Promising Approaches to Comprehensive Sex Education: Evidence From Three Decades of Research

Despite strong evidence that comprehensive sex education (CSE) has a range of important outcomes beyond pregnancy and disease prevention, limited research has explored the most promising approaches to achieving those outcomes. To identify evidence for approaches and strategies associated with effective CSE, we conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched ERIC, PsycINFO, and MEDLINE for studies evaluating CSE outcomes of school-based K-12 educational efforts, meeting inclusion criteria (n = 80). We then identified those studies that described approaches or strategies associated with reported CSE outcomes beyond pregnancy and disease prevention. After updating the search to 2024, we used an inductive iterative process to group studies based on common approaches and strategies (n = 79). Pedagogical, curricular, classroom, and school-wide approaches associated with effective CSE include: critical theory-based pedagogies; sex education across the curriculum; beginning in early grades; LGBTQ+ -inclusive curricula; media literacy; and gender-integrated classrooms. Positive outcomes were also associated with presence of Gender and Sexuality Alliances, School-based health centers, whole school approaches, parent involvement and teacher preparation. Over three decades of research provides support for approaches and strategies associated with CSE that achieves a range of beneficial outcomes beyond pregnancy and disease prevention.