A Content Analysis of US K-12 Health Education Standards Inclusion of Sexual Refusal Education

US universities may implement sexual health education focused on sexual refusals or how one communicates unwillingness to engage in sexual activity, as a form of sexual harm prevention. However, within the K–12 school system, adolescents often lack access to this education. The goal of this study was to assess whether and at which grade levels K–12 schools recommended that sexual refusal education be taught by reviewing their health education standards. We conducted a content analysis of the health education standards from 50 states and the District of Columbia in the US to evaluate the guidelines provided to health educators regarding sexual refusals. Health standards that addressed sexual refusal included: (1) defining sexual refusal and its characteristics, and (2) identifying conflict management techniques not directly related to sexual communication. Of the 51 states coded, 34 (66.7%) provided recommendations about sexual refusal education, and 48 (94.1%) provided recommendations on conflict management education. Recommendations for teaching about sexual refusals were more likely to appear as adolescents progressed through the K–12 system. While state health standards do not always explicitly discuss sexual refusals, they may implicitly address the topic through conflict management. Educators and policymakers should advocate for more detailed education on sexual refusals in the K–12 school system.