August 5, 2010

The Kids'll Respond to Good Points and Respect

Justin Katz

One wonders how the side of the culture war that proclaims itself "pro-science" will adjust its thinking in response to this finding (emphasis added):

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.

Having followed this sort of research over the past decade, I'll confirm that this result really isn't surprising. Only a smokescreen of spin and obfuscation makes it seem so. Abstinence-only education teaches children to think of sex in terms that should lead them to have less of it. "Comprehensive" sex education teaches them how to have sex. Moreover, it has nowhere been the case that abstinence represents the sum total of the lessons that children receive.

As Joseph Bottum puts it:

While the study emphasized that the abstinence-only classes "would not be moralistic," there was an underlying assumption in those classes that the children themselves were moral beings—a striking difference between the abstinence-only and safe sex–only interventions. In the abstinence-only program, it was emphasized that "abstinence can foster attainment of future goals." In contrast, the safe sex–only intervention concentrated on education about sexually transmitted diseases and condom use—that is, it focused on the present only. The first program assumed that children look forward, anticipate, and hope. The second assumed that, like the lowest animals, they are aware only of the here and now.

Conservatives — especially religious conservatives — tend to believe that treating children as moral beings who can rise above their lusts is a worthwhile practice, even if it has no measurable effect on their present behavior. That the other side is loath to acknowledge that it does have a measurable effect suggests that they, for some reason, prefer that children learn to indulge their basest instincts, perhaps because it makes them riper for dependency.

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Has any really long-term stuff been done to see if the end results (unwanted pregnancy or STD infection) are different between the two groups?

Also, I wonder if the -method- of teaching sex-ed isn't working and could be tweaked. I know a fair number of folks would prefer to have the 'you need to wear a condom and/or be on birth control; you can always get them from me, the nurse, your doctor, or the store' should come personally from a student's advisor rather than in a health class, where the level of conversation is often limited to the least common denominator of comfort amongst 26 diverse students.

Posted by: mangeek at August 5, 2010 4:20 PM

Interesting that you go in that direction. Why not suggest that this program — since it works — should be implemented in a broader group of schools and perhaps expanded where implemented? That doesn't mean that other lessons couldn't or shouldn't be incorporated into students' curricula, but the fact that you discern competing models suggests that there's something about the "comprehensive" approach that is disconnected from its practical results.

As for your suggestion, I'd be skeptical. For such a "trusted advisor" to be plausible, he or she would have to effectively bless whatever decisions the students make, and the lesson is still how to have sex, not whether to have sex.

Those whom I knew, growing up, with such advisor figures in their lives clearly took the message to be "go for it," or at a minimum, "I won't judge when you discover that you can't control yourself, because control isn't reasonable to expect."

Posted by: Justin Katz at August 5, 2010 6:37 PM

I'm sort of obligated to 'whatever works' by my own philosophy, but I also think that intentionally -not- teaching something for fear that students will take advantage of their newfound knowledge seems seedy and sets a poor academic precedent.

This study measures 'sex' and 'condom use', but not real outcomes. That's also a problem. I certainly know plenty of risk-taking folks who have made it to 30 abortion and STD free, and plenty of sticklers for the rules who are raising teenagers now or have herpes. Put simply, the inputs and the outputs don't seem to match from my limited anecdotal perspective. If the goal is to reduce teen pregnancy and STDs, shouldn't those be the results measured? I understand that doing that would require a much larger and longer study, which would seem the next logical step to vet the abstinence-only model.

I went to a school where we had 'trusted faculty advisors', and I always felt that their one-on-one input was far more valuable than classroom interaction. Granted, I didn't always listen, but the relationship I had with them made it easier for them to identify 'when' I was falling off the tracks and more importantly, 'why'. I never felt that I was being encouraged or allowed to do bad stuff, quite the opposite.

Unfortunately, I think that 'comprehensive' sex-ed is ignored as much as math, science, and English at urban schools. There are still plenty of post-sex-ed kids who think they can get pregnant from 'doing BJs' (as they call it), or don't know about the 'changes' their bodies are going through (nor the ramifications of those changes).

As as 'teaching kids how to have sex', this study discredits that theory just as much as it supports the abstinence-only approach... There was no difference between 'no intervention' and 'comprehensive intervention'. Everyone older than 9 in the city knows full-well 'how' to have sex, even if they have no idea how fertility or infections work.

I also got comprehensive sex-ed, and I can tell you, it was no more 'how to have sex' than the dictionary. It wasn't as graphic or as encouraging as our mind's eye, the curriculum was more along the lines of those 'what's happening to my body' books.

The fear is that kids are being bombarded with pro-sex messages and pressure from all sides by the time they're twelve. I'm not sure anything short of a cultural revolution will change the 'everything else' that pushes adolescent sexuality. Is it wise or ethical to leave the sexually active kids in the dark about how they can protect themselves? We need bigger, longer, more meaningful studies of outcomes to make those determinations.

Posted by: mangeek at August 6, 2010 1:13 AM

Well, now we're getting to the fallacy of the anti-abstinence-ed movement: That to encourage abstinence education is to eliminate all mention of birth control and so on. In actuality, we're typically discussing a single course that, if in school (rather than church groups or elsewhere) is hardly a full school year's worth of lessons.

I'm not arguing that kids would remain entirely innocent or ignorant about sex were it not for comprehensive sex ed. I'm arguing that, in a highly sexualized cultural environment, the safe-sex regimen merely affirms the pervasive message that they will not be able to (and perhaps shouldn't try to) resist temptation. Abstinence programs should strive to offer that contrary message, and they do work.

As for your insistence that we perform studies until we know every variable, that's just not how society functions. Take a program that appears to be working and implement it more broadly. Note that, in your first comment, you're entirely willing to experiment with comprehensive sex ed in the field, as it were. Expanding abstinence programs should be no different.

Posted by: Justin Katz at August 6, 2010 5:25 AM
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