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Sex Education that Goes Beyond Sex

• Posted November 28, 2018
• By Grace Tatter

Historically, the measure of a good sex education program has been in the numbers: marked decreases in the rates of sexually transmitted diseases, teen pregnancies, and pregnancy-related drop-outs. But, increasingly, researchers, educators, and advocates are emphasizing that sex ed should focus on more than physical health. Sex education, they say, should also be about relationships.

Giving students a foundation in relationship-building and centering the notion of care for others can enhance wellbeing and pave the way for healthy intimacy in the future, experts say. It can prevent or counter gender stereotyping and bias. And it could minimize instances of sexual harassment and assault in middle and high school — instances that may range from cyberbullying and stalking to unwanted touching and nonconsensual sex. A recent study from Columbia University's Sexual Health Initative to Foster Transformation (SHIFT) project suggests that comprehensive sex education protects students from sexual assault even after high school.

If students become more well-practiced in thinking about caring for one another, they’ll be less likely to commit — and be less vulnerable to — sexual violence, according to this new approach to sex ed. And they’ll be better prepared to engage in and support one another in relationships, romantic and otherwise, going forward. 

Giving students a foundation in relationship-building can enhance wellbeing and pave the way for healthy intimacy in the future, experts say. It can also prevent or counter gender stereotyping, and it could minimize instances of sexual harassment and assault in middle and high school.

Introducing Ethics Into Sex Ed

Diving into a conversation even tangentially related to sex with a group of 20 or so high school students isn’t easy. Renee Randazzo helped researcher Sharon Lamb pilot the Sexual Ethics and Caring Curriculum while a graduate student at the University of Massachusetts Boston. She recalls boys snickering during discussions about pornography and objectification. At first, it was hard for students to be vulnerable.

But the idea behind the curriculum is that tough conversations are worth having. Simply teaching students how to ask for consent isn’t enough, says Lamb, a professor of counseling psychology at UMass Boston, who has been researching the intersection between caring relationships, sex, and education for decades. Students also to have understand why consent is important and think about consent in a variety of contexts. At the heart of that understanding are questions about human morality, how we relate to one another, and what we owe to one another. In other words, ethics.

“When I looked at what sex ed was doing, it wasn’t only a problem that kids weren’t getting the right facts,” Lamb says. “It was a problem that they weren’t getting the sex education that would make them treat others in a caring and just way.”

She became aware that when schools were talking about consent — if they were at all — it was in terms of self-protection. The message was: Get consent so you don’t get in trouble.

But there’s more at play, Lamb insists. Students should also understand the concept of mutuality — making decisions with a partner and understanding and addressing other people’s concerns or wishes — and spend time developing their own sense of right and wrong. 

“If a young person is not in a healthy relationship, they can’t negotiate sex in a meaningful way. Even if they’re not having sex yet, they’re grappling with the idea of what a healthy relationship is.”

The curriculum she developed invites students to engage in frank discussions about topics like objectification in the media and sexting. If a woman is shamed for being in a sexy video, but she consented to it, does she deserve the criticism? Regardless of what you think, can you justify your position?

“How do they want to treat people, what kind of partner do they want to be? That takes discussion,” Lamb says. “It’s not a skill-training thing.”

The idea behind the curriculum isn’t that anything goes, so long as students can discuss their reasoning. Instead, the goal is that students develop the critical-reasoning skills to do the right thing in tricky situations. 

After Randazzo’s students got over their cases of the giggles, the conversations were eye-opening, she says. “You give them the opportunity unpack their ideas and form their own opinions,” she says.

Healthy Relationships — and Prevention

Most sexual assault and violence in schools is committed by people who know their victims — they’re either dating, friends, or classmates. Regardless, they have a relationship of some sort, which is why a focus on relationships and empathy is crucial to reducing violence and preparing students for more meaningful lives.

And while it might seem uncomfortable to move beyond the cut-and-dried facts of contraception into the murkier waters of relationships, students are hungry for it. A survey by researchers at the Harvard Graduate School of Education's  Making Caring Common  initiative found that 65 percent of young-adult respondents wished they had talked about relationships at school.

“It’s so critical that kids are able to undertake this work of learning to love somebody else,” says developmental psychologist Richard Weissbourd , the director of Making Caring Common and lead author of a groundbreaking report called The Talk: How Adults Can Promote Young People’s Healthy Relationships and Prevent Misogyny and Sexual Harassment . “They’re not going to be able to do it unless we get them on the road and are willing to engage in thoughtful conversations.”

Nicole Daley works with OneLove , a nonprofit focused on teen violence prevention. She previously worked extensively with Boston Public Schools on violence prevention. She echoes Lamb and Weissbourd: A focus on relationships is key to keeping students safe.

“If a young person is not in a healthy relationship, they can’t negotiate sex in a meaningful way,” she says. “Really discussing healthy relationships and building that foundation is important. Even if they’re not having sex yet, they’re grappling with the idea of what healthy relationship is.”

And it’s critical to start that work before college.

Shael Norris spent the first two decades of her career focusing on college campuses, but now is focused on younger students with her work through Safe BAE . By college, many people’s ideas about how to act when it comes to sex or romance are entrenched, she says. The earlier young people can start interrogating what they know about sex and relationships, the better.

Safe BAE is led by Norris and young survivors of sexual assault. The organization works to educate students about healthy relationships, sexual violence, students’ rights under Title IX, and other related topics.

Movement to change middle and high school curricula to include a focus on healthy relationships and consent has been slow, Norris notes. In 2015, Senators Tim Kaine (D-Va.) and Claire McCaskill (D-Mo.) introduced the Teach Safe Relationships Act, which would have mandated secondary schools teach about safe relationships, including asking for consent, in health education courses. It didn’t go anywhere. And while eight states now mandate some sort of sexual consent education , there’s no consensus about what that should entail.

Instead, the momentum for a more comprehensive sexual education that considers relationships and violence prevention is coming from individual teachers, students and parents.

“We don’t have to wait for politicians to start having conversations about this,” Norris says.

A New Approach to Sex Ed

• Develop an ethical approach to sex ed. Place emphasis on helping students learn how to care for and support one another. This will reduce the chance they’ll commit, or be vulnerable to, sexual violence.
• Don’t just tell students how to ask for consent; prompt them to consider why concepts like consent are important. It’s not just about staying out of legal trouble — it’s also about respecting and caring for others.
• Respect students’ intelligence and engage them in discussions about who they want to be as people. Serious dialogue about complicated topics will hone their critical-thinking skills and help them be prepared to do the right thing.
• Even without access to a curriculum, students, parents and educators can work together to facilitate conversations around sexual violence prevention through clubs, with help from organizations like Safe BAE.

Additional Resource

• National Sexuality Education Standards: Core Content and Skills, K–12

Part of a special series about preventing sexual harassment at school.  Read the whole series .

Illustration by Wilhelmina Peragine

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Comprehensive sexuality education: For healthy, informed and empowered learners

Did you know that only 37% of young people in sub-Saharan Africa can demonstrate comprehensive knowledge about HIV prevention and transmission? And two out of three girls in many countries lack the knowledge they need as they enter puberty and begin menstruating? Early marriage and early and unintended pregnancy are global concerns for girls’ health and education: in East and Southern Africa pregnancy rates range 15-25%, some of the highest in the world. These are some of the reasons why quality comprehensive sexuality education (CSE) is essential for learners’ health, knowledge and empowerment. 

What is comprehensive sexuality education or CSE?

Comprehensive sexuality education - or the many other ways this may be referred to - is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that empowers them to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives.

CSE presents sexuality with a positive approach, emphasizing values such as respect, inclusion, non-discrimination, equality, empathy, responsibility and reciprocity. It reinforces healthy and positive values about bodies, puberty, relationships, sex and family life.

How can CSE transform young people’s lives?

Too many young people receive confusing and conflicting information about puberty, relationships, love and sex, as they make the transition from childhood to adulthood. A growing number of studies show that young people are turning to the digital environment as a key source of information about sexuality.

Applying a learner-centered approach, CSE is adapted to the age and developmental stage of the learner. Learners in lower grades are introduced to simple concepts such as family, respect and kindness, while older learners get to tackle more complex concepts such as gender-based violence, sexual consent, HIV testing, and pregnancy.

When delivered well and combined with access to necessary sexual and reproductive health services, CSE empowers young people to make informed decisions about relationships and sexuality and navigate a world where gender-based violence, gender inequality, early and unintended pregnancies, HIV and other sexually transmitted infections still pose serious risks to their health and well-being. It also helps to keep children safe from abuse by teaching them about their bodies and how to change practices that lead girls to become pregnant before they are ready.

Equally, a lack of high-quality, age-appropriate sexuality and relationship education may leave children and young people vulnerable to harmful sexual behaviours and sexual exploitation.

What does the evidence say about CSE?

The evidence on the impact of CSE is clear:

• Sexuality education has positive effects, including increasing young people’s knowledge and improving their attitudes related to sexual and reproductive health and behaviors.
• Sexuality education leads to learners delaying the age of sexual initiation, increasing the use of condoms and other contraceptives when they are sexually active, increasing their knowledge about their bodies and relationships, decreasing their risk-taking, and decreasing the frequency of unprotected sex.
• Programmes that promote abstinence as the only option have been found to be ineffective in delaying sexual initiation, reducing the frequency of sex or reducing the number of sexual partners. To achieve positive change and reduce early or unintended pregnancies, education about sexuality, reproductive health and contraception must be wide-ranging.
• CSE is five times more likely to be successful in preventing unintended pregnancy and sexually transmitted infections when it pays explicit attention to the topics of gender and power
• Parents and family members are a primary source of information, values formation, care and support for children. Sexuality education has the most impact when school-based programmes are complemented with the involvement of parents and teachers, training institutes and youth-friendly services .

How does UNESCO work to advance learners' health and education?

Countries have increasingly acknowledged the importance of equipping young people with the knowledge, skills and attitudes to develop and sustain positive, healthy relationships and protect themselves from unsafe situations.

UNESCO believes that with CSE, young people learn to treat each other with respect and dignity from an early age and gain skills for better decision making, communications, and critical analysis. They learn they can talk to an adult they trust when they are confused about their bodies, relationships and values. They learn to think about what is right and safe for them and how to avoid coercion, sexually transmitted infections including HIV, and early and unintended pregnancy, and where to go for help. They learn to identify what violence against children and women looks like, including sexual violence, and to understand injustice based on gender. They learn to uphold universal values of equality, love and kindness.

In its International Technical Guidance on Sexuality Education , UNESCO and other UN partners have laid out pathways for quality CSE to promote health and well-being, respect for human rights and gender equality, and empower children and young people to lead healthy, safe and productive lives. An online toolkit was developed by UNESCO to facilitate the design and implementation of CSE programmes at national level, as well as at local and school level. A tool for the review and assessment of national sexuality education programmes is also available. Governments, development partners or civil society organizations will find this useful. Guidance for delivering CSE in out-of-school settings is also available.

Through its flagship programme, Our rights, Our lives, Our future (O3) , UNESCO has reached over 30 million learners in 33 countries across sub-Saharan Africa with life skills and sexuality education, in safer learning environments. O3 Plus is now also reaching and supporting learners in higher education institutions.

To strengthen coordination among the UN community, development partners and civil society, UNESCO is co-convening the Global partnership forum on CSE together with UNFPA. With over 65 organizations in its fold, the partnership forum provides a structured platform for intensified collaboration, exchange of information and good practices, research, youth advocacy and leadership, and evidence-based policies and programmes.

Good quality CSE delivery demands up to date research and evidence to inform policy and implementation . UNESCO regularly conducts reviews of national policies and programmes – a report found that while 85% of countries have policies that are supportive of sexuality education, significant gaps remain between policy and curricula reviewed. Research on the quality of sexuality education has also been undertaken, including on CSE and persons with disabilities in Asia and East and Southern Africa .

How are young people and CSE faring in the digital space?

More young people than ever before are turning to digital spaces for information on bodies, relationships and sexuality, interested in the privacy and anonymity the online world can offer. UNESCO found that, in a year, 71% of youth aged 15-24 sought sexuality education and information online.

With the rapid expansion in digital information and education, the sexuality education landscape is changing . Children and young people are increasingly exposed to a broad range of content online some of which may be incomplete, poorly informed or harmful.

UNESCO and its Institute of Information Technologies in Education (IITE) work with young people and content creators to develop digital sexuality education tools that are of good quality, relevant and include appropriate content. More research and investment are needed to understand the effectiveness and impact of digital sexuality education, and how it can complement curriculum-based initiatives. Part of the solution is enabling young people themselves to take the lead on this, as they are no longer passive consumers and are thinking in sophisticated ways about digital technology.

A foundation for life and love

• Safe, seen and included: report on school-based sexuality education
• International Technical Guidance on Sexuality Education
• Safe, seen and included: inclusion and diversity within sexuality education; briefing note
• Comprehensive sexuality education (CSE) country profiles
• Evidence gaps and research needs in comprehensive sexuality education: technical brief
• The journey towards comprehensive sexuality education: global status report
• Definition of Sustainable Development Goal (SDG) thematic indicator 4.7.2: Percentage of schools that provided life skills-based HIV and sexuality education within the previous academic year
• From ideas to action: addressing barriers to comprehensive sexuality education in the classroom
• Facing the facts: the case for comprehensive sexuality education
• UNESCO strategy on education for health and well-being
• UNESCO Health and education resource centre
• Campaign: A foundation for life and love
• UNESCO’s work on health and education

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• Health education
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Sex Education in America: the Good, the Bad, the Ugly

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The debate over the best way to teach sexual health in the U.S. continues to rage on, but student voice is often left out of the conversation when schools are deciding on what to teach. So Myles and PBS NewsHour Student Reporters from Oakland Military Institute investigate the pros and cons of the various approaches to sex ed and talk to students to find out how they feel about their sexual health education.

TEACHERS: Guide your students to practice civil discourse about current topics and get practice writing CER (claim, evidence, reasoning) responses.  Explore lesson supports.

What is comprehensive sex education?

Comprehensive sex education teaches that not having sex is the best way to avoid STIs and unintended pregnancies, but it also includes medically accurate information about STI prevention, reproductive health, as well as discussions about healthy relationships, consent, gender identity, LGBTQ issues and more. What is sexual risk avoidance education? Sexual risk avoidance education is also known as abstinence only or abstinence-leaning education. It generally teaches that not having sex is the only morally acceptable, safe and effective way to prevent pregnancy and STIs — some programs don’t talk about birth control or condoms– unless it is to emphasize failure rates.

What are the main arguments for comprehensive sex education?

“Comprehensive sex ed” is based on the idea that public health improves when students have a right to learn about their sexuality and to make responsible decisions about it. Research shows it works to reduce teen pregnancies, delay when teens become sexually active and reduce the number of sexual partners teens have.

What are the main arguments against comprehensive sex education?

Some people, particularly parents and religious groups, take issue with comprehensive sex ed because they believe it goes against their cultural or religious values, and think that it can have a corrupting influence on kids. They say that by providing teens with this kind of information you are endorsing and encouraging sex and risk taking. Some opponents also argue that this type of information should be left up to parents to teach their kids about and shouldn’t be taught in schools.

State Laws and Policies Across the US (SIECUS) 

STDs Adolescents and Young Adults (CDC) 

Myths and Facts about Comprehensive Sex Education (Advocates for Youth)

Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy (Journal of Adolescent Health)

Abstinence-Only-Until Marriage: An Updated Review of US Policies and Programs and Their Impact (Journal of Adolescent Health) 

Sexual Risk Avoidance Education: What you need to know (ASCEND) 

We partnered with PBS NewsHour Student Reporting Labs for this episode. Check out their journalism resources for students: https://studentreportinglabs.org/

To learn more about how we use your information, please read our privacy policy.

The Importance of Sex Education

This essay will argue for the importance of comprehensive sex education in schools. It will discuss how proper sex education can lead to informed decisions, safer practices, and a reduction in teen pregnancy and sexually transmitted infections. The piece will explore the debate over sex education and the potential benefits of a well-rounded program. At PapersOwl, you’ll also come across free essay samples that pertain to Adolescence.

How it works

“This is the real world, and in the real world, you need protection,” – Cherie Richards. Students, specifically teenagers, need correct information and the right resources to learn, help and protect themselves. When students have no knowledge whatsoever, they turn to media or even pornography to get information because their parents aren’t open enough about sex or the topic. Sex education is a type of teaching where students are taught about sexuality, contraceptive methods, how to prevent sexually transmitted diseases, the importance of protection and attitudes and principles about sex.

There is also another kind of sex education which is abstinence-only. While being abstinence-only, some also teach about the process of sex education which could then lead to students learning how to make the right choices.

Implementing more sex education or different types of sex ed. programs would be very beneficial for students and parents both. Both parties would receive education about the topic without the awkwardness of it all. Some parents prefer the abstinence-only method which is not an accurate way to teach, especially hormonal teenagers. Nolan mentions that “Young people won’t stop having sex because they are not given information and contraceptive advice” (Nolan 1998). Most teens are already curious and saying they can’t do something and then not informing them on the topic makes them want to know about it more. Abstinence also excludes the teaching of healthy adult relationships. Richard Hoefer states in one of his writings that “abstinence-only education is less effective at preventing pregnancy and sexually transmitted infections (STIs) than comprehensive sex education” (Hoefer 2017).

Another issue with abstinence only teaching is that if students don’t use this method they are more prone to STIs and pregnancy. Also abstinence programs usually offer inaccurate medical information and outdated stereotypes and assumptions. Hoefer believes that this “misinformation can contribute to larger societal problems such as sexism and heterosexism, and make it difficult for students to engage in healthy and safe intimacy even into adulthood” (Hoefer 2017). Right now, the rate of teen birth and abortions is the highest among other countries, with over one million teens becoming pregnant every year. In another study aimed towards younger adults and teens (18-24), it showed that they have the highest rate of stds. At the same time, “Africa also has the highest number of teen pregnancies in the world” (UNICEF 2017). And even though the rate of teen marriage and pregnancy has gone down in Malaysia and Indonesia, it is still considered quite high compared to the others.

In Japan and South Korea, more developed countries, their teen pregnancy rates are at 4.6% and 2.9%, which are the lowest in the world. Japan and China, among other countries, use the abstinence-only method, and this is more than likely why their rates are extremely low. If these countries were to implement sex education in their communities, they could possibly lower their teen pregnancy rates in the cases where child marriages are higher, or in the abstinence only countries, they could higher their adult pregnancy rates meaning people would not be scared of getting pregnant. It is proven that sex education can reduce teen pregnancy and teen births. Sex education has lowered the United States’ teen birth rate based on a report done in California. The statistics showed that “the birth rate went from 36.2 to 34.1 per 1,000 births to adolescent mothers” (Ventura County Star, 2008). An epidemiologist, Trisha Mueller, found that sex education does work and it also delays teens having sex which then leads to the teen pregnancy rate lowering. Based on a national survey of 2,019 teens aged 15 to 19 in 2002, it was found that teenage boys were three times more likely to use contraceptive methods compared to those who did not have sex ed. For teenage girls who took sex education, having sex before the age of 15 was reduced 59%, while boys’ was 71%, compared to those who didn’t take sex ed. That specific study concluded that “Sex education provides youth with the knowledge and skills to make healthy and informed decisions about sex, and this study indicates that sex education is making a difference in the sexual behaviors of American youth” (Mueller 2008).

Sex education should be implemented in schools because it can reduce teen pregnancy. Informing students how to protect themselves with different contraceptive methods would urge students to use those instead of having unprotected, uninformed sexual relations. Teaching them about contraceptives would also give students places to get different types of contraceptives, male or female, such as condoms, birth control, spermicide, etc. It’s also better for students to get information about sex and different contraceptives from the right resources like schools, rather than from the media. The media could offer potentially harmful resources or ways to do things if a student is desperate, such as the “plastic bag condom” or “double wrapping” methods. Klopp stated in his article “sometimes the only place left to go for this information are peers and the popular media, both of which often give confusing, misinformed, and even dangerous information regarding sexuality” (Klopp 2003). Sex education in schools can also protect younger children and teenagers in many different forms including molestation at a young age, informing them about their own bodies, among other things. To protect children from violence or sexual abuse, children should be given a brief accurate lesson, or a few, about sex at an early age. We should provide children with an adequate sex education. The only “issue” would be how do we represent this sex education without scaring the children or going too in depth for certain ages. When would it be appropriate to provide sex education to children, and can sex education be guaranteed to avoid sex harassment to children? To figure out how to answer these questions, we’d first have to answer these questions. What is sex education mean? How important is it to teach sex education to children? Who should teach sex education to young children? With the thoughts of early sexeducation, the expectation would be to limit the amount of harassment happening. There are many sexually abused children who never came out or received the attention for what was been done to them. Shame, guilt and the fear of being blamed has leaned them away from telling parents or guardians. This is mainly because the victims, more often than not, do not understand what sexual abuse is and they don’t think about their rights to decline being treated this way.

