Article

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

ABSTRACT

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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    • "Finally, delaying initiation of sexual intercourse before marriage has been an objective of many national policies to prevent HIV and unintended pregnancy among young people. Although helping young people delay initiation may have public health benefits, the public health and medical communities have expressed concern about policies focused on " abstinence only " [23] [24]. Few analyses in the developing world have examined sexual initiation longitudinally [10] [25] (i.e., measured incidence of sexual debut), compared risk factors for incidence and prevalence of sexual intercourse (i.e., ever had sex), or examined the influence of risk factors on trends over time. "
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    ABSTRACT: Purpose: The purpose of the study was to identify risk factors and time trends for sexual experience and sexual debut in rural Uganda. Methods: Using population-based, longitudinal data from 15- to 19-year olds in Rakai, Uganda, we examined temporal trends in the prevalence of sexual experience and potential risk factors for sexual experience (n = 31,517 person-round observations) using logistic regression. We then identified factors associated with initiation of sex between survey rounds, using Poisson regression to estimate incidence rate ratios (IRR; n = 5,126 person-year observations). Results: Sexual experience was more common among adolescent women than men. The prevalence of sexual experience rose for most age-gender groups after 1994 and then declined after 2002. Factors associated with higher prevalence of sexual experience (without adjustment for other factors) included age, not enrolled in school, orphanhood, lower socioeconomic status, and drinking alcohol in the past 30 days; similar factors were associated with initiation of sex. Factors independently associated with initiation of sex included older age, nonenrollment in school (IRR = 1.7 for women and 1.8 for men), alcohol use (IRR = 1.3 for women and men), and being a double orphan among men (IRR = 1.2). Sexual experience began to decline around 2000, whereas increases in school enrollment began as early as 1994 and declines in orphanhood occurred after 2004 (as antiretroviral therapy became available). Conclusions: Sexual experience among youth in Rakai was associated with social factors particularly school enrollment. Changes in these social factors also appear to influence change over time in sexual experience.
    Full-text · Article · Oct 2015 · Journal of Adolescent Health
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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.
    Full-text · Article · May 2012 · BMC Medical Education
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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.
    Full-text · Article · Feb 2012 · AIDS education and prevention: official publication of the International Society for AIDS Education
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