Support for sex education and teenage pregnancy prevention programmes in the USA: results from a national survey of likely voters

ABSTRACT

Support for sex education in middle and high school and for the inclusion of a variety of topics in sex education programmes is strong among likely voters in the USA. This survey was conducted with a diverse sample of 965 adults who were invited from the largest probability-based panel in the USA. In addition to supporting sex education in schools, likely voters support continued government funding for teenage pregnancy prevention programmes and want those programmes to include abstinence as well as birth control and sexually transmitted disease (STD) prevention. There are some differences in support for the inclusion of particular topics in sex education among likely voters by political affiliation. Analyses adjusting for race/ethnicity, income, employment, education, age and gender, found that Republicans were more likely to support the inclusion of abstinence, while Democrats were more likely to support the inclusion of birth control, healthy relationships, consent and sexual orientation. There were no differences between Democrats and Republicans in support for including puberty and STDs, including HIV. This investigation adds to a growing literature showing that there is very high support for sex education and federal funding of teenage pregnancy prevention programmes in the USA.

KEYWORDS:

• Sex education
• teenage pregnancy
• voter preferences
• Republicans
• Democrats
• USA

Introduction

A majority of adults in the USA support sex education in schools that includes a variety of different topics including abstinence, contraception, and sexually transmitted diseases (STDs) (Bleakley, Hennessy, and Fishbein 2006; Canan and Jozkowski 2017; Dunn et al. 2014; Eisenberg et al. 2013; Herrman et al. 2013; Kershner et al. 2017). High levels of support exist among numerous groups previously surveyed inclufding individuals that identify as politically conservative (Bleakley, Hennessy, and Fishbein 2006; Canan and Jozkowski 2017; Kershner et al. 2017), middle school and high school teachers (Eisenberg et al. 2013), and college students (Canan and Jozkowski 2017). Previous surveys that asked respondents whether they identify as conservative or liberal found that respondents who were more liberal generally held more positive attitudes about sex education that includes information about methods of preventing pregnancy and STDs. However, a majority of respondents of every political affiliation supported sex education that includes information about both contraception and abstinence (Bleakley, Hennessy, and Fishbein 2006; Canan and Jozkowski 2017; Kershner et al. 2017).

Parents also strongly support sex education programmes in public middle and high schools (Bleakley, Hennessy, and Fishbein 2006; Heller and Johnson 2013; Herrman et al. 2013; NPR 2004). In a previous study, more than 93% of parents, regardless of political affiliation, (e.g. both Democrats and Republicans) felt sex education was ‘very important’ or ‘somewhat important’ in public middle schools, and over 97% of parents of both political parties felt sex education was ‘very important’ or ‘somewhat important’ to include in public high school (Kantor and Levitz 2017). Parents of both political parties endorsed including a broad array of topics in school-based sex education (Kantor and Levitz 2017).

Several other studies have examined parents’ views on sex education and these also show very high support for sex education in schools (Alton et al. 2009; Constantine, Jerman, and Huang 2007; Eisenberg et al. 2008; Howard et al. 2017; Ito et al. 2006; Millner, Mulekar, and Turrens 2015). Very few parents believe sex education should not be taught in schools (Eisenberg et al. 2008; Kantor and Levitz 2017). Parents, regardless of race/ethnicity, income or age, support sex education which includes a wide range of topics (Constantine, Jerman, and Huang 2007; Eisenberg et al. 2008). Generally speaking, younger age, African American identity, attending religious services less frequently, higher education levels, lower household income, and being more politically liberal increase the odds of parents supporting sex education that includes a wide array of topics (Constantine, Jerman, and Huang 2007; Ito et al. 2006). However, overall parents in every demographic group are supportive of sex education in schools.