Sex education has only recently become important in the past few years but child sexual abuse has existed throughout history. Implementing sex education into schools can decrease the rate of child sexual abuse and would provide a way out for children and teenagers. Child sexual abuse is any form of sexual activity forced onto a child whether by a person younger or older than the child. Children and teenagers are vulnerable and can be exposed to sexual abuse without anyone knowing. If they did not receive any counseling or teaching, they do not have full understanding of what being taken advantage of means. It also leaves them in a situation where they could be preyed on again. In America, there are 39 million survivors from child sexual abuse. By their 18th birthday, one in four females and one in six males are sexually abused. Sex education gives children and teenagers information about how to prevent sex abuse, that sexual abuse does not happen to everyone else and that they need to get help if they were abused. It teaches children and teenagers to be well aware of sexual abuse. In order to decrease the rate of child sexual abuse, bringing sex education into schools is well needed because children and teenagers would learn about child abusers and sex abuse and they could distinguish them from the good. Children and teenagers would be more aware of the current situation in this modern society and they would know the actions to be taken if necessary. With that, victims would be able to understand that they are not alone and many are willing to lend a hand. There has also been one sex ed program that was organized where students learned to say no to inappropriate acts committed by someone else.

In this specific program, 10 eighth graders from 3 middle schools participated in a yearlong training program. Its motto was “Diplomas Before Diapers”, and its mission is to reduce teenage pregnancy and prepare young people to become healthy, responsible adults. It does not teach abstinence, but urges safe sex and saying no to sexual acts to prolong the amount of childhood before parenthood. The program wants to help young people postpone sexual involvement and parenting, build self-esteem, develop leadership qualities and improve communication and decision-making skills. The curriculum also covers information and discussion of drug and alcohol use and violence prevention. The program helps the students enrolled and their peers. The students enrolled are trained not to give advice, but to listen and to be the first to refer others to the appropriate help. The New Haven public schools offer both a special school for pregnant students, which is Polly McCabe, and a free day care center at Wilbur Cross High School. Although it was said that “One student thought these services might actually encourage teenagers to have babies” (Tuhus 1998) it is very unlikely. All the rest thought that those programs wouldn’t be nearly enough to make up for the large negative change in the lives of young parents. One of the things they hope to convey to their peers is that “contrary to popular belief, not everyone their age is having sex” (Tuhus 1998). The adults in the program also let students know that they are available to talk if they feel uncomfortable speaking to other adults. There wasn’t very much research on how to implement sex education in schools but I believe there could be quite a few solutions. Federal funding for sex education could be raised so more programs could open. By raising funding, colleges could open classes specifically for sex education, rather than having school nurses or PE teachers teaching the class. Another plus of bringing more funding could mean more classes taught by educated individuals would mean better, more reliable information would be taught.

For young teens and adults, sex ed would provide students with the right resources and information involving sex, their own identities and different contraceptives. With these tools, students would utilize this in their everyday lives, whether it be at a younger age or an adult. Donovan mentioned “if young people can discuss sexual drives both at home and at school, they are more likely to accept their own sexuality and take early advice on family planning” (Donovan 1990). When teens are more comfortable speaking about this topic, they are more likely to ask questions from the correct resources and receive reliable information.

Children and teenagers need reliable and factual information about sex, sexual relationships and other various related issues in order to make a right decision for their present and future. They need to understand about what can happen if there are misconceptions about sex, it in turn becomes dangerous. These children are responsible for bringing up the next generations. The implementation of sex education in schools will be able to prepare them properly. Not only that, based on the evidences and research done as well as collected carefully, it proves that sex education brings many benefits by reducing the rate of teen pregnancy, providing teenagers with accurate and helpful information, and also protecting them from harm.

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The Importance of Access to Comprehensive Sex Education

Comprehensive sex education is a critical component of sexual and reproductive health care.

Developing a healthy sexuality is a core developmental milestone for child and adolescent health.

Youth need developmentally appropriate information about their sexuality and how it relates to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

AAP supports broad access to comprehensive sex education, wherein all children and adolescents have access to developmentally appropriate, evidence-based education that provides the knowledge they need to:

• Develop a safe and positive view of sexuality.
• Build healthy relationships.
• Make informed, safe, positive choices about their sexuality and sexual health.

Comprehensive sex education involves teaching about all aspects of human sexuality, including:

• Cyber solicitation/bullying.
• Healthy sexual development.
• Body image.
• Sexual orientation.
• Gender identity.
• Pleasure from sex.
• Sexual abuse.
• Sexual behavior.
• Sexual reproduction.
• Sexually transmitted infections (STIs).
• Abstinence.
• Contraception.
• Interpersonal relationships.
• Reproductive coercion.
• Reproductive rights.
• Reproductive responsibilities.

Comprehensive sex education programs have several common elements:

• Utilize evidence-based, medically accurate curriculum that can be adapted for youth with disabilities.
• Employ developmentally appropriate information, learning strategies, teaching methods, and materials.
• Human development , including anatomy, puberty, body image, sexual orientation, and gender identity.
• Relationships , including families, peers, dating, marriage, and raising children.
• Personal skills , including values, decision making, communication, assertiveness, negotiation, and help-seeking.
• Sexual behavior , including abstinence, masturbation, shared sexual behavior, pleasure from esx, and sexual dysfunction across the lifespan.
• Sexual health , including contraception, pregnancy, prenatal care, abortion, STIs, HIV and AIDS, sexual abuse, assault, and violence.
• Society and culture , including gender roles, diversity, and the intersection of sexuality and the law, religion, media, and the arts.
• Create an opportunity for youth to question, explore, and assess both personal and societal attitudes around gender and sexuality.
• Focus on personal practices, skills, and behaviors for healthy relationships, including an explicit focus on communication, consent, refusal skills/accepting rejection, violence prevention, personal safety, decision making, and bystander intervention.
• Help youth exercise responsibility in sexual relationships.
• Include information on how to come forward if a student is being sexually abused.
• Address education from a trauma-informed, culturally responsive approach that bridges mental, emotional, and relational health.

Comprehensive sex education should occur across the developmental spectrum, beginning at early ages and continuing throughout childhood and adolescence :

• Sex education is most effective when it begins before the initiation of sexual activity.
• Young children can understand concepts related to bodies, gender, and relationships.
• Sex education programs should build an early foundation and scaffold learning with developmentally appropriate content across grade levels.
• AAP Policy outlines considerations for providing developmentally appropriate sex education throughout early childhood, middle childhood, adolescence, and young adulthood.

Most adolescents report receiving some type of formal sex education before age 18. While sex education is typically associated with schools, comprehensive sex education can be delivered in several complementary settings:

• Schools can implement comprehensive sex education curriculum across all grade levels
• The Sexuality Information and Education Council of the United States (SIECUS) provides guidelines for providing developmentally appropriate comprehensive sex education across grades K-12.
• Pediatric health clinicians and other health care providers are uniquely positioned to provide longitudinal sex education to children, adolescents, and young adults.
• Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents outlines clinical considerations for providing comprehensive sex education at all developmental stages, as a part of preventive health care.
• Research suggests that community-based organizations should be included as a source for comprehensive sexual health promotion.
• Faith-based communities have developed sex education curricula for their congregations or local chapters that emphasize the moral and ethical aspects of sexuality and decision-making.
• Parents and caregivers can serve as the primary sex educators for their children, by teaching fundamental lessons about bodies, development, gender, and relationships.
• Many factors impact the sex education that youth receive at home, including parent/caregiver knowledge, skills, comfort, culture, beliefs, and social norms.
• Virtual sex education can take away feelings of embarrassment or stigma and can allow for more youth to access high quality sex education.

Comprehensive sex education provides children and adolescents with the information that they need to:

• Understand their body, gender identity, and sexuality.
• Build and maintain healthy and safe relationships.
• Engage in healthy communication and decision-making around sex.
• Practice healthy sexual behavior.
• Understand and access care to support their sexual and reproductive health.

Comprehensive sex education programs have demonstrated success in reducing rates of sexual activity, sexual risk behaviors, STIs, and adolescent pregnancy and delaying sexual activity. Many systematic reviews of the literature have indicated that comprehensive sex education promotes healthy sexual behaviors:

• Reduced sexual activity.
• Reduced number of sexual partners.
• Reduced frequency of unprotected sex.
• Increased condom use.
• Increased contraceptive use.

However, comprehensive sex education curriculum goes beyond risk-reduction, by covering a broader range of content that has been shown to support social-emotional learning, positive communication skills, and development of healthy relationships.

A 2021 review of the literature found that comprehensive sex education programs that use a positive, affirming, and inclusive approach to human sexuality are associated with concrete benefits across 5 key domains:

Benefits of comprehensive sex education programs 

When children and adolescents lack access to comprehensive sex education, they do not get the information they need to make informed, healthy decisions about their lives, relationships, and behaviors.

Several trends in sexual health in the US highlight the need for comprehensive sex education for all youth.

Education about condom and contraceptive use is needed:

• 55% of US high school students report having sexual intercourse by age 18 .
• Self-reported condom use has decreased significantly among high school students.
• Only 9% of sexually active high school students report using both a condom for STI-prevention and a more effective form of birth control to prevent pregnancy .

STI prevention is needed:

• Adolescents and young adults are disproportionately impacted by STIs.
• Cases of chlamydia, gonorrhea, and syphilis are rising rapidly among young people.
• When left untreated , these infections can lead to infertility, adverse pregnancy and birth outcomes, and increased risk of acquiring new STIs.
• Youth need comprehensive, unbiased information about STI prevention, including human papillomavirus (HPV) .

Continued prevention of unintended pregnancy is needed:

• Overall US birth rates among adolescent mothers have declined over the last 3 decades.
• There are significant geographic disparities in adolescent pregnancy rates, with higher rates of pregnancy in rural counties and in southern and southwestern states.
• Social drivers of health and systemic inequities have caused racial and ethnic disparities in adolescent pregnancy rates.
• Eliminating disparities in adolescent pregnancy and birth rates can increase health equity, improve health and life outcomes, and reduce the economic impact of adolescent parenting.

Misinformation about sexual health is easily available online:

• Internet use is nearly universal among US children and adolescents.
• Adolescents report seeking sexual health information online .
• Sexual health websites that adolescents visit can contain inaccurate information .

Prevention of sex abuse, dating violence, and unhealthy relationships is needed:

• Child sexual abuse is common: 25% of girls and 8% of boys experience sexual abuse during childhood .
• Youth who experience sexual abuse have long-term impacts on their physical, mental, and behavioral health.
• 1 in 11 female and 1 in 14 male students report physical DV in the last year .
• 1 in 8 female and 1 in 26 male students report sexual DV in the last year .
• Youth who experience DV have higher rates of anxiety, depression, substance use, antisocial behaviors, and suicide risk.

The quality and content of sex education in US schools varies widely.

There is significant variation in the quality of sex education taught in US schools, leading to disparities in attitudes, health information, and outcomes. The majority of sex education programs in the US tend to focus on public health goals of decreasing unintended pregnancies and preventing STIs, via individual behavior change.

There are three primary categories of sex educational programs taught in the US :

• Abstinence-only education , which teaches that abstinence is expected until marriage and typically excludes information around the utility of contraception or condoms to prevent pregnancy and STIs.
• Abstinence-plus education , which promotes abstinence but includes information on contraception and condoms.
• Comprehensive sex education , which provides medically accurate, age-appropriate information around development, sexual behavior (including abstinence), healthy relationships, life and communication skills, sexual orientation, and gender identity.

State laws impact the curriculum covered in sex education programs. According to a report from the Guttmacher Institute :

• 26 US states and Washington DC mandate sex education and HIV education.
• 18 states require that sex education content be medically accurate.
• 39 states require that sex education programs provide information on abstinence.
• 20 states require that sex education programs provide information on contraception.

US states have varying requirements on sex education content related to sexual orientation :

• 10 states require sex education curriculum to include affirming content on LGBTQ2S+ identities or discussion of sexual health for youth who are LGBTQ2S+.
• 7 states have sex education curricular requirements that discriminate against individuals who are LGBTQ2S+.Youth who live in these states may face additional barriers to accessing sexual health information.

Abstinence-only sex education programs do not meet the needs of children and adolescents.

While abstinence is 100% effective in preventing pregnancy and STIs, research has conclusively shown that abstinence-only sex education programs do not support healthy sexual development in youth.

Abstinence-only programs are ineffective in reaching their stated goals, as evidenced by the data below:

• Abstinence-only programs are unsuccessful in delaying sex until marriage .
• Abstinence-only sex education programs do not impact the rates of pregnancy, STIs, or HIV in adolescents .
• Youth who take a “virginity pledge” as part of abstinence-only education programs have the same rates of premarital sex as their peers who do not take pledges, but are less likely to use contraceptives .
• US states that emphasize abstinence-only education have higher rates of adolescent pregnancy and birth .

Abstinence-only programs can harm the healthy sexual and mental development of youth by:

• Withholding information or providing inaccurate information about sexuality and sexual behavior .
• Contributing to fear, shame, and stigma around sexual behaviors .
• Not sharing information on contraception and barrier protection or overstating the risks of contraception .
• Utilizing heteronormative framing and stigma or discrimination against students who are LGBTQ2S+ .
• Reinforcing harmful gender stereotypes .
• Ignoring the needs of youth who are already sexually active by withholding education around contraception and STI prevention.

Abstinence-plus sex education programs focus solely on decreasing unintended pregnancy and STIs.

Abstinence-plus sex education programs promote abstinence until marriage. However, these programs also provide information on contraception and condom use to prevent unintended pregnancy and STIs.

Research has demonstrated that abstinence-plus programs have an impact on sexual behavior and safety, including:

• HIV prevention.
• Increase in condom use .
• Reduction in number of sexual partners .
• Delay in initiation of sexual behavior .

While these programs add another layer of education, they do not address the broader spectrum of sexuality, gender identity, and relationship skills, thus withholding critical information and skill-building that can impact healthy sexual development.

AAP and other national medical and public health associations support comprehensive sex education for youth.

Given the evidence outlined above, AAP and other national medical organizations oppose abstinence-only education and endorse comprehensive sex education that includes both abstinence promotion and provision of accurate information about contraception, STIs, and sexuality.

National medical and public health organizations supporting comprehensive sex education include:

• American Academy of Pediatrics .
• American Academy of Family Physicians.
• American College of Obstetricians and Gynecologists .
• American Medical Association .
• American Public Health Association .
• Society for Adolescent Health and Medicine .

Pediatric clinics provide a unique opportunity for comprehensive sex education.

Pediatric health clinicians typically have longitudinal care relationships with their patients and families, and thus have unique opportunities to address comprehensive sex education across all stages of development.

The clinical visit can serve as a useful adjunct to support comprehensive sex education provided in schools, or to fill gaps in knowledge for youth who are exposed to abstinence-only or abstinence-plus curricula.

AAP policy and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents provide recommendations for comprehensive sex education in clinical settings, including:

• Encouraging parent-child discussions on sexuality, contraception, and internet/media use.
• Understanding diverse experiences and beliefs related to sexuality and sex education and meeting the unique needs of individual patients and families.
• Including discussions around healthy relationships, dating violence, and intimate partner violence in clinical care.
• Discussing methods of contraception and STI/HPV prevention prior to onset of sexual intercourse.
• Providing proactive and developmentally appropriate sex education to all youth, including children and adolescents with special health care needs.

Perspective

Karen Torres, Youth activist

There were two cardboard bears, and a person explained that one bear wears a bikini to the beach and the other bear wears shorts – that is the closest thing I ever got to sex ed throughout my entire K-12 education. I often think about that bear lesson because it was the day our institutions failed to teach me anything about my body, relationships, consent, and self-advocacy, which became even more evident after I was sexually assaulted at 16 years old. My story is not unique, I know that many young people have been through similar traumas, but many of us were also subjected to days, months, and years of silence and embarrassment because we were never given the knowledge to know how to spot abuse or the language to ask for help. Comprehensive sex ed is so much more than people make it out to be, it teaches about sex but also about different types of experiences, how to respect one another, how to communicate in uncomfortable situations, how to ask for help and an insurmountable amount of other valuable lessons.

From these lessons, people become well-rounded, people become more empathetic to other experiences, and people become better. I believe comprehensive sex ed is vital to all people and would eventually work as a part to build more compassionate communities.

Many US children and adolescents do not receive comprehensive sex education; and rates of formal sex education have declined significantly in recent decades.

Barriers to accessing comprehensive sex education include:

Misinformation, stigma, and fear of negative reactions:

• Misinformation and stigma about the content of sex education curriculum has been the primary barrier to equitable access to comprehensive sex education in schools for decades .
• Despite widespread parental support for sex education in schools, fears of negative public/parent reactions have led school administrators to limit youth access to the information they need to make healthy decisions about their sexuality for nearly a half-century.
• In recent years, misinformation campaigns have spread false information about the framing and content of comprehensive sex education programs, causing debates and polarization at school board meetings .
• Nearly half of sex education teachers report that concerns about parent, student, or administrator responses are a barrier to provision of comprehensive sex education.
• Opponents of comprehensive sex education often express concern that this education will lead youth to have sex; however, research has demonstrated that this is not the case . Instead, comprehensive sex ed is associated with delays in initiation of sexual behavior, reduced frequency of sexual intercourse, a reduction in number of partners, and an increase in condom use.
• Some populations of youth lack access to comprehensive sex education due to a societal belief that they are asexual, in need of protection, or don’t need to learn about sex. This barrier particularly impacts youth with disabilities or special health care needs .
• Sex ed curricula in some schools perpetuate gender/sex stereotypes, which could contribute to negative gender stereotypes and negative attitudes towards sex .

Inconsistencies in school-based sex education:

• There is significant variation in the content of sex education taught in schools in the US, and many programs that carry the same label (eg, “abstinence-plus”) vary widely in curriculum.
• While decisions about sex education curriculum are made at the state level, the federal government has provided funding to support abstinence-only education for decades , which incentivizes schools to use these programs.
• Since 1996, more than $2 billion in federal funds have been spent to support abstinence-only sex education in schools.
• 34 US states require schools to use abstinence-only curriculum or emphasize abstinence as the main way to avoid pregnancy and STIs.
• Only 16 US states require instruction on condoms or contraception.
• It is not standard to include information on how to come forward if a student is being sexually abused, and many schools do not have a process for disclosures made.
• Because of this, abstinence-only programs are commonly used in US schools, despite overwhelming evidence that they are ineffective in delaying sexual behavior until marriage, and withhold critical information that youth need for healthy sexual and relationship development.

Need for resources and training:

• Integration of comprehensive sex education into school curriculum requires financial resources to strengthen and expand evidence-based programs.
• Successful implementation of comprehensive sex education requires a trained workforce of teachers who can address the curriculum in age-appropriate ways for students in all grade-levels.
• Education, training, and technical assistance are needed to support pediatric health clinicians in addressing comprehensive sex education in clinical settings, as a complement to school-based education.

Lack of diversity and cultural awareness in curricula:

• A history of systemic racism, discrimination, and long-standing health, social and systemic inequities have created racial and ethnic disparities in access to sexual health services and representation in sex education materials. The legacy of intergenerational trauma in the medical system should be acknowledged in sex education curricula.
• Sex education curriculum is often centered on a white audience, and does not address or reflect the role of systemic racism in sexuality and development .
• Traditional abstinence-focused sex education programs have a heteronormative focus and do not address the unique needs of youth who are LGBTQ2S+ .
• Sex education programs often do not address reproductive body diversity, the needs of those with differences in sex development, and those who identify as intersex .
• Sex education programs often do not reflect the unique needs of youth with disabilities or special health care needs .
• Sex education programs are often not tailored to meet the religious considerations of faith communities.
• There is a need for sex education programs designed to help youth navigate sexual health and development in the context of their own culture and community .

Disparities in access to comprehensive sex education.

The barriers listed above limit access to comprehensive sex education in schools and communities. While these barriers impact youth across the US, there are some populations who are less likely to have access to comprehensive to sex education.

Youth who are LGBTQ2S+:

• Only 8% of students who are LGBTQ2S+ report having received sexual education that was inclusive .
• Students who are LGBTQ2S+ are 50% more likely than their peers who are heterosexual to report that sex education in their schools was not useful to them .
• Only 13% of youth who are bisexual+ and 10% of youth who are transgender and gender expansive report receiving sex education in schools that felt personally relevant.
• Only 20% of youth who are Black and LGBTQ2S+ and 13% of youth who are Latinx and LGBTQ2S+ report receiving sex education in schools that felt personally relevant.
• Only 10 US states require affirming content on LGBTQ2S+ relationships in sex education curriculum.

