STD education: challenge for the 80s.

Discussion focuses on 3 aspects of sexually transmitted diseases (STD) education: the need for and appropriateness of school-based STD education; some elements of timely, high quality STD education; and strategies for dealing constructively with controversy. More than half of the estimated 20 million STD victims in the US this year will be persons under age 25. Almost 1/4 will be victims of STD before they receive their high school diplomas. STD are the most pervasive, destructive, and expensive communicable disease problems facing American youth. If the twin criteria of true experimental design and of measuring appropriate outcomes are applied to published studies, then the effectiveness of classroom STD education has not as yet been properly evaluated. The evaluation criteria which should be applied to health education programs are uniquely based on nonacademic goals, that is, ultimate outcomes are generally not observable in the academic environment. The federal government has been virtually precluded from supporting or conducting appropriate behavioral studies because of laws protecting individual privacy, and most school systems are similarly restricted when it comes to asking students about their personal or family lives, of which sexual matters are among the most intimate. Programs designed according to accepted concepts of learning and decision making need to be implemented, even if their benefits must be regarded as potential, until such time as research obstacles can be resolved. STD education objectives should be drawn from the behaviors relevant to the prevention, acquisition, transmission, and disposition of an STD. The behaviors are organized into 5 behavioral sets and described here as decision steps: decisions about when, how, and with whom to engage in sexual behavior; decisions specific to health protection if sexual behavior includes genital contact; decisions in response to suspected illness; decisions in response to diagnosed disease; and decisions related to other people. Within each decision step are various alternative choices, some that enhance health and others that jeopardize it. Once behavioral objectives have been formulated, decisions about content should be directed toward predisposing, enabling, or reinforcing those behaviors. Emphasis should be on the following: risk reduction; recognition; response; referral; and responsible resource. No particular instructional methods possess inherent superiority. It is questionable whether young people derive a maximum benefit from STD instruction if they have not initially learned rudimentary physiological and sociological facts of sexual life and how to discuss such matters. School systems should not delay efforts to meet the 1990 goal of high quality, timely STD education for every child in the US. Guidelines for community leaders who plan education programs are listed.