Comprehensive sex education has been shown to improve academic success; prevent child abuse, dating violence and bullying; and prevent unintended pregnancy, HIV, and other sexually transmitted infections. Twenty-nine states mandate sexual health education. Ohio is not one of them. In Ohio, sex education varies district by district, school by school, sometimes even classroom by classroom. This means that young people are not getting consistent information about healthy relationships; consent; puberty and anatomy; sexually transmitted infections and contraceptives. [bctt tweet="What did we learn about sex education in Cuyahoga County? You may be surprised, read more here" username="CommunitySols"]

In Ohio, sex education varies district by district, school by school, sometimes even classroom by classroom.

The lack of sexual health education policy in Ohio is a challenge for advocates and community health organizations that want to support school districts with professional development opportunities and programming. Students have also expressed the challenges they face when it comes to getting a comprehensive sexual health education, as evidenced by community conversations with Cuyahoga County teens earlier this year. In June 2017, The Collaborative for Comprehensive School Age Health, a network of more than 25 public and private organizations working toward increased access to comprehensive, medically accurate and inclusive sexual health education and services in Northeast Ohio, put out a survey to all public middle and high schools in Cuyahoga County. The goal of the survey was to have a deeper knowledge of the sex education landscape in the county, in order to provide technical assistance and resources to interested school districts. A goal was also to provide community members with a resource to inform advocacy for improvements in sex education curriculum and policy. The interactive map represents our findings and is a living document. We invite all schools participate - to keep the information current.

Click here to see the interactive map we made from the data gathered for this report

Methodology & DefinitionsThe survey was sent out through individual email communication to school administrators, principals, and health and physical education teachers (who commonly teach sex education). Emails were followed up with by individual phone calls to attempt to include as many schools as possible. The survey questions focused on what approach to sex education schools used; whether they use a specific curriculum for sex education; if they bring in outside speakers and if so, from what organizations.Approaches to sex education vary but can be categorized into three common types.

Abstinence-only until marriage sex education stresses that abstinence until marriage is the only morally correct option of sexual expression. It often stresses failure rates of contraceptives and discusses the negative social emotional and physical outcomes of sexual behavior.
Abstinence-based sex education is not values based. It stresses abstinence, but includes information about sexually transmitted infections and HIV; contraceptives; and healthy relationships.
Comprehensive sexual health education is not values-based. It discusses a spectrum of experiences when it comes to sexuality, and covers topics like abstinence, healthy relationships, consent, puberty, anatomy, contraceptives, HIV and sexually transmitted infections. It is inclusive of different sexual orientations, gender identities, races and religions.

One challenge with the data collected from surveys is that it is subjective. In most cases, one individual from a school responded to the survey, and their responses about approaches to sex education may or may not be an accurate representation of all sex education offered at the school. To help ensure accurate responses, the survey intentionally did not ask respondents to categorize their approach outright, but rather used descriptions of the three approaches (above) and asked respondents to select the description that best represented their school’s approach. Another challenge is that the data is not complete. Not all schools responded to the survey, and schools that did may have left out information about speakers or curriculum. Collecting as much complete information about sex education in the county going forward will be important to get a complete picture.FindingsA representative from 78 schools, or about 60 percent of the public middle and high schools in Cuyahoga County, responded to the survey, which means that for about 40 percent of the schools, there is currently no data available for analysis. Of the schools that responded, the largest group (37 schools, 47 percent) categorized their approach to sex education as abstinence-based. The next most common approach was comprehensive sex education, which 24 schools, or 31 percent, identified as their approach. Nine of the schools reported not teaching any sex education at all, and eight schools reported having sex education but not having a specific approach.

Nine of the schools reported not teaching any sex education at all.

It is difficult to make any conclusions about the geographic distribution of different approaches to sex education, in part because the data is still incomplete. It is our hope that this project will raise awareness of this issue and prompt residents from districts around the county to encourage their schools to participate in the survey.

Sex Education Approaches at Public Middle and High Schools in Cuyahoga County

From the data that has been collected thus far, it is clear that there is a wide range of approaches to sex education across the county. Even within districts, different school buildings may be using different sex education curriculum or have different approaches. If the national goal is for all young people to have access to accurate and age-appropriate information about their sexual health, it is clear that many schools in Cuyahoga County have more work to do to achieve that goal.

