Challenging Dogma

...Using social sciences to improve the practice of public health

Saturday, April 21, 2007

Abstinence-Only Education: How Many Sex-Ed Curricula Have Failed Our Youth – Melissa Waxman

It is no secret that teen pregnancies and sexually transmitted diseases’ and infections’ (STDs and STIs) incidence rates have increased over the last decade. One popular campaign to reduce these rates stems from a moral vantage point that views sexual abstinence as the only acceptable standard of behavior for young people outside of marriage. By its very nature, the narrow focus of the abstinence-only approach avoids educating at-risk youth about alternate safe sex practices. As a result, it deprives America’s youth of the information required to make informed decisions, and the knowledge necessary to practice safe sex.

Sex is “What it’s All About”
While abstaining from sex is the only way to be sure one will not contract an STI or become pregnant, it is impossible to expect the youth of our “sex sells” society to see abstinence as an obvious course for their sexual future. While sexual education is present in one form or another in every high school health education curriculum, the majority of teens cite television as a source for some or most of their information about sex (1). During the 19.67 hours of television that the average American adolescent watches every week, our youth are obtaining information that creates the bulk of their idea about typical sexual practices (1, 2). And although television is the primary media source, magazines and radio are not-to-be-forgotten sources of information for 64% of sexually active teens who look to the media for advice and information about sex (1).

Based on Albert Bandura’s Social Learning Theory, the fact that the majority of our youth look to media for information and guidance is not surprising. His theory stems from the idea that an individual’s behavior is learned observationally through modeling (3). The media is crammed with people in situations that adolescents can relate to and use as a guide for action. Sex as a subject can be touchy, but still remains present in all areas of media products including movies, music, and cosmetics. By no fault of their own, adolescents are forming ideas about social norms and desirable behaviors just by turning on the television or buying a music clip. Bandura’s theory can be clearly seen when looking at correlations between sexual content on television and relating behavioral outcomes; higher exposure to sexual content leads to earlier initiation of sexual intercourse(4). Based on the Social Learning Theory, it is impossible for an abstinence-only educational movement to succeed in our present society. Abstinence can not serve as a guide for action when adolescents do not see it being modeled.

Sex Is Taboo
Many things in our present society are considered taboo; money, mental illness, and sex to name a few. Sex is one of the most controversial topics because although nobody likes to talk about it, especially to teenagers, it is all over our world in the media. The majority of sexual information is being absorbed by our adolescents from the media and not from the other two primary sources of information; family and formal education (1). As a national initiative, abstinence-only education is only increasing the stigma surrounding sexual communication. As an educational resource, teachers were valued highest among sources of sexual information along with magazines while parents were among the lowest valued sources (5). If sexual education from teachers becomes limited to “Sex before marriage is unacceptable,” stigma surrounding sex communication can only increase.

As a result of the social stigma surrounding sexually active teenagers, adolescent health has been, and will continue to be, compromised. This stigma has influenced how sexually active teens perceive others’ reactions to their status in a negative way. The idea of being faced with negative judgment from their peers and role models has proved a heavy weight for many teens, and is linked with a decrease in seeking medical care for STDs(6). Compared with any other age group, adolescents are at the greatest risk of acquiring an STD (7). On a medical and economical stance, our society can’t afford to increase the social stigma of premarital sex by making it more taboo and less likely to be a topic of conversation and education for adolescents that need the information most.

Sex As An Established Social/Behavioral Norm
According to the Information Processing Theory of communication, which highlights a number of steps between learning something and incorporating it into one’s behaviors, belief in an idea or product is necessary if one is to behave according to that idea or product (8). The majority of adolescents have rejected the idea of abstinence-only education as an adequate form of sex education for kids in our society (9). Why shouldn’t they when sex can be seen in mass media or among their friends and families? This can be explained using a concept similar to those channeled by advertising executives. Consumers, or adolescents for the sake of this argument, are presented with a product/idea, comprehend it, believe it, remember it, and behave accordingly (9). In the case of abstinence as the only permissible sexual “product”, adolescents are halted at the belief stage. It is clear to them that abstinence is not their only possible option when they are bombarded with examples of other products being advertised in every area of their lives. Abstinence-only education is fighting an uphill battle in the US so long as our country sticks to its fundamentals of free speech and expression (1). As a whole, adolescents do not believe that abstinence is the only acceptable way to live life before marriage. A public health intervention that is rejected by the majority of its target population will never be effective no matter how strongly it is federally backed or how well-funded its initiatives.