Youth with disabilities or special health care needs:

• Youth with disabilities or special health care needs have a particular need for comprehensive sex education, as these youth are less likely to learn about sex or sexuality form their parents , healthcare providers , or peer groups .
• In a national survey, only half of youth with disabilities report that they have participated in sex education .
• Typical sex education may not be sufficient for youth with Autism Spectrum Disorder, and special methods and curricula are necessary to match their needs .
• Lack the desire or maturity for romantic or sexual relationships.
• Are not subject to sexual abuse.
• Do not need sex education.
• Only 3 states explicitly include youth with disabilities within their sex education requirements.

Youth from historically underserved communities:

• Students who are Black in the US are more likely than students who are white to receive abstinence-only sex education , despite significant support from parents and students who are Black for comprehensive sex education.
• Youth who are Black and female are less likely than peers who are white to receive education about where to obtain birth control prior to initiating sexual activity.
• Youth who are Black and male and Hispanic are less likely than their peers who are white to receive formal education on STI prevention or contraception prior to initiating sexual activity.
• Youth who are Hispanic and female are less likely to receive instruction about waiting to have sex than youth of other ethnicities.
• Tribal health educators report challenges in identifying culturally relevant sex education curriculum for youth who are American Indian/Alaska Native.
• In a 2019 study, youth who were LGBTQ2S+ and Black, Latinx, or Asian reported receiving inadequate sex education due to feeling unrepresented, unsupported, stigmatized, or bullied.
• In survey research, many young adults who are Asian American report that they received inadequate sex education in school.

Youth from rural communities:

• Adolescents who live in rural communities have faced disproportionate declines in formal sex education over the past two decades, compared with peers in urban/suburban areas.
• Students who live in rural communities report that the sex education curriculum in their schools does not serve their needs .

Youth from communities and schools that are low-income:

• Data has shown an association between schools that are low-resource and lower adolescent sexual health knowledge, due to a combination of fewer school resources and higher poverty rates/associated unmet health needs in the student body.
• Youth with family incomes above 200% of the federal poverty line are more likely to receive education about STI prevention, contraception, and “saying no to sex,” than their peers below 200% of the poverty line.

Youth who receive sex education in some religious settings:

• Most adolescents who identify as female and who attended church-based sex education programs report instructions on waiting until marriage for sex, while few report receiving education about birth control.
• Young people who received sex education in religious schools report that education focused on the risks of sexual behavior (STIs, pregnancy) and religious guilt; leading to them feeling under-equipped to make informed decisions about sex and sexuality later in life.
• Youth and teachers from religious schools have identified a need for comprehensive sex education curriculum that is tailored to the needs of faith communities .

Youth who live in states that limit the topics that can be covered in sex education:

• Students who live in the 34 states that require sex education programs to stress abstinence are less likely to have access to critical information on STI prevention and contraception.
• Prohibitions on addressing abortion in sex education or mandates that sex education curricula include medically inaccurate information on abortion designed to dissuade youth from terminating a pregnancy.
• Limitations on the types of contraception that can be covered in sex education curricula.
• Requirements that sex education teachers promote heterosexual, monogamous marriage in sex education.
• Lack of requirements to address healthy relationships and communication skills.
• Lack of requirements for teacher training or certification.

Comprehensive sex education has significant benefits for children and adolescents.

Youth who are exposed to comprehensive sex education programs in school demonstrate healthier sexual behaviors:

• Increased rates of contraception and condom use.
• Fewer unplanned pregnancies.
• Lower rates of STIs and HIV.
• Delayed initiation of sexual behavior.

More broadly, comprehensive sexual education impacts overall social-emotional health , including:

• Enhanced understanding of gender and sexuality.
• Lower rates of homophobia and related bullying.
• Lower rates of dating violence, intimate partner violence, sexual assault, and child sexual abuse.
• Healthier relationships and communication skills.
• Understanding of reproductive rights and responsibilities.
• Improved social-emotional learning, media literacy, and academic achievement.

Comprehensive sex education curriculum goes beyond risk reduction, to ensure that youth are supported in understanding their identity and sexuality and making informed decisions about their relationships, behaviors, and future. These benefits are critical to healthy sexual development.

Impacts of a lack of access to comprehensive sex education.

When youth are denied access to comprehensive sex education, they do not get the information and skill-building required for healthy sexual development. As such, they face unnecessary barriers to understanding their gender and sexuality, building positive interpersonal relationships, and making informed decisions about their sexual behavior and sexual health.

Impacts of a lack of comprehensive sex education for all youth can include :

• Less use of condoms, leading to higher risk of STIs, including HIV.
• Less use of contraception, leading to higher risk of unplanned pregnancy.
• Less understanding and increased stigma and shame around the spectrum of gender and sexual identity.
• Perpetuated stigma and embarrassment related to sex and sexual identity.
• Perpetuated gender stereotypes and traditional gender roles.
• Higher rates of youth turning to unreliable sources for information about sex, including the internet, the media, and informal learning from peer networks.
• Challenges in interpersonal communication.
• Challenges in building, maintaining, and recognizing safe, healthy peer and romantic relationships.
• Lower understanding of the importance of obtaining and giving enthusiastic consent prior to sexual activity.
• Less awareness of appropriate/inappropriate touch and lower reporting of child sexual abuse.
• Higher rates of dating violence and intimate partner violence, and less intervention from bystanders.
• Higher rates of homophobia and homophobic bullying.
• Unsafe school environments.
• Lower rates of media literacy.
• Lower rates of social-emotional learning.
• Lower recognition of gender equity, rights, and social justice.

In addition, the lack of access to comprehensive sex education can exacerbate existing health disparities, with disproportionate impacts on specific populations of youth.

Youth who identify as women, youth from communities of color, youth with disabilities, and youth who are LGBTQ2S+ are particularly impacted by inequitable access to comprehensive sex education, as this lack of education can impact their health, safety, and self-identity. Examples of these impacts are outlined below.

A lack of comprehensive sex education can harm young women.

• Female bodies are more prone to STI infection and more likely to experience complications of STI infection than male bodies.
• Female bodies are disproportionately impacted by long-term health consequences of STIs , including pelvic inflammatory disease, infertility, and ectopic pregnancy.
• Female bodies are less likely to have or recognize symptoms of certain STI infections .
• Human papillomavirus (HPV) is the most common STI in young women , and can cause long-term health consequences such as genital warts and cervical cancer.
• Women bear the health and economic effects of unplanned pregnancy.
• Comprehensive sex education addresses these issues by providing medically-accurate, evidence based information on effective strategies to prevent STI infections and unplanned pregnancy.
• Students who identify as female are more likely to experience sexual or physical dating violence than their peers who identify as male. Some of this may be attributed to underreporting by males due to stigma.
• Students who identify as female are bullied on school property more often than students who identify as male.
• Young women ages 16-19 are at higher risk of rape, attempted rape, or sexual assault than the general population.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful gender norms, and building the skills required for respectful, equitable relationships.

A lack of comprehensive sex education can harm youth from communities of color.

• Youth of color benefit from seeing themselves represented in sex education curriculum.
• Sex education programs that use a framing of diversity, equity, rights, and social justice , informed by an understanding of systemic racism and discrimination, have been found to increase positive attitudes around reproductive rights in all students.
• There is a critical need for sex education programs that reflect youth’s cultural values and community .
• Comprehensive sex education can address these needs by developing curriculum that is inclusive of diverse communities, relationships, and cultures, so that youth see themselves represented in their education.
• Racial and ethnic disparities in STI and HIV infection.
• Racial and ethnic disparities in unplanned pregnancy and births among adolescents.
• Nearly half of youth who are Black ages 13-21 report having been pressured into sexual activity .
• Adolescent experience with dating violence is most prevalent among youth who are American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial.
• Adolescents who are Latinx are more likely than their peers who are non-Latinx to report physical dating violence .
• Youth who are Black and Latinx and who experience bullying are more likely to suffer negative impacts on academic performance than their white peers.
• Students who are Asian American and Pacific Islander report bullying and harassment due to race, ethnicity, and language.
• Comprehensive sex education addresses these issues by guiding the development of healthy self-identities, challenging harmful stereotypes, and building the skills required for respectful, equitable relationships.
• Young people of color—specifically those from Black , Asian-American , and Latinx communities– are often hyper-sexualized in popular media, leading to societal perceptions that youth are “older” or more sexually experienced than their white peers.
• Young men of color—specifically those from Black and Latinx communities—are often portrayed as aggressive or criminal in popular media, leading to societal perceptions that youth are dangerous or more sexually aggressive or experienced than white peers.
• These media portrayals can lead to disparities in public perceptions of youth behavior , which can impact school discipline, lost mentorship and leadership opportunities, less access to educational opportunities afforded to white peers, and greater involvement in the juvenile justice system.
• Comprehensive sex education addresses these issues by including positive representations of diverse youth in curriculum, challenging harmful stereotypes, and building the skills required for respectful relationships.

A lack of comprehensive sex education can harm youth with disabilities or special health care needs.

• Youth with disabilities need inclusive, developmentally-appropriate, representative sex education to support their health, identity, and development .
• Youth with special health care needs often initiate romantic relationships and sexual behavior during adolescence, similar to their peers.
• Youth with disabilities and special health care needs benefit from seeing themselves represented in sex education to access the information and skills to build healthy identities and relationships.
• Comprehensive sex education addresses this need by including positive representation of youth with disabilities and special health care needs in curriculum and providing developmentally-appropriate sex education to all youth.
• When youth with disabilities and special health care needs do not get access to the comprehensive sex education that they need, they are at increased risk of sexual abuse or being viewed as a sexual offender.
• Youth with disabilities and special health care needs are more likely than peers without disabilities to report coercive sex, exploitation, and sexual abuse.
• Youth with disabilities and special health care needs report more sexualized behavior and victimization online than their peers without disabilities.
• Youth with disabilities are at greater risk of bullying and have fewer friend relationships than their peers.
• Comprehensive sex education addresses these issues by providing education on healthy relationships, consent, communication, and bodily autonomy.

A lack of comprehensive sex education can harm youth who are LGBTQ2S+.

• Most sex education curriculum is not inclusive or representative of LGBTQ2S+ identities and experiences.
• Because school-based sex education often does not meet their needs, youth who are LGBTQ2S+ are more likely to seek sexual health information online , and thus are more likely to come across misinformation.
• The majority of parents support discussion of sexual orientation in sex education classes.
• Comprehensive sex education addresses these issues by including positive representation of LGBTQ2S+ individuals, romantic relationships, and families.
• Sex education curriculum that overlooks or stigmatizes youth who are LGBTQ2S+ contributes to hostile school environments and harms the healthy sexual and mental development .
• Youth who are LGBTQ2S+ face high levels of discrimination at school and are more likely to miss school because of bullying or victimization .
• Ongoing experiences with stigma, exclusion, and harassment negatively impact the mental health of youth who are LGBTQ2S+.
• Comprehensive sex education provides inclusive curriculum and has been shown to improve understanding of gender diversity, lower rates of homophobia, and reduce homophobic bullying in schools.
• Youth who are LGBTQ2S+ are more likely than their heterosexual peers to report not learning about HIV/STIs in school .
• Lack of education on STI prevention leaves LGBTQ2S+ youth without the information they need to make informed decisions, leading to discrepancies in condom use between LGBTQ2S+ and heterosexual youth.
• Some LGBTQ2S+ populations carry a disproportionate burden of HIV and other STIs: these disparities begin in adolescence , when youth who are LGBTQ2S+ do not receive sex education that is relevant to them.
• Comprehensive sex education provides the knowledge and skills needed to make safe decisions about sexual behavior , including condom use and other forms of STI and HIV prevention.
• Youth who are LBGTQ2S+ or are questioning their sexual identity report higher rates of dating violence than their heterosexual peers.
• Youth who are LGBTQ2S+ or are questioning their sexual identity face higher prevalence of bullying than their heterosexual peers.
• Comprehensive sex education teaches youth healthy relationship and communication skills and is associated with decreases in dating violence and increases in bystander interventions .

A lack of comprehensive sex education can harm youth who are in foster care.

• More than 70% of children in foster care have a documented history of child abuse and or neglect.
• More than 80% of children in foster care have been exposed to significant levels of violence, including domestic violence.
• Youth in foster care are racially diverse, with 23% of youth identifying as Black and 21% of identifying as Latinx, who will have similar experiences as those highlighted in earlier sections of this report.
• Removal is emotionally traumatizing for almost all children. Lack of consistent/stable placement with a responsive, nurturing caregiver can result in poor emotional regulation, impulsivity, and attachment problems.
• Comprehensive sex education addresses these issues by providing evidence-based, culturally appropriate information on healthy relationships, consent, communication, and bodily autonomy.

Sex education is often the first experience that youth have with understanding and discussing their gender and sexual health.

Youth deserve to a strong foundation of developmentally appropriate information about gender and sexuality, and how these things relate to their bodies, community, culture, society, mental health, and relationships with family, peers, and romantic partners.

Decades of data have demonstrated that comprehensive sex education programs are  effective  in reducing risk of STIs and unplanned pregnancy. These benefits are critical to public health. However, comprehensive sex education goes even further, by instilling youth with a broad range of knowledge and skills that are  proven  to support social-emotional learning, positive communication skills, and development of healthy relationships.

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Building an evidence- and rights-based approach to healthy decision-making

As they grow up, young people face important decisions about relationships, sexuality, and sexual behavior. The decisions they make can impact their health and well-being for the rest of their lives. Young people have the right to lead healthy lives, and society has the responsibility to prepare youth by providing them with comprehensive sexual health education that gives them the tools they need to make healthy decisions. But it is not enough for programs to include discussions of abstinence and contraception to help young people avoid unintended pregnancy or disease. Comprehensive sexual health education must do more. It must provide young people with honest, age-appropriate information and skills necessary to help them take personal responsibility for their health and overall well being. This paper provides an overview of research on effective sex education, laws and policies that shape it, and how it can impact young people’s lives.

What is sexual health education?

Sex education is the provision of information about bodily development, sex, sexuality, and relationships, along with skills-building to help young people communicate about and make informed decisions regarding sex and their sexual health. Sex education should occur throughout a student’s grade levels, with information appropriate to students’ development and cultural background. It should include information about puberty and reproduction, abstinence, contraception and condoms, relationships, sexual violence prevention, body image, gender identity and sexual orientation. It should be taught by trained teachers. Sex education should be informed by evidence of what works best to prevent unintended pregnancy and sexually transmitted infections, but it should also respect young people’s right to complete and honest information. Sex education should treat sexual development as a normal, natural part of human development.

Why is sexual health education important to young people’s health and well-being?

Comprehensive sexual health education covers a range of topics throughout the student’s grade levels. Along with parental and community support, it can help young people:

• Avoid negative health consequences. Each year in the United States, about 750,000 teens become pregnant, with up to 82 percent of those pregnancies being unintended.[1,2] Young people ages 15-24 account for 25 percent of all new HIV infections in the U.S.[3] and make up almost one-half of the over 19 million new STD infections Americans acquire each year.4 Sex education teaches young people the skills they need to protect themselves.
• Communicate about sexuality and sexual health. Throughout their lives, people communicate with parents, friends and intimate partners about sexuality. Learning to freely discuss contraception and condoms, as well as activities they are not ready for, protects young people’s health throughout their lives. Delay sexual initiation until they are ready. Comprehensive sexual health education teaches abstinence as the only 100 percent effective method of preventing HIV, STIs, and unintended pregnancy – and as a valid choice which everyone has the right to make. Dozens of sex education programs have been proven effective at helping young people delay sex or have sex less often.[5]
• Understand healthy and unhealthy relationships. Maintaining a healthy relationship requires skills many young people are never taught – like positive communication, conflict management, and negotiating decisions around sexual activity. A lack of these skills can lead to unhealthy and even violent relationships among youth: one in 10 high school students has experienced physical violence from a dating partner in the past year.[6] Sex education should include understanding and identifying healthy and unhealthy relationship patterns; effective ways to communicate relationship needs and manage conflict; and strategies to avoid or end an unhealthy relationship.[7]
• Understand, value, and feel autonomy over their bodies. Comprehensive sexual health education teaches not only the basics of puberty and development, but also instills in young people that they have the right to decide what behaviors they engage in and to say no to unwanted sexual activity. Furthermore, sex education helps young people to examine the forces that contribute to a positive or negative body image.
• Respect others’ right to bodily autonomy. Eight percent of high school students have been forced to have intercourse[8], while one in ten students say they have committed sexual violence.[9] Good sex education teaches young people what constitutes sexual violence, that sexual violence is wrong, and how to find help if they have been assaulted.
• Show dignity and respect for all people, regardless of sexual orientation or gender identity. The past few decades have seen huge steps toward equality for lesbian, gay, bisexual, and transgender (LGBT) individuals. Yet LGBT youth still face discrimination and harassment. Among LGBT students, 82 percent have experienced harassment due to the sexual orientation, and 38 percent have experienced physical harassment.[10]
• Protect their academic success. Student sexual health can affect academic success. The Centers for Disease Control and Prevention (CDC) has found that students who do not engage in health risk behaviors receive higher grades than students who do engage in health risk behaviors. Health-related problems and unintended pregnancy can both contribute to absenteeism and dropout.[11]

What does the research say about effective sex education?

• A 2012 study that examined 66 comprehensive sexual risk reduction programs found them to be an effective public health strategy to reduce adolescent pregnancy, HIV, and STIs.[12]
• Research from the National Survey of Family Growth assessed the impact of sexuality education on youth sexual risk-taking for young people ages 15-19 and found that teens who received comprehensive sex education were 50 percent less likely to experience pregnancy than those who received abstinence-only-until-marriage programs.[13]
• Even accounting for differences in household income and education, states which teach sex education and/or HIV education that covers abstinence as well as contraception, tend to have the lowest pregnancy rates.[14]
• National Sexuality Education Standards provide a roadmap. The National Sexuality Education Standards, developed by experts in the public health and sexuality education field and heavily influenced by the National Health Education Standards, provide guidance about the minimum essential content and skills needed to help students make informed decisions about sexual health.15 The standards focus on seven topics as the minimum, essential content and skills for K–12 education: Anatomy and Physiology, Puberty and Adolescent Development, Identity, Pregnancy and Reproduction, Sexually Transmitted Diseases and HIV, Healthy Relationships, and Personal Safety. Topics are presented using performance indicators—what students should learn by the end of grades 2, 5, 8, and 12.[16] Schools which are developing comprehensive sexual health education programs should consult the National Sexuality Education Standards to provide students with the information and skills they need to develop into healthy adults.
• 16 programs demonstrated a statistically significant delay in the timing of first sex.
• 21 programs showed statistically significant declines in teen pregnancy, HIV or other STIs.
• 16 programs helped sexually active youth to increase their use of condoms.
• 9 programs demonstrated success at increasing use of contraception other than condoms.
• 40 percent delayed sexual initiation, reduced number of sexual partners, or increased condom or contraceptive use;
• 30 percent reduced the frequency of sex, including return to abstinence; and
• 60 percent reduced unprotected sex.[17]
• The Office of Adolescent Health, a division of the U.S. Department of Health and Human Services, keeps a list of evidence-based interventions, with ratings based on the rigor of program impact studies and strength of the evidence supporting the program model. Thirty-one programs meet the OAH’s effectiveness criteria and that were found to be effective at preventing teen pregnancies or births, reducing sexually transmitted infections, or reducing rates of associated sexual risk behaviors (defined by sexual activity, contraceptive use, or number of partners).[18]

What’s wrong with abstinence-only-until-marriage programs?

Many students receive abstinence-only-until marriage programs instead of or in addition to more comprehensive programs. These programs:

• Depict abstinence until heterosexual marriage as the only moral choice for young people
• Mention contraception only in terms of failure rates
• Focus on heterosexual youth, ignoring the needs of LGBTQ youth
• Often use outdated gender roles, urging “modesty” for all girls while painting all boys as sexual aggressors.
• Have been found to contain false information
• Are not supported by the majority of Americans.[19]

Only one abstinence-only program has ever been proven effective at helping young people delay sex; yet in withholding information about contraception, it leaves those who do have sex completely at risk. Studies show that 99 percent of people will use contraception in their lifetimes,[20] and that the provision of information about contraception does not hasten the onset of sexual debut or increase sexual activity.[10] Meanwhile, thirty years of public health research clearly demonstrate that comprehensive sex education can help young people delay sexual initiation while also assisting them to use protection when they do become sexually active. We want young people to behave responsibly when it comes to decisions about sexual health, and that means society has the responsibility to provide them with honest, age-appropriate comprehensive sexual health education; access to services to prevent pregnancy and sexually transmitted infections; and the resources to help them lead healthy lives.

All young people need comprehensive sexual health education, while others also need sexual health services. Youth at disproportionate risk for sexual health disparities may also need targeted interventions designed specifically to build self efficacy and agency. Further, administrators and other policy makers must recognize that structural determinants, socio-cultural factors and cultural norms have been shown to have a strong impact on youth sexual health and must be tackled to truly redress sexual health disparity fueled by social inequity.

