The controversial Pono Choices sex education program taught in some Hawaii middle schools has helped increase students’ knowledge of preventing teen pregnancies and sexually transmitted infections, as designed, but students were not significantly deterred from engaging in risky sexual behaviors, an external review of the program released Friday concluded.

Pono Choices, billed as a “culturally responsive” program to help reduce teen pregnancies and prevent sexually transmitted infections, was developed by the University of Hawaii at Manoa’s Center on Disability Studies as part of a $108 million U.S. Department of Health and Human Services grant involving 39 states and the District of Columbia.

The University of Hawaii contracted with Hilo-based IMPAQ International to perform a multiyear evaluation of the program — one of seven sexual health education programs approved by the state Department of Education for use in grades 6 to 8 — as part of the grant’s requirements.

The company performed classroom observations and surveyed students who went through the Pono Choices program as well as students who were taught using other sexual health education curricula before and after they took the class. Students also were surveyed a year later.

Thirty-four randomly selected middle schools participated in the IMPAQ study, which was conducted over three semesters from spring 2012 to spring 2013 and included 1,783 students. The study achieved a 97 percent response rate for the base-line survey and an 87 percent response rate for the one‐year follow‐up survey.

“Overall, the results from comparing before and after surveys for students participating in the Pono Choices program suggest that the program achieved its intended effects on students’ knowledge, attitudes, skills and intentions,” the authors of the external review wrote.

The report said that although Pono Choices “was much more effective” at increasing students’ knowledge of preventing teen pregnancies and sexually transmitted infections than other curricula being taught, it didn’t appear to persuade students to abstain from high-risk sexual behavior (defined as intercourse without a condom or effective method of birth control) or delay having sex for the first time.

“This may be due to the fact that most students were only 13 years old at the one‐year follow‐up, which may simply have been too young to be sexually active or for knowledge gains to be reflected in either delaying initiation of sexual intercourse or using condoms and other forms of birth control,” the report said.

(Nearly 7 percent of middle-schoolers at Hawaii public schools say they’ve had sex, according to the 2015 Hawaii Youth Risk Behavior Survey; 3.5 percent of high school students say they had sex before age 13.)

The study also found:

>> Roughly 1 in 7 students (14.9 percent) surveyed before taking the Pono Choices course said they intended to engage in sexual intercourse in the next 12 months. After taking the course, the percentage dipped slightly to 13.3 percent but increased to 17.2 percent a year later. “Intent to have sexual intercourse in the coming year actually went in the reverse direction, with a higher percentage of students reporting an intent to have sex a year after participating in the program than before,” the study said.

>> Before going through the Pono Choices program, 88.9 percent of students said that they planned to use a condom if they had sex in the next 12 months. That percentage increased to 94.6 percent after taking the class and dropped slightly to 93 percent a year later.

>> Pono Choices students were more knowledgeable about effective ways to prevent pregnancies and sexually transmitted infections, but there, was little difference between other students in terms of their attitudes toward healthy sexual behaviors and increased intent to abstain from sex or engage in safe sex after participating in the program.

The program was introduced in 2011 but gained widespread attention during a 2013 special legislative session on gay marriage, when criticisms surfaced that the curriculum was medically inaccurate — classifying the anus as genitalia, for example — and included explicit lessons inappropriate for students as young as 11 years old.

The DOE halted the program at least twice and asked UH to revise the curriculum using recommendations made by a stakeholder review panel; 10 changes were made before the program could be taught again. The department also changed its policies to make sex education optional and require parents to enroll their children in it for them to participate.

A DOE spokeswoman said four schools so far plan to use Pono Choices in the upcoming school year.

State Rep. Bob McDermott, who led the charge against Pono Choices, called the external study results dismal and biased.

“I am not surprised at the dismal results of Pono Choices,” McDermott (R, Ewa Beach-Iroquois Point) said. “This program was riddled with incompetence from the start, when they defined the anus as a genital organ.”

He added that the survey portion, “where kids were given gift cards upon completion, clearly suffered from inherit input bias as a result of the financial inducement to these young people. Its results are unreliable in my view; 10-year-olds will say what you want when you give them money.”

The program was developed, according to the university, in response to low condom use among Hawaii youth, high teen pregnancy rates and high rates of the sexually transmitted disease chlamydia.

Hawaii youth continue to have the lowest rate of condom use in the nation: 51.6 percent of sexually active youth did not use a condom during their most recent sexual intercourse, compared with 43 percent nationally, according to the Centers for Disease Control and Prevention.

Hawaii’s teen birthrate, however, has been falling. In 2014 there were 23 births per 1,000 females age 15 to 19, according to the Hawaii Health Data Warehouse. The rate has dropped by almost half from 40.7 births per 1,000 females age 15 to 19 years in 2009.

Judith Clark, executive director of the nonprofit Hawaii Youth Services Network, said youths need access to comprehensive sexual health education.

“Any good sexual health curriculum encourages young people to delay initiation of sex until they are physically and emotionally ready to do that. But it also recognizes that for some young people, they will not choose abstinence,” said Clark, whose organization has been working to build capacity to implement evidence-based approaches to teen pregnancy prevention in the state. “Those young people need to be prepared to lower their risk of unplanned pregnancy and sexually transmitted infections by knowing about things like contraception.”

The state Board of Education last summer approved a revised sex education policy that expanded a long-standing abstinence-based policy to include lessons on contraception, disease prevention and skills to help students make “healthy decisions” about sexuality and relationships.