Sound Body

No to sex

The best way to keep kids from having sex may be (surprise): just tell them not to do it.

By Stephen Smith
Globe Staff / February 15, 2010

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To a street-savvy 17-year-old, there isn’t much mystery when it comes to what will work - and what won’t - in a sex education class.

“When you preach abstinence, you sound like a parent,’’ said Hillary Little, who grew up in Boston and attends Worcester Academy. “I feel like my mom’s talking to me when adults come to me and say, ‘Abstinence is the only way. You shouldn’t have sex.’ That’s so unrealistic.

“People are going to do it.’’

Or maybe not.

Earlier this month, shockwaves rattled partisans of the long-flaring feud that has ensnarled sex education in the United States. A study by University of Pennsylvania researchers offered perhaps the most convincing evidence ever that young adolescents might actually heed messages to delay their first sexual encounters - especially if those messages aren’t preachy.

The study, appearing in the Archives of Pediatrics & Adolescent Medicine, showed that sixth- and seventh-graders in Philadelphia who attended abstinence-only classes were less likely to become sexually active than their peers who went to sessions emphasizing condom use exclusively or classes combining lessons on abstinence and condoms. Previous studies of abstinence education, sometimes lambasted for scientific shoddiness, had largely failed to show the strategy altered teens’ behavior.

The new research was robust. The scientists were fastidious. The findings were statistically significant.

And yet, the question is scarcely settled. Proponents of abstinence education hailed the study as proof they were right all along. Inveterate opponents of abstinence-only education said the Penn approach was different than its forerunners: less judgmental, never depicting sex outside of marriage as something inherently wrong.

The tinderbox that is sex education, it turns out, is as combustible as ever.

“It is a mini culture war, no doubt about it,’’ said Bill Albert, chief program officer for the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “The reason why this is so fraught with controversy and elicits such passion is because it touches on some primal issues that people care deeply about - education of our children, when and under what circumstances to start a family, sex.’’

Teen pregnancy rates climbed steadily through the 1970s before leveling off and, then, starting to decline in the early 1990s. It was the age of AIDS, when the viral disease was viewed as a near-certain death sentence, sparking a profound change in sexual behaviors.

Starting with the Clinton administration and accelerating during the presidency of George W. Bush, federal health agencies favored sex education programs that championed abstinence until marriage. And it wasn’t just in the United States: Abstinence figured prominently in the Bush administration’s campaign to treat and prevent AIDS in Africa and Asia.

Critics charged the abstinence campaigns were thinly veiled morality lessons that misled teenagers about other methods of protection, spreading false notions, for example, about the reliability of condoms.

“They just didn’t get their scientific facts right,’’ said Dr. John Santelli, of Columbia University’s Mailman School of Public Health. “Or they had a very strong moral tone that the world of ‘Ozzie and Harriet’ from the ’50s was right for everybody.’’

Advocates of abstinence education argue it’s people like Santelli who have it wrong.

The executive director of the National Abstinence Education Association, Valerie Huber, acknowledged in an interview that the Penn study released this month was more rigorous than earlier research. Still, she said that Santelli and other foes had been too harsh in their blanket denunciations of earlier studies.

“When opponents just repeat the same sound bites without a real understanding of what the broad abstinence field looks like, it can cast a much different view of what these programs really are,’’ Huber said. “That’s another reason I’m actually happy the conversation has been reopened as a result of this study.’’

That research was led by a husband-and-wife team, John and Loretta Jemmott. He’s a social psychologist at Penn, and she’s a nursing professor. A third researcher, Geoffrey Fong of the University of Waterloo in Canada, collaborated with the couple.

Long interested in sex education, the scientists decided to conduct a study modeled on the gold-standard principles of drug trials. They recruited 662 African-American adolescents whose average age was 12. The researchers decided to focus on black youths, John Jemmott said, because they tend to become sexually active at a younger age than other adolescents.

“We wanted to focus on a younger group that didn’t have a lot of sexual experience because we figured an abstinence intervention would have the best chance of being effective with them,’’ Jemmott said. “We also know that when people are older when they have sex for the first time, they are more mature, they are more responsible, and they are more likely to use a condom.’’

The students were assigned randomly to four kinds of sex education classes and a fifth class that addressed health issues more broadly and did not specifically cover sex education. Abstinence class instructors were told to eliminate any overtones of morality and to correct any false impressions students might voice about condoms.

Nearly 33 percent of the adolescents who had abstinence-only education said, when asked by researchers, that they had become sexually active during the two years following the classes. By comparison, about 42 percent of students whose classes emphasized a more comprehensive approach including abstinence and condom use responded they had engaged in sex. The students who reported the highest rate of sexual initiation - 52 percent - were those who attended lessons focused solely on safe condom use.

In their research paper, the study authors speculated that their abstinence-only class would not have met criteria the federal government used during the Clinton and Bush administrations to award grants because it did not emphasize remaining chaste until marriage. Their class did not deal in such absolutes; instead, through role playing and other well-tested techniques used to influence behavior, students explored how becoming pregnant or contracting a sexually transmitted disease could dash dreams for the future.

The research emerges at a pivotal moment: For the first time since the early 1990s, teen pregnancy rates rose in 2006. At the same time, the Obama administration has shifted away from a singular emphasis on abstinence-only education. For the upcoming budget period, the administration has proposed spending $205 million on teen pregnancy prevention “through science-based prevention approaches,’’ according to a federal official.

Albert, of the National Campaign to Prevent Teen and Unplanned Pregnancy, said he believes the Penn abstinence program would meet that standard, while cautioning there’s no guarantee that what worked in Philadelphia will translate to other neighborhoods or to older adolescents.

“But I don’t think we can let the perfect be the enemy of the good,’’ Albert said. “We now have a good program that’s been well-evaluated and well-tested. Let’s go try it elsewhere.’’

The study: How to stop kids at the start
Researchers randomly assigned more than 600 African-American sixth- and seventh-graders in Philadelphia to five classes. Four of the classes offered different approaches to sex education, with the goal of getting youths to avoid sexual activity; one of those four aimed only at ways to abstain from sex. A fifth class discussed general health issues but not sex education.

The case for ‘just say no’
In the abstinence-only class, students attended two four-hour classes on Saturdays, with six to eight students per class.

-The adolescents were advised on how to avoid being pressured into having sex, including specific things they could say. Role-playing reinforced the lessons.

-Groups discussed the benefits of abstaining vs. being sexually active, and made lists comparing the two.

-Students were asked to think about their goals for the next five or 10 years, leading them to think about potential consequences of sexual activity such as pregnancy and sexually transmitted diseases.

-Students were asked to agree or disagree with statements such as “It’s impossible for a boy to say no to sex.’’ They were then instructed to stand under signs saying “agree’’ or “disagree’’ - an exercise intended to address peer pressure.

-Morality issues were kept out of the instruction. If students asked about condoms, for example, answers were limited to scientific findings about condom use.

What the study found

Students who said they started having sex in the two years after completing:

8 hours of abstinence-only classes:
32.6 percent

8 hours of comprehensive sex-education classes, including lessons on abstinence and condom use:
41.2 percent

12 hours of comprehensive sex-education classes, including lessons on abstinence and condom use:
42.4 percent

8 hours of general health classes:
46.6 percent

8 hours of classes that focused on correct condom use:
51.8 percent

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