How is the content of a student’s sex education decided?

Many factors help shape the content of a student’s sex education. These include:

• State and federal funding the school district receives
• State laws and standards regarding sex education
• School district level policies and/or standards regarding curricula and content
• The program or curriculum a district or individual school selects
• The individual(s) who delivers the program.

With thousands of school districts around the nation, students’ experiences can vary drastically from district to district and school to school.

What are federal, state, and local structures that affect sex education?

In the United States, education is largely a state and local responsibility, as dictated by the 10th Amendment of the U.S. Constitution. This amendment states that “the powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”[3] Because the Constitution doesn’t specifically mention education, the federal government does not have any direct authority regarding curriculum, instruction, administration, personnel, etc. In 1980, the U.S. Department of Education was created. While this move centralized federal efforts and responsibilities into one office, it did not come with an increase in federal jurisdiction over the educational system.

The U.S. Department of Education currently has no authority over sexual health education. However, there have been federal funds allocated, primarily through the Department of Health and Human Services that school systems and community-based agencies have used throughout the last three decades to provide various forms of sex education.[21]

• Federal funding: Until FY2010, there was no designated funding for a comprehensive approach to sex education. In 1982, federal support of abstinence-only programs began, and in 1996, expanded drastically. From 1996-2010, over $1.5 billion in federal funding went to abstinence-only programs, which were conducted with little oversight and were proven ineffective. While one large stream of funding for abstinence-only programs was cancelled in 2010, at publication one still exists (as authorized by Congress through Title V funding) and is funded at $50 million per year.[22]

In 2010, two streams of funding became available for evidence-based sex education interventions.[22]

• PREP: The Personal Responsibility Education Program (PREP) was authorized by Congress as a part of the Affordable Care Act of 2010. PREP provides grants ($75 million over five years) for programs which teach about both abstinence and contraception in order to help young people reduce their risk for unintended pregnancy, HIV, and STIs. In Fiscal Year 2012, 45 states applied for PREP. PREP grants are issued to states, typically the state health departments. All programs implemented with PREP funding are to educate adolescents about both abstinence and contraception for the prevention of pregnancy and STIs, including HIV/AIDS, and must cover at least three adulthood preparation subjects such as healthy relationships, adolescent development, financial literacy, educational and career success, and healthy life skills.
• The President’s Teen Pregnancy Prevention Initiative (TPPI) funds medically-accurate and age-appropriate programs to reduce teen pregnancy. Seventy-five grantees in 32 states received TPPI funds in FY 2012. TPPI grants are distributed by the Office of Adolescent Health to local public and private entities. Grantees must implement an evidence-based program which has been proven effective at preventing teen pregnancy. According to OAH, 31 programs meet these criteria, including one abstinence-only-until-marriage program.
• States may accept PREP, TPPI, or Title V funds. Many states accept funds for both abstinence-only programs and evidence-based interventions. In 2013, 19 SEAs and 17 LEA received five year cooperative agreements from CDC/DASH to implement ESHE within their school systems.

In addition, in 2013, CDC/Division of School Health issued a request for proposals to fund State Education Agencies (SEAs) and Large Municipal Education Agencies (LEAs) to implement Exemplary Sexual Health Education (ESHE). ESHE is defined as a systematic, evidence-informed approach to sexual health education that includes the use of grade-specific, evidence-based interventions, but also emphasizes sequential learning across elementary, middle, and high school grade levels.[23]

States may accept PREP, TPPI, or Title V funds. Many states accept funds for both abstinence-only programs and evidence-based interventions. In 2013, 19 SEAs and 17 LEAs received five year cooperative agreements from CDC/DASH to implement ESHE within their school systems.[22]

• The Real Education for Healthy Youth Act: While there is as yet no law that supports comprehensive sexual health education, there is pending legislation. The Real Education for Healthy Youth Act (S. 372/H.R. 725), introduced in February 2013 by the late Senator Frank Lautenberg (D-NJ) and Representative Barbara Lee (D-CA), would ensure that federal funding is allocated to comprehensive sexual health education programs that provide young people with the skills and information they need to make informed, responsible, and healthy decisions. This legislation sets forth a vision for comprehensive sexual health education programs in the United States.
• 30 states have no law that governs sex education, and schools are not required to provide it
• 25 states mandate that sex education, if taught, must include abstinence, but do not require it to include contraception.
• Six states mandate that sex education include either a ban on discussing homosexuality, or material about homosexuality that is overtly discriminatory.[22]

Each state has a department of education headed by a chief state school officer, more commonly known as the Superintendent of Public Instruction or the Commissioner of Education (titles vary by state). State departments of education are generally responsible for disbursing state and federal funds to local school districts, setting parameters for the length of school day and year, teacher certification, testing requirements, graduation requirements, developing learning standards and promoting professional development. Generally, the chief state school officer is appointed by the Governor, though in a few states they are elected.[23]

State departments of education may also have Standards which provide benchmark measures that define what students should know and be able to do at specified grade levels. These sometimes, but not always, address sexual health education. For instance, Connecticut and New Jersey have standards similar to the National Sexuality Education Standards in place and which address reproduction, prevention of STIs and pregnancy, and healthy relationships. A number of other states have general health education standards which do not directly address sexual health, while others make mention of HIV/STI prevention and abstinence but don’t demand the most thorough instruction in sexual health.[24]

• Local Policy: At the school district level, Pre-K-12 public schools are generally governed by local school boards (with the exception of Hawaii which does not have any local school board system). Local school boards are typically comprised of 5 to 7 members who are either elected by the public or appointed by other government officials.[21]

Local school boards are responsible for ensuring that each school in their district is in compliance with the laws and policies set by the state and federal government. Local school board also have broad decision and rule-making authority with regards to the operations of their local school district, including determining the school district budget and priorities; curriculum decisions such as the scope and sequence of classroom content in all subject areas; and textbook approval authority. [21]

Typically, school boards set the sex education policy for a school district. They must follow state law. Some school boards provide guidelines or standards, while others select specific curricula for schools to deliver. Most school boards are advised by School Health Advisory Councils (SHACs). SHAC members are individuals who represent the community and who provide advice about health education.[21]

How can I work for comprehensive sexual health education for students in my community?

There are a number of ways to help ensure that students get the information they need to live healthy lives, build healthy relationships, and take personal responsibility for their health and well being.

• Urge your Members of Congress to support the Real Education for Healthy Youth Act, in person, by phone, or online.
• Contact your school board and urge them to adopt the National Sexuality Education Standards and require comprehensive sexual health programs.
• Join a School Health Advisory Council in your area – both young people and adults are eligible to serve on most.
• Organize within your community – a group of individuals, or a coalition of like-minded organizations – to do one or all of the above.

Young people have the right to lead healthy lives. As they develop, we want them to take more and more control of their lives so that as they get older, they can make important life decisions on their own. The balance between responsibility and rights is critical because it sets behavioral expectations and builds trust while providing young people with the knowledge, ability, and comfort to manage their sexual health throughout life in a thoughtful, empowered and responsible way. But responsibility is a two-way street. Society needs to provide young people with honest, age-appropriate information they need to live healthy lives, and build healthy relationships, and young people need to take personal responsibility for their health and well being. Advocates must also work to dismantle barriers to sexual health, including poverty and lack of access to health care.

Emily Bridges, MLS, and Debra Hauser, MPH

Advocates for Youth © May 2014

1. CDC. Youth Risk Behavior Surveillance, 2011. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.

2. Finer LB et al., Disparities in rates of unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.

3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2011. Atlanta: U.S. Department of Health and Human Services; 2012.

4. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2012. Atlanta: U.S. Department of Health and Human Services; 2013.

5. Alford S, et al. Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. 2nd ed. Washington, DC: Advocates for Youth, 2008;

6. Dating Matters: Strategies to Promote Health Teen Relationships. Atlanta: Center for Disease Control and Prevention; 2013.

7. National Sexual Education Standards: Core Content and Skills, K-12. A Special Publication of the Journal of School Health. 2012: 6-9. http://www.futureofsexed.org/documents/josh-fose-standards-web.pdf. Accessed October 2, 2013.

8. Davis A. Interpersonal and Physical Dating Violence among Teens. National Council on Crime and Delinquency, 2008. Retrieved November 15, 2013 from http://www.nccdglobal.org/sites/default/files/publication_pdf/focus-dating-violence.pdf

9. Ybarra ML and Mitchell KJ. “Prevalence Rates of Male and Female Sexual Violence Perpetrators in a National Sample of Adolescents.” JAMA Pediatrics, December 2013.

10. Gay, Lesbian, and Straight Education Network. The 20011 National School Climate Survey: The School Related Experiences of Our Nation’s Lesbian, Gay, Bisexual and Transgender Youth. New York, NY: GLSEN, 2012.

11. CDC. Sexual Risk Behaviors and Academic Achievement. Atlanta, GA: CDC, (2010); http://www.cdc.gov/HealthyYouth/ health_and_academics/pdf/sexual_risk_behaviors.pdf; last accessed 5/23/2010. 12. Chin B et al. “The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services.” American Journal of Preventive Medicine, March 2012.

13. Kohler PK, Manhart LE, Lafferty WE. Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy. Journal of Adolescent Health. 2007; 42(4): 344-351.

14. Stanger-Hall KF, Hall DW. “Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.

15. National Sexual Education Standards: Core Content and Skills, K-12. A Special Publication of the Journal of School Health. 2012: 6-9. http://www.futureofsexed.org/documents/josh-fose-standards-web.pdf. Accessed October 2, 2013.

16. National Sexual Education Standards: Core Content and Skills, K-12. A Special Publication of the Journal of School Health. 2012: 6-9. http://www.futureofsexed.org/documents/josh-fose-standards-web.pdf. Accessed October 2, 2013.

17. Kirby D. Emerging Answers 2007. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007. 18. Office of Adolescent Health. “Evidence-Based Programs (31 Programs). Accessed March 5, 2014 from http://www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/db/programs.html

19. Public Religion Research Institute. Survey – Committed to Availability, Conflicted about Morality: What the Millennial Generation Tells Us about the Future of the Abortion Debate and the Culture Wars. 2011. Accessed from http://publicreligion.org/research/2011/06/committed-to-availability-conflicted-about-morality-what-the-millennial-generation-tells-us-about-the-future-of-the-abortion-debate-and-the-culture-wars/ on May 13, 2014.

20. Daniels K, Mosher WD and Jones J, Contraceptive methods women have ever used: United States, 1982–2010,National Health Statistics Reports, 2013, No. 62, <http://www.cdc.gov/nchs/data/nhsr/nhsr062.pdf>, accessed Mar. 20, 2013.

21. Future of Sex Education. “Public Education Primer. “ Accessed from http://www.futureofsexed.org/documents/public_education_primer.pdf on May 13, 2014.

22. Sexuality Information and Education Council of the United States, Siecus State Profiles, Fiscal Year 2012. Accessed from http://www.siecus.org/index.cfm?fuseaction=Page.ViewPage&PageID=1369 on May 13, 2014.

23. Centers for Disease Control and Prevention. “In Brief: Rationale for Exemplary Sexual Health Education (ESHE) for PS13-1308. Accessed from http://www.cdc.gov/healthyyouth/fundedpartners/1308/strategies/education.htm on May 13, 2014.

24. Answer. “State sex education policies by state.” Accessed from http://answer.rutgers.edu/page/state_policy/ on May 13, 2014.

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The Importance of Sexual Education Essay

Personal sexuality.

Sexual education has an integral role in removing one’s doubts on sexuality and sex related topics. It has often been identified that sexual education helps one to get a clear picture of the male and female sexuality. The sexual counseling and orientation class that I received was really effective in taking away the veil of sexual illiteracy and it enabled me to understand what human sexuality is. Regarding my personal experience with the class, I can identify it as one of the most effective classes which I ever attended and it helped me in changing my concepts about sex. As it was a class that covered almost all the sections of sexuality, the participants got the opportunity in properly identifying and clarifying their doubts on this topic. It was effective to get a clear picture of sexually-transmitted diseases and their evil effects on mankind. The proposed paper is an attempt to explore what sexuality is and the misconceptions of individuals about sexuality, based on personal experience of attending an orientation class on sexuality.

Researchers show their willingness to reach the conclusion that misconceptions and vague beliefs about sexuality contribute severe physical and mental disorder and behavioral problems. Various studies prove that effective orientation courses and sex education programs help to solve sexual problems and permit a person to mould a desired outcome in a person’s sexual life. The course promotes enormous knowledge and scientific information about sexuality in adolescence. In case of an adolescent, physical and mental changes affect seriously. In case of a male, biological changes such as puberty, growth of sexual organs and sexual attractions towards opposite sex are very common. In my own personal opinion the orientation course helped me to create scientific notions about sexual difficulties and sex-related diseases. The course helped me to deal sex as something serious and responsible phenomena in a person’s life. The web article entitled Sexual Difficulties remarks that; “Sexual difficulties belong to the group of conditions known as psychosomatic disorders, in which the body expresses the distress via a symptom, such as low libido.” ( Sexual Difficulties, p. 1).

Adolescent period is the most crucial time in a person’s life and the detailed description by the course person gives new knowledge about the behavioral changes and disorder problems. Both male and female suffer from lack of love, consideration, respect and proper interaction. Like other people, I also have some vague concepts about sexual changes and psychological impacts on a person’s life. After the orientation course I could understand more about male and female anatomy and their psychological impacts. Through the course I have got an opportunity to comprehend the term gender problem. Effective interaction between the course person and the listeners reduced the complications of the topic and it enabled me to admit sex is not only a means of enjoyment and merrymaking but a vital part of the process of human growth.

Like any other student, I was also not an exception and I had kept a false illusion over sexuality. One of the prominent lessons that I learned during the classes was about the gender issues. As I am one of the members of the male chauvinist society, I had formed my concept of sexuality with male possessing dominance. These classes planted in me the seeds that sexuality is a positive and healthy experience in which man and woman have equal roles. It was the class that cultivated in me the due respect to my opposite sex and I began to regard them equal to me. Understanding of female and male sexual anatomy and physiology helped realizing the genital change and growth in male and female. The transitional period of male and female from adolescence to youthhood is always problematic to children that their ignorance often leads them to mental and physical disorders. Some of the studies have identified children becoming depressed caused with the lack of sexual education. But it is possible for one to say that sexual education is always effective. The words of Dr. D Kirby, et al. make clear this fact when they rightly comment thus, “…there can also be many negative consequences of adolescent sexual behavior.”(Kirby, et al ). Now I am capable of recognizing the real physiological problems of children. I have also understood the ill-effects of prostitution and sexually transmitted diseases.

The course which I attended says how the relationship between partners can make a stronger one. They are of the opinion that if the partners build up a good communication with each other along with a good sexual relationship they can lead their life happily. While going through this class I realized that it is only by making a deep communication I can make my family relationship an ardent one. In the relationship with my partner I find some dissatisfaction because we are not always sharing our likes and dislikes. I think it is because of this there is a great gap between us. Now there is no good relationship between us because there is no deep communication between us. But after attending this class I understood about the relationship between the male and female sexual anatomy and how deep love and communication can help to make a good relation with my partner. I also got a good idea about sexually-transmitted diseases and what all difficulties will be there in the sexual relationship and by hearing the solutions I tried to change my attitudes toward my partner. Earlier I was not concerned about my partner’s wish or difficulties but now I care my partner and I try to understand the difficulties which my partner faces and in the coming days I will take care to make our relationship a success. I understood from the class that if there is a true love between partners and if they try to understand each other one can make their life a fruitful one.

The course gave a lot of valuable information about how to lead a happy and peaceful married life and what are the ways to attain such perfection. The course mainly focused on to have an understanding about the good and bad effects of keeping a sexual relation. The course gave comfortable contents which every one can put into practice. First of all the good content I consider is keeping a deep love and communication between the partners. This information is enough to lead a happy life, because if these two are put into practice there will be no clash and quarrel between the partners in sexual matter. For instance if one does not reveal his or her dissatisfaction about the manner of the partner in sexual relation, it will make a silent pain in the mind of the dissatisfied person and this will lead the person to be in a great hatred to his or her partner and thereby the relation too. So there should be a healthy communication and a kind of ardent love between the partners to avoid such hatred and other similar situations. The other comfortable content I found in the course is the description and discussion of male and female anatomy and physiology as it helps both the partners to understand every likes and dislikes of the other and can mingle with the other in an appropriate way. The discussion about sexual difficulties and solutions are also comfortable as it is highly favorable to know the causes of such difficulties and also the methods to solve those problems. The most important content I found in the course is the discussion about sexually transmitted diseases as it will create awareness among the people who keep different relations. So it will play a crucial role to change such attitudes and thereby the relation. These are the comfortable contents that I found in the course and are valuable to lead a better life.

Male and female anatomy and physiological features constituted more important knowledge for me. Each male and female has his/her own physical and genetic features. Comparing the physical changes of female in adulthood, female development is too fast and noticeable. I think one of the most valuable one is that the course provided proper awareness about inevitable relationship between physical growth and psychological changes. The given information helped me to know more about the structure of both male and female physical organs, especially the various changes of genital organs and their biological functions. The knowledge about opposite sex enabled me to respect persons from opposite sex. Childhood sexuality and its significance in development process were highly thought-provoking areas of the discussion. Genetic abnormalities and various sexual diseases are not familiar topics for me. Jane Coad and Melvyn Dunstall write “There are genetic conditions that result in a range of variable sexual development, such as Klinefelter’s syndrome and Turner’s syndrome.” (Coad, and Dunstall, p. 100). The course and orientation programs were helpful to number of people who have only some vague knowledge about personal sexuality.

To conclude, one can infer that there should be attempts to educate children on sexuality and the human body. From my personal experience of attending the class on sexuality, I have understood the importance of sexual education as it helps students to understand persons of their opposite sex. Proper understanding of male and female anatomy and physiological features is important in one’s life. Attending such classes remind one about the significance of a healthy sexual relation and its role in promoting better life situations. Scientific information about sexuality and the transition in the adolescent period also assumes significance. Male biological changes such as, puberty, growth of sexual organs and their sexual attraction to their opposite sex are quite common and if one is totally ignorant of these facts he/she may face some mental stress or in some cases it may lead to mental depression. Regarding sexual relation in married life, one can see that sex and sexual satisfaction have integral roles. Failure in understanding his/her pair in sexual relationship often leads to the ruin of family relationships. So, one is sure of the fact that sexual education has an elite role in one’s life. Proper sexual education should be given to children to avoid sexual illiteracy and sexual crimes.

Works Cited

• Coad, Jane., and Dunstall, Melvyn. Anatomy and Physiology for Midwives . Elsevier Health Science. 2001. Web.
• Kirby, Douglas., etal. School- Based Program to Reduce Sexual Risk Behaviors: a Review of Effectiveness . Public Health Report, 109. 3(1994): 339-360. Pub Med Central Journal List. 2009.Web.
• Sexual Difficulties. Andrology Australia.2006.
• Chicago (A-D)
• Chicago (N-B)

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5 Exercises for a Better Sex Life

Any physical activity can improve your sexual health. But a few exercises are especially beneficial.

By Danielle Friedman

As far as your muscles are concerned, sex is just another workout. And like most workouts, the more conditioned you are, the more enjoyable it can be.

Yes, you can train for sex.

“It’s important to remember that sex is movement, and it’s exercise,” said Debby Herbenick, director of the Center for Sexual Health Promotion at the Indiana University School of Public Health. If you want to have satisfying sex, she said, you’ll likely benefit from moving your body outside of the bedroom.

If you’re happy with your sex life, a regular fitness habit can help to ensure your body c ontinues to function properly. If you feel like your sex life could be more satisfying, exercise may help with erectile dysfunction , pain with penetration and low sex drive , among other issues.

Regular physical activity can also help you become more self aware. “You learn to listen to your body ,” Dr. Herbenick said, “and then you can carry that wisdom over to your sexual life.”

While pretty much any workout routine can improve sex over time, a few specific types of movement can be especially helpful for sexual function and enjoyment, depending on your needs and physical ability. Here are five exercises that experts in sexual health and fitness recommend.

Work in bursts of high intensity cardio.

Your cardiovascular health directly impacts your sexual health, and not just because sex can sometimes be vigorous and aerobic, Dr. Herbenick said.

The cardiovascular system powers two bodily systems that are important for sex: erections and vaginal lubrication. Without proper blood flow, one will likely have trouble achieving or maintaining either, she said. Research also suggests that, for some people, aerobic exercise itself can stimulate arousal.

If you don’t already do aerobic exercise, begin by establishing a solid cardio baseline through regular, moderate-intensity activity, said Darlene Marshall, a personal trainer in upstate New York who has helped clients train for better sex.

