Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine

Department of Population and Family Health, Columbia University, New York, New York, United States
Journal of Adolescent Health (Impact Factor: 3.61). 02/2006; 38(1):83-7. DOI: 10.1016/j.jadohealth.2005.06.002
Source: PubMed


Abstinence from sexual intercourse represents a healthy choice for teenagers, as teenagers face considerable risk to their reproductive health from unintended pregnancy and sexually transmitted infections (STIs) including infection with the human immunodeficiency virus (HIV). Remaining abstinent, at least through high school, is strongly supported by parents and even by adolescents themselves. However, few Americans remain abstinent until marriage, many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents. Abstinence as a behavioral goal is not the same as abstinence-only education programs. Abstinence from sexual intercourse, while theoretically fully protective, often fails to protect against pregnancy and disease in actual practice because abstinence is not maintained. Providing "abstinence only" or "abstinence until marriage" messages as a sole option for teenagers is flawed from scientific and medical ethics viewpoints. Efforts to promote abstinence should be based on sound science. Although federal support of abstinence-only programs has grown rapidly since 1996, the evaluations of such programs find little evidence of efficacy in delaying initiation of sexual intercourse. Conversely, efforts to promote abstinence, when offered as part of comprehensive reproductive health promotion programs that provide information about contraceptive options and protection from STIs have successfully delayed initiation of sexual intercourse. Moreover, abstinence-only programs are ethically problematic, being inherently coercive and often providing misinformation and withholding information needed to make informed choices. In many communities, abstinence-only education (AOE) has been replacing comprehensive sexuality education. In some communities, AOE has become the basis for suppression of free speech in schools. Abstinence-only education programs provide incomplete and/or misleading information about contraceptives, or none at all, and are often insensitive to sexually active teenagers. Federally funded abstinence-until-marriage programs discriminate against gay, lesbian, bisexual, transgender and questioning youth, as federal law limits the definition of marriage to heterosexual couples. Schools and health care providers should encourage abstinence as an important option for teenagers. "Abstinence-only" as a basis for health policy and programs should be abandoned.

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    • "Because of their developmental, social, and financial state of maturity, adolescents are generally less able than independent adults to deal with the adverse consequences of sexual intercourse should they occur. Contraception, condoms, and other means can mitigate the risks for unintended pregnancy and infection, but there is no disagreement that abstinence is the most efficacious preventive measure [18-22]. Thus, reluctance to proceed beyond providing information to recommending against sexual intercourse in this age group appears inconsistent with practice standards for other behavioral health risk factors and with data on associated harms. "
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    ABSTRACT: Behavioral factors contribute importantly to morbidity and mortality, and physicians are trusted sources for information on reducing associated risks. Unfortunately, many clinical encounters do not include prevention counseling, and medical school curriculum plays an important role in training and promoting such counseling among medical students. We surveyed all 93 freshman medical students at entry to the University of California, Davis School of Medicine in 2009 to evaluate baseline knowledge of population health principles and examine their approach to clinical situations involving four common behavioral risk factors illustrated in brief clinical vignettes: smoking, alcohol use in a patient with indications of alcoholism, diet and exercise in an overweight sedentary patient, and a 16-year-old contemplating initiation of sexual intercourse. Based on vignette responses, we assessed willingness to (1) provide information on risks, (2) recommend elimination of the behavior as the most efficacious means for reducing risk, (3) include strategies apart from elimination of the behavior for lowering risk (i.e., harm reduction), and (4) assure of their intention to continue care whether or not recommendations are accepted. Students answered correctly 71.4 % (median; interquartile range 66.7 % - 85.7 %) of clinical prevention and population health knowledge questions; men scored higher than women (median 83.3 % vs. 66.7 %, p<0.02). Students showed high willingness to provide information and strategies for harm reduction apart from risk elimination, while respecting patient autonomy. Willingness to recommend elimination of high-risk behaviors "always or nearly always" was high for smoking (78.5 %), alcohol consumption in a patient with indications of alcoholism (64.5 %), and diet and exercise in a sedentary and overweight individual (87.1 %), and low for the 16-year-old considering initiating sexual intercourse (28.0 %; Friedman test, p<0.001). Willingness was not associated with the respondent's background knowledge of population health principles or gender. Students showed high willingness to educate and respect patient autonomy. There was high willingness to recommend elimination of risk behaviors for smoking, alcohol, and poor diet/exercise, but not for sexual intercourse in an adolescent considering sexual debut. Further research should address promoting appropriate science-based preventive health messages, and curriculum should include explicit discussion of content of recommendations.
    BMC Medical Education 05/2012; 12(1):28. DOI:10.1186/1472-6920-12-28 · 1.22 Impact Factor
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    • "Until recently, the United States Congress appropriated funding to support for abstinence until marriage education despite a lack of evidence supporting its efficacy in reducing high risk sexual behaviors (Trenholm et al., 2007; Waxman, 2004), and research supporting the use of comprehensive approaches to sex education (Kirby, Laris, & Rolleri, 2007; Santelli, Ott, Lyon, Rogers, & Summers, 2006; Santelli et al., 2006). Unlike abstinence until marriage education, which emphasizes abstinence as the expected approach to promote sexual and reproductive health in youth, comprehensive sex education programs also provide extensive information on how to prevent unintended pregnancy, STIs, and HIV infection (Santelli, Ott, Lyon, Rogers, Summers, et al., 2006). "
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    ABSTRACT: Though African-American youth in the South are at high risk for HIV infection, abstinence until marriage education continues to be the only option in some public schools. Using community-based participatory research methods, we conducted 11 focus groups with African-American adults and youth in a rural community in North Carolina with high rates of HIV infection with marked racial disparities. Focus group discussions explored participant views on contributors to the elevated rates of HIV and resources available to reduce transmission. Participants consistently identified the public schools' sex education policies and practices as major barriers toward preventing HIV infection among youth in their community. Ideas for decreasing youth's risk of HIV included public schools providing access to health services and sex education. Policymakers, school administrators, and other stakeholders should consider the public school setting as a place to provide HIV prevention education for youth in rural areas.
    AIDS education and prevention: official publication of the International Society for AIDS Education 02/2012; 24(1):41-53. DOI:10.1521/aeap.2012.24.1.41 · 1.51 Impact Factor
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    • "Eighty-four percent of adolescents and 85% of adults agreed that it should be taught that young people should be married before they have a child. However, abstinence-only education has been the subject of controversy as it does not incorporate contraceptive methods as part of an broad-based approach to adolescent pregnancy prevention (Brindis, 2006; Santelli et al., 2006). "
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    ABSTRACT: Recent research has shown that 82% of adolescent pregnancies are unintended. Social marketing has potential to reduce unintended adolescent pregnancy but its effectiveness in this area has not been thoroughly evaluated. This arti-cle reviews the literature on social marketing and assesses its potential to reduce unintended adolescent pregnancy. We identified five communication principles as relevant to adolescent reproductive health messaging: Countermarketing, making credible and likeable "arguments" for behavior change, use of theory-based models, social modeling and behav-ioral alternatives, and risk communication when the behavioral choices are clear. We examine studies of social marketing on other health risk behaviors and a case study of a recent campaign to promote parent-child communication about wait-ing to have sex. Findings suggest that to reduce unintended pregnancy and improve reproductive health outcomes among adolescents, there is a need for targeted prevention messages and social marketing approaches.
    The Open Communication Journal 12/2007; 1(1). DOI:10.2174/1874916X00701010001
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