Despite this high level of support among many groups, sex education and federal funding for teenage pregnancy prevention and the types of programmes that should be funded has often been highly politicised in the USA (Irvine 2004; Kantor et al. 2008; Uzzell and Troiano 2019). Since 2009, the Teen Pregnancy Prevention Program (TPPP) and the Personal Responsibility Education Program (PREP) have provided federal funding for teenage pregnancy programmes that have evidence of helping teens delay sex, improve contraceptive use, and/or prevent pregnancy. In 2017, the Trump Administration announced that it was ending funding for current projects funded under the TPPP which led to five lawsuits (Uzzell and Troiano 2019). Subsequently, the Trump Administration announced new requirements for the TPPP, which were also challenged in court (Uzzell and Troiano 2019).

Support for funding of specific approaches to teenage pregnancy prevention funded by the government has been less widely studied (Power to Decide 2017) and has not been previously studied among likely voters. Thus, this study included questions about whether likely voters support federal government funding for teenage pregnancy prevention programmes at all, what approach to those programmes they wanted, and whether they supported continued funding of two of the main federally-funded programmes in the USA: the Teen Pregnancy Prevention Program (TPPP) and the Personal Responsibility Education Program (PREP), including examining any differences between likely voters that identify as Democrats compared to Republicans.

Methods

Study sample

Participants were adults in the USA recruited through GfK’s KnowledgePanel in February 2018. The panel is the largest probability-based panel of adults in the USA and members were originally recruited to the panel using address-based sampling. More information on the methodology of the overall GfK panel is available online (GfK 2019). As part of enrolling in the panel, participants complete a survey that asks for demographic information including their gender, age, race/ethnicity, highest level of education received, household income, home ownership status, marital status, current employment status, political affiliation and language proficiency.

The total sample for this study included 1,001 likely voters weighted to represent the US population on gender, age, race/ethnicity, census region, education, household income and language proficiency. Potential respondents from the panel received an e-mail invitation requesting their participation and 52% of those invited completed the eligibility screening. Inclusion criteria for the study were age 18 and over and whether or not respondents were likely voters. Likely voters were determined by the question ‘How often do you vote in elections?’ Respondents who answered, ‘About half the time’, ‘Nearly always’, or ‘Always’ were considered likely voters and were invited to participate in the survey. Seventy-seven percent of those completing the eligibility screening met the inclusion criteria and completed the survey. Respondents completed their surveys online.

Measures

In the initial demographic survey for the GfK panel, participants indicated political affiliation from a list of seven categories: strong Republican/Democrat, not strong Republican/Democrat, leans Republican/Democrat, or Undecided/Independent/Other. The significance of the results did not differ by each of the possible ways of collapsing the Republican/Democrat political affiliation categories, so the levels were collapsed into a Democrat or Republican dichotomous variable to facilitate analysis and interpretation of the data. Thirty-six respondents indicated that they were Undecided, Independent, or Other and were removed from the sample as this study sought to examine possible distinctions between Democrats and Republicans in support for sex education and federal funding of teenage pregnancy prevention programmes. Thus, the final sample included 965 likely voters.

The survey included 21 questions assessing preferred terminology related to sex education, overall support for sex education in middle and high school as well as support for including particular topics, and support for federal funding of programmes to prevent unplanned teenage pregnancy as well as desired approaches to those programmes. The median survey completion time was 10 minutes. This analysis focuses on results related to support for sex education in middle and high school, which topics should be included in middle and high school sex education, support for federal funding for programmes to prevent unplanned teenage pregnancy, and what approach those programmes should take.

Support for sex education in middle and high school was measured with two questions. The first of these asked, ‘How important do you think it is to have sex education in [middle school/high school]?’ Answer options included ‘very important’, ‘somewhat important’, ‘not important’, ‘should not be taught in [middle school/high school]’, and ‘should not be taught in school at all’.

Support for the inclusion of particular topics in middle school and high school was assessed with two separate questions, ‘Should sex education in [middle school/high school] include the following topics?’ with dichotomous yes/no responses for each of the seven topics. The topics surveyed were ‘puberty and the physical, social and emotional changes that take place during the teen years’, ‘healthy and unhealthy romantic relationships’, ‘abstinence’, ‘birth control methods’, ‘sexually transmitted diseases, including HIV’, ‘sexual orientation (e.g. information about being straight, gay, lesbian, or bisexual)’, and ‘consent’. These measures were repeated from a previous survey on support for sex education among parents (Kantor and Levitz 2017). We operationalised strong support as support for the inclusion of a particular topic among more than 75% of any given group.