Then, once you can comfortably walk or jog at a “conversational” pace for about 20 minutes, add intervals of high-intensity effort, she said — to train for the bursts of exertion sex can require. Depending on your fitness level, running or cycling sprints, brisk stair climbs or high intensity interval training are all good options.

“The goal is to help your body avoid becoming overwhelmed, cardiovascularly, during sex,” Ms. Marshall said.

Do Kegels — correctly.

The health of your pelvic floor, the hammock of muscles that sits at the base of the pelvis, can make the difference between a gratifying sexual experience and a lackluster or even painful one — for women and men — said Janelle Howell, a pelvic floor specialist in Chicago. Between 10 and 20 percent of women in the United States report pain during sex.

When your pelvic floor muscles are weak or tight, you may not experience as powerful an orgasm. Tight pelvic floor muscles can also make penetrative sex painful. Healthy pelvic floor muscles need both strength and flexibility to be able to contract and fully release on command.

Kegel exercises , which mimic the effort of holding and releasing urine or gas, can be an effective way to strengthen the pelvic floor muscles, Dr. Howell said. The key is to make sure that after every contraction, you fully relax the muscles — something many people don’t do properly.

For women, Dr. Howell suggests imagining an elevator slowly going up, then slowly going all the way back down to the ground floor, to ensure the muscles fully release. For men, tighten your pelvic floor muscles, hold for three seconds, then fully relax for three seconds.

If you have a tight pelvic floor, experts advise skipping the Kegels and focusing instead on diaphragmatic breathing , which can help to relax and lengthen the muscles. (A pelvic floor physical therapist can offer a full assessment.)

Limber up your hips.

Most people spend hours a day sitting, which can lead to tight hip muscles, fascia and ligaments. When your hips are tight, you may experience back and pelvic pain during sex.

“I hear a lot that people can only do one position,” because they’re stiff or other positions hurt, Dr. Howell said.

Improving your hip mobility can help your whole lower body move more fluidly and comfortably, and may improve pelvic pain during sex, she said.

As a first step, Ms. Marshall recommends releasing some of the constricted areas by placing a tennis ball against your glutes and rolling it around, then shifting it to your hips and hamstrings, massaging each area until you feel the muscle release. This can be done sitting or against a wall.

From there, stretch your hips, hip flexors, glutes, back muscles and hamstrings by doing a figure-four stretch , 90/90 stretch , cat cow or happy baby pose , Dr. Howell said, or “any movement that’s bringing your chest closer towards your knees.”

Finally, dynamic exercises such as deep squats and glute bridges mobilize the hips and build strength. And if you want to dial up the intensity, weighted squats , leg presses and kettlebell swings can increase the power in your glutes and hamstrings.

“I love kettlebell swings for sexual training,” Ms. Marshall said, because they involve “a rhythmic movement of flexion and extension in the hips.”

Focus on your entire core.

The more strength you have in your core, the more you will be able to move easily during sex. Most of the nerves and muscles that are involved in sex are integrated into the core, and strong core muscles can also help to reduce back and hip pain before, during and after sex.

“Strengthening the core can really help with endurance during sex, helping you feel strong and solid in your body,” said Rachel Zar, a sex therapist in Chicago.

To work the full cylinder of muscles that make up the core, Dr. Howell recommends doing planks daily. “You can start small,” she said. “Say you can only hold it for five to 10 seconds — that’s going to help you to engage all of your core muscles at one time.”

Another bonus to working the core muscles? Dr. Herbenick and her team have found that, for some people, contracting and releasing their core muscles helped them become aroused. Consider your planks foreplay.

Practice five minutes of daily yoga.

Yoga can help improve hip mobility and build core strength. And practicing slow, deep, diaphragmatic breathing is especially valuable for sex, Dr. Herbenick said, because it helps to relax both the body’s parasympathetic nervous system and the pelvic floor.

“You might find that vaginal penetration is more comfortable. You might find that erections come more easily,” she said. “Stress is the enemy of erections.”

If you don’t feel up to moving through yoga positions, practicing the breath work alone is valuable, Dr. Howell noted. “Even just laying on the yoga mat, putting your hands on your belly and just breathing into your belly can really start to calm that nervous system,” she said, “which can then support more pleasure in your sex life.”

Danielle Friedman is a journalist in New York and the author of “Let’s Get Physical: How Women Discovered Exercise and Reshaped the World.” More about Danielle Friedman

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• Published: 01 May 2024

Temporal dynamics of the multi-omic response to endurance exercise training

• MoTrPAC Study Group ,
• Lead Analysts &

MoTrPAC Study Group

Nature volume  629 ,  pages 174–183 ( 2024 ) Cite this article

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• Epigenetics
• Metabolomics
• Transcriptomics

Regular exercise promotes whole-body health and prevents disease, but the underlying molecular mechanisms are incompletely understood 1 , 2 , 3 . Here, the Molecular Transducers of Physical Activity Consortium 4 profiled the temporal transcriptome, proteome, metabolome, lipidome, phosphoproteome, acetylproteome, ubiquitylproteome, epigenome and immunome in whole blood, plasma and 18 solid tissues in male and female Rattus norvegicus over eight weeks of endurance exercise training. The resulting data compendium encompasses 9,466 assays across 19 tissues, 25 molecular platforms and 4 training time points. Thousands of shared and tissue-specific molecular alterations were identified, with sex differences found in multiple tissues. Temporal multi-omic and multi-tissue analyses revealed expansive biological insights into the adaptive responses to endurance training, including widespread regulation of immune, metabolic, stress response and mitochondrial pathways. Many changes were relevant to human health, including non-alcoholic fatty liver disease, inflammatory bowel disease, cardiovascular health and tissue injury and recovery. The data and analyses presented in this study will serve as valuable resources for understanding and exploring the multi-tissue molecular effects of endurance training and are provided in a public repository ( https://motrpac-data.org/ ).

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Regular exercise provides wide-ranging health benefits, including reduced risks of all-cause mortality 1 , 5 , cardiometabolic and neurological diseases, cancer and other pathologies 2 , 6 , 7 . Exercise affects nearly all organ systems in either improving health or reducing disease risk 2 , 3 , 6 , 7 , with beneficial effects resulting from cellular and molecular adaptations within and across many tissues and organ systems 3 . Various ‘omic’ platforms (‘omes’) including transcriptomics, epigenomics, proteomics and metabolomics, have been used to study these events. However, work to date typically covers one or two omes at a single time point, is biased towards one sex, and often focuses on a single tissue, most often skeletal muscle, heart or blood 8 , 9 , 10 , 11 , 12 , with few studies considering other tissues 13 . Accordingly, a comprehensive, organism-wide, multi-omic map of the effects of exercise is needed to understand the molecular underpinnings of exercise training-induced adaptations. To address this need, the Molecular Transducers of Physical Activity Consortium (MoTrPAC) was established with the goal of building a molecular map of the exercise response across a broad range of tissues in animal models and in skeletal muscle, adipose and blood in humans 4 . Here we present the first whole-organism molecular map of the temporal effects of endurance exercise training in male and female rats and provide multiple insights enabled by this MoTrPAC multi-omic data resource.

Multi-omic analysis of exercise training

Six-month-old male and female Fischer 344 rats were subjected to progressive treadmill endurance exercise training (hereafter referred to as endurance training) for 1, 2, 4 or 8 weeks, with tissues collected 48 h after the last exercise bout (Fig. 1a ). Sex-matched sedentary, untrained rats were used as controls. Training resulted in robust phenotypic changes (Extended Data Fig. 1a–d ), including increased aerobic capacity (VO 2 max) by 18% and 16% at 8 weeks in males and females, respectively (Extended Data Fig. 1a ). The percentage of body fat decreased by 5% in males at 8 weeks (Extended Data Fig. 1b ), without a significant change in lean mass (Extended Data Fig. 1c ). In females, the body fat percentage did not change after 4 or 8 weeks of training, whereas it increased by 4% in sedentary controls (Extended Data Fig. 1b ). Body weight of females increased in all intervention groups, with no change for males (Extended Data Fig. 1d ).

a , Experimental design and tissue sample processing. Inbred Fischer 344 rats were subjected to a progressive treadmill training protocol. Tissues were collected from male and female animals that remained sedentary or completed 1, 2, 4 or 8 weeks of endurance exercise training. For trained animals, samples were collected 48 h after their last exercise bout (red pins). b , Summary of molecular datasets included in this study. Up to nine data types (omes) were generated for blood, plasma, and 18 solid tissues, per animal: ACETYL: acetylproteomics; protein site acetylation; ATAC, chromatin accessibility, ATAC-seq data; IMMUNO, multiplexed immunoassays; METAB, metabolomics and lipidomics; METHYL, DNA methylation, RRBS data; PHOSPHO, phosphoproteomics; protein site phosphorylation; PROT, global proteomics; protein abundance; TRNSCRPT, transcriptomics, RNA-seq data; UBIQ, ubiquitylome, protein site ubiquitination. Tissue labels indicate the location, colour code, and abbreviation for each tissue used throughout this study: ADRNL, adrenal gland; BAT, brown adipose tissue; BLOOD, whole blood, blood RNA; COLON, colon; CORTEX, cerebral cortex; HEART, heart; HIPPOC, hippocampus; HYPOTH, hypothalamus; KIDNEY, kidney; LIVER, liver; LUNG, lung; OVARY, ovaries; PLASMA, plasma; SKM-GN, gastrocnemius (skeletal muscle); SKM-VL, vastus lateralis (skeletal muscle); SMLINT, small intestine; SPLEEN, spleen; TESTES, testes; VENACV, vena cava; WAT-SC, subcutaneous white adipose tissue. Icons next to each tissue label indicate the data types generated for that tissue. c , Number of training-regulated features at 5% FDR. Each cell represents results for a single tissue and data type. Colours indicate the proportion of measured features that are differential.

Whole blood, plasma and 18 solid tissues were analysed using genomics, proteomics, metabolomics and protein immunoassay technologies, with most assays performed in a subset of these tissues (Fig. 1b and Extended Data Fig. 1e,f ). Specific details for each omic analysis are provided in Extended Data Fig. 2 , Methods, Supplementary Discussion and Supplementary Table 1 . Molecular assays were prioritized on the basis of available tissue quantity and biological relevance, with the gastrocnemius, heart, liver and white adipose tissue having the most diverse set of molecular assays performed, followed by the kidney, lung, brown adipose tissue and hippocampus (Extended Data Fig. 1e ). Altogether, datasets were generated from 9,466 assays across 211 combinations of tissues and molecular platforms, resulting in 681,256 non-epigenetic and 14,334,496 epigenetic (reduced-representation bisulfite sequencing (RRBS) and assay for transposase-accessible chromatin using sequencing (ATAC-seq)) measurements, corresponding to 213,689 and 2,799,307 unique non-epigenetic and epigenetic features, respectively.

Differential analysis was used to characterize the molecular responses to endurance training (Methods). We computed the overall significance of the training response for each feature, denoted as the training P value, where 35,439 features at 5% false discovery rate (FDR) comprise the training-regulated differential features (Fig. 1c and Supplementary Table 2 ). Timewise summary statistics quantify the exercise training effects for each sex and time point. Training-regulated molecules were observed in the vast majority of tissues for all omes, including a relatively large proportion of transcriptomics, proteomics, metabolomics and immunoassay features (Fig. 1c ). The observed timewise effects were modest: 56% of the per-feature maximum fold changes were between 0.67 and 1.5. Permutation testing showed that permuting the group or sex labels resulted in a significant reduction in the number of selected analytes in most tissues (Extended Data Fig. 3a–d and Supplementary Discussion ). For transcriptomics, the hypothalamus, cortex, testes and vena cava had the smallest proportion of training-regulated genes, whereas the blood, brown and white adipose tissues, adrenal gland and colon showed more extensive effects (Fig. 1c ). For proteomics, the gastrocnemius, heart and liver showed substantial differential regulation in both protein abundance and post-translational modifications (PTMs), with more restricted results in white adipose tissue, lung and kidney protein abundance. For metabolomics, a large proportion of differential metabolites were consistently observed across all tissues, although the absolute numbers were related to the number of metabolomic platforms used (Extended Data Fig. 1e ). The vast number of differential features over the training time course across tissues and omes highlights the multi-faceted, organism-wide nature of molecular adaptations to endurance training.

Multi-tissue response to training

To identify tissue-specific and multi-tissue training-responsive gene expression, we considered the six tissues with the deepest molecular profiling: gastrocnemius, heart, liver, white adipose tissue, lung and kidney. In sum, 11,407 differential features from these datasets were mapped to their cognate gene, for a total of 7,115 unique genes across the tissues (Fig. 2a , Extended Data Fig. 4a and Supplementary Table 3 ). Most of the genes with at least one training-responsive feature were tissue-specific (67%), with the greatest number appearing in white adipose tissue (Fig. 2a ). We identified pathways enriched by these tissue-specific training-responsive genes (Extended Data Fig. 4b ) and tabulated a subset of highly specific genes to gain insight into tissue-specific training adaptation (Supplementary Table 4 ). Focusing on sexually conserved responses revealed tissue-dependent adaptations. These included changes related to immune cell recruitment and tissue remodelling in the lung, cofactor and cholesterol biosynthesis in the liver, ion flux in the heart, and metabolic processes and striated muscle contraction in the gastrocnemius ( Supplementary Discussion ). A detailed analysis of white adipose tissue adaptations to exercise training is provided elsewhere 14 . We also observed ‘ome’-specific responses, with unique transcript and protein responses at the gene and pathway levels (Extended Data Fig. 4c,d , Supplementary Discussion and Supplementary Tables 5 and 6 ).

a , UpSet plot of the training-regulated gene sets associated with each tissue. Bars and dots indicating tissue-specific differential genes are coloured by tissue. Pathway enrichment analysis is shown for selected sets of genes in b , c as indicated by the arrows. b , c , Significantly enriched pathways (10% FDR) corresponding to genes that are differential in both LUNG and WAT-SC datasets ( b ) and the 22 genes that are training-regulated in all six tissues considered in a ( c ). Redundant pathways (those with an overlap of 80% or greater with an existing pathway) were removed. ESR, oestrogen receptor; T H 17, T helper 17.

2,359 genes had differential features in at least two tissues (Fig. 2a ). Lung and white adipose tissue had the largest set of uniquely shared genes ( n  = 249), with predominantly immune-related pathway enrichments (Fig. 2b ); expression patterns suggested decreased inflammation in the lung and increased immune cell recruitment in white adipose tissue (Supplementary Tables 2 and 3 ). Heart and gastrocnemius had the second-largest group of uniquely shared genes, with enrichment of mitochondrial metabolism pathways including the mitochondria fusion genes Opa1 and Mfn1 (Supplementary Table 3 ).

Twenty-two genes were training-regulated in all six tissues, with particular enrichment in heat shock response pathways (Fig. 2c ). Exercise induces the expression of heat shock proteins (HSPs) in various rodent and human tissues 15 . A focused analysis of our transcriptomics and proteomics data revealed HSPs as prominent outliers (Extended Data Fig. 5a and Supplementary Discussion ). Specifically, there was a marked, proteomics-driven up-regulation in the abundance of HSPs, including the major HSPs HSPA1B and HSP90AA1 (Extended Data Fig. 5b,c ). Another ubiquitous endurance training response involved regulation of the kininogenases KNG1 and KNG2 (Supplementary Table 3 ). These enzymes are part of the kallikrein–kininogen system and have been implicated in the hypotensive and insulin-sensitizing effects of exercise 16 , 17 .

Transcription factors and phosphosignalling

We used proteomics and transcriptomics data to infer changes in transcription factor and phosphosignalling activities in response to endurance training through transcription factor and PTM enrichment analyses (Methods). We compared the most significantly enriched transcription factors across tissues (Fig. 3a , Extended Data Fig. 6a and Supplementary Table 7 ). In the blood, we observed enrichment of the haematopoietic-associated transcription factors GABPA, ETS1, KLF3 and ZNF143; haematopoietic progenitors are proposed to be transducers of the health benefits of exercise 18 . In the heart and skeletal muscle, we observed a cluster of enriched Mef2 family transcription factor motifs (Fig. 3a ). MEF2C is a muscle-associated transcription factor involved in skeletal, cardiac and smooth muscle cell differentiation and has been implicated in vascular development, formation of the cardiac loop and neuron differentiation 19 .

a , Transcription factor motif enrichment analysis of the training-regulated transcripts in each tissue. The heat map shows enrichment z -scores across the differential genes for the 13 tissues that had at least 300 genes after mapping transcript IDs to gene symbols. Transcription factors were hierarchically clustered by their enrichment across tissues. CRE, cAMP response element. b , Estimate of activity changes in selected kinases and signalling pathways using PTM signature enrichment analysis on phosphoproteomics data. Only kinases or pathways with a significant difference in at least one tissue, sex or time point ( q value < 0.05) are shown. The heat map shows normalized enrichment score (NES) as colour; tissue, sex and time point combinations as columns, and either kinases or pathways as rows. Kinases are grouped by family; rows are hierarchically clustered within each group. FSH, follicle-stimulating hormone; TSH, thyroid-stimulating hormone.

Phosphorylation signatures of key kinases were altered across many tissues (Fig. 3b and Supplementary Table 8 ). This included AKT1 across heart, kidney and lung, mTOR across heart, kidney and white adipose tissue, and MAPK across heart and kidney. The liver showed an increase in the phosphosignature related to regulators of hepatic regeneration, including EGFR1, IGF and HGF (Extended Data Fig. 6b , Supplementary Discussion ). Increased phosphorylation of STAT3 and PXN, HGF targets involved in cell proliferation, suggest a mechanism for liver regeneration in response to exercise (Extended Data Fig. 6c ). In the heart, kinases showed bidirectional changes in their predicted basal activity in response to endurance training (Extended Data Fig. 6d and Supplementary Discussion ). Several AGC protein kinases showed a decrease in predicted activity, including AKT1, whereas tyrosine kinases, including SRC and mTOR, were predicted to have increased activity. The known SRC target phosphorylation sites GJA1 pY265 and CDH2 pY820 showed significantly increased phosphorylation in response to training (Extended Data Fig. 6e ). Notably, phosphorylation of GJA1 Y265 has previously been shown to disrupt gap junctions, key transducers of cardiac electrical conductivity 20 . This suggests that SRC signalling may regulate extracellular structural remodelling of the heart to promote physiologically beneficial adaptations. In agreement with this hypothesis, gene set enrichment analysis (GSEA) of extracellular matrix proteins revealed a negative enrichment in response to endurance training, showing decreased abundance of proteins such as basement membrane proteins (Extended Data Fig. 6f–h and Supplementary Table 9 ).

Molecular hubs of exercise adaptation

To compare the dynamic multi-omic responses to endurance training across tissues, we clustered the 34,244 differential features with complete timewise summary statistics using an empirical Bayes graphical clustering approach (Methods). By integrating these results onto a graph, we summarize the dynamics of the molecular training response and identify groups of features with similar responses (Extended Data Fig. 7 and Supplementary Table 10 ). We performed pathway enrichment analysis for many graphically defined clusters to characterize putative underlying biology (Supplementary Table 11 ).

We examined biological processes associated with training using the pathway enrichment results for up-regulated features at 8 weeks of training (Extended Data Fig. 8 , Supplementary Table 12 and Supplementary Discussion ). Compared with other tissues, the liver showed substantial regulation of chromatin accessibility, including in the nuclear receptor signalling and cellular senescence pathways. In the gastrocnemius, terms related to peroxisome proliferator-activated receptors (PPAR) signalling and lipid synthesis and degradation were enriched at the protein level, driven by proteins including the lipid droplet features PLIN2, PLIN4 and PLIN5. At the metabolomic level, terms related to ether lipid and glycerophospholipid metabolism were enriched. Together, these enrichments highlight the well-known ability of endurance training to modulate skeletal muscle lipid composition, storage, synthesis and metabolism. The blood displayed pathway enrichments related to translation and organelle biogenesis and maintenance. Paired with the transcription factor analysis (Fig. 3a ), this suggests increased haematopoietic cellular mobilization in the blood. Less studied tissues in the context of exercise training, including the adrenal gland, spleen, cortex, hippocampus and colon, also showed regulation of diverse pathways ( Supplementary Discussion ).

To identify the main temporal or sex-associated responses in each tissue, we summarized the graphical cluster sizes by tissue and time (Extended Data Fig. 7a ). We observed that the small intestine and plasma had more changes at weeks 1 and 2 of training. Conversely, many up-regulated features in brown adipose tissue and down-regulated features in white adipose tissue were observed only at week 8. The largest proportion of opposite effects between males and females was observed at week 1 in the adrenal gland. Other tissues, including the blood, heart, lung, kidney and skeletal muscle (gastrocnemius and vastus lateralis), had relatively consistent numbers of up-regulated and down-regulated features.

