Facts of Life: Issue Briefings for Health Reporters - from the Center for the Advancement of Health

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:

Sylvana Bennett, M.D.
University of California, San Diego Medical Center
(619) 543-6922
sebennett@ucsd.edu

Patricia Goodson, Ph.D.
Texas A&M University
(979) 845-1756
patricia-goodson@tamu.edu

Douglas Kirby, Ph.D.
ETR Associates (831) 438-4060 x 144
dougk@etr.org

Marilyn Maxwell, M.D.
Saint Louis University School of Medicine
(314) 577-6143
maxwellm@slu.edu

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.
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.
 
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© Copyright 2006, Center for the Advancement of Health

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

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Facts of Life: Issue Briefings for Health Reporters
The Center for the Advancement of Health
http://www.cfah.org/factsoflife/index.cfm