Questions related to federal funding for teenage pregnancy prevention were replicated from a previous survey of adults conducted by Power to Decide (2017). First, respondents were asked about preferred approach for programmes to prevent unplanned teenage pregnancy that are funded by the US government, and were able to select whether these programmes should focus on ‘encouraging teens to postpone sex’, ‘providing teens with information on birth control and protection from sexually transmitted infections’, or ‘both encouraging teens to postpone sex and proving teenagers with information about birth control and protection from sexually transmitted infections’. This was followed by a dichotomous yes/no question assessing general support for federal funding for unplanned teenage pregnancy prevention programmes. Respondents answering yes to this question were then asked ‘Do you believe that federally funded programmes (e.g. programmes that are funded by the United States government) designed to prevent unplanned teen pregnancy should focus on … ’ and could choose either ‘encouraging teens to delay sex until they are married’ or ‘encouraging teens to delay sex until they are ready and preparing them for the possible consequences of sex’. Then, a question on strength of support for federal funding for TPPP and PREP asked, ‘The Teen Pregnancy Prevention Program (TPPP) and the Personal Responsibility Education Program (PREP) provide federal funding for programmes that are proven to help teenagers delay sex, improve contraceptive use, and/or prevent pregnancy. How much do you support or oppose maintaining federal funding for these programmes?’ and was assessed with a 5-point Likert scale, ranging from ‘strongly support’ to ‘strongly oppose’.

Statistical analyses

All analyses were completed in SPSS version 21. A paired sample t-test was used to compare the mean level of support for including the seven topics in sex education in both middle and high school. Logistic regression models controlled for race/ethnicity, household income, marital status, employment, education, age and gender when comparing levels of support for sex education in school and support for inclusion of 7 key topics by political affiliation. These demographics were included in the regression models as they are associated in the literature with differences in level of support for sex education. Independent sample t-tests were used to compare means in level of support for federally-funded teenage pregnancy prevention programmes. Chi-square tests were used to assess differences by political affiliation in support for federal funding for programmes to prevent unplanned teen pregnancy.

Results

Sample characteristics are presented in Table 1.

Table 1. Demographics of a probability-based sample of adult likely voters in the USA.

Demographics	All	Democrats	Republicans
	n = 965	54.0% (n = 521)	46.0% (n = 444)
Sex
Female	52.0% (n = 501)	54.7% (n = 285)	48.8% (n = 216)
Male	48.0% (n = 464)	45.3% (n = 236)	51.2% (n = 227)
Median household income range	$75,000-$84,999	$75,000-$84,999	$75,000-$84,999
Marital Status
Married	61.0% (n = 589)	52.8% (n = 275)	70.8% (n = 314)
Single	39.0% (n = 376)	47.2% (n = 246)	29.2% (n = 129)
Employment
Employed	63.8% (n = 615)	66.4% (n = 346)	60.9% (n = 270)
Unemployed	36.2% (n = 350)	33.6% (n = 175)	39.1% (n = 173)
Race/Ethnicity
Black, Non-Hispanic	11.6% (n = 112)	20.6% (n = 107)	1.1% (n = 5)
Hispanic	13.1% (n = 127)	18.8% (n = 98)	6.4% (n = 29)
Other, Non-Hispanic	5.4% (n = 52)	5.6% (n = 29)	5.1% (n = 23)
2+ Races, Non-Hispanic	1.4% (n = 13)	1.5% (n = 8)	1.2% (n = 5)
White, Non-Hispanic	68.5% (n = 661)	53.5% (n = 279)	86.2% (n = 382)
Age
18–29	16.6% (n = 160)	18.6% (n = 97)	14.2% (n = 63)
30–44	21.6% (n = 208)	22.4% (n = 117)	20.7% (n = 92)
45–59	27.2% (n = 267)	28.5% (n = 149)	26.6% (n = 118)
60+	34.2% (n = 330)	30.5% (n = 159)	38.5% (n = 171)
Education
Some College	67.7% (n = 653)	64.9% (n = 338)	70.9% (n = 314)
No College	32.3% (n = 313)	35.1% (n = 183)	29.1% (n = 129)

