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Facts
of Life
Facts of Life:
Issue Briefings for Health Reporters
Vol. 10, No. 10
October 2005
Saying No to Teen Sex
The Issue
The Facts
How to Measure Abstinence
Expert Sources
References
The
Issue:
Abstinence-based
sex education programs for school children are multiplying across the nation,
due in no small part to a 1996 change in the federal welfare law outlining
a specific abstinence curriculum that the programs must follow to receive
federal funding.1 According to the law, acceptable programs should
teach abstinence from sex outside of marriage as “the expected standard” and
that “sexual activity outside the context of marriage is likely to
have
harmful psychological and physical effects.” Since 1996, programs meeting
these and other criteria have received more than $50 million in federal funds. 2
Testing Abstinence
Despite their increasing
popularity and government support, there are few randomized controlled trials – the
gold standard in health research – or systematic reviews of how abstinence-based
programs affect outcomes such as postponement of sex until marriage, rates
of sexually transmitted diseases among young adults or teen pregnancy rates.
Program curricula vary from state to state and school district to school
district, making comparison and evaluation difficult.
Abstinence After
Sex
According to 2003 data
from the Centers for Disease Control and Prevention’s Youth Risk Behavior
Surveillance System, more than 45 percent of high school students have had
sex at least once.3 Some abstinence programs have tailored their
messages to reach sexually experienced youth, but few studies examine the
effects of abstinence messages in this group of teens.4
The
Facts:
- A 2001 policy
statement from the American Academy of Pediatrics, reaffirmed in
2005, encourages pediatricians to make information on contraception
available at local schools where the sex education curriculum does
not discuss contraception. 7
- In a 2004 survey of
1,000 Americans conducted by the Kaiser Family Foundation, only 15 percent
said schools should teach a strict abstinence-only curriculum without any
mention of condoms or other contraceptives. 5
- Public school districts
in the South were almost five times more likely than districts in the Northeast
to offer abstinence-only sex education curricula, according to a 1999 survey
of 825 districts nationwide. 6
- A review of 21 abstinence-only
education programs in Texas found that masturbation, “sexual identity
and orientation” and “the common occurrence of sexual fantasies” were
among the topics least likely to be discussed. 8
- A report on federally
funded abstinence-only programs found that the programs increased students’ favorable
attitudes about abstinence but did not significantly affect their attitudes
about marriage or change their perceptions about peer pressure to have
sex. 9
- AIDS education programs
do not affect abstinence rates among adolescents, but they do boost the
likelihood that the teens will have condom-protected versus unprotected
sexual intercourse, according to a 2005 study. 10
- Teens who made a “virginity
pledge” but later had sexual intercourse before marriage were less
likely to use contraception during their first sexual encounter than those
who did not pledge, according to a 2001 study. 11
- Rates of sexually
transmitted diseases do not differ between those who have taken a virginity
pledge and those who have not taken the pledge, according to a 2005 study. 12
- A 2000 review found
black adolescent boys are less likely than white and Hispanic peers to
receive sex education before their first sexual intercourse. 13
- A 1998 randomized
trial comparing abstinence and safe sex programs for black adolescents
concluded that teens in the abstinence groups were less likely than those
in the safe sex group to have sex in the three months after the trial,
but this difference disappeared 6 months and 12 months later. 14
- Sexually active middle
school students had fewer sexual partners after participating in an abstinence-only
education program compared to their peers who did not go through the program,
according to a 2005 Ohio study. 4
How
To Measure Abstinence
Health
professionals, parents, teachers and lawmakers want to know whether
abstinence programs will help children delay sex until marriage and
protect them from pregnancy and sexually transmitted diseases, and
which, if, any of the abstinence-based curricula are the most deserving
of federal funding. However, measuring the successes and failures
of abstinence education has proved difficult for several reasons:
Defining
the Terms: It seems easy to define but a 2003 15 review
of Texas abstinence-only programs by Texas A&M University professor
Patricia Goodson concluded that students, program instructors and program
directors all emphasized different ideas when asked to describe abstinence.
Program directors defined abstinence as refraining from sexual intercourse,
oral and anal sex, while instructors were more likely to include any type
of “petting”. The researchers were also surprised by how many
students thought of abstinence in positive terms, emphasizing self-control,
greater choice and future opportunities in their definitions.
Asking
the Right Questions: Researchers try to measure the effects of
abstinence programs by comparing teen pregnancy rates, the onset of sexual
activity or STD rates between teens who participate in the programs and
those who do not. It can be tricky to gather the essential data for those
questions because of “the controversy surrounding asking teens about
sex, pregnancy and abortion,” says Sylvana Bennett, M.D., of the
University of California, San Diego Medical Center. Bennett conducted one
of the few systematic reviews of school teen pregnancy programs in the
United States, published in 2005.16 Because of pressure from
parents who did not want their children interviewed about such sensitive
topics, “Several of the studies I reviewed stated that they were
required to drop some of their questions,” Bennett says.
Making
Useful Comparisons: Abstinence curricula are often tailored for
a specific state’s school district’s requirements, making it
difficult to compare outcomes across programs. “One pregnancy prevention
program that worked great in inner city Chicago may not have worked in
a suburban school in Utah and vice versa,” says Bennett.