We next focused on characterizing shared molecular responses in the three striated muscles (gastrocnemius, vastus lateralis and heart). The three largest graphical clustering paths of differential features in each muscle tissue converged to a sex-consistent response by week 8 (Fig. 4a ). Because of the large number of muscle features that were up-regulated in both sexes at week 8, we further examined the corresponding multi-omic set of analytes (Fig. 4b ). Pathway enrichment analysis of the genes associated with these differential features demonstrated a sex- and muscle-consistent endurance training response that reflected up-regulation of mitochondrial metabolism, biogenesis and translation, and cellular response to heat stress (Fig. 4c and Supplementary Table 11 ).

a , Graphical representation of training-differential features in the three muscle tissues: gastrocnemius (SKM-GN), vastus lateralis (SKM-VL) and heart. Each node represents one of nine possible states (rows) at each of the four training time points (columns). Triangles to the left of row labels map states to symbols used in Fig. 5a . Edges represent the path of differential features over the training time course (see Extended Data Fig. 7 for a detailed explanation). Each graph includes the three largest paths of differential features in that tissue, with edges split by data type. Both node and edge size are proportional to the number of features represented. The node corresponding to features that are up-regulated in both sexes at 8 weeks of training (8w_F1_M1) is circled in each graph. b , Line plots of standardized abundances of all 8w_F1_M1 muscle features. The black line represents the average value across all features. c , Network view of significant pathway enrichment results (10% FDR) corresponding to the features in b . Nodes represent pathways; edges represent functionally similar node pairs (set similarity ≥ 0.3). Nodes are included only if they are significantly enriched in at least two of the muscle tissues, as indicated by node colour. Node size is proportional to the number of differential feature sets (for example, gastrocnemius transcripts) for which the pathway is significantly enriched. High-level biological themes were defined using Louvain community detection of the nodes. d , A subnetwork of a larger cluster identified by network clustering 8w_F1_M1 features from SKM-GN. Mech., mechanical.

We used a network connectivity analysis to study up-regulated features in the gastrocnemius at week 8 (Extended Data Fig. 9a,b , Methods and Supplementary Discussion ). Mapping features to genes revealed overlaps between transcriptomic, chromatin accessibility, and proteomic assays, but no overlaps with methylation. Three molecular interaction networks were compared (Methods), and BioGRID 21 was used for further clustering analysis, which identified three clusters (Extended Data Fig. 9c and Supplementary Table 13 ). The largest cluster was significantly enriched for multiple muscle adaptation processes (Fig. 4d and Supplementary Table 14 ). This analysis illustrates the direct linkage among pathways and putative central regulators, emphasizing the importance of multi-omic data in identifying interconnected networks and understanding skeletal muscle remodelling.

Connection to human diseases and traits

To systematically evaluate the translational value of our data, we integrated our results with extant exercise studies and disease ontology (DO) annotations (Methods). First, we compared our vastus lateralis transcriptomics results to a meta-analysis of long-term training gene-expression changes in human skeletal muscle tissue 8 , demonstrating a significant and direction-consistent overlap (Extended Data Fig. 9d–g and Supplementary Discussion ). We also identified a significant overlap between differential transcripts in the gastrocnemius of female rats trained for 8 weeks and differentially expressed genes identified in the soleus in a study of sedentary and exercise-trained female rats selectively bred for high or low exercise capacity 22 (Extended Data Fig. 9h ). Similarly, adaptations from high-intensity interval training in humans 23 significantly overlapped with the proteomics response in rats (Extended Data Fig. 9i ), particularly for female rats trained for 8 weeks (Extended Data Fig. 9j ). Finally, we performed DO enrichment analysis using the DOSE R package 24 (Supplementary Table 15 and Methods). Down-regulated genes from white adipose tissue, kidney and liver were enriched for several disease terms, suggesting a link between the exercise response and type 2 diabetes, cardiovascular disease, obesity and kidney disease (5% FDR; Extended Data Fig. 9k and Supplementary Discussion ), which are all epidemiologically related co-occurring diseases 25 . Overall, these results support a high concordance of our data from rats with human studies and their relevance to human disease.

Sex-specific responses to exercise

Many tissues showed sex differences in their training responses (Extended Data Fig. 10 ), with 58% of the 8-week training-regulated features demonstrating sex-differentiated responses. Opposite responses between the sexes were observed in adrenal gland transcripts, lung phosphosites and chromatin accessibility features, white adipose tissue transcripts and liver acetylsites. In addition, proinflammatory cytokines exhibited sex-associated changes across tissues (Extended Data Fig. 11a,b and Supplementary Table 16 ). Most female-specific cytokines were differentially regulated between weeks 1 and 2 of training, whereas most male-specific cytokines were differentially regulated between weeks 4 and 8 (Extended Data Fig. 11c ).

We observed extensive transcriptional remodelling of the adrenal gland, with more than 4,000 differential genes. Notably, the largest graphical path of training-regulated features was negatively correlated between males and females, with sustained down-regulation in females and transient up-regulation at 1 week in males (Extended Data Fig. 11d ). The genes in this path were also associated with steroid hormone synthesis pathways and metabolism, particularly those pertaining to mitochondrial function (Supplementary Table 11 ). Further, transcription factor motif enrichment analysis of the transcripts in this path showed enrichment of 14 transcription factors (5% FDR; Supplementary Table 17 ), including the metabolism-regulating factors PPARγ, PPARα and oestrogen-related receptor gamma (ERRγ). The gene-expression levels of several significantly enriched transcription factors themselves followed the same trajectory as this path (Extended Data Fig. 11e ).

In the rat lung, we observed decreased phosphosignalling activity with training primarily in males (Fig. 3b ). Among these, the PRKACA phosphorylation signature showed the largest sex difference at 1 and 2 weeks (Extended Data Fig. 11f–h and Supplementary Table 8 ). PRKACA is a kinase that is involved in signalling within multiple cellular pathways. However, four PRKACA substrates followed this pattern and were associated with cellular structures (such as cytoskeleton and cell–cell junctions): DSP, MYLK, STMN1 and SYNE1 (Extended Data Fig. 11i ). The phosphorylation of these proteins suggests a sex-dependent role of PRKACA in mediating changes in lung structure or mechanical function with training. This is supported as DSP and MYLK have essential roles in alveolar and epithelial cell remodelling in the lung 26 , 27 .

Immune pathway enrichment analysis of training-regulated transcripts at 8 weeks showed limited enrichment in muscle (heart, gastrocnemius and vastus lateralis) and brain (cortex, hippocampus, hypothalamus), down-regulation in the lung and small intestine, and strong up-regulation in brown and white adipose tissue in males only (Fig. 5a , Extended Data Fig. 12a and Supplementary Table 11 ). Many of the same immune pathways (Supplementary Table 18 ) and immune-related transcription factors (Supplementary Table 19 ) were enriched in both adipose tissues in males. Furthermore, correlation between the transcript expression profiles of male-specific up-regulated features in the adipose tissues and immune cell markers from external cell-typing assays revealed a strong positive correlation for many immune cell types, including B, T and natural killer cells, and low correlation with platelets, erythrocytes and lymphatic tissue (Fig. 5b,c , Methods and Supplementary Table 20 ). These patterns suggest recruitment of peripheral immune cells or proliferation of tissue-resident immune cells as opposed to non-biological variation in blood or lymph content. Correlations at the protein level were not as marked (Extended Data Fig. 12b,c ). Complementary analyses using CIBERTSORTx produced similar results (Extended Data Fig. 12d,e ). In summary, our data suggest an important role of immune cell activity in the adaptation of male adipose tissue to endurance training.

a , Enrichment analysis results of the training-differential transcripts at 8 weeks in Kyoto Encyclopedia of Genes and Genomes (KEGG) immune system pathways (10% FDR). NK, natural killer. b , Line plots of standardized abundances of selected training-differential transcripts. Brown and white adipose tissue show male-specific up-regulation at week 8 (8w_F0_M1). The small intestine (SMLINT) shows down-regulation in females and partial down-regulation in males at week 8 (8w_F-1_M0 or 8w_F-1_M-1). c , Box plots of the sample-level Pearson correlation between markers of immune cell types, lymphatic tissue or cell proliferation and the average value of features in b at the transcript level. A pink dot indicates that the marker is also one of the differential features plotted in b . A pound sign indicates that the distribution of Pearson correlations for a set of at least two markers is significantly different from 0 (two-sided one-sample t -test, 5% FDR). When only one marker is used to define a category on the y axis, the gene name is provided in parentheses. In box plots, the centre line represents median, box bounds represent 25th and 75th percentiles, whiskers represent minimum and maximum excluding outliers and blue dots represent outliers.

The small intestine was among the tissues with the highest enrichment in immune-related pathways (Extended Data Fig. 12a ), with down-regulation of transcripts at 8 weeks, and a more robust response in females (Fig. 5b ). This transcript set was significantly enriched with pathways related to gut inflammation (Supplementary Table 11 ). We observed positive associations between these transcripts and markers of several immune cell types, including B, T, natural killer and dendritic cells, suggesting decreased abundance (Fig. 5c and Supplementary Discussion ). Endurance training also decreased the expression of transcripts with genetic risk loci for inflammatory bowel disease (IBD), including major histocompatability complex class II 28 , a finding that also emerged through the DO enrichment analysis (Supplementary Table 15 ). Endurance training is suggested to reduce systemic inflammation, in part by increasing gut microbial diversity and gut barrier integrity 29 . In accordance, we observed decreases in Cxcr3 and Il1a with training (Extended Data Fig. 12f ), both of which are implicated in the pathogenesis of IBD 30 , 31 . Together, these data suggest that endurance training improves gut homeostasis, potentially conferring systemic anti-inflammatory effects.

Multi-tissue changes in mitochondria and lipids

We summarized the organism-wide metabolic changes for metabolomic datasets using RefMet metabolite classes (Fig. 6a and Supplementary Table 21 ) and for non-metabolomics datasets using metabolic subcategories of KEGG pathways (10% FDR; Extended Data Fig. 13a and Supplementary Table 11 ). The liver showed the greatest number of significantly enriched metabolite classes, followed by the heart, lung and hippocampus (Fig. 6a and Supplementary Discussion ). Inspection of individual metabolites and acylcarnitine groups revealed changes associated with functional alterations in response to training (Extended Data Fig. 13b–d and Supplementary Discussion ). Of particular interest, trimethylamine- N -oxide has been associated with cardiovascular disease 32 . We observed up-regulation of 1-methylhistidine, a marker of muscle protein turnover, in the kidney at 1, 2 and 4 weeks, which may indicate muscle breakdown and clearance through the kidney during early training time points. Cortisol levels were increased as expected from the physiological stress of training, and we observed a substantial increase in the kidney, again probably owing to renal clearance 33 . The liver showed up-regulation of 1-methylnicotinamide, which may have a role in inflammation 34 , at 8 weeks.

a , RefMet metabolite class enrichment calculated using GSEA with the −log 10 training P value. Significant chemical class enrichments (5% FDR) are shown as black circles with size is proportional to FDR. Small grey circles are chemical class enrichments that were not significant, and blank cells were not tested owing to low numbers of detected metabolites. TCA, tricarboxylic acid cycle. b , GSEA results using the MitoCarta MitoPathways gene set database and proteomics (PROT) or acetylome (ACETYL) timewise summary statistics for training. NESs are shown for significant pathways (10% FDR). Mitochondrial pathways shown as rows are grouped using the parental group in the MitoPathways hierarchy. OXPHOS, oxidative phosphorylation. c , Line plots of standardized abundances of liver training-differential features across all data types that are up-regulated in both sexes, with a later response in females (LIVER: 1w_F0_M1 − >2w_F0_M1 − >4w_F0_M1 − >8w_F1_M1). The black line represents the average value across all features. d , Network view of pathway enrichment results corresponding to features in c . Nodes indicate significantly enriched pathways (10% FDR); edges connect nodes if there is a similarity score of at least 0.375 between the gene sets driving each pathway enrichment. Node colours indicate omes in which the enrichment was observed. e , log 2 fold changes (logFC) relative to sedentary controls for metabolites within the ‘Lipids and lipid related compounds’ category in the 8-week liver. Heat map colour represents fold change (red, positive; blue, negative). Compounds are grouped into columns based on category (coloured bars).

The heart showed enrichment of various carbohydrate metabolism subcategories across many omes (Extended Data Fig. 13a ), and remarkably, all enzymes within the glycolysis–gluconeogenesis pathway showed a consistent increase in abundance, except for GPI, FBP2 and DLAT (Extended Data Fig. 13e ). Oxidative phosphorylation was enriched in most tissues and is consistent with the joint analyses of the muscle tissues (Fig. 4c ), suggesting potential changes in mitochondria biogenesis. We estimated proportional mitochondrial changes to endurance training using mitochondrial RNA-sequencing (RNA-seq) reads (Extended Data Fig. 14a–c ) and changes of mitochondrial functions through GSEA using gene expression, protein abundance and protein PTMs (Fig. 6b , Extended Data Fig. 14d and Supplementary Tables 22 – 25 ). Increased mitochondrial biogenesis was observed in skeletal muscle, heart and liver across these analyses. Moreover, sex-specific mitochondrial changes were observed in the adrenal gland, as described above, and in the colon, lung and kidney. These results highlight a highly adaptive and pervasive mitochondrial response to endurance training; a more in-depth analysis of this response is provided elsewhere 35 .

In the liver, we observed substantial regulation of metabolic pathways across the proteome, acetylome and lipidome (Fig. 6a,b and Extended Data Fig. 13a ). For example, there was significant enrichment in 12 metabolite classes belonging to ‘lipids and lipid-related compounds’ (Fig. 6a and Supplementary Table 26 ). We therefore focused on the large group of features that increased in abundance over time for both sexes (Fig. 6c ). Most of these liver features corresponded to protein abundance and protein acetylation changes in the mitochondrial, amino acid and lipid metabolic pathways (Fig. 6d and Supplementary Table 27 ). We also observed an increase in phosphatidylcholines and a concomitant decrease in triacylglycerols (Fig. 6e ). Finally, there was increased abundance and acetylation of proteins from the peroxisome, an organelle with key functions in lipid metabolism (Extended Data Fig. 14e ). To our knowledge, these extensive changes in protein acetylation in response to endurance training have not been described previously. Together, these molecular adaptations may constitute part of the mechanisms underlying exercise-mediated improvements in liver health, particularly protection against excessive intrahepatic lipid storage and steatosis 36 .

Mapping the molecular exercise responses across a whole organism is critical for understanding the beneficial effects of exercise. Previous studies are limited to a few tissues, a narrow temporal range, or a single sex. Substantially expanding on the current work in the field, we used 25 distinct molecular platforms in as many as 19 tissues to study the temporal changes to endurance exercise training in male and female rats. Accordingly, we identified thousands of training-induced changes within and across tissues, including temporal and sex-biased responses, in mRNA transcripts, proteins, post-translational modifications and metabolites. Each omic dataset provides unique insights into exercise adaptation, where a holistic understanding requires multi-omic analysis. This work illustrates how mining our data resource can both recapitulate expected mechanisms and provide novel biological insights.

This work can be leveraged to deepen our understanding of exercise-related improvement of health and disease management. The global heat shock response to exercise may confer cytoprotective effects, including in pathologies related to tissue damage and injury recovery 37 . Increased acetylation of liver mitochondrial enzymes and regulation of lipid metabolism may link exercise to protection against non-alcoholic fatty liver disease and steatohepatitis 36 . Similarly, exercise-mediated modulation of cytokines, receptors and transcripts linked to intestinal inflammation or IBD may be associated with improved gut health. These examples highlight unique training responses illuminated by a multi-omics approach that can be leveraged for future hypothesis-driven research on how exercise improves whole-body and tissue-specific health.

We note limitations in our experimental design, datasets and analyses ( Supplementary Discussion ). In short, samples were collected 48 h after the last exercise bout to capture sustained alterations, thereby excluding acute responses. Our assays were performed on bulk tissue and do not cover single-cell platforms. Our resource has limited omic characterization for certain tissues, and additional platforms with emerging biological relevance were not utilized, including microbiome profiling. Moreover, our results are hypothesis-generating and require biological validation; supporting this, we have established a publicly accessible tissue bank from this study.

This MoTrPAC resource provides future opportunities to enhance and refine the molecular map of the endurance training response. We expect that this dataset will remain an ongoing platform to translate tissue- and sex-specific molecular changes in rats to humans. MoTrPAC has made extensive efforts to facilitate access, exploration and interpretation of this resource. We developed the MoTrPAC Data Hub to easily explore and download data ( https://motrpac-data.org/ ), software packages to provide reproducible source code and facilitate data retrieval and analysis in R (MotrpacRatTraining6mo and MotrpacRatTraining6moData 38 , 39 ), and visualization tools for data exploration ( https://data-viz.motrpac-data.org ). Altogether, this multi-omic resource serves as a broadly useful reference for studying the milieu of molecular changes in endurance training adaptation and provides new opportunities to understand the effects of exercise on health and disease.

All methods are included in the  Supplementary Information .

Reporting summary

Further information on research design is available in the  Nature Portfolio Reporting Summary linked to this article.

Data availability

MoTrPAC data are publicly available via http://motrpac-data.org/data-access . Data access inquiries should be sent to [email protected]. Additional resources can be found at http://motrpac.org and https://motrpac-data.org/ . Interactive data visualizations are provided through a website ( https://data-viz.motrpac-data.org ) and HTML reports summarizing the multi-omic graphical analysis results in each tissue 40 . Processed data and analysis results are additionally available in the MotrpacRatTraining6moData R package 39 ( https://github.com/MoTrPAC/MotrpacRatTraining6moData ). Raw and processed data for were deposited in the appropriate public repositories as follows. RNA-seq, ATAC-seq and RRBS data were deposited at the Sequence Read Archive under accession PRJNA908279 and at the Gene Expression Omnibus under accession GSE242358 ; multiplexed immunoassays were deposited at IMMPORT under accession SDY2193 ; metabolomics data were deposited at Metabolomics Workbench under project ID PR001020 ; and proteomics data were deposited at MassIVE under accessions MSV000092911 , MSV000092922 , MSV000092923 , MSV000092924 , MSV000092925 and MSV000092931 . We used the following external datasets: release 96 of the Ensembl R. norvegicus (rn6) genome ( https://ftp.ensembl.org/pub/release-96/fasta/rattus_norvegicus/dna/ ) and gene annotation ( https://ftp.ensembl.org/pub/release-96/gtf/rattus_norvegicus/Rattus_norvegicus.Rnor_6.0.96.gtf.gz ); RefSeq protein database ( https://ftp.ncbi.nlm.nih.gov/refseq/R_norvegicus/ , downloaded 11/2018); the NCBI gene2refseq mapping files ( https://ftp.ncbi.nlm.nih.gov/gene/DATA/gene2refseq.gz , accessed 18 December 2020); RGD rat gene annotation ( https://download.rgd.mcw.edu/data_release/RAT/GENES_RAT.txt , accessed 12 November 2021); BioGRID v4.2.193 ( https://downloads.thebiogrid.org/File/BioGRID/Release-Archive/BIOGRID-4.2.193/BIOGRID-ORGANISM-4.2.193.tab3.zip ); STRING v11.5 ( https://stringdb-downloads.org/download/protein.physical.links.v11.5/10116.protein.physical.links.v11.5.txt.gz ); GENCODE release 39 metadata and annotation files ( https://ftp.ebi.ac.uk/pub/databases/gencode/Gencode_human/release_39/ , accessed 20 January 2022); MatrisomeDB ( https://doi.org/10.1093/nar/gkac1009 ); MitoPathways database available through MitoCarta ( https://personal.broadinstitute.org/scalvo/MitoCarta3.0/ ); PTMSigDB v1.9.0 PTM set database ( https://doi.org/10.1074/mcp.TIR118.000943 ); UniProt human proteome FASTA for canonical protein sequences (UniProtKB query “reviewed:true AND proteome:up000005640”, download date 3 March 2021); the CIBERSORT LM22 leukocyte gene signature matrix ( https://doi.org/10.1007/978-1-4939-7493-1_12 ); published results from Amar et al. 8 , Bye et al. 22 and Hostrup et al. 23 ; and GTEx v8 gene-expression data (dbGaP Accession phs000424.v8.p2). Details are provided in the Supplementary Information , Methods.

Code availability

Code for reproducing the main analyses is provided in the MotrpacRatTraining6mo R package 38 ( https://motrpac.github.io/MotrpacRatTraining6mo/ ). MoTrPAC data processing pipelines for RNA-seq, ATAC-seq, RRBS and proteomics are available in the following Github repositories: https://github.com/MoTrPAC/motrpac-rna-seq-pipeline 41 , https://github.com/MoTrPAC/motrpac-atac-seq-pipeline 42 , https://github.com/MoTrPAC/motrpac-rrbs-pipeline 43 and https://github.com/MoTrPAC/motrpac-proteomics-pipeline 44 . Normalization and quality control scripts are available at https://github.com/MoTrPAC/MotrpacRatTraining6moQCRep 45 .