Importance of sex education in schools

Overall, among likely voters, there was strong support for sex education in schools (see Table 2). For middle school, 64.1% (n = 617) of likely voters felt sex education is ‘very important’ and 24.6% (n = 237) feel it is ‘somewhat important.’ The remaining 11.3% of likely voters were split between those who indicated that sex education in middle school is ‘not important’ (3.6%, n = 35), ‘sex education should not be taught in middle school’ (4.2%, n = 40) or that ‘sex education should not be taught in school at all’ (3.5%, n = 34). For high school, 82.7% (n = 768) of likely voters felt sex education was ‘very important’ and 15.3% (n = 142) felt it was ‘somewhat important’. A small percentage answered that sex education in high school was ‘not important’ (1.5%, n = 14), that ‘sex education should not be taught in high school’ (0.5%, n = 5) or that ‘sex education should not be taught in school at all’ (0.2%, n = 2).

Table 2. Importance of sex education overall and by political affiliation.

	Middle School			High School
	Overall	Republican	Democrat	Overall	Republican	Democrat
Very Important	64.1% (n = 617)	49.0% (n = 216)	76.8% (n = 401)	82.7% (n = 768)	73.4% (n = 301)	90.0% (n = 467)
Somewhat Important	24.6% (n = 237)	31.7% (n = 140)	18.6% (n = 97)	15.3% (n = 142)	23.7% (n = 97)	8.7% (n = 45)
Not Important	3.6% (n = 35)	5.0% (n = 22)	2.5% (n = 13)	1.5% (n = 14)	2.0% (n = 8)	1.2% (n = 6)
Should not be taught in [MS/HS]	4.2% (n = 40)	7.3% (n = 32)	1.5% (n = 8)	0.5% (n = 5)	1.0% (n = 4)	0.2% (n = 1)
Should not be taught in school at all	3.5% (n = 34)	7.0% (n = 31)	0.6% (n = 3)	0.2% (n = 2)	N/A	N/A

N/A indicates too small a percentage to allow for analysis by political affiliation.

Importance of sex education in schools by political affiliation

We found that a majority of likely voters who were either Democrats or Republicans felt sex education was very or somewhat important in middle and high school. Among Democrats, there was strong support for sex education: 76.8% (n = 401) felt it is ‘very important’ and 18.6% (n = 97) felt it is ‘somewhat important’ to include sex education in middle school. Among Republicans, 49.0% (n = 216) felt it is ‘very important’ and 31.7% (n = 140) felt it is ‘somewhat important’ to include sex education in middle school. Support for sex education in high school was higher than for sex education in middle school among both Democrats and Republicans, with both groups strongly supporting the inclusion of sex education in high school. Among likely voters that were Democrats, 90.0% (n = 467) responded that it was ‘very important’ and 8.7% (n = 45) responded that it was ‘somewhat important’ to include sex education in high school. Among Republicans, 73.4% (n = 301) of likely voters responded that including sex education in high school was ‘very important’ and 23.7% (n = 97) answered it was ‘somewhat important.’

When comparing the differences between Republicans and Democrats in ratings of the importance of sex education in middle and high school, we found a significant difference in the belief that sex education is important in middle school and high school. On average, Democrats found sex education significantly more important than Republicans in middle school (β = 0.31, p < .001) as well as in high school (β = 0.20, p < .001).

When controlling for race/ethnicity, income, marital status, employment, education, age, and gender, identifying as a Democrat slightly increased the likelihood of indicating that sex education is important in both middle school (β = 0.58, p < 0.001) and high school (β = 0.20, p < 0.001). However, it is noteworthy that over 80% of likely voters who are either Democrats or Republicans felt it was very or somewhat important to include sex education in both middle and high school.

Overall support for inclusion of sex education topics

Overall, there was strong support among likely voters for including 6 of the 7 key topics in sex education in both middle and high school: puberty, healthy relationships, abstinence, birth control methods, sexually transmitted diseases including HIV, and consent (see Table 3).

