The World Bank Economic Review 13

# Attitudes

Table 4 presents results on attitude indicators. Columns (1) and (2) present results on attitudes towards the use of condoms, (3) and (4) on conservatism with respect to age of initiation of sexual activities, (5) and (6) on attitudes toward denouncing and seeking help in the event of sexual abuse, and columns (7) − and (8) show results for an overall index of attitudes, containing all variables used in columns (1 6).

For the general attitudes index the study finds significant effects of 0.24 standard deviations in terms of attitudes one week after the intervention and 0.17 standard deviations six months after. Significant effects were again found for each subindex six months after the intervention, and the pattern of positive effects on all partial indices is again apparent.

The training was successful in generating more positive attitudes towards the use of condoms at the first follow-up (0.17 standard deviation) and at the second follow-up (0.10 standard deviation). In the sexually conservative attitudes subindex composed of the following variables: (a) indicates that individuals their age should not have multiple sexual partners in the same month; (b) thinks it is too early for individuals of their age to engage in sexual activities; and (c) feels confident he/she will be able to wait to have sex until emotionally prepared to do so, teens scored 0.13 standard deviations higher six months after the intervention. Column (6) shows that treated teens are 0.11 standard deviations more likely to agree with the need to report cases of sexual abuse to the authorities and the need to seek medical attention in such situations. For attitude indicators, there was no consistent evidence of spillovers across classrooms.<sup>18</sup>

# Sexual Activity and Condom Demand

Table 5 reports results on sexual activity and condom voucher redemptions. Specifically, columns 1–3 report effects of the course on self-reported sexual activity six months after the end of the course.<sup>19</sup> Columns 1–3 uniformly show that the course did not increase or decrease self-reported sexual activity among adolescents. Column 1 shows that students were not more likely to be sexually active in the past six months compared to the control group. Similarly, the frequency of sex did not change in the previous six months compared to the control group (column 2) nor in terms of number of partners (column 3). The finding that sexual education does not result in increases in sexual activity is a robust finding in this literature (cf. Kirby, Laris, and Rolleri 2007).

Given that the objective population is teens at high risk of sexual initiation, the setting is not designed to capture other sexual behavior outcomes such as STIs and pregnancy, given their extremely low prevalence (the control group means for these self-reported outcomes are 1 percent and 2 percent; thus there is little room for improvement). The study nevertheless estimated treatment effects for these outcomes and found no statistically significant changes (columns 4 and 5 of table 5).

Of course, the validity of studies using self-reported sexual behavior among adolescents has long been a criticism in this literature (Brener, Billy, and Grady 2003). This challenge was addressed by measuring the percentage of students who redeem vouchers for condoms. This strategy makes it possible to address the possible lack of reliability in self-reported outcomes via an objective safe-sex behavior metric. Condom availability is important for adolescent health given the sporadic nature of adolescent sexual activity. Column 6 in table 5 reports the results of the voucher experiment.

The administrative data from voucher redemption shows statistically significant and important effects. The table shows that 28 percent of treatment students redeem them, compared to 18 percent of control

> 18 Classroom level spillover effects were also statistically undetectable using a dose-response model. Specifically, this was implemented by defining the spillover variable as one over the number of classrooms in grade 9 in the school. Spillover coefficients again followed the same pattern of no significant effects.

> 19 Note that for this table the dependent variables are not an index but a single variable, so the study does not standardize them. This has the benefit of allowing for comparability with other studies. Furthermore, in this table there is no control for baseline value of the dependent variable because it was not available at baseline (except for columns 3-5).