(P498) The Relationship Between State-Level Sex Education Mandates and Gonorrhea and Chlamydia Diagnosis Rates in Children Aged 15 to 19

Background: A disproportionate amount of the sexually transmitted infection (STI) burden in the United States lies with adolescents, so high school sex education is a core mitigation strategy to prevent long-term population transmission. Sex education policies are determined at the state level and are highly variable year to year. This study elucidates the effects of sex education mandates on STI rates in this higher-risk group.

Methods: We leverage three datasets: 1. The CDC’s data on state-level gonorrhea and chlamydia diagnosis rates from 2001 to 2019 among adolescents aged 15 to 19 years, 2. The Guttmacher Institute’s state-level sex education policy data for the same period, and 3. State-level socioeconomic data from the American Community Survey through IPUMS USA. We use descriptive data analysis and statistical modeling to determine whether the targeted addition of sex education policies in certain states has resulted in the intended declines in STI rates among adolescents.

Results: The United States saw increased numbers of mandated sex education policies from 2001 to 2019, with new policies created during that period. In contrast, the number of states reporting specific STI education policies decreased modestly over the same period. Policy introduction and removal were highly variable, with the status of sex education changing 17 times across the country over the 19-year study period. Average state-level diagnosis rates for chlamydia in children aged 15 to 19 increased approximately 1.5-fold between 2001 and 2019, with a period of attenuation from 2011-2014. Average rates for gonorrhea changed little during 2001-2013 but increased approximately 1.5-fold between 2013 and 2019.

Conclusion: The changeable implementation of state-level sex education policies during 2001-2019 created challenges for detecting measurable effects on chlamydia and gonorrhea diagnosis rates. However, the increasing rates of STI diagnoses during this period, despite the nominal addition of mandated sex education policies, reflect a need to adjust our approach to sex education. As STI rates rise, it is important to view the effects of sex education policies critically and find ways to implement them more effectively to increase access to comprehensive sex education within our inequitable health and education systems.