Programs that Work
Postponing Sexual Involvement/Human Sexuality Educational Series
Healthy and Safe Children
Youths abstaining from sexual activity or not engaging in risky sexual behavior
Age of Child
Type of Setting
Health Care Provider
Type of Service
Type of Outcome Addressed
Teen Sex / Pregnancy
Evidence Level (What does this mean?)
The Postponing Sexual Involvement (PSI) program is a school-based program designed to delay sexual activity among adolescents. The curriculum was widely introduced into the Atlanta public schools in 1985 and was taught to eighth graders by health educators, nurses, and adolescent counselors using teens as primary presenters. The origins of PSI began in the mid-1970s, with the initiation of the knowledge-based sex education course "Human Sexuality," which consisted of five classroom sessions covering basic human sexuality, decisionmaking, and contraceptive methods. Evaluations of the Human Sexuality program, however, showed that simply providing information was not effective in changing behavior.
The PSI program was developed to complement the Human Sexuality program and is based on the "social influence" theory, which holds that young people are more likely to become sexually involved because of social and peer pressures than because of a lack of knowledge about sexuality and sexual activity. PSI uses activities that help identify the origins of pressure to engage in sexual activity, examines the motivations behind that pressure, and helps students develop skills to respond to that pressure effectively. The program is also built on research that shows that teenage leaders produce greater and more lasting effects on other teens' behavior than do adults.
Junior high students in seventh and eighth grades.
In an evaluation of the pilot PSI program in Atlanta, Georgia, Howard and McCabe (1990) studied a population of 536 low-income minority students, including 395 from the 24 schools that received PSI and 141 students from 29 control schools in the area (that received those schools' regular sexual education program). Ninety-nine percent of all students in both groups were African American. Students were included in the study sample if they were born at Atlanta’s large public hospital (Grady Memorial Hospital) in 1972, if they were entering eighth grade in 1985, and if they or their mothers had received care from the public hospital within the past five years (an indicator of poverty). The majority of the baseline measures did not differ significantly between treatment and control groups, however a greater percentage of PSI program students were from families in the lowest income category (56 percent versus 45 percent), and a greater percentage of control students lived with two parents (57 percent versus 36 percent). These demographic differences suggest that the PSI program group was from a higher-risk population than the control group. For analyses, students were divided into two groups: those who had not had sexual intercourse before the program, and those who had. Analyses were limited to those who had not had sexual intercourse at baseline. Of the 536 students who completed all interviews, 131 (24 percent) reported that they had had sexual intercourse before baseline, while 387 students (72 percent) said they had not (18 students had indeterminate answers and were dropped from the analysis). Of the 387 baseline virgins, 278 attended PSI schools with 256 actually attending the program, and 109 attended control schools. Five telephone health surveys were administered to the students over a five-year period, including three during the eighth grade and two during the ninth grade. The questionnaire was part of a larger study on health habits, so students were unaware they were participating in an evaluation of the PSI program. At the end of ninth grade, retention rates were 85 percent for the PSI students and 81 percent for the control students.
Howard (1992) conducted a twelfth grade follow-up to Howard and McCabe (1990). By the end of twelfth grade, 56 percent of the treatment group and 43 percent of the comparison group were retained in the study (237 treatment and 66 comparison group children, respectively). Analyses included all students, regardless of sexual activity at baseline.
Based on PSI, a similar program was implemented in the UK, consisting of 25 to 30 one-hour lessons given to students in curriculum years nine (ages 13-14) and ten (ages 14-15). The evaluation of the British PSI program (Mellanby et al., 1995) matched schools based on size. Depending on school schedules, the schools were then assigned to either the treatment (1,175 students) or control group (5,398 students), which received the school's existing sex education program. The evaluation surveyed three consecutive years of eleventh year students (age 15-16). The first group of students did not receive any portion of the program, the second group received half of the program while they were in year ten, and the third group received both years of the program. The outcome measures used in the study included changes in attitudes, knowledge of risk factors, sexual activity, and age at first intercourse.
