Chong et al.

2 The objective of this research is to test whether, in a predominantly Catholic, middle-income country, information technologies in a school setting can help overcome sexual education–related informational barriers faced by teenagers. Naturally, evaluations of sexual health curricula have been done before. Review papers by Kirby, Laris, and Rolleri (2007); Chin et al. (2012); Fonner et al. (2014), and Goesling et al. (2014) conclude that most comprehensive sexual education programs that have been evaluated rigorously are effective at improving knowledge, attitudes, and self-reported behaviors. Fonner et al. (2014) in particular focus on poor and middle-income country studies and reach the same conclusion. However, this large literature focuses on facilitator-led interventions, which implies that it is difficult to ensure consistent delivery in face-to-face interventions when scaling up. Furthermore, many teachers block this type of education because of dis- comfort discussing sex-related decisions with teens. As a result of these factors, elaborate interventions struggle to translate encouraging results from controlled trials into larger settings (Collins et al. 2002). Information and communication technologies (ICTs) for sexual education hence hold promise to im- prove school-based sexual education along three dimensions: reducing loss of effectiveness when scaling up, reducing costs of implementation, and overcoming educator reluctance to present sexual education material.

The study implements a large randomized evaluation of a comprehensive Internet-based sexual health education course geared to adolescents in Colombian public schools. Assignment to treatment is randomized both across 69 schools as well as within schools at the classroom level (in order to measure information spillovers within the school). The course covers topics that range from sexual rights to the use of contraceptives. It was implemented during a full academic semester in close collaboration with public schools as part of the students’ obligatory curricula.

The sample consisted of 4,599 students enrolled in 138 ninth-grade classrooms from 69 public schools spread across 21 major Colombian cities. The control group received the status quo: brief biology class coverage or sporadic visits by health personnel.<sup>1</sup> To measure differences in outcomes after treatment, the study uses three sources of data: a follow-up survey one week after course completion to measure short-term changes in knowledge and attitudes, a second follow-up survey six months after the course to measure the same outcomes in the longer term; and redemption from local health clinics of a voucher for condoms.

The main focus of the study is on knowledge and attitude indicators since these are the main outcomes of interest in the literature studying young adolescents who, for the most part, have not had sex. Furthermore, these two factors have been shown to be the strongest protective factors in preventing sexually transmitted infections (STIs), hu- man immunodeficiency virus (HIV), and pregnancy among teens (Kirby, Lepore, and Ryan 2007). Recent research has also documented the important role that social norms play in responsible sexual behavior (Munshi and Myaux 2005; Ashraf, Field, and Lee 2014). By changing knowledge and attitudes in youth attending school, sexual education can ultimately play a fundamental role in achieving desirable aggregate changes in sexual behavior.

The condom voucher makes it possible to avoid obvious problems with self-reported sexual behavior data, and follows O’Donnell et al. (1995) and Thornton (2008). Increased condom demand and distribution is a common policy target and tool as part of efforts to reduce sexually transmitted infections and teenage pregnancy. The researchers view this as a key part of the design of the study, given the concern in this literature regarding the relationship between knowledge and attitude outcomes and actual behavior (Ross et al. 2007), and the challenge of gathering accurate responses to sensitive questions on sexual practices.

1 Control schools were asked not to modify their current sexual education because of their participation in the study.