Challenging Dogma


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

Friday, April 20, 2007

Federally Funded Abstinence-Only School Based Programs: Using The Social Sciences To Critique This Failed Public Health Intervention- Jennifer Booth

Introduction
School-based sexual education programs can be divided into two main categories, a) abstinence-only and b) abstinence-plus (also referred to as comprehensive sexual education). Since the 1980’s, the Federal Government has allocated considerable amounts of funding to schools to teach abstinence-only education, in spite of the lack of rigorous scientific data to prove their effectiveness. (1) Despite their popularity with policy makers and wide-spread use, their ability to prevent teen sexuality remains to be confirmed. (2) The failure of this public health intervention to promote abstinence among adolescents is due to the Federal Government’s lack of knowledge about the importance of self-efficacy, the detrimental effects of some fear based campaigns, and adolescent perspectives in relation to adolescent behavioral change.

Self-Efficacy
The first inherent problem with abstinence-only education is that many high school adolescents view abstinence as unrealistic. High school adolescents who believe that these types of programs are unrealistic have many legitimate reasons including, previously or currently participating in sexual intercourse, or viewing abstinence until marriage as an improbable goal. These adolescent thoughts coincide with the 2005 Youth Risk Behavior Surveillance. (3) This national survey illustrated that among ninth through twelfth grade students, 46.8% had already participated in sexual intercourse.

It is evident that many adolescent high school students believe that they are incapable of remaining abstinent until marriage. Therefore, these students lack self-efficacy. Self-efficacy is defined by the Social Sciences as “…an impression that one is capable of performing in a certain manner or attaining certain goals. It is a belief that one has the capabilities to execute the courses of action required to manage prospective situations.” (4) Therefore, if an adolescent lacks self-efficacy in regards to remaining abstinent they are more likely to disregard their abstinence-only education. Conversely, if an adolescent possesses self-efficacy in regards to remaining abstinent, they are more likely to actively engage in their abstinence-only education.

Self-efficacy has been shown to be a critical component of behavioral change. (5) (6) Social Scientists have studied self-efficacy in many diverse populations including individuals who practice high risk HIV behaviors and adolescents who drink alcohol. A study conducted by Kang et al. (5), concluded that self-efficacy was associated with high risk HIV behaviors. In this study, individuals who lacked self-efficacy in relation to avoiding the HIV virus were more likely to be involved in high risk behaviors compared to individuals who possessed self-efficacy. A second study conducted by Watkins et al. (6), demonstrated that adolescent self-efficacy towards alcohol consumption was associated with parental monitoring of under aged drinking. In this study, adolescents who experienced parental monitoring were more likely to possess self-efficacy to abstain from drinking compared to adolescents who did not experience this type of parental monitoring.

Therefore, the goals of abstinence-only education can only be obtained by adolescents who possess the self-efficacy to refrain from sexual activity until marriage. The number of adolescents who do possess this self-efficacy is likely to be low secondary to the results of the 2005 Youth Risk Behavior Surveillance Survey which examined the elevated number of adolescents who have already participated in sexual intercourse. Furthermore, this Survey failed to take into consideration the number of adolescents who are homosexual or bi-sexual who may be incapable of obtaining legal marriages as adults. In the absence of self-efficacy, the goals of these abstinence-only programs will be unattainable for many students, resulting in a lack of meaningful sexual education for the majority. As a result, countless adolescents are left with a lack of scientifically sound sexual education which can result in unprotected sexual intercourse, high risk sexual behavior, unintended pregnancy, adolescent parenthood, transmission of sexually transmitted diseases, and an overall deficit of knowledge regarding sexual health.

Fear Based Campaigns
The second inherent problem with abstinence-only education is that many programs rely heavily on the elements of fear, shame and false information to promote abstinence. Teachers of abstinence-only education are encouraged to provoke fear and shame in their students by teaching that pre-marital sex is commonly associated with: poor educational attainment, reduced income, negative psychological outcomes such as depression and suicide, decreased likelihood of a secure marriage, insecure relationships, lack of personal integrity, and emotional harm related to pre-marital sex. (7) In addition to provoking fear and shame, abstinence–only programs teach false and misleading information regarding contraception, sexuality and abortion. For example, “the popular claim that condoms help prevent the spread of STDs, is not supported by the data” in addition to “in heterosexual sex, condoms fail to prevent HIV approximately 31% of the time.” (8) Adolescents exposed to these types of programs are left with a lack of scientifically sound sexual education, in addition to being exposed to feeling of fear and shame.

Fear based campaigns have frequently been utilized in public health interventions; but do they bring about behavioral change? Allen’s study (9) confirmed that properly designed fear based campaigns do have the ability to change behavior. Allen’s study stressed the fact that fear alone is not enough to change behavior; in addition to fear, high-efficacy messages are necessary to change undesirable behavior. “High-efficacy messages” are successful at changing undesirable behavior because they teach the necessary skills for behavioral change, and promote self-efficacy. A subsequent study by Job (10) showed that when fear is not combined with high-efficacy messages, health promotion messages are often disregarded, and individuals continue practicing undesirable behavior.

