Tuesday, September 06, 2005

Another Study Shows that Abstinence-Only Education Does Not Result in Abstinence

Another study has just been published, looking at the efficacy of abstinence-only sex education. What happens when you tell teens about the dangers of sex, and nothing about how to prevent them?

The paper is not available online, but here's the press release from Case Western Reserve School of Medicine:
Abstinence-only education can influence teen sexual behavior and beliefs, according to a Case Western Reserve School of Medicine study published in the American Journal of Health Behavior.

The study examined the effectiveness of For Keeps, an abstinence-until-marriage sex education program that has been presented to more than 25,000 students at public and private schools in the Greater Cleveland area.

The goal of the curriculum, developed by Operation Keepsake is to increase abstinence beliefs and intention, increase efficacy in situational resistance, reduce early sexual experimentation and encourage renewed abstinence among teens already sexually active. The study involved 2,069 middle school students questioned about their sexual knowledge and practices before and five months after receiving the For Keeps curriculum. Students were enrolled in classrooms that were assigned to be intervention or controls (receiving the curriculum after the evaluation was completed).

Researchers led by Elaine A. Borawski, Ph.D., in the Department of Epidemiology and Biostatistics, found that after going through the program, teens reported significant increases in their HIV/STD knowledge, their personal beliefs about the importance of abstinence and their intentions to remain abstinent in the near future.

But the program did not affect students' confidence to avoid risky sexual situations, and sexually inexperienced and female students actually reported a decrease in their intent to use condoms in the future. However, no changes in condom use intentions were observed among sexually active or male students. The study also found that the program did not significantly reduce the likelihood that teens would engage in sexual intercourse or to use a condom consistently.

A surprising finding revealed that while sexually active students exposed to the intervention were not more likely to abstain from sex, they did report fewer casual sex encounters and fewer sexual partners than their peers who did not receive the program.

"This community-based evaluation reveals that abstinence-only intervention can influence knowledge, beliefs and intentions, and among sexually experienced students, may reduce the prevalence of casual sex," Borawski said, adding that the intent of teens to reduce their condom use merits further study to determine long-term implications. Study Finds Mixed Results On Teen Sexual Behavior From Abstinence-only Intervention

The "surprising finding" is probably what is technically known as a "spurious result." If you conduct enough statistical tests, one will eventually give a "significant" result, simply because the entire analytic process is based on probabilities.

So, OK, they took this course, and afterwards they reported that abstinence was important and the virginal students said that they intended to remain abstinent, compared to the control group (or perhaps compared to pretesting, you can't really tell from this). I have already seen the "Abstinence Education Works" headlines on the web pages of those who just know that this is better than teaching facts, but this study doesn't seem to say that.

A fundamental problem in psychology is the linkage between intention and behavior. There are many, many chapters and journal publications in the scientific literature, trying to understand why it is that there is often a near-zero correlation between stated general intentions and actual behavior. (See, for instance, this web site about Fishbein and Ajzen's Reasoned Action Model.) So we will not quite take these self-reported intentions as if they were actual changes in behavior, especially given the many studies showing that abstinence-pledgers engage in risky sexual behaviors.

Students who were still virgins (at least females) tended to expect not to use a condom when they did have sex. Take that as you will, this is alot of the reason researchers find the same or higher rates of STDs among those who have pledged abstinence as among those who haven't.

Among students who are already sexually active, interestingly, there was no change in their intention to use a condom. They also expressed no desire to stop having sex.

Back to the "surprising finding," that sexually active teens reported a decrease in casual sex encounters after the class. In this study, it appears that the control group received no treatment, that is, they did not attend an informative sex-ed class. We would not be surprised if just talking about sex, and discussing some of the consequences, caused teenagers to think twice. Even if this was a replicable result, it only means that having a sex-ed class of some sort might cause teens to be somewhat more careful about casual sex.

Apparently there was some kind of follow-up, producing the "surprising finding" as well as this important nugget: The study also found that the program did not significantly reduce the likelihood that teens would engage in sexual intercourse...

Look, it's nice that their attitudes changed, but I would be much more impressed if the kids who took the "abstinence-only" class actually practiced abstinence more than anybody else. And they didn't.

It would be interesting to see the published paper. Unfortunately, it is not online, as far as I can tell. I hate to comment based on a press release, but as it comes from the university itself, I will assume that it accurately reports the findings.

In sum, this study found that sitting in a particular abstinence-only class resulted in students expressing more pro-abstinence attitudes. The sexually inexperienced respondents, and non-virgin females, also expected to be less likely to use a condom when they did have sex, compared to the control group, but the expectation of using a condom did not change among males who had already had sex.

Most importantly, students who took the class did not actually practice abstinence any more than the control group.


Anonymous Tish said...

Jim, I read that information on "intent to use a condom" differently. Girls who were not already sexually active had a reduced intention, boys, active and not, did not have a reduced intention.

Is that perhaps because the boys' intention to use condoms was lower than the girls' to begin with? I can't tell from this.

We agree, though, that any program that makes teen less likely to use condoms properly is harmful.

September 06, 2005 11:08 AM  
Blogger JimK said...

Tish, it is very hard to penetrate the prose of a press release to figure out what really happened. There should be a table in the article that compares pretest and post-test values, and another that compares treatment and control groups. But we don't have that in the press release. You could be right about what they meant.

September 06, 2005 12:29 PM  

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