Table 3. Support for including select sex education topics overall and by political affiliation.

	Middle School			High School
Topic	Overall	Republican	Democrat	Overall	Republican	Democrat
Puberty	97.8% (n = 868)	97.6% (n = 368)	97.8% (n = 500)	97.2% (n = 895)	97.3% (n = 393)	97.1% (n = 501)
Healthy Relationships	88.8% (n = 788)	84.7% (n = 320)	91.9% (n = 468)	95.8% (n = 883)	94.1% (n = 381)	97.3% (n = 501)
Abstinence	89.8% (n = 795)	93.6% (n = 352)	86.8% (n = 442)	91.8% (n = 842)	95.1% (n = 385)	89.3% (n = 458)
Birth Control	81.6% (n = 725)	76.6% (n = 288)	85.3% (n = 436)	93.8% (n = 866)	91.9% (n = 372)	95.4% (n = 494)
STDs, including HIV	95.9% (n = 851)	95.5% (n = 361)	96.3% (n = 490)	98.7% (n = 912)	99.3% (n = 403)	98.3% (n = 509)
Sexual Orientation	68.6% (n = 610)	48.1% (n = 182)	83.8% (n = 428)	78.9% (n = 729)	63.1% (n = 256)	91.3% (n = 473)
Consent	93.0% (n = 818)	91.2% (n = 342)	94.4% (n = 476)	96.0% (n = 884)	95.6% (n = 388)	96.5% (n = 496)

The only topic for which there was not strong support among all groups is sexual orientation. Less than half (48.1%, n = 182) of Republicans compared to 83.8% (n = 428) of Democrats supported including information about sexual orientation in middle school sex education. For high school, 63.1% (n = 256) of Republicans and 91.3% (n = 473) of Democrats supported including information about sexual orientation in sex education. Levels of support among both Democrats and Republicans for including each of the other sex education topics were strong (Table 3).

Differences in support for topics by political affiliation

Looking at the relationship between political affiliation and support for particular sex education topics, support for inclusion of puberty and STDs, including HIV, in sex education in both middle and high school did not significantly differ by political affiliation. However, Democrats were significantly more likely than Republicans to support some topics as part of middle school sex education including birth control methods, consent, healthy relationships and sexual orientation. Among Republicans, on average, support for including information about birth control methods (OR = 0.56, p < 0.001), consent (OR = 0.60, p = 0.057), healthy relationships (OR = 0.49, p < 0.001) and sexual orientation (OR = 0.18, p < 0.001) was lower than among Democrats. Republicans were significantly more likely than Democrats to support the inclusion of abstinence in middle school sex education (OR = 2.25, p < 0.001). For high school sex education, Democrats were significantly more likely to support including birth control methods, healthy relationships and sexual orientation. Among Republicans, on average, support for including birth control methods (OR = 0.55, p = 0.031), healthy relationships (OR = 0.46, p < 0.001) and sexual orientation (OR = 0.162, p < 0.001) was lower than among Democrats. Republicans were significantly more likely than Democrats to support the inclusion of abstinence in high school sex education (OR = 2.28, p = 0.002).

In models that controlled for race/ethnicity, income, employment status, education, age and gender, differences in support for the inclusion of certain topics remained (Table 4). Republicans were 2.39 times more likely than Democrats to want information about abstinence included in middle school and 2.51 times more likely than Democrats to want information about abstinence included in high school sex education (Table 4). Republicans were significantly less likely than Democrats to want information about healthy relationships (OR = 0.41, p < .001), birth control (OR = 0.39, p < .001), consent (OR = 0.39, p = .004) or sexual orientation (OR = 0.15, p < .001) included in middle school sex education. Republicans were also significantly less likely than Democrats to indicate that the topics of healthy relationships (OR = 0.34, p = .008), birth control (OR = 0.32, p = .001), consent (OR = 0.33, p = .013) or sexual orientation education (OR = 0.15, p < .001) should be included in high school sex education.

