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The purpose of this study is to describe how school-based sexuality education (SBSE) in the context of health education frames and teaches sexuality, sexual orientation, and gender identity. Understanding how schools address sexuality and gender provides insight into how school systems might ostracize sexual and gender diverse (SGD) youth. This study used content analysis to survey 13 health education textbooks in the United States. The content of textbooks provides a sampling of cultural, economic, and political activities and the ways they may be portrayed in the school setting. All textbooks had to be (1) health education textbooks, (2) intended for middle and high school, (3) published in the last 15 years, and (4) required or recommended by a state or local Department of Education, or produced by a publisher recommended by a department of education. Results of this study indicate that 11 of the 13 reviewed textbooks had abstinence based or abstinence only until marriage sexuality education that presented narrow, binary definitions of gender and sexual orientation, and that ignored or provided misinformation about gender identity and sexual orientation. Results of this study suggest that school personnel should consider alternatives to widely available health textbooks to teach more inclusive, affirming, and effective sexuality education.

One uniquely marginalizing school environment for sexual and gender diverse (SGD) youth is school based sex education (SBSE). While research has documented the negative sexual and mental health impacts these marginalizing environments can have for SGD youth, we know less about the developmental competencies that this population of youth exercises to survive in and cope with these environments. In this paper, we aim to answer the following question: What are the developmental competencies that SGD youth exercise in sex education spaces? We conducted focus groups with SGD youth (n = 17) in a Midwestern metropolitan region. Our study documents youth exercising six adaptive competencies to persevere through oppressive SBSE. Our data holds several scholarly and practical implications. In our discussion section, we present recommendations for creating inclusive and affirming school environments and nurturing these competencies in youth.

Decision-making has been identified as one of the most important skillsets in sexual health. This exploratory qualitative study explored how US middle and high school textbooks integrate the recommended sexual health decision-making skills recommended by Future of Sex Education (FOSE), a collaboration of organisations in the USA supporting comprehensive sex education. Using content analysis, we assessed 13 U.S. middle and high school health education textbooks recommended by school districts, state boards of education, and publishers. While textbooks touched on the knowledge and content areas for each skill set, skills were not taught to the extent that the skill was achieved or using a scaffolded approach that showed significant growth from middle to high school textbooks. As a result, young people receive inadequate content to competently perform the skills recommended by current National Standards. Changing state and district level health and sex education policies and aligning the curriculum with these standards, can better promote youth sexual decision-making.

The purpose of this study is to describe the experiences of lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth with school-based sexuality education (SBSE), as well as to document strategies LGBTQ+ youth are using to address their evolving and specific sexual health needs outside of SBSE. Researchers conducted focus groups with 17 adolescents (ages 14-18) from urban and suburban Midwestern cities. Results of this study indicate LGBTQ+ youth find SBSE to be heteronormative, cisgender focused, and primarily focused on pregnancy and disease prevention, which contributes to LGBTQ+ youth experiences of exclusion. In response to SBSE that did not meet student needs, participants reported seeking sexual health information outside of SBSE. Other sources included family and other trusted adults, the Internet, and community resource centers. Students reported variable rates of use and trustworthiness across these resources. Results of this study suggest that school personnel should consider alternatives to traditional SBSE models to meet the needs of LGBTQ+ youth, and that an important part of SBSE should include guidelines for Internet safety.