Three Decades of Evidence: Promising Approaches to Effective Comprehensive Sex Education

Purpose: 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. This paper reports evidence for approaches and strategies associated with effective CSE, based on a systematic literature review of school-based programs. Methods: Researchers searched ERIC, PsycINFO, and MEDLINE for studies evaluating CSE outcomes of school-based K-12 educational efforts, meeting inclusion criteria (n = 80). They identified those that described approaches or strategies associated with reported CSE outcomes beyond pregnancy and disease prevention. They updated the search to 2024, then used an inductive iterative process to group studies into 2 main categories and 8 subcategories based on common approaches and strategies. Seventy-nine studies are included in this review. Results: Pedagogical, curricular, classroom, and school-wide approaches associated with effective CSE included 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 the presence of GSAs, SBHCs, whole school approaches, parent involvement, and teacher preparation. Conclusions: Over 3 decades of research provides support for approaches and strategies associated with CSE that achieves a range of beneficial outcomes beyond pregnancy and disease prevention.