sites will likely be needed

for success, and teen-appropriate humor and perspective could be

especially attractive. One site currently has been developed and is

administered solely by teens; its motto is “by teens, for teens.”9

Third, might there be a way for professional groups like the

American Academy of Pediatrics, the Society for Adolescent Health

and Medicine, the American Academy of Family Physicians, and the

National PTA to create a standardized but fully teen-centric core set

of materials, lessons, and interactive components that could then

be “localized” by community groups? Detailed information on ado-

lescent-centered services and where to go for what types of help,

including information on confidentiality, cost issues, and privacy,

would be particularly useful for teens. Fourth, how can online sys-

tems support and amplify evidence-based programs already in use?

Are there some instances in which the online platform is prefer-

able?

Given the controversies about sex education that have limited

the full use of well-designed, evidence-based programs, the accep-

tance and use of online sex education and support remain to be de-

termined. However, because the Internet is essentially unregu-

lated, there is no need to secure anyone’s particular approval for any

site or its content, improving access of teens to sex information with-

out school board approval. In addition, although not all teens are in

school, odds are that they are online. The Internet is already a ma-

jor source of sex information, some of it inaccurate, so why not en-

courage development of responsible, relevant sex information that

would appeal to teens and be easy to use?Itmay be an idea for which

the time has come