Aarons et al. (2000) conducted a randomized controlled evaluation of the effect of the PSI program in a sample of six Washington, D.C., junior high schools. The schools were paired according to class size, location, and racial/ethnic distribution, and then randomly assigned to the treatment or control group. The treatment in this study was an expanded version of PSI, consisting of reproductive health classes, the PSI curriculum, health risk screening, and "booster" educational activities during the following school year. Of 812 eligible students, 582 enrolled in the six schools at the beginning of the study obtained written parental consent to participate. Students were surveyed at baseline (522 students), with the first follow up at the end of the seventh grade (503 students). The following year 459 students had useable surveys at the beginning of eighth grade, and 422 students had useable surveys at the end of eighth grade. The surveys were cross-sectional and anonymous, i.e., results indicate the average of the group of students at each individual point in time. A comparison of baseline characteristics between treatment and control groups revealed some significant differences between groups, however the way the differences might have positively or negatively affected the results is not obvious. At baseline, 44 percent of the seventh grade males and 81 percent of the seventh grade females reported being virgins.
Key Evaluation Findings
Howard and McCabe's (1990) evaluation of the pilot PSI program found that, among students who had not had sexual intercourse prior to the program:
- By the end of eighth grade, students in the control group were five times more likely to have begun having sex than were PSI students (20 percent versus 4 percent). By the beginning of ninth grade, the difference between these rates was still significant at 27 percent and 12 percent, respectively. By the end of ninth grade, the difference between groups was still significant, with rates of 39 percent versus 24 percent.
- For females in the study, by the end of eighth grade students in the control group were significantly more likely than students in the PSI group to have engaged in sexual intercourse (15 percent versus 1 percent). The differences between groups remained statistically significant in the ninth grade, with rates of 18 percent versus 7 percent at the beginning of the school year, and 27 percent versus 17 percent by the end of the school year.
- For male students, those in the control group were significantly more likely to have engaged in sexual intercourse by the end of eighth grade (29 percent versus 8 percent), with rates of 42 percent versus 22 percent at the beginning of ninth grade, and 61 percent versus 39 percent at the end of ninth grade.
- No statistically significant differences remained between groups in rates of initiation of sexual intercourse.
- There was no significant difference between groups with respect to use of birth control; 90 percent of the PSI group and 91 percent of the control group said they used a method of birth control at the time of last intercourse.
- In each year, PSI students increased their knowledge related to contraception, sexually transmitted diseases, and the true prevalence of sexual activity among their peers. Within control populations, there was no annual increase in correct answers when asked questions to test their knowledge of these issues.
- There was a significantly lower rate in sexual activity among PSI students compared with control students. In year three, control students were 1.45 times more likely to have had sex than program students.
- For virginity status among female participants,
- at the end of seventh grade, treatment group females were significantly more likely than control group females to report they were virgins.
- at the beginning of eighth grade no significant differences were found between groups.
- at the end of eighth grade, significantly more treatment group females than control group females reported that they were virgins.
- With regard to the use of birth control/condoms at the time of last intercourse for female, nonvirgin students, treatment group females were significantly more likely to report usage than were control group females at all three measurement points.
- No significant differences in virginity or use of birth control/condoms were observed among male participants at any time during the study.
Public and private junior high schools, community-based health organizations, and faith-based groups.
The Ford Foundation funded the pilot Atlanta implementation. Nationally, programs are supported with federal, state, local, foundation, and agency funds.
The PSI program in combination with the Human Sexuality program covers four main areas: an emphasis on abstinence from or delay of sexual activity, life-skills training, sexuality education, and contraceptive education. Abstinence is presented as the best way to prevent unintended pregnancy and sexually transmitted diseases. The program also teaches that young teens are not yet mature enough to handle the consequences of sexual activity. The life-skills component includes activities that help students build decisionmaking skills, set goals for their lives, learn how to say no to sex, and negotiate within relationships. Sexuality education refers to a broad-based curriculum covering physical growth and the development of healthy sexual attitudes and values. Contraceptive education covers methods of contraception, how such methods are used, and their effectiveness in preventing pregnancy and sexually transmitted diseases.
The PSI program uses three principles—experiential learning (active involvement on the part of the students); a single, consistent message (postponing sexual activity); and repetition and reinforcement.
When implemented in Atlanta in 1985, students received both the Human Sexuality and the PSI programs. The five Human Sexuality sessions were taught by hospital nurses and health educators. PSI was delivered in five classroom sessions, each 45 to 60 minutes long, was directed by two student leaders, and involved group discussion and role-playing activities. The first four sessions were given either in the same week or weekly over four weeks. The fifth session, which was designed to reinforce the material, was given one to three months later.