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Acknowledgements

Funding: The MoTrPAC Study is supported by NIH grants U24OD026629 (Bioinformatics Center), U24DK112349, U24DK112342, U24DK112340, U24DK112341, U24DK112326, U24DK112331, U24DK112348 (Chemical Analysis Sites), U01AR071133, U01AR071130, U01AR071124, U01AR071128, U01AR071150, U01AR071160, U01AR071158 (Clinical Centers), U24AR071113 (Consortium Coordinating Center), U01AG055133, U01AG055137 and U01AG055135 (PASS/Animal Sites). This work was also supported by other funding sources: NHGRI Institutional Training Grant in Genome Science 5T32HG000044 (N.R.G.), National Science Foundation Graduate Research Fellowship Grant No. NSF 1445197 (N.R.G.), National Heart, Lung, and Blood Institute of the National Institute of Health F32 postdoctoral fellowship award F32HL154711 (P.M.J.B.), the Knut and Alice Wallenberg Foundation (M.E.L.), National Science Foundation Major Research Instrumentation (MRI) CHE-1726528 (F.M.F.), National Institute on Aging P30AG044271 and P30AG003319 (N.M.), and NORC at the University of Chicago grant no. P30DK07247 (E.R.). Parts of this work were performed in the Environmental Molecular Science Laboratory, a US Department of Energy national scientific user facility at Pacific Northwest National Laboratory in Richland, WA. The views expressed are those of the authors and do not necessarily reflect those of the NIH or the US Department of Health and Human Services. Some figures were created using Biorender.com. Fig. 1b was modified with permission from ref. 46 .

Author information

These authors contributed equally: David Amar, Nicole R. Gay, Pierre M. Jean-Beltran

These authors jointly supervised this work: Sue C. Bodine, Steven A. Carr, Karyn A. Esser, Stephen B. Montgomery, Simon Schenk, Michael P. Snyder, Matthew T. Wheeler

Authors and Affiliations

Department of Medicine, Stanford University, Stanford, CA, USA

David Amar, David Jimenez-Morales, Malene E. Lindholm, Shruti Marwaha, Archana Natarajan Raja, Jimmy Zhen, Euan Ashley, Matthew T. Wheeler, Karen P. Dalton, Steven G. Hershman, Mihir Samdarshi & Christopher Teng

Department of Genetics, Stanford University, Stanford, CA, USA

Nicole R. Gay, Bingqing Zhao, Jose J. Almagro Armenteros, Nasim Bararpour, Si Wu, Stephen B. Montgomery, Michael P. Snyder, Clarisa Chavez, Roxanne Chiu, Krista M. Hennig, Chia-Jui Hung, Christopher A. Jin & Navid Zebarjadi

Proteomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA

Pierre M. Jean-Beltran, Hasmik Keshishian, Natalie M. Clark, Steven A. Carr, D. R. Mani, Charles C. Mundorff & Cadence Pearce

Department of Internal Medicine, University of Iowa, Iowa City, IA, USA

Dam Bae, Ana C. Lira, Sue C. Bodine, Michael Cicha, Luis Gustavo Oliveira De Sousa, Bailey E. Jackson, Kyle S. Kramer, Andrea G. Marshall & Collyn Z-T. Richards

Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA

Surendra Dasari

Metabolomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA

Courtney Dennis, Julian Avila-Pacheco & Clary B. Clish

Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

Charles R. Evans & Charles F. Burant

School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA

David A. Gaul, Evan M. Savage & Facundo M. Fernández

Department of Medicine, Duke University, Durham, NC, USA

Olga Ilkayeva, William E. Kraus & Kim M. Huffman

Duke Molecular Physiology Institute, Duke University, Durham, NC, USA

Olga Ilkayeva, Michael J. Muehlbauer, William E. Kraus, Christopher Newgard, Kim M. Huffman & Megan E. Ramaker

Emory Integrated Metabolomics and Lipidomics Core, Emory University, Atlanta, GA, USA

Anna A. Ivanova, Xueyun Liu & Kristal M. Maner-Smith

BRCF Metabolomics Core, University of Michigan, Ann Arbor, MI, USA

Maureen T. Kachman, Alexander (Sasha) Raskind & Tanu Soni

Division of Endocrinology, Nutrition, and Metabolism, Mayo Clinic, Rochester, MN, USA

Ian R. Lanza

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Venugopalan D. Nair, Gregory R. Smith, Yongchao Ge, Stuart C. Sealfon, Mary Anne S. Amper, Kristy Guevara, Nada Marjanovic, German Nudelman, Hanna Pincas, Irene Ramos, Stas Rirak, Aliza B. Rubenstein, Frederique Ruf-Zamojski, Nitish Seenarine, Sindhu Vangeti, Mital Vasoya, Alexandria Vornholt, Xuechen Yu & Elena Zaslavsky

Environmental Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA

Paul D. Piehowski

Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA

Jessica L. Rooney, Russell Tracy, Elaine Cornell, Nicole Gagne & Sandy May

Department of Pathology, Stanford University, Stanford, CA, USA

Kevin S. Smith, Nikolai G. Vetr, Stephen B. Montgomery & Daniel Nachun

Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA

Cynthia L. Stowe, Fang-Chi Hsu, Scott Rushing & Michael P. Walkup

Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA

Gina M. Many, James A. Sanford, Joshua N. Adkins, Wei-Jun Qian, Marina A. Gritsenko, Joshua R. Hansen, Chelsea Hutchinson-Bunch, Matthew E. Monroe, Ronald J. Moore, Michael D. Nestor, Vladislav A. Petyuk & Tyler J. Sagendorf

Department of Biochemistry, Emory University, Atlanta, GA, USA

Tiantian Zhang, Zhenxin Hou & Eric A. Ortlund

Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, MA, USA

David M. Presby, Laurie J. Goodyear, Brent G. Albertson, Tiziana Caputo, Michael F. Hirshman, Nathan S. Makarewicz, Pasquale Nigro & Krithika Ramachandran

Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA

Alec Steep & Jun Z. Li

Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Yifei Sun & Martin J. Walsh

Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA

• Sue C. Bodine

Department of Physiology and Aging, University of Florida, Gainesville, FL, USA

Karyn A. Esser & Marco Pahor

Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, La Jolla, CA, USA

Simon Schenk

Department of Biomedical Data Science, Stanford University, Stanford, CA, USA

Stephen B. Montgomery

Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

Gary Cutter

Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

Robert E. Gerszten & Jeremy M. Robbins

Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA

Michael E. Miller

Department of Medicine, Mayo Clinic, Rochester, MN, USA

K. Sreekumaran Nair

Department of Statistics, Stanford University, Stanford, CA, USA

Trevor Hastie & Rob Tibshirani

Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA

Rob Tibshirani

Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA

Brian Bouverat, Christiaan Leeuwenburgh & Ching-ju Lu

Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA

• Barbara Nicklas

Department of Health and Exercise Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA

W. Jack Rejeski

National Institute on Aging, National Institutes of Health, Bethesda, MD, USA

• John P. Williams

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA

Elisabeth R. Barton

Department of Biomedical Sciences, University of Missouri, Columbia, MO, USA

Frank W. Booth

Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA

Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA

Frank W. Booth & R. Scott Rector

Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA

Department of Kinesiology and Health Education, University of Texas, Austin, TX, USA

Roger Farrar

Department of Medicine, Division of Endocrinology and Diabetes, University of California, Los Angeles, CA, USA

Andrea L. Hevener

Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, USA

Benjamin G. Ke & Chongzhi Zang

Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, USA

Sarah J. Lessard

Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA

Andrea G. Marshall

Department of Health Sciences, Stetson University, Deland, FL, USA

Scott Powers

Department of Medicine, University of Missouri, Columbia, MO, USA

R. Scott Rector

NextGen Precision Health, University of Missouri, Columbia, MO, USA

Cell Biology and Physiology, Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA

John Thyfault

Center for Skeletal Muscle Research at Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, USA

Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA

Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA, USA

Department of Molecular Physiology and Biological Physics, University of Virginia School of Medicine, Charlottesville, VA, USA

Fralin Biomedical Research Institute, Center for Exercise Medicine Research at Virginia Tech Carilion, Roanoke, VA, USA

Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA, USA

Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA

Ali Tugrul Balci & Maria Chikina

Petit Institute of Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA

Samuel G. Moore

Department of Medicine, Emory University, Atlanta, GA, USA

Karan Uppal

Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA

Marcas Bamman & Anna Thalacker-Mercer

Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

Bryan C. Bergman, Daniel H. Bessesen, Wendy M. Kohrt, Edward L. Melanson, Kerrie L. Moreau, Irene E. Schauer & Robert S. Schwartz

Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

Thomas W. Buford

Human Performance Laboratory, Ball State University, Muncie, IN, USA

Toby L. Chambers, Bridget Lester, Scott Trappe & Todd A. Trappe

Translational Research Institute, AdventHealth, Orlando, FL, USA

Paul M. Coen, Bret H. Goodpaster & Lauren M. Sparks

Department of Pediatrics, University of California, Irvine, CA, USA

Dan Cooper, Fadia Haddad & Shlomit Radom-Aizik

Pennington Biomedical Research Center, Baton Rouge, LA, USA

Kishore Gadde, Melissa Harris, Neil M. Johannsen, Tuomo Rankinen & Eric Ravussin

College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

Catherine M. Jankowski

Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

Nicolas Musi

Population and Public Health, Pennington Biomedical Research Center, Baton Rouge, LA, USA

Robert L. Newton Jr

Biochemistry and Structural Biology, Center for Metabolic Health, Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA

Blake B. Rasmussen

Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA

Elena Volpi

MoTrPAC Study Group

• Primary authors

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• , Nicole R. Gay
• , Pierre M. Jean-Beltran

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• , Surendra Dasari
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• , Stuart C. Sealfon
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•  & Tiantian Zhang

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• Joshua N. Adkins
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• , Steven A. Carr
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Co-corresponding Authors

Bioinformatics center.

• , Karen P. Dalton
• , Trevor Hastie
• , Steven G. Hershman
• , Mihir Samdarshi
• , Christopher Teng
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Exercise Intervention Core

•  & W. Jack Rejeski
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• , Chia-Jui Hung
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• , Christopher A. Jin
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• Marcas Bamman
• , Bryan C. Bergman
• , Daniel H. Bessesen
• , Thomas W. Buford
• , Toby L. Chambers
• , Paul M. Coen
• , Dan Cooper
• , Fadia Haddad
• , Kishore Gadde
• , Bret H. Goodpaster
• , Melissa Harris
• , Kim M. Huffman
• , Catherine M. Jankowski
• , Neil M. Johannsen
• , Wendy M. Kohrt
• , Bridget Lester
• , Edward L. Melanson
• , Kerrie L. Moreau
• , Nicolas Musi
• , Robert L. Newton Jr
• , Shlomit Radom-Aizik
• , Megan E. Ramaker
• , Tuomo Rankinen
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• , Lauren M. Sparks
• , Anna Thalacker-Mercer
• , Scott Trappe
• , Todd A. Trappe
•  & Elena Volpi

Contributions

All authors reviewed and revised the manuscript. Detailed author contributions are provided in the  Supplementary Information .

Corresponding authors

Correspondence to Sue C. Bodine , Karyn A. Esser , Simon Schenk , Stephen B. Montgomery , Michael P. Snyder , Steven A. Carr or Matthew T. Wheeler .

Ethics declarations

Competing interests.

S.C.B. has equity in Emmyon, Inc. G.R.C. sits on data and safety monitoring boards for AI Therapeutics, AMO Pharma, Astra-Zeneca, Avexis Pharmaceuticals, Biolinerx, Brainstorm Cell Therapeutics, Bristol Meyers Squibb/Celgene, CSL Behring, Galmed Pharmaceuticals, Green Valley Pharma, Horizon Pharmaceuticals, Immunic, Mapi Pharmaceuticals, Merck, Mitsubishi Tanabe Pharma Holdings, Opko Biologics, Prothena Biosciences, Novartis, Regeneron, Sanofi-Aventis, Reata Pharmaceuticals, NHLBI (protocol review committee), University of Texas Southwestern, University of Pennsylvania, Visioneering Technologies, Inc.; serves on consulting or advisory boards for Alexion, Antisense Therapeutics, Biogen, Clinical Trial Solutions LLC, Genzyme, Genentech, GW Pharmaceuticals, Immunic, Klein-Buendel Incorporated, Merck/Serono, Novartis, Osmotica Pharmaceuticals, Perception Neurosciences, Protalix Biotherapeutics, Recursion/Cerexis Pharmaceuticals, Regeneron, Roche, SAB Biotherapeutics; and is the president of Pythagoras Inc., a private consulting company. S.A.C. is a member of the scientific advisory boards of Kymera, PrognomiQ, PTM BioLabs, and Seer. M.P.S. is a cofounder and scientific advisor to Personalis, Qbio, January AI, Filtricine, SensOmics, Protos, Fodsel, Rthm, Marble and scientific advisor to Genapsys, Swaz, Jupiter. S.B.M. is a consultant for BioMarin, MyOme and Tenaya Therapeutics. D.A. is currently employed at Insitro, South San Francisco, CA. N.R.G. is currently employed at 23andMe, Sunnyvale, CA. P.M.J.B. is currently employed at Pfizer, Cambridge, MA. Insitro, 23andMe and Pfizer had no involvement in the work presented here.

Peer review

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Nature thanks Atul Deshmukh, Jorge Ruas and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Peer review reports are available.

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Extended data figures and tables

Extended data fig. 1 animal phenotyping and data availability..

a-d) Clinical measurements before and after the training intervention in untrained control rats (SED), 4-week trained rats (4w), and 8-week trained rats (8w). Data are displayed pre and post for each individual rat (connected by a line), with males in blue and females in pink. Filled symbols (n = 5 per sex and time point) represent rats used for all omics analyses, whereas the rat utilized for proteomics only (n = 1 per sex and time point) is represented by a non-filled symbol. Significant results by ANOVA of the overall group effect (#, p < 0.05; ##, p < 0.01) and interaction between group and time (§, p < 0.05; §§ p < 0.01) are indicated. Significant within-group differential responses from a Bonferroni post hoc test are indicated (*, q-value < 0.05; **, q-value < 0.01). a) Aerobic capacity through a VO 2 max test until exhaustion. Data are reported in ml/(kg.min) for all individual rats and time points. b) Body fat percentage. c) Percent lean mass. ( b-c ) were assessed through nuclear magnetic resonance spectroscopy. d) Body weight (in grams). e) Description of available datasets. Colored cells indicate that data are available for that tissue and assay. Individual panels and platforms are shown for metabolomics and the multiplexed immunoassays. f) Detailed availability of sample-level data across assays. Each column represents an individual animal, ordered by training group and colored by sex. Gray cells indicate that data were generated for that animal and assay; black cells indicate that data were not generated. Rows are ordered by ome and colored by assay and tissue.

Extended Data Fig. 2 Quality control metrics for omics data.

a) Proteomics multiplexing design using TMT11 reagents for isobaric tagging and a pooled reference sample. The diagram describes processing of a single tissue. Following multiplexing, peptides were used for protein abundance analysis, serial PTM enriched for phosphosite and optional acetylsite quantification, or ubiquitylsite quantification through enrichment of lysine-diglycine ubiquitin remnants. b) Total number of fully quantified proteins per plex in each global proteome dataset. c-e) The total number of fully quantified phosphosites (c) , acetylsites (d) , and ubiquitylsites (e) per plex in each dataset. f) Distributions of coefficients of variation (CVs) calculated from metabolomics features identified in pooled samples and analyzed periodically throughout liquid chromatography-mass spectrometry runs. CVs were aggregated and plotted separately for named and unnamed metabolites. g) Transcription start site (TSS) enrichment (top) and fraction of reads in peaks (FRiP, bottom) across ATAC-seq samples per tissue. h) Distributions of RNA integrity numbers (RIN, top) and median 5′ to 3′ bias (bottom) across samples in each tissue in the RNA-Seq data. i) Percent methylation of CpG, CHG and CHH sites in the RRBS data. For boxplots in (h,i) : center line represents median; box bounds represent 25th and 75th percentiles; whiskers represent minimum and maximum excluding outliers; filled dots represent outliers. j) Number of wells across multiplexed immunoassays with fewer than 20 beads. Measurements from these 182 wells were excluded from downstream analysis. k) 2D density plot of targeted analytes’ mean fluorescence intensity (MFI) versus corresponding CHEX4 MFI from the same well for each multiplexed immunoassay measurement, where CHEX4 is a measure of non-specific binding.

Extended Data Fig. 3 Permutation tests.

a-b) Permutation tests of groups within males (a) and females (b) . For each sex, the original group labels were shuffled to minimize the number of animal pairs that remain in the same group. Only the group labels were shuffled and all other covariates remained as in the original data. For each permuted dataset, the differential abundance pipeline was rerun and the number of transcripts that were selected at 5% FDR adjustment were re-counted. c-d) Permutation tests of sex within groups. For each group and each sex, half of the animals were selected randomly and their sex was swapped. Only the sex labels were shuffled and all other covariates remained as in the original data. For each permutation the differential analysis pipeline was rerun and the timewise summary statistics were extracted. A gene was considered sexually dimorphic if for at least one time point the z-score (absolute) difference between males and females was greater than 3. c) Counts of sexually dimorphic genes among the IHW-selected genes of the original data. d) Counts of sexually dimorphic genes among the 5% FDR selected genes within each permuted dataset. Each boxplot in (a-d) represents the differential abundance analysis results over 100 permutations of the transcriptomics data in a specific tissue. Center line represents median; box bounds represent 25th and 75th percentiles; whiskers represent minimum and maximum excluding outliers; open circles represent outliers. Added points represent the results of the true data labels, and their shape corresponds to the empirical p-value ( ● : p > 0.05; ×: 0.01 < p < 0.05; *: p ≤ 0.01).

Extended Data Fig. 4 Correlations between proteins and transcripts throughout endurance training.

a) Number of tissues in which each gene, including features mapped to genes from all omes, is training-regulated. Only differential features from the subset of tissues with deep molecular profiling (lung, gastrocnemius, subcutaneous white adipose, kidney, liver, and heart) and the subset of omes that were profiled in all six of these tissues (DNA methylation, chromatin accessibility, transcriptomics, global proteomics, phosphoproteomics, multiplexed immunoassays) were considered. Numbers above each bar indicate the number of genes that are differential in exactly the number of tissues indicated on the x-axis. b) Pathways significantly enriched by tissue-specific training-regulated genes represented in Fig. 2a (q-value < 0.1). KEGG and Reactome pathways were queried, and redundant pathways were removed (i.e., those with an overlap of 80% or greater with an existing pathway). c) Heatmaps showing the Pearson correlation between the TRNSCRPT and PROT timewise summary statistics (z- and t-scores, respectively) (top, gene-level) and pathway-level enrichment results (Gene Set Enrichment Analysis normalized enrichment scores) (bottom, pathway-level). d) Scatter plots of pathway GSEA NES of the TRNSCRPT and PROT datasets in the seven tissues for which these data were acquired. Pathways showing high discordance or agreement across TRNSCRPT and PROT and with functional relevance or general interest were highlighted.

Extended Data Fig. 5 Heat shock response.

a) Scatter plots of the protein t-scores (PROT) versus the transcript z-scores (TRNSCRPT) by gene at 8 weeks of training (8 W) relative to sedentary controls. Data are shown for the seven tissues for which both proteomics and transcriptomics was acquired. Red points indicate genes associated with the heat shock response, and the labeled points indicate those with a large differential response at the protein level. b-c) Line plots showing protein b) and transcript (c) log 2 fold-changes relative to the untrained controls for a subset of heat shock proteins with increased abundance during exercise training. Each line represents a protein in a single tissue.

Extended Data Fig. 6 Regulatory signaling pathways modulated by endurance training.

a) Heatmap of differences in TF motif enrichment in training-regulated genes across tissues. Each value reflects the average difference in motif enrichment for shared transcription factors. Tissues are clustered with complete linkage hierarchical clustering. b) (left) Filtered PTM-SEA results for the liver showing kinases and signaling pathways with increased activity. (right) Heatmap showing t-scores for phosphosites within the HGF signaling pathway. c) Hypothetical model of HGF signaling effects during exercise training. Phosphorylation of STAT3 and PXN is known to modulate cell growth and cell migration, respectively. Error bars=SEM. d) Filtered PTM-SEA results for the heart showing selected kinases with significant enrichments in at least one time point. Heatmap shows the NES as color and enrichment p-value as dot size. Kinases are grouped by kinase family and sorted by hierarchical clustering. e) (top) Log 2 fold-change of GJA1 and CDH2 protein abundance in the heart. No significant response to exercise training was observed for these proteins (F-test; q-value > 0.05). (bottom) Log 2 fold-changes for selected Src kinase phosphosite targets, GJA1 pY265 and CDH2 pY820, in the heart. These phosphosites show a significant response to exercise training (F-test, 5% FDR). Error bars=SEM. f) Gene Set Enrichment Analysis (GSEA) results from the heart global proteome dataset using the matrisome gene set database. Heatmap shows NES as color and enrichment p-value as dot size. Rows are clustered using hierarchical clustering. g) Log 2 fold-change for basement membrane proteins in heart. Proteins showing a significant response to exercise training are highlighted in orange (F-test; 5% FDR). Error bars=SEM. h) Log 2 protein fold-change of NTN1 protein abundance in heart. A significant response to exercise training was observed for these proteins (F-test; 5% FDR). Error bars=SEM.

