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Prevention of early, unintended pregnancy, abortions, and sexually transmitted infections among adolescents is a very high priority in the United States and Europe, and the United Kingdom has a target to halve pregnancy rates among under-18-year-olds by 2010. School-based sexual health education provides an obvious approach, but evaluations of the effectiveness of such interventions, both within high-income and low-income countries have not been very encouraging. In this week's PLoS Medicine, Judith Stephenson and colleagues report the long-term results of the RIPPLE trial comparing peer-led and teacher-led approaches, which builds on previous studies of school-based sex education.

Most studies to date have depended upon self-reported behavioural outcomes such as pregnancy or abortion. Yet, self-reported sexual behaviour is notoriously prone to reporting errors, and there is considerable potential for biased misreporting after an intervention that aims to change behaviours. Also, most of these previous evaluations have only had relatively short follow-up, and many have used non-randomised designs.

Despite the relatively weak evidence of the effectiveness of sexual health education as a whole, except to improve knowledge, such education is widely implemented. This is justifiable on the grounds that providing young people with the knowledge and skills to improve their sexual health can be seen as a human right, and because strong evidence suggests sexual education does not encourage increased sexual activity or sexual risk.

However, there is considerable dispute as to what the best strategy should be for sexual health education in school, with strong advocates for peer-led over the more standard teacher-led sex education 

 -  Ross DA (2008) Approaches to Sex Education: Peer-Led or Teacher-Led? PLoS Med 5(11): e229 doi:10.1371/journal.pmed.0050229