More specifically, session 1 addressed students' beliefs about why teenagers have sex and presented reasons for why they should postpone sexual activity. Session 2 focused on the influence of the media, while session 3 focused on peer pressures and how to respond to them, as well as the need to set a "stopping point" in physically expressing affection. Session 4 helped students develop assertiveness skills in resisting pressures to have sex. Lastly, session 5 reinforced the concepts from the previous sessions.
The student leaders were recruited from among eleventh and twelfth graders, and each received 20 hours of initial training, followed by monthly two-hour training sessions. Student leaders learned to present information, conduct discussions, teach assertiveness skills, and lead role-playing.
Issues to Consider
This program received a "promising" rating. While the PSI program did have several positive effects related to postponing sexual activity for both male and female students, results from Howard (1992) suggest that the delay was not maintained by the end of twelfth grade. Study results were mixed with respect to use of birth control, with Howard (1992) reporting no program effects, and the study by Aarons et al. (2000) reporting positive findings for female students only.
An area of potential concern is program replication. The program in Great Britain was based on the PSI program and seems to have been successful in obtaining similar results regarding youths delaying their sexual activity. However, a large-scale replication in California did not produce any of the positive effects seen in the Atlanta study. The California program replication, called the Education Now and Babies Later initiative, took place from 1992 to 1994. An evaluation of 10,600 students (Kirby et al., 1997) found that youths in treatment and control groups were equally likely to have become sexually active or to have reported a pregnancy or sexually transmitted disease 17 months after the program.
The California program, however, may not have been a faithful replication for several reasons. The program was randomly delivered to classrooms within the same school, with some students receiving the program and some receiving the standard sexuality curriculum offered by the school. It is possible that, given the peer pressure associated with sexual activity, providing only some of the students with the program makes it less effective. Second, the PSI program component did not follow the Human Sexuality program offered in the Atlanta schools, although the students were required to participate in a similar program. The study did not find any significant effects with the students who were taught by peer leaders; in addition it was found that some of the teen leaders were not sufficiently trained or lacked experience. Furthermore, 90 percent of the classes were taught by adults. Personal observations of the sessions revealed that some of the adults did not like the program's emphasis on postponing sexual involvement and the exclusion of information about contraception and disease prevention. This identifies a problem with the replication given that the Human Sexuality program in Atlanta provided that information.
The program was originally piloted in Atlanta. It has been used in several locations throughout the United States, Great Britain, Canada, and New Zealand.
Resources Coordinator: Jane Fonda Center
Emory University School of Medicine
Building A Briarcliff Campus
1256 Briarcliff Road
Atlanta GA 30306
phone: (404) 712-4710
fax: (404) 712-8739
The Postponing Sexual Involvement Educational Series was updated with a new 15 segment video and leader's guide in 2006. The updated materials are available for purchase from the Jane Fonda Center at Emory University (www.janefondacenter.emory.edu).
A series of training materials is available for use in orienting teen leaders, consisting of a leader's guide, a live-action video, and five teen-leader survival guides. Other training also is available through Emory University's Jane Fonda Center.
Aarons, Sigrid J., Renee R. Jenkins, Tina R. Raine, M. Nabil El-Khorazaty, Kathy M. Woodward, Rick L. Williams, Marc C. Clark, and Barbara K. Wingrove,
"Postponing Sexual Intercourse Among Urban Junior High School Students: A Randomized Controlled Evaluation," Journal of Adolescent Health, Vol. 27, No. 6, 2000, pp. 236-247.
Frost, Jennifer J., and Jacqueline Darroch Forrest, "Understanding the Impact of Effective Teenage Pregnancy Prevention Programs," Family Planning Perspectives, Vol. 27, No. 5, 1995, pp. 188-195.
Howard, Marion M., "Delaying the Start of Intercourse Among Adolescents," Adolescent Medicine, Vol. 3, No. 2, 1992, pp. 181-193.
Howard, Marion M., and Judith B. McCabe, "Helping Teenagers Postpone Sexual Involvement," Family Planning Perspectives, Vol. 22, No. 1, 1990, pp. 21-26.
Kirby, Douglas, Meg Korpi, Richard P. Barth, and Helen H. Cagampang, "The Impact of the Postponing Sexual Involvement Curriculum Among Youths in California," Family Planning Perspectives, Vol. 29, No. 3, 1997, pp. 100-108.
Mellanby, Alex R., Fran A. Phelps, Nicola J. Crichton, and John H. Tripp, "School Sex Education: An Experimental Programme with Educational and Medical Benefit," British Medical Journal, Vol. 311, 1995, pp. 414-417.