Sex Education: Experimental Evidence on the Impact of the Message and Messenger on Adolescent Sexual Behavior

Last registered on May 03, 2021

Pre-Trial

Trial Information

General Information

Title
Sex Education: Experimental Evidence on the Impact of the Message and Messenger on Adolescent Sexual Behavior
RCT ID
AEARCTR-0007624
Initial registration date
May 02, 2021
Last updated
May 03, 2021, 12:27 PM EDT

Locations

Primary Investigator

Affiliation
University of Oxford

Other Primary Investigator(s)

PI Affiliation
Baylor College of Medicine, Botswana-Baylor Children’s Clinical Centre of Excellence

Additional Trial Information

Status
Completed
Start date
2014-08-01
End date
2016-09-01
Secondary IDs
Abstract
Governments have institutionalized sex education in schools worldwide. While a growing body of evidence exists on sex education messages that can reduce risky sex, little is known about the messenger. We estimate the effect of sex education in Botswana in a large-scale randomized trial that varied both the message and the messenger: teachers, who deliver sex education in the status quo, and near-peers, who are young and aspirational figures. These results are noteworthy in a context where risky sexual behavior is highly consequential, with an average HIV rate of 25 percent. More generally, these results demonstrate the role of messengers in influencing both beliefs and behavior.
External Link(s)

Registration Citation

Citation
Anabwani, Gabriel and Noam Angrist. 2021. "Sex Education: Experimental Evidence on the Impact of the Message and Messenger on Adolescent Sexual Behavior." AEA RCT Registry. May 03. https://doi.org/10.1257/rct.7624-1.0
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Experimental Details

Interventions

Intervention(s)
We include two different sex education messengers – teachers, who deliver sex education in the status quo, and near-peers, who are young and aspirational figures. We will explore messenger mechanisms along three primary channels: compliance, beliefs, and preferences. Along the compliance margin, delivery of the information will depend on showing up at school and transferring information undistorted. Along the beliefs margin, different messengers might be more trustworthy and relatable. Along the preferences margin, conditional on beliefs, different messengers could be differentially persuasive. A teenager can listen, ignore, or rebel to information. Listening to a prescription derives from beliefs and can be enhanced through role model effects. An alternative option of teenage rebellion has been explored extensively in psychology and described as “reactance.”

The two messengers deliver the same sex education message. The sex education message provided information that younger partners are five times less likely to have HIV than older partners and are a safer sex option. A study in Kenya found that revealing that older partners are significantly more likely to have HIV than younger partners led to a large reduction in teen pregnancy of 28 percent (Dupas 2011). We deliver a similar sex education message in Botswana. Similar to Kenya, HIV rates increase dramatically with age in Botswana. 3.6 percent of 15 to 19 year-old boys are infected with HIV relative to 43.8 percent in 40 to 44 year old men (Statistics Botswana 2013). Yet, 90 percent of young people do not know that 40-year old men are most likely to have HIV. In this context, revealing the relative HIV risk of older versus younger male sexual partners may make the previously underestimated cost of older partners known and salient. This knowledge of relative risks by age further makes clear that dating age-mates is a relatively safer sex option. This message is in sharp contrast to the dominant alternative message: abstain. The typical abstinence message emphasizes extreme risk avoidance (“don’t have sex until marriage”). This message fails to provide a realistic safe sex option to youth who will not abstain. If sexual behavior is more likely to change on the intensive margin (type of sex) rather than the extensive margin (sex or no sex) providing safe sex alternatives, such as revealing younger partners are lower risk than older partners, will be more effective.
Intervention Start Date
2014-08-01
Intervention End Date
2014-12-30

Primary Outcomes

Primary Outcomes (end points)
risk beliefs about HIV and sexual partners, risky sexual behavior as measured by objective measures of teenage pregnancy
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
self-reported sexual behavior
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
In this paper we estimate the effect of sex education in a randomized trial in Botswana when delivered by two different messengers – teachers, who deliver sex education in the status quo, and near-peers, who are young and aspirational figures. The trial was conducted in close collaboration with the government and at large scale, covering 42,000 students in a third of the country. The sex education message provided information that younger partners are five times less likely to have HIV than older partners and are a safer sex option. This message previously reduced pregnancy by 28 percent in a randomized trial in Kenya (Dupas 2011). Since we adapted a message shown to reduce risky sex, we can uniquely test the effectiveness of the messenger; if the underlying message does not work, the effect of any messenger would always be zero. We also directly retested the effectiveness of the message by comparing results to a control group.
Experimental Design Details
Randomization Method
Randomization generated using stata code on a computer.
Randomization Unit
School. Stratification was conducted by school type (primary or junior school) and region.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
347
Sample size: planned number of observations
42,000
Sample size (or number of clusters) by treatment arms
116 control, 116 teacher arm, 115 near-peer
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Ministry of Education
IRB Approval Date
2014-06-13
IRB Approval Number
DEPRS 7/1/5/ XII (23)
IRB Name
MIT COUHES
IRB Approval Date
2014-10-01
IRB Approval Number
1408006559
IRB Name
Health Research and Development Committee (HRDC)
IRB Approval Date
2014-06-24
IRB Approval Number
00756

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials