OBJECTIVE:

To examine the impact of sexuality education practices on adolescent birthrates while controlling for demographic characteristics and religious/political factors at a state level.

DESIGN:

Prospective cohort study.

SETTING:

Twenty-four states, from 1997 through 2005.

PARTICIPANTS:

Girls aged 15 to 17 years.

MAIN EXPOSURE:

The state sexuality education practices (ie, sexually transmitted disease prevention, pregnancy prevention, condom efficacy) for 1996 through 2004 from the Centers for Disease Control and Prevention School Health Profiles Survey.

MAIN OUTCOME MEASURES:

State birthrates for girls aged 15 to 17 years for 1997 through 2005 from the Centers for Disease Control and Prevention.

RESULTS:

In a longitudinal, unadjusted model, our findings provide evidence that increased sexuality education within school curricula is associated with lower adolescent birthrates (average sexuality education topics β = -0.61; P = .001). However, the effect of sexuality education disappeared when taking into consideration the demographic characteristics, religiosity, and abortion policies of the state (average sexuality education topics β = -0.12; P = .26). States with higher religiosity rankings and greater political conservatism had higher adolescent birthrates.

CONCLUSIONS:

The effects of sexuality education were constrained by state characteristics and do not independently explain the considerable variations in adolescent birthrates found across states. Our findings underscore the strong influence of state characteristics on adolescent birthrates above and beyond sexuality education, which must be considered when evaluating the efficacy of sexuality education programs.