In school
districts where most of the students come from the same background, abstinence
strategies that have proven successful elsewhere can be thwarted. A recent
study of an abstinence program for Ohio middle schoolers, for instance, “seems
to be unique in that the program did appear to have an effect on sexual behavior
of the sexually experienced,” according to study author Elaine Borawski
of Case Western Reserve University.4
Waiting
for Data: It’s easy enough to give a multiple-choice test
after an abstinence program to find out if students have changed their
attitudes toward premarital sex and the risks of pregnancy and STDs. But
most studies are not long enough to find out whether the new information
and attitudes translate into new behaviors. 2, 12, 17, 18 “I
do think that part of the problem is asking teens about behavior before
they have had time to change it,” Bennett says.
Expert
Sources:
References
1.U.S. Social
Security Act 510 (b)(1) Last accessed 9-22-05 at http://www.socialsecurity.gov/OP_Home/ssact/title05/0510.htm.
2. M.H. Thomas (2000)
Abstinence-based programs for prevention of adolescent pregnancies. Journal
of Adolescent Health, 26, 5-17.
3. Centers for Disease
Control and Prevention (2004). Surveillance Summaries. Morbidity and
Mortality Weekly Report, 53 (No.SS-2).
4. E.A. Borawski et al.
(2005) Effectiveness of abstinence-only intervention in middle school teens. American
Journal of Health Behavior, 29, 423-434.
5. National Public Radio/Kaiser
Family Foundation/ John F. Kennedy School of Government Poll. “Sex
Education in America.” Poll results last accessed 9-8-05 at http://www.kff.org/newsmedia/upload/Sex-Education-in-America-Summary.pdf.
6. D.J. Landry et al.
(1999) Abstinence promotion and the provision of information about contraception
in public school district sexuality education policies. Family Planning
Perspectives, 31, 280-286.
7. Committee
on Psychosocial Aspects of Child and Family Health and Committee on Adolescence
(2001) American Academy of Pediatrics: Sexuality education for children and
adolescents. Pediatrics, 108, 498-502.
8 .K.L. Wilson et al.
(2005) A review of 21 curricula for abstinence-only-until-marriage programs. Journal
of School Health, 75, 90-98.
9. R.A. Maynard et al.
(2005) First-Year Impacts of Four Title V, Section 510 Abstinence Education
Programs. Evaluation contracted by U.S. Department of Health and Human
Services, Office of the Assistant Secretary for Planning and Evaluation.
Last accessed 9-8-05 at http://aspe.hhs.gov/hsp/05/abstinence/execsum.pdf.
10. C.H. Tremblay and
D.C. Ling (2005) AIDS education, condom demand, and the sexual activity of
American youth. Health Economics, 14, 851-867.
11. P.S. Bearman and H.
Brückner (2001). Promising the future: Virginity pledges and the transition
to first intercourse. American Journal of Sociology, 106, 859-912.
12. H. Brückner and
P. Bearman (2005) After the promise: the STD consequences of adolescent virginity
pledges. Journal of Adolescent Health, 36, 271-278.
13. L.D. Lindberg et al.
(2000) Adolescents' reports of reproductive health education, 1988 and 1995. Family
Planning Perspectives, 32, 220-226.
14. J. Jemmott et al.
(1998). "Abstinence and safer sex HIV risk-reduction interventions for
African-American adolescents, a randomized trial." Journal of the
American Medical Association, 279, 1529-1536.
15. P. Goodson et al.
(2003) Defining abstinence: views of directors, instructors and participants
in abstinence-only-until-marriage programs in Texas. Journal of School
Health, 73, 91-96.
16. S.E. Bennett and N.P.
Assefi (2005) School-based teenage pregnancy prevention programs: a systematic
review of randomized controlled trials. Journal of Adolescent Health,
36, 72-81.
17. S.D. Pinkerton (2001)
A relative risk-based, disease-specific definition of sexual abstinence failure
rates. Health Education and Behavior, 28, 10-20.
18. T.E. Smith et al.
(2003) Measurement in abstinence education: critique and recommendations. Evaluation
and the Health Professions, 26, 180-205.
The
Center for the Advancement of Health is an independent nonprofit organization
that promotes greater recognition of how psychological, social, behavioral,
economic and environmental factors influence health and illness. The Center
advocates the highest quality research and communicates it to the medical
community and the public. The fundamental aim of the Center is to translate
into policy and practice the growing body of evidence that can lead to the
improvement and maintenance of the health of individuals and the public.
The Center was founded by the John D. and Catherine T. MacArthur Foundation
and the Nathan Cummings Foundation, which continue to provide core funding.
Funding for this series was provided by the Robert Wood Johnson Foundation.
For Information Contact:
Lisa Esposito
Editor, Health Behavior News Service
Center for the Advancement of Health
2000 Florida Ave., NW, Suite 210
Washington, DC 20009
p. 202.387.2829 / f. 202.387-2857
press@cfah.org
http://www.cfah.org
© Copyright 2005, Center
for the Advancement of Health
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