Table 4. Odds of republicans supporting inclusion of sex education topics by political affiliation.

Topic	AOR	OR	SE	95% CI	Significance
Puberty
Middle School	0.44	0.89	0.608	(0.13, 1.45)	p = 0.177
High School	1.05	1.08	0.481	(0.41, 2.70)	p = 0.913
Healthy Relationships
Middle School	0.41*	0.49	0.254	(0.25, 0.68)	p < 0.001
High School	0.34*	0.46	0.407	(0.15, 0.75)	p = .008
Abstinence
Middle School	2.39*	2.25	0.267	(1.41, 4.05)	p < 0.001
High School	2.51*	2.28	0.291	(1.42, 4.45)	p = 0.002
Birth Control
Middle School	0.39*	0.56	0.207	(0.26, 0.58)	p < 0.001
High School	0.32*	0.55	0.345	(0.16, 0.63)	p = 0.001
STDs, including HIV
Middle School	0.72	0.79	0.392	(0.33, 1.55)	p = 0.396
High School	0.57	2.17	0.922	(0.09, 3.48)	p = 0.543
Sexual Orientation
Middle School	0.15*	0.18	0.187	(0.10, 0.22)	p < 0.001
High School	0.15*	0.16	0.218	(0.10, 0.24)	p < 0.001
Consent
Middle School	0.39*	0.60	0.328	(0.20, 0.74)	p = 0.004
High School	0.33*	0.77	0.469	(0.13, 0.82)	p = 0.017

* p < .05

Note: Democrats were the reference category for comparison. Covariates were race/ethnicity, household income, employment status, education, age and gender.

Support for federal funding for programmes to prevent unplanned teen pregnancy

In addition to questions about sex education, the survey included questions about whether the US government should provide funding to programmes to reduce unplanned teenage pregnancy, what approach to these programmes should be encouraged by the US government, and whether funding should be maintained for the two main evidence-based unplanned pregnancy prevention efforts in the USA, TPPP and PREP. These questions were previously used to survey US adults (Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy) 2017) but had not previously been asked specifically among likely voters. These federal programmes support a number of different approaches to teenage pregnancy prevention including youth development, sex education and abstinence education.

When likely voters were asked to choose which approach they felt programmes ‘programs designed to prevent unplanned teen pregnancy and funded by the United States government focus on’, a majority 74.4% (n = 669) answered that programmes should focus on ‘both encouraging teens to postpone sex and providing teens with information about birth control and protection from sexually transmitted infections.’ Much smaller percentages wanted programmes to ‘focus only on providing teens with information on birth control and protection from sexually transmitted infections (STIs)’ (15.9%, n = 143) or ‘focus only on encouraging teens to postpone sex’ (9.7%, n = 87).

Seventy-three percent (n = 703) of likely voters said that the US government should provide funding for teenage pregnancy prevention programmes. Those answering ‘yes’ to whether they supported funding were then asked a follow up question about what approach the programmes should take: whether programmes should ‘encourage teens to delay sex until they are married’ or ‘encourage teens to delay sex until they are ready and prepare them for the possible consequences of sex’. A strong majority, 84.4% (n = 591) chose ‘encouraging teens to delay sex until they are ready and preparing them for the possible consequences of sex’. A small percentage answered that teen pregnancy prevention programmes should focus only on encouraging teens to delay sex until they are married (15.6%, n = 109) (Table 5).

Table 5. Overall support for federal funding overall and by political affiliation.