Extended Data Fig. 7 Graphical representation of differential results.

a) Number of training-regulated features assigned to groups of graphical states across tissues and time. Red points indicate features that are up-regulated in at least one sex (e.g., only in males: F0_M1; only in females: F1_M0; in both sexes: F1_M1), and blue points indicate features down-regulated in at least one sex (only in males: F0_M-1; only in females: F-1_M0; in both sexes: F-1_M-1). Green points indicate features that are up-regulated in males and down-regulated in females or vice versa (F-1_M1 and F1_M-1, respectively). Point size is proportional to the number of features. Point opacity is proportional to the within-tissue fraction of features represented by that point. Features can be represented in multiple points. The number of omes profiled in each tissue is provided in parentheses next to the tissue abbreviation. b) A schematic example of the graphical representation of the differential analysis results. Top: the z-scores of four features. A positive score corresponds to up-regulation (red), and a negative score corresponds to down regulation (blue). Bottom: the assignment of features to node sets and full path sets (edge sets are not shown for conciseness but can be easily inferred from the full paths). Node labels follow the [time]_F[x]_M[y] format where [time] shows the animal sacrifice week and can take one of (1w, 2w, 4w, or 8w), and [x] and [y] are one of (−1,0,1), corresponding to down-regulation, no effect, and up-regulation, respectively. c) Graphical representation of the feature sets. Columns are training time points, and rows are the differential abundance states. Node and edge sizes are proportional to the number of features that are assigned to each set.

Extended Data Fig. 8 Key pathway enrichments per tissue.

Key pathway enrichments for features that are up-regulated in both sexes at 8 weeks of training in each tissue. For display purposes, enrichment q-values were floored to 1e-10 (Enrichment FDR (−log10) = 10). Bars are colored by the number of omes for which the pathway was significantly enriched (q-value < 0.01) (lighter gray: 1 ome; darker gray: 2 omes; black: 3 omes). Pathways were selected from Supplementary Table 10 .

Extended Data Fig. 9 Associations with signatures of human health and complex traits.

a) Jaccard coefficients between gene sets identified by different omes in 8-week gastrocnemius up-regulated features (“X” marks overlap p > 0.05). b) Network connectivity p-values (Pathways, Biogrid, and string) among the gastrocnemius week-8 multi-omic genes and with the single-omic genes. c) Proportion of features from each ome represented in the gastrocnemius response clusters, identified by the network clustering analysis. d-g) Overlap between our rat vastus lateralis differential expression results and the meta-analysis of human long-term exercise studies by Amar et al. d-e) Spearman correlation (d) and its significance (e) between the meta-analysis fold-changes and the log 2 fold-changes foreach sex and time point. f) GSEA results. Genes were ranked by meta-analysis (−log 10 p-value*log 2 fold-change) and the rat training-differential, sex-consistent gene sets were tested for enrichment at the bottom of the ranking (negative scores) or the top (positive scores). g) Overlap between the rat gene sets from (f) and the high-heterogeneity human meta-analysis genes (I 2  > 75%). h) -log 10 overlap p-values (Fisher’s exact test), comparing rat female gastrocnemius and vastus lateralis week-8 differential transcripts from this study (p < 0.01) and the differential genes from the rat female soleus data of Bye et al. (p < 0.01). HCR: high capacity runners, LCR: low capacity runners. i) A comparison of rat gastrocnemius differential proteins from this study (p < 0.01) and the human endurance training proteomics results of Hostrup et al. (p < 0.01) using Fisher’s exact test. Left: -log 10 overlap p-values. Right: -log 10 sex concordance p-values. j) Statistics of the overlapping proteins from ( i ), week-8 female comparison (y: rat z-scores, x: human t-scores). k) DOSE disease enrichment results of the white adipose, kidney, and liver gene sets. DOSE was applied only on diseases that are relevant for each tissue. The network shows the results for the sex-consistent down-regulated features at week-8.

Extended Data Fig. 10 Characterization of the extent of sex difference in the endurance training response.

The extent of sex differences in the training response were characterized in two ways: first, by correlating log 2 fold-changes between males and females for each training-differential feature; second, by calculating the difference between the area under the log 2 fold-change curve for each training-differential feature, including a (0,0) point (Δ AUC , males - females). The first approach characterizes differences in direction of effect while the second approach characterizes differences in magnitude. Left plot for each tissue: density line plots of correlations from the first approach. Densities or correlations corresponding to features in each ome are plotted separately, with a label that provides the ome and the number of differential features represented. Right plot for each tissue: 2D density plot of Δ AUC against the correlation between the male and female log 2 fold-changes for each training-differential feature used to simultaneously evaluate sex differences in the direction and magnitude of the training response. Points at the top-center of these 2D density plots represent features with high similarity between males and females in terms of both direction and magnitude; features on the right and left sides of the plots represent features with greater magnitudes of response in males and females, respectively.

Extended Data Fig. 11 Sex differences in the endurance training response.

a) Heatmap of the training response of immunoassay analytes across tissues. Gray indicates no data. Bars indicate the number of training-regulated analytes in each tissue (top) and the number of tissues in which the analyte is training-regulated (right, 5% FDR). b) Training-differential cytokines across tissues. 5, 24, and 9 cytokines were annotated as anti-, pro-, and pro/anti- inflammatory, respectively. Bars indicate the number of annotated cytokines in each category that are differential (5% FDR). c) Counts of early vs. (1- or 2-week) vs. late (4- or 8-week) differential cytokines, according to states assigned by the graphical analysis, including all tissues. Cytokines with both early and late responses in the same tissue were excluded. d) Line plots of standardized abundances of training-differential features that follow the largest graphical path in the adrenal gland (i.e., 1w_F-1_M1 − >2w_F-1_M0 − >4w_F-1_M0 − >8w_F-1_M0 according to our graphical analysis notation). The black line represents the average value across all features. The closer a colored line is to this average, the darker it is (distance calculated using sum of squares). e) Line plots of transcript-level log 2 fold-changes corresponding to six transcription factors (TFs) whose motifs are significantly enriched by transcripts in (d) . TF motif enrichment q-values are provided in the legend (error bars = SEM). f) Male versus female NES from PTM-SEA in the lung. Anticorrelated points corresponding to PRKACA NES are in dark red. g) Line plots of standardized abundances of training-differential phosphosites that follow the largest graphical edges of phosphosites in the lung (1w_F1_M-1 − >2w_F1_M-1 − >4w_F0_M-1). h) Top ten kinases with the greatest over-representation of substrates (proteins) corresponding to training-differential phosphosites in (g) . MeanRank scores by library are shown, as reported by KEA3. i) Line plots showing phosphosite-level log 2 fold-changes of PRKACA phosphosite substrates identified in the lung as differential with disparate sex responses (error bars = SEM).

Extended Data Fig. 12 Assessment of immune responses to endurance training.

a) Heatmap of the number and percent of KEGG and Reactome immune pathways significantly enriched by training-regulated features at 8 weeks. b) Line plots of standardized abundances of training-differential proteins in white adipose tissue up-regulated only in males at 8 weeks. Black line shows average across all features. c) Boxplots of the sample-level Pearson correlation between markers of immune cell types, lymphatic tissue, or cell proliferation and the average value of features in (b) at the protein level. Center line represents median; box bounds represent 25th and 75th percentiles; whiskers represent minimum and maximum excluding outliers; filled dots represent outliers. A pink point indicates that the marker is also one of the differential features plotted in (b) . # indicates when the distribution of Pearson correlations for a set of at least two markers is significantly different from 0 (two-sided one-sample t-test, 5% BY FDR). When only one marker is used to define a category on the y-axis, the gene name is provided in parentheses. d) Trajectories of mean absolute signal of various immune cell types in BAT or WAT-SC following deconvolution of bulk RNA-Seq with CIBERSORTx (error bars = SEM). e) Immune cell type enrichment analysis results of training-differentially expressed transcripts. Points represent significant enrichments (5% FDR, one-sided Mann-Whitney U test). f) Line plots showing the log 2 fold-changes for Cxcr3 and Il1a transcripts in the small intestine (error bars = SEM).

Extended Data Fig. 13 Metabolic effects of endurance training.

a) Significant enrichments for relevant categories of KEGG metabolism pathways from features that are up- or down- regulated in both sexes at 8 weeks (8w_F1_M1 and 8w_F-1_M-1 nodes, respectively). Triangles point in the direction of the response (up or down). Points are colored by ome. b) Log 2 fold-change of metabolites regulated across many tissues (F-Test, 5% FDR, error bars=SEM). c) Log 2 fold-change of training-regulated metabolites: 1-methylhistidine in the kidney, cortisol in the kidney, and 1-methylnicotinamide in the liver (F-Test, 5% FDR, error bars = SEM). d) Volcano plots showing abundance changes (log 2 fold-changes; logFC) and significance (-log 10 nominal p-values) for acyl-carnitines. Features are colored based on the carnitine chain length. e) Protein abundance changes in the glycolysis and gluconeogenesis pathway in the heart tissue after 8 weeks of training. Line plots show the log 2 fold-changes over the training time course (error bars = SEM). Red and blue boxes indicate a statistically significant (F-test, 5% FDR) increase and decrease in abundance, respectively, for both males and females at 8 weeks.

Extended Data Fig. 14 Mitochondria and peroxisome adaptations to endurance training.

a) Boxplots showing the percent of mitochondrial genome reads across samples in each tissue that map to the mitochondrial genome (% MT reads). b) Comparison of % MT reads between untrained controls and animals trained for 8 weeks. Plot shows tissues with a statistically significant change after 8 weeks in at least one sex (red asterisk, two-sided Dunnett’s test, 10% FDR). For boxplots in (b,c) : center line represents median; box bounds represent 25th and 75th percentiles; whiskers represent minimum and maximum excluding outliers; filled dots represent outliers. c) Boxplots showing the percent of mitochondrial genome reads across tissue, sex, and time points. Center line represents median; box bounds represent 25th and 75th percentiles; whiskers represent minimum and maximum excluding outliers; open circles represent outliers. Red asterisks indicate a significant change throughout the training time course (F-test, 5% FDR). Center line represents median; box bounds represent 25th and 75th percentiles; whiskers represent minimum and maximum excluding outliers; blue dots represent outliers. d) GSEA using the MitoCarta MitoPathways gene set database and transcriptome (TRNSCRPT) or phosphoproteome (PHOSPHO) differential analysis results. NES are shown for significant pathways (10% FDR) for all tissues, sexes, and time points within the heatmap. Mitochondria pathways (rows) are grouped using the parental group in the MitoPathways hierarchy. e) Protein abundance and protein acetylation level changes in the peroxisome KEGG pathway in the liver tissue after 8 weeks of training. Red boxes indicate an increase in abundance for both males and females, while red circles indicate an increase in at least one acetylsite within the protein (8w_F1_M1 cluster).

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MoTrPAC Study Group., Lead Analysts. & MoTrPAC Study Group. Temporal dynamics of the multi-omic response to endurance exercise training. Nature 629 , 174–183 (2024). https://doi.org/10.1038/s41586-023-06877-w

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The Campus-Left Occupation That Broke Higher Education

Elite colleges are now reaping the consequences of promoting a pedagogy that trashed the postwar ideal of the liberal university.

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F ifty-six years ago this week, at the height of the Vietnam War, Columbia University students occupied half a dozen campus buildings and made two principal demands of the university: stop funding military research, and cancel plans to build a gym in a nearby Black neighborhood. After a week of futile negotiations, Columbia called in New York City police to clear the occupation.

The physical details of that crisis were much rougher than anything happening today. The students barricaded doors and ransacked President Grayson Kirk’s office. “Up against the wall, motherfucker, this is a stick-up,” Mark Rudd, the student leader and future member of the terrorist organization Weather Underground, wrote in an open letter to Kirk, who resigned a few months later. The cops arrested more than 700 students and injured at least 100, while one of their own was permanently disabled by a student.

In other ways, the current crisis brings a strong sense of déjà vu: the chants, the teach-ins, the nonnegotiable demands, the self-conscious building of separate communities, the revolutionary costumes, the embrace of oppressed identities by elite students, the tactic of escalating to incite a reaction that mobilizes a critical mass of students. It’s as if campus-protest politics has been stuck in an era of prolonged stagnation since the late 1960s. Why can’t students imagine doing it some other way?

Perhaps because the structure of protest reflects the nature of universities. They make good targets because of their abiding vulnerability: They can’t deal with coercion, including nonviolent disobedience. Either they overreact, giving the protesters a new cause and more allies (this happened in 1968, and again last week at Columbia), or they yield, giving the protesters a victory and inviting the next round of disruption. This is why Columbia’s president, Minouche Shafik, no matter what she does, finds herself hammered from the right by Republican politicians and from the left by her own faculty and students, unable to move without losing more ground. Her detractors know that they have her trapped by their willingness to make coercive demands: Do what we say or else we’ll destroy you and your university. They aren’t interested in a debate.

Michael Powell: The unreality of Columbia’s ‘liberated zone’

A university isn’t a state —it can’t simply impose its rules with force. It’s a special kind of community whose legitimacy depends on mutual recognition in a spirit of reason, openness, and tolerance. At the heart of this spirit is free speech, which means more than just chanting, but free speech can’t thrive in an atmosphere of constant harassment. When one faction or another violates this spirit, the whole university is weakened as if stricken with an illness. The sociologist Daniel Bell, who tried and failed to mediate a peaceful end to the Columbia occupation, wrote afterward:

In a community one cannot regain authority simply by asserting it, or by using force to suppress dissidents. Authority in this case is like respect. One can only earn the authority—the loyalty of one’s students—by going in and arguing with them, by engaging in full debate and, when the merits of proposed change are recognized, taking the necessary steps quickly enough to be convincing.

The crackdown at Columbia in 1968 was so harsh that a backlash on the part of faculty and the public obliged the university to accept the students’ demands: a loss, then a win. The war in Vietnam ground on for years before it ended and history vindicated the protesters: another loss, another win. But the really important consequence of the 1968 revolt took decades to emerge. We’re seeing it now on Columbia’s quad and the campuses of elite universities around the country. The most lasting victory of the ’68ers was an intellectual one. The idea underlying their protests wasn’t just to stop the war or end injustice in America. Its aim was the university itself—the liberal university of the postwar years, which no longer exists.

That university claimed a special role in democratic society. A few weeks after the 1968 takeover, the Columbia historian Richard Hofstadter gave the commencement address to a wounded institution. “A university is a community, but it is a community of a special kind,” Hofstadter said—“a community devoted to inquiry. It exists so that its members may inquire into truths of all sorts. Its presence marks our commitment to the idea that somewhere in society there must be an organization in which anything can be studied or questioned—not merely safe and established things but difficult and inflammatory things, the most troublesome questions of politics and war, of sex and morals, of property and national loyalty.” This mission rendered the community fragile, dependent on the self-restraint of its members.

The lofty claims of the liberal university exposed it to charges of all kinds of hypocrisy, not least its entanglement with the American war machine. The Marxist philosopher Herbert Marcuse, who became a guru to the New Left, coined the phrase repressive tolerance for the veil that hid liberal society’s mechanisms of violence and injustice. In this scheme, no institution, including the university, remained neutral, and radical students embraced their status as an oppressed group.

Charles Sykes: The new rules of political journalism

At Stanford (where my father was an administrator in the late ’60s, and where students took over a campus building the week after the Columbia revolt), white students compared themselves to Black American slaves. To them, the university was not a community dedicated to independent inquiry but a nexus of competing interest groups where power, not ideas, ruled. They rejected the very possibility of a disinterested pursuit of truth. In an imaginary dialogue between a student and a professor, a member of the Stanford chapter of Students for a Democratic Society wrote: “Rights and privacy and these kinds of freedom are irrelevant—you old guys got to get it through your heads that to fight the whole corrupt System POWER is the only answer.”

A long, intricate , but essentially unbroken line connects that rejection of the liberal university in 1968 to the orthodoxy on elite campuses today. The students of the ’68 revolt became professors—the German activist Rudi Dutschke called this strategy the “long march through the institutions”—bringing their revisionist thinking back to the universities they’d tried to upend. One leader of the Columbia takeover returned to chair the School of the Arts film program. “The ideas of one generation become the instincts of the next,” D. H. Lawrence wrote. Ideas born in the ’60s, subsequently refined and complicated by critical theory, postcolonial studies, and identity politics, are now so pervasive and unquestioned that they’ve become the instincts of students who are occupying their campuses today. Group identity assigns your place in a hierarchy of oppression. Between oppressor and oppressed, no room exists for complexity or ambiguity. Universal values such as free speech and individual equality only privilege the powerful. Words are violence. There’s nothing to debate.

The post-liberal university is defined by a combination of moneymaking and activism. Perhaps the biggest difference between 1968 and 2024 is that the ideas of a radical vanguard are now the instincts of entire universities—administrators, faculty, students. They’re enshrined in reading lists and codes of conduct and ubiquitous clichés. Last week an editorial in the Daily Spectator , the Columbia student newspaper, highlighted the irony of a university frantically trying to extricate itself from the implications of its own dogmas: “Why is the same university that capitalizes on the legacy of Edward Said and enshrines The Wretched of the Earth into its Core Curriculum so scared to speak about decolonization in practice?”

A Columbia student, writing to one of his professors in a letter that the student shared with me, explained the dynamic so sharply that it’s worth quoting him at length:

I think [the protests] do speak to a certain failing on Columbia’s part, but it’s a failing that’s much more widespread and further upstream. That is, I think universities have essentially stopped minding the store, stopped engaging in any kind of debate or even conversation with the ideologies which have slowly crept in to every bit of university life, without enough people of good conscience brave enough to question all the orthodoxies. So if you come to Columbia believing in “decolonization” or what have you, it’s genuinely not clear to me that you will ever have to reflect on this belief. And after all this, one day the university wakes up to these protests, panics under scrutiny, and calls the cops on students who are practicing exactly what they’ve been taught to do from the second they walked through those gates as freshmen.

The muscle of independent thinking and open debate, the ability to earn authority that Daniel Bell described as essential to a university’s survival, has long since atrophied. So when, after the October 7 Hamas attack on Israel, Jewish students found themselves subjected to the kind of hostile atmosphere that, if directed at any other minority group, would have brought down high-level rebukes, online cancellations, and maybe administrative punishments, they fell back on the obvious defense available under the new orthodoxy. They said that they felt “unsafe.” They accused pro-Palestinian students of anti-Semitism—sometimes fairly, sometimes not. They asked for protections that other groups already enjoyed. Who could blame them? They were doing what their leaders and teachers had instructed them was the right, the only, way to respond to a hurt.

Adam Serwer: The Republicans who want American carnage

And when the shrewd and unscrupulous Representative Elise Stefanik demanded of the presidents of Harvard and Penn whether calls for genocide violated their universities’ code of conduct, they had no good way to answer. If they said yes, they would have faced the obvious comeback: “Why has no one been punished?” So they said that it depended on the “context,” which was technically correct but sounded so hopelessly legalistic that it led to the loss of their jobs. The response also made nonsense of their careers as censors of unpopular speech. Shafik, of Columbia, having watched her colleagues’ debacle, told the congresswoman what she wanted to hear, then backed it up by calling the cops onto campus—only to find herself denounced on all sides, including by Senator Tom Cotton, who demanded that President Joe Biden deploy the United States military to Columbia, and by her own faculty senate, which threatened a vote of censure.

T he right always knows how to exploit the excesses of the left. It happened in 1968, when the campus takeovers and the street battles between anti-war activists and cops at the Democratic convention in Chicago helped elect Richard Nixon. Republican politicians are already exploiting the chaos on campuses. This summer, the Democrats will gather again in Chicago, and the activists are promising a big show. Donald Trump will be watching.

Elite universities are caught in a trap of their own making, one that has been a long time coming. They’ve trained pro-Palestinian students to believe that, on the oppressor-oppressed axis, Jews are white and therefore dominant, not “marginalized,” while Israel is a settler-colonialist state and therefore illegitimate. They’ve trained pro-Israel students to believe that unwelcome and even offensive speech makes them so unsafe that they should stay away from campus. What the universities haven’t done is train their students to talk with one another.