Where Would they Be Without Education?
It is the feeling of many adults and teachers that the benefits of abstinence should be taught in all sex education programs, but not to the exclusion of other sexual education such as condom use (10). Looking at condom statistics alone, there was a steady increase in the percent of sexually active teens using condoms from 1991 to present, but this number slowed from an 11% increase between 1991 and 1997 to a 6% increase between 1997 and 2003 (11). Similarly, the number of sexually active adolescents decreased 2.7% between 1991 and 1997 while only decreasing 0.1% between 1997 and 2003 (11). These numbers gathered by the United States Centers for Disease Control and Prevention (CDC) indicate that the federally funded Title-V abstinence-only-until-marriage initiatives introduced in 1998 had no effect on the number of sexually active teens and may have even contributed to the decline in condom use among active teens. These data suggest that abstinence-only education is hardly educational.

The abstinence-only initiative’s educational message is that abstinence is the only way to prevent pregnancy and STDs. It also presents abstinence as the only acceptable behavior before marriage and ignores what many teens might have read, heard, or seen for themselves by excluding the idea of pre-marital sex and contraceptives all together (12). Furthermore, an evaluation of a number of widely used abstinence-only curricula found that 11 of the 13 curricula evaluated provide entirely false claims about STD transmission, abortion, and pregnancy (12). With this information comes the question of ethics. There is a clear problem when addressing the issue of providing selected information and misinformation to teenagers who we know are or will become sexually active during their grade-school experience. The media is no place to learn to properly use a condom or get information about STDs. Based on a number of credited social/behavioral models such as the Theory of Reasoned Action, it is obvious that health education influences the ideas that play a huge role in making health decisions. If the only direct sexual education being provided to adolescents excludes vital information for making health choices, there is no reason to believe that adolescents who chose to have sex, as a number of them do, will know how to do so safely and take actions to avoid unwanted pregnancies or STD contraction.

Failure To Influence
Although some administrative officials feel that abstinence-only education is what’s best for our nation’s youth, the sciences predicting society’s reactions, behavioral and otherwise, consider this public health intervention useless. The abstinence-only education initiative fights nature and nurture, especially in adolescents when puberty sparks sexual experimentation and peers have the greatest impact on the individual. The initiative’s goal is to change behavior at the individual level but it does not address its competitors at the societal level. The Model of Cascading Influence states that influences have to be made at all levels of society from the general environment down to the group/peers in order to elicit a desired reaction from the individual. By cutting directly to the individual without regard for social norms, media influences, or taboos the abstinence-only education initiative is set for failure.

1. Linn S. Consuming Kids; Protecting our Children from the Onslaught of Marketing and Advertising. New York, NY: Anchor Books, 2005.
2. Center for Screen-Time Awareness. Facts and Figures about our TV Habit. Washington, DC: Center for Screen-Time Awareness.
3. Kearsley G. Social Learning Theory (A. Bandura). Explorations in Learning and Instruction: The Theory into Practice Database.
4. Research Highlights. Does Watching Sex on Television Influence Teens’ Sexual Activity? Santa Monica, CA: RAND Health.
5. Romero RJ, Lora MN, & Caneta R. Adolescents and sources of sex information: preferences and perceived usefulness. Atencion Primaria 2001; 27:12-17
6. Cunningham SD, Tschann J, Gurvey JE, Fortenberry JD, Ellen JM. Attitudes about sexual disclosure and perceptions of stigma and shame. Sexually Transmitted Infections 2002; 78:334-338.
7. Eng T. & Butler W. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academies Press, 1997.
8. Machado M. Information Processing Theory. Austin, TX: University of Texas.
9. Sadvoszky V, Kovar CK, Brown C, & Armbruster M. The need for sexual health information: percentions and desires of yound adults. American Journal of Maternal Child Nursing. 2006; 31:373-380.
10. BleakleyA, Hennessy M, Fishbein M. Puiblic Opinion on sex Education in US Schools. Archives of Pediatrics and Adolescent Medicine 2006; 160:1151-1156.
11. Advocates for Youth. Trends in Sexual Risk Behaviors among High School Students- United States, 1991 to 1997 and 1999 to 2003. Washington, DC: Advocates for Youth.
12. Connolly C. Some Abstinence Programs Mislead Teens, Report Says. 2004; December 2: A01

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