J Pediatr Adolesc Gynecol (2005) 18:105–111 Original Studies Reproductive Health Education and Sexual Risk Among High-Risk Female Adolescents and Young Adults Rosedelia Ancheta, MS 1 , Colin Hynes 1 , and Lydia A. Shrier, MD, MPH 1,2 1 Division of Adolescent/Young Adult Medicine, Children’s Hospital Boston; 2 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA Abstract. Study Objective: The objective of this study was to explore the associations of sources, content, and timing of reproductive health education with cognitive and behavioral sexual risk in a sample of high-risk female ad- olescents and young adults. Design: Female adolescents and young adults (n = 113, median age 17 years) receiving treatment for a sexually transmitted disease (STD) reported sources of reproductive health education, topics covered, and when first formal edu- cation occurred. Dependent variables included sexual risk knowledge; condom attitudes, negotiation skills, and use (consistent and at last sex); and number of sexual partners. Results: Most participants reported receiving reproduc- tive health education from both parental (80%) and formal sources (92%). Parents discussed the menstrual cycle (94%) more frequently than other sex education topics, while formal sources focused most on teaching about STDs (91%). Although median age of first formal instruction was 12 years, 26% of girls received their first formal education during or after the year they initiated coitus. Girls with a parental source of education and those receiving formal instruction on pregnancy reported greater ability to negotiate condom use. Girls who received education later in relation to the onset of sexual activity and those with a parental source of education reported more sexual partners. Conclusions: Early reproductive health education and education from both parental and formal sources is associ- ated with reduced sexual risk among high-risk adolescent girls. Interestingly, receiving parental education is also asso- ciated with more sexual partners, suggesting that parental educational efforts may be reactive to their daughters’ in- creasing sexual risk behavior. Future research should exam- ine multiple sources of reproductive health education and Address correspondence to: Lydia A. Shrier, MD, MPH, Division of Adolescent/Young Adult Medicine, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115; E-mail: lydia.shrier@ childrens.harvard.edu Ms. Ancheta is now with Children’s Hospital Medical Center, Cincinnati, OH.  2005 North American Society for Pediatric and Adolescent Gynecology 1083-3188/05/$22.00 Published by Elsevier Inc. doi:10.1016/j.jpag.2005.01.005 the timing of education from these sources to enhance under- standing the dynamic interactions between reproductive health education and adolescent sexual risk. Key Words. Reproductive health education—Adoles- cent—Sexual risk behavior—STD Introduction Reproductive health education is essential to the pre- vention of sexual risk behavior and its associated adverse outcomes of unwanted pregnancy, AIDS, and other sexually transmitted diseases (STDs) in ado- lescents. Youths receive reproductive health education from multiple sources, including formal education courses (e.g., school or religious), parents, peers, and the media. 1–3 Topics covered vary widely and may include HIV/AIDS, STDs, reproduction, the menstrual cycle, abstinence, methods of birth control, abortion, and sexual orientation. 1,4,5 Little is known about the association of content and sources of reproductive health education with sexual risk among those at high- est risk for adverse outcomes, sexually active girls who have already acquired an STD. 6 On national surveys, formal reproductive health education is reported by nearly all adolescents 4 and teachers. 5 A national study conducted by Zelnick and Kim found that sexually active adolescents who participated in a sex education course were more likely to use birth control at first intercourse and to have fewer premarital pregnancies. 7 Kirby summarized evaluations of school-based sexuality and HIV educa- tion programs covering both abstinence and contracep- tion and concluded that some of these programs can