	Overall	Republican	Democrat
Should programmes designed to prevent unplanned teen pregnancy and funded by the United States government focus on …
Encouraging teens to postpone sex.	9.7% (n = 87)	16% (n = 65)	4.5% (n = 22)
Providing teens with information on birth control and protection from sexually transmitted infections.	15.9% (n = 143)	10.1% (n = 41)	20.7% (n = 102)
Both encouraging teens to postpone sex and providing teens with information about birth control and protection from sexually transmitted infections.	74.4% (n = 669)	74.0% (n = 301)	74.8% (n = 368)
Should the federal government fund programmes to prevent unplanned teen pregnancy?
Yes	73.4% (n = 703)	56.3% (n = 247)	87.9% (n = 456)
No	26.6% (n = 255)	43.7% (n = 192)	12.1% (n = 63)
[IF ‘Yes’] Do you believe that federally funded programmes (e.g. programmes that are funded by the United States government) designed to prevent unplanned teen pregnancy should focus on …
Encouraging teens to delay sex until they are ready and preparing them for the possible consequences of sex.	84.4% (n = 591)	74.9% (n = 185)	89.6% (n = 592)
Encouraging teens to delay sex until they are married.	15.6% (n = 109)	25.1% (n = 62)	10.4% (n = 47)
TPPP and PREP provide federal funding for programmes that are proven to help teens delay sex, improve contraceptive use, and/or prevent pregnancy. How much do you support or oppose maintaining federal funding for these programmes?
Strongly support	35.2% (n = 338)	17.1% (n = 78)	49.9% (n = 259)
Support	33.1% (n = 318)	35.5% (n = 156)	31.2% (n = 162)
Neither support or oppose	22.2% (n = 213)	29.8% (n = 131)	15.8% (n = 82)
Oppose	5.5% (n = 53)	10.0% (n = 44)	1.5% (n = 8)
Strongly oppose	4.0% (n = 38)	7.0% (n = 31)	1.5% (n = 8)

Respondents were then asked to indicate their level of support for the two specific programmes which current fund evidence-based teen pregnancy prevention in the USA, the TPPP and PREP. Over two-thirds of likely voters answered they either strongly supported (35.2%, n = 338) or supported (33.1%, n = 318) continuing funding for these programmes. Only 5.5% (n = 53) said they opposed or strongly opposed (4.0%, n = 38) continuing federal funding for these programmes. However, 22.2% (n = 213) indicated that they neither supported nor opposed maintaining funding for these programmes.

Differences in support for federal funding by political affiliation

Over two-thirds of Republican likely voters (74.0%, n = 301) and Democratic likely voters (74.8%, n = 368) felt that programmes designed to prevent unplanned teenage pregnancy and funded by the US government should focus on both encouraging teenagers to postpone sex and providing teenagers with information about birth control and protection from STIs rather than only encouraging teenagers to postpone sex or only providing teenagers with information on birth control and protection from STIs (Table 5).

A series of chi-square tests were run to evaluate the differences in support by political affiliation. Democrats were more likely than Republicans (χ² (1) = 121.56, p < .001) to think the federal government should fund programmes to prevent unplanned teenage pregnancy. Among those who felt that the federal government should fund these programmes, Democrats were more likely than Republicans (χ² (1) = 26.5, p < .001) to think programmes should focus both on encouraging teenagers to delay sex until they are ready and preparing them for the possible consequences of sex. Republicans were more likely than Democrats (χ² (1) = 26.5, p < .001) to think these programmes should focus only on encouraging teenagers to delay sex until they are married.

While there were some differences by political affiliation, it is important to note that the majority of likely voters from both political parties supported federal funding for programmes to prevent unplanned teenage pregnancy that cover both the possible consequences of sex and delaying sex. The majority of both Democrats (87.9%, n = 456) and Republicans (56.3%, n = 247) supported the federal government funding programmes to prevent unplanned teen pregnancy and the majority of both Democrats (89.6%, n = 592) and Republicans (74.9%, n = 185) who supported this funding felt programmes should cover both delaying sex and preparing teenagers for the possible consequences of sex as opposed to focusing only on encouraging teenagers to delay sex until they are married.

On a 5-point Likert scale, on average, Democrats more strongly supported (M = 4.27, SD = 0.89) maintaining federal funding for the Teen Pregnancy Prevention Program (TPPP) and Personal Responsibility Program (PREP) than Republicans (M = 3.47, SD = 1.11), t(957) = −12.36, p < .001). However, both Democrats and Republicans supported maintaining funding for TPPP and PREP.

