The Post Pushes Abstinence

The Post is getting bolder in its conservative flag-waving in the news sections. Yesterday an article appeared online, breathlessly asserting that a new study shows that abstinence education actually causes teenagers to be sexually abstinent. Today they put that article on the front page of the morning paper, above the fold.

Sex education classes that focus on encouraging children to remain abstinent can convince a significant proportion to delay sexual activity, researchers reported Monday in a landmark study that could have major implications for the nation's embattled efforts to protect young people against unwanted pregnancies and sexually transmitted diseases.

In the first carefully designed study to evaluate the controversial approach to sex ed, researchers found that only about a third of 6th and 7th graders who went through sessions focused on abstinence started having sex in the next two years. In contrast, nearly half of students who got other classes, including those that included information about contraception, became sexually active.

"I think we've written off abstinence-only education without looking closely at the nature of the evidence," said John B. Jemmott III, a professor at the University of Pennsylvania, who led the federally funded study. "Our study shows this could be one approach that could be used."

The research, published in the Archives of Pediatric & Adolescent Medicine, comes amid intense debate over how to reduce sexual activity, pregnancies, births and sexually transmitted diseases among children and teenagers. After declining for more than a decade, births, pregnancies and STDs among U.S. teens have begun increasing again.

The Obama administration eliminated more than $150 million in federal funding targeted at abstinence programs, which are relatively new and have little rigorous evidence supporting their effectiveness. Instead it is launching a new $114 million pregnancy prevention initiative that will fund only programs that have been shown scientifically to work. The administration Monday proposed expanding that program to $183 million next year. The move came after intensifying questions about the effectiveness of abstinence programs. Study finds focus on abstinence in sex-ed classes can delay sexual activity

First, this is not the first carefully designed study to evaluate abstinence education, there have been lots of them, and they typically find that abstinence education does not result in responsible sexual behavior among young people. For instance, The Post indirectly refers to results released last week by the Guttmacher Institute showing that the teen pregnancy rate has begun an alarming increase in recent years, with rates for blacks and Hispanics significantly higher than for whites. The Guttmacher report says:

“After more than a decade of progress, this reversal is deeply troubling,” says Heather Boonstra, Guttmacher Institute senior public policy associate. “It coincides with an increase in rigid abstinence-only-until-marriage programs, which received major funding boosts under the Bush administration. A strong body of research shows that these programs do not work. Fortunately, the heyday of this failed experiment has come to an end with the enactment of a new teen pregnancy prevention initiative that ensures that programs will be age-appropriate, medically accurate and, most importantly, based on research demonstrating their effectiveness.” Following Decade-Long Decline, U.S. Teen Pregnancy Rate Increases As Both Births And Abortions Rise

Here is the abstract of the paper reported on in The Post, this is the only thing you can access online:

Objective To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents.

Design Randomized controlled trial.

Setting Urban public schools.

Participants A total of 662 African American students in grades 6 and 7.

Interventions An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex–only intervention targeted increased condom use; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.

Outcome Measures The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.

Results The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

Conclusion Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.

Wow, I wish I could see the whole paper. Significant results: abstinence-only classes reduced sexual activity relative to the no-sex-ed control group, for both sex-ever and sex in the past 3 months. Comprehensive sex-ed reduced promiscuity compared to the control group.

It does not appear from the abstract that abstinence-only resulted in significantly lower sexual intercourse rates than comprehensive sex-ed.

These results are based on fourteen-year-old inner-city girls' verbal reports to a grown-up about whether they had had sex.

One thing to notice is that this abstract gives "model-estimated probability of ever having sexual intercourse," it is not the actual percentage of participants who did, as The Post suggests. Another thing to notice is the huge confidence interval around the abstinence-only result, especially compared to the other groups. Basically this is saying that though the risk ratio is calculated at 0.67, they are 95 percent certain that if you tried this with a huge sample the result would lie between 0.48 and 0.96, where 1.0 means no effect at all and less than 1.0 means a decrease in risk. In other words, it could be something or it could be nothing. By the way, the abstract does not make clear what variables went into the denominator of the risk ratio, so it is uninterpretable as a number, all we know is that this value is very uncertain. Is this compared to the control group, all the other groups, the comprehensive group? The narrative suggests it is a comparison between abstinence-only and the control group which received no sex ed at all.

There is not enough information in The Post article or any other I have found to allow thorough evaluation of the study. According to The Post, which has presumably looked at the published paper, 33 percent of students in the "abstinence" condition (which was "wait till you're ready," not "wait till marriage") had had sex after two years, as had 47 percent of the no-sex-ed control group, while 52 percent who received the "safe sex" class had sex, and 42 percent of the "comprehensive" (abstinence and condoms) condition had.

We are really more interested in the difference between abstinence-only and comprehensive sex education here, comparing 33 percent to 42 percent sexual-activity rates after the two types of classes. Classes that tell kids to use condoms (the safer-sex only condition) should not be expected to increase abstinence. And really, you go into 6th and 7th grade classes and tell students that they should use a condom when they have sex, and don't tell them they should wait? The ethics of that are worrisome.

These are 6th and 7th grade poor, black, inner-city kids. The information they receive at home is not going to be comparable to other demographic groups, their school is not going to be a good one, and their peers are going to be having sex at a younger age than other segments of the population. This researcher, John B. Jemmott III, specializes in reducing HIV/AIDS rates in African-American populations, and this study might provide important insights about very young adolescents within that target population. The average age of participants here was 12.2; the abstinence lessons might have gotten an extra 9 percent of them to wait till they were 14 before having sex, compared to the comprehensive class.

I wouldn't scoff at a reliable (replicated) 9-percent reduction in middle-school sex rates, but this study cannot be generalized beyond a very narrow population, and as The Post article notes, "critics say" the so-called abstinence-only classes were nothing like those funded by the federal government. (But somebody from the National Abstinence Education Association says that's just "an effort to dismiss abstinence education rather than understanding what it is"...)

It is frustrating and sad to see The Post putting a study like this on the top of the front page and pushing it as a breakthrough. There is no information given about what kind of "abstinence-only" classes were taught here, but it is clear they are not like the ones that the federal government funded under the Bush administration. This is a very young target audience from a special population and there is no reason to think that these results will generalize to any other group. Twelve-year-olds who were taught not to have sex had a lower rate of sexual intercourse at the age of fourteen than those who were not taught about sex at all.