If the national goal is for all young people to have access to accurate and age-appropriate information about their sexual health, it is clear that many schools in Cuyahoga County have more work to do to achieve that goal.

The map also includes layers which reveal a few key health indicators that are relevant to sexual health education: Chlamydia infection rates by municipality[1], Gonorrhea infection rates by municipality[2] and teen birth rates by school district.[3] Approximately half of the new cases of sexually transmitted infections (STIs) occur among people aged 15-24.[4] This means that young people especially are in need of quality education, prevention and treatment services

Chlamydia Infection Rates by Municipality

Gonorrhea Infection Rates by Municipality

In Cuyahoga County, municipalities with higher poverty rates are more likely to have higher rates of new STI cases. The same is true of municipalities with higher proportions of African-American residents. While poverty and race are closely linked in Cuyahoga County, the percent of African-American residents was a slightly better predictor of higher STI rates than poverty rates. In other words, African-American communities are disproportionately impacted by STIs to a greater extent than poor white communities.

In Cuyahoga County, municipalities with higher poverty rates are more likely to have higher rates of new STI cases.

The highest rates of Chlamydia infectionswithin the county are inNorth Randall (1,818 per 100,000 in population), East Cleveland (1,747), Warrensville Heights (1,351) and Cleveland (1,317).[5]The highest rates of Gonorrhea infections within the county are in North Randall (876 per 100,000 in population), East Cleveland (828), Warrensville Heights (539) and Highland Hills (531). It is worth noting that Highland Hills only had one year of data available low instances of Gonnorrhea, and this rate is based on six incidences of Gonorrhea in 2014, so this finding should be interpreted with caution.

Teen Birth Rates by School District

Similar to STI rates across the county, teen birth rates are higher in communities with high poverty rates and higher percentages of African-American residents. The school districts with the highest teen birth rates were Warrensville Heights City School District (49.9 births per 1,000 females age 15-19), Maple Heights City School District (49.1), Cleveland Municipal School District (46.9) and East Cleveland City School District (46.8).

The school districts with the highest teen birth rates were Warrensville Heights City School District, Maple Heights City School District, Cleveland Municipal School District and East Cleveland City School District.

An important caveat is that we are not making any causal determinations about the approach to sex education in communities and the sexual health outcomes included in the interactive map. People of color and people living in poverty are frequently at increased risk for poor health outcomes – for a myriad of reasons – and sexual health outcomes are no different. These outcomes do point to the need throughout our county ‒ and especially for young people in municipalities with high disease morbidity ‒ to have access to comprehensive sexual health education, including information about how they can access the services they need to live healthy lives.

These outcomes do point to the need throughout our county ‒ and especially for young people in municipalities with high disease morbidity ‒ to have access to comprehensive sexual health education, including information about how they can access the services they need to live healthy lives.

Recommendations/Next StepsA comprehensive sex education policy that includes funding; support for professional development and training; and time in the school-year to implement sex education curriculum would provide school districts with the foundation to teach comprehensive sex education from kindergarten through grade twelve. School districts would also benefit from district level comprehensive sex education policies to ensure continuity between grade levels. School districts need resources to either train teachers to implement sex education internally, or contract outside organizations to come to the schools to teach sex education. If you do not see your school represented on this map, please contact us. This is just the first step at increasing awareness about sex education programming in Cuyahoga County.

We would like to acknowledge former Community Solutions intern Cassie Dutton for her data collection work for this report.

To see the entire interactive map click here.

[1] Cleveland Department of Public Health. 2013-2015 Cuyahoga County Sexually Transmitted Diseases Report: Chlamydia and Gonorrhea. Average rates calculated by The Center for Community Solutions using all available years of data (2013-2015).[2] Cleveland Department of Public Health. 2013-2015 Cuyahoga County Sexually Transmitted Diseases Report: Chlamydia and Gonorrhea. Average rates calculated by The Center for Community Solutions using all available years of data (2013-2015).[3] Ohio Department of Health, ACS 2016 5-Year Estimates. Births to Teens ages 15-19, 2013-2017. Calculated by The Center for Community Solutions.[4] Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008.[5] Cleveland Department of Public Health. 2013-2015 Cuyahoga County Sexually Transmitted Diseases Report: Chlamydia and Gonorrhea. Average rates calculated by The Center for Community Solutions using all available years of data (2013-2015).

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