Discussion

The current study adds to a growing body of literature which shows that there is a high level of support in the USA for providing sex education in middle and high school. Among likely voters who identify as either Republicans or Democrats, support is strong for including sex education in both middle and high school and for including a broad range of topics including puberty, healthy relationships, abstinence, birth control, STDs including HIV, and consent. A majority of both Republicans and Democrats want each of the topics included in both middle school and high school, with the exception of the topic of sexual orientation. Just under half of Republicans want sexual orientation included in middle school sex education programmes. Other research has shown that attitudes related to LGBT-inclusion are shifting rapidly (Ayoub and Garretson 2017), so future studies on support for the inclusion of sexual orientation in middle school are likely to see higher levels of support.

When controlling for factors previously associated with support for sex education, there are no differences between likely voters who were Republicans or Democrats on including the topics of puberty and STDs, including HIV, in middle and high school. However, when controlling for demographic factors (i.e. race/ethnicity, income, employment status, education, age and gender), there are higher levels of support among Republicans than Democrats for including abstinence as a topic in both middle and high school. In addition, Democrats are more likely than Republicans to want the topics of healthy relationships, birth control, consent and sexual orientation included in middle school and high school sex education programmes.

Likely voters have not previously been surveyed about their support for federal funding of teenage pregnancy prevention programmes, the type of programme approach they want, and whether they support continued funding for the particular programmes that are currently in place in the USA, the Teen Pregnancy Prevention Program (TPPP) and the Personal Responsibility Education Program (PREP). Among likely voters, both Democrats and Republicans believe that programmes funded by the US government should focus on ‘both encouraging teens to postpone sex and providing teens with information about birth control and protection from sexually transmitted infections.’ Most believe that the federal government should fund programmes and most support maintaining federal funding for TPPP and PREP. Less than 10% oppose or strongly oppose maintaining funding for TPPP and PREP. It is noteworthy that 22.2% of the overall sample neither supports nor opposes the programmes. This is likely because of lack of familiarity with the programmes, although we cannot be sure that this fully explains the percentage that chose the neutral option.

The USA has shifted between federal funding predominantly for abstinence-only-until-marriage approaches and, since 2009, predominantly funding for evidence-based approaches to teenage pregnancy prevention. However, under the Trump administration, there have been efforts to move funds from evidence-based approaches to abstinence-only approaches. For example, in two Funding Opportunity Announcements for programmes to be funded under the Teen Pregnancy Prevention Program (TPPP), potential grantees were given the option of either a ‘sexual risk reduction’ or a ‘sexual risk avoidance,’ a more recent term that is being used by proponents of abstinence-only-until-marriage programmes (Boyer 2018). While lawsuits prevented the current evidence-based requirements from shifting, it is likely that attempts to move funding towards abstinence-only approaches will continue. Thus, understanding that likely voters, regardless of identifying as Republicans or Democrats, want federal funding to exist for pregnancy prevention programmes and want the approach to include both abstinence and information about birth control and how to prevent sexually transmitted infections has important policy salience. Policy makers should consider the perspectives of likely voters as they decide on funding approaches to teenage pregnancy prevention.

This study suggests important areas for future research including monitoring trends to see if support for teaching about sexual orientation in middle and high school increases as broader acceptance and awareness of LGBTQ issues increases. In addition, it would be helpful to ask many groups more in-depth questions related to the education they want adolescents to receive in sex education both in schools and from other sources such as websites, social media and popular culture.

Limitations

This investigation did not look robustly at the content that likely voters believe should be taught to middle and high school students about each of these topics as part of sex education, or the range of information on each topic that likely voters believe young people need. For example, including birth control in sex education could be as simple as mentioning the existence of methods of pregnancy prevention. It could also include opportunities for young people to role play talking about birth control with potential sexual partners or learning about where to go to obtain birth control. However, the measures used here only tell us that respondents believed the topic should be included. The development of more complex measures would be useful in future investigations.

Despite these limitations, this study remains an important contribution as likely voters have not been previously surveyed about their beliefs about sex education and the topics it should include or about their views on US federal funding for programmes to prevent unintended teenage pregnancy and the approaches those programmes should take.

Disclosure statement

No potential conflict of interest was reported by the authors.