After reviewing these studies, it is evident that abstinence-only education programs are incorrectly utilizing fear based campaigns. These types of programs are merely relying on the elements of fear, shame and false information to promote abstinence, while withholding necessary high-efficacy messages regarding sexuality. Due to the fact that abstinence-only education programs fail to incorporate high-efficacy messages regarding sexuality into their curriculums, adolescents are once again left with a lack of scientifically sound sexual education. In addition, adolescents who have already become sexually active, or who do not possess the self-efficacy to refrain from sexual activity until marriage are filled with emotions of fear and shame. As a result of these emotions, adolescents are less likely to confide in trusted adults about their sexuality, therefore possibly placing themselves in high risk sexual situations.

Teen Perspectives
The last inherent problem with abstinence-only education is that adolescents are unable to personally connect with the programs, because these programs were not designed to “speak” to an adolescent audience. When addressing such a personal and sensitive topic such as adolescent sexuality, it is paramount to structure the program around the needs of the audience. During these types of abstinence-only programs, there is a struggle between what the teachers are capable of teaching (“Just Say No!”), and what the adolescents desire to learn.

In order to prevent this, many studies have been conducted which examined what adolescents need and want from their sexual education. Though both studies were conducted by separate researchers, they both share a common adolescent voice. The first study by Aquilino et al, (11) concluded that adolescents felt that abstinence-only education was only appropriate for elementary school, but that health education with a focus on contraception was necessary for junior and high school adolescents. In addition, these adolescents did not believe they should be told not to have sex, rather they felt a better method of preventing teen sexuality and pregnancy was discussing sexual feelings and sexual decision making with trusted adults. Another study by Sadovszky et al. (12) highlighted that adolescents want more information in general regarding sexual health including STIs, pregnancy, and contraception. Both studies emphasized that adolescents desire to be informed and prepared when it comes to sexual intercourse.

While abstinence-only education many appear appropriate for policy makers, these types of programs fail to include information relevant to adolescents. Adolescents desire to be supported and educated regarding their sexual choices, and need nurturing adults to aide them with these difficult choices. Adolescents need and deserve more than “Just Say No”! By not tailoring these programs to the needs of adolescents, it is likely that the majority of adolescents will disregard there abstinence-only teachings. Therefore, adolescents are once again left with a lack of scientifically sound sexual education, which can result in adolescents placing themselves in high risk sexual situations.

In conclusion, Federally Funded abstinence-only education programs fail to promote abstinence amongst adolescents. It is necessary that policy makers utilize the Social Sciences to recognize why these programs are considered failed public health interventions. Research has already shown that adolescents are having sex, so it is necessary that public health professionals create successful sexual education programs using the Social Sciences that protect our vulnerable teens.

References
1. Dailard C. Sex Education: Politicians, Parents, Teachers and Teens. The Guttmacher Report 2001; 4(1). [Cited 2006 May 27.]Available from http://www.guttmacher.org/pubs/tgr/04/1/gr040109.html
2. Kirby, D. Emerging Answers. The National Campaign To Prevent Teen Pregnancy 2001. [Cited 2006 February 28.]Available from http://www.teenpregnancy.org/resources/data/pdf/emeranswsum.pdf
3. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Surveillance Summaries. Youth Risk Behavior Surveillance-United States, 2005. Vol.55/SS-5.
4. Wikipedia. Self-Efficacy. http://en.wikipedia.org/wiki/Self-efficacy.
5. Kang SY, Deren S, Andia J, Colon H, Robles R. Effects of changes in perceived self-efficacy on HIV risk behaviors over time. Addictive Behaviors 2004; 29 (3): 567-574.
6. Watkins J, Howard-Barr E, Moore M, Werch C. The mediating role of adolescent self-efficacy in the relationship between parental practices and adolescent alcohol use 2006. Journal of Adolescent Health; 38: 448-450.
7. Sexuality Information and Education Council of the United States. SIECS-A Revamped Federal Abstinence-Only-Until-Marriage Program Goes Extreme. Available at http://www.siecus.org/pubs/cbaereport.html. Accessed April 16, 2007.
8. United States House Of Representatives. The Content Of Federally Funded Abstinence-Only Education Programs. Washington, DC: Committee On Government Reform-Minority Staff Special Investigation Division, 2004.
9. Allen W. A meta-analysis of fear appeals: implications for effective public health campaigns. Health Education and Behavior 2000; 27(5):591-615.
10. Job S. Effective and Ineffective Use of Fear in Health Promotion Campaigns. American Journal of Public Health 1988; 78 (2): 163-167.
11. Aquilino M, Bragadottir H. Adolescent pregnancy. Teen perspepctives on prevention. American Journal of Maternal and Child Nursing 2000; 25(4): 192-7.
12. Sadovszky V, Kovar C, Brown C, Armbruster M. The need for sexual health information: perceptions and desires of young adults. American Journal of Maternal and Child Nursing 2006; 31(6): 373-80

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