Introduction
Adolescents and teens that are sexually active or engage
in risky sexual behavior are at a high risk for unintended pregnancy, HIV and
other sexually transmitted diseases (STDs). In 2011, nearly 330,000 babies
(8.4% of all births) were born to teen mothers who were 15 -19 years of age,
representing a birth rate of 31.3 births per 1,000 women in this age group (1,2).
Furthermore, nearly half of all
reported STDs are among individuals aged 15-24 years (2). In an effort to mitigate the social and
economic impact of these outcomes, education-based interventions targeting
young people are supported by the federal government.
Multiple types of interventions have been implemented in
schools around the country to help prevent or reduce risky sexual behavior
among young people. In addition to comprehensive sexual education, some states
receive funding for abstinence-only education under the Federal Title V
Maternal and Child Health program. The current funding level for
abstinence-only education under Title V is $50 million annually for FY2011 - FY2014
(2). Unfortunately, evaluations of abstinence-only courses and curriculums have
failed to show evidence of reducing the likelihood for teens to become sexually
active or use contraception (4 - 7). A prominent study conducted by Mathematica
Policy Research Inc. concluded that abstinence-only program participants had
just as many sexual partners as non-participants and had sex at the same median
age as non-participants. Contraception
use was also just as likely among program participants compared to
non-participants (4).
This intervention critique aims to highlight three basic
weaknesses inherent in the general approaches of abstinence-only education
programs funded under Title V. At
the core of these criticisms are three fundamental deficits. First, these programs undermine the
impact of societal messages about sex delivered via the media such as
television/movies, music, the internet and magazines; this is important, as the
media is a powerful tool for influencing youths’ beliefs (attitudes and
subjective norms) about sex.
Second, while these approaches teach youth to avoid situations that can
lead to sex, they are less likely to focus on the difficulties of making good
decisions when they are already in a physical situation. Finally, in many cases, educators and
curriculum developers have neglected to consider that the use negative
messaging (scare tactics and “slut-shaming”) to promote abstinence may cause
adverse effects among youth. Such tactics may have little impact on teens that
desire autonomy or to rebel against authority and can promote risky behavior. In the same vein, these methods may be
considered offensive and turn participants off to the entire program.
Critique argument 1: The impact of the
media
The media plays a huge role in framing how people think
about sex and offers an unrestrained resource for social learning. It serves as
a “super peer” to adolescents
(especially young girls) by teaching them how to behave in romantic contexts and
sexual situations (8,9). Essentially, the media provides young people with
skewed perceptions of sex and normative sexual behavior – this may involve promoting
overestimations of the frequency of sex and unrealistic expectations or
scenarios (10). The conclusions
which youth draw about sex based on their exposure to the media are in line
with the theory of cognitive heuristic availability. This theory provides that individuals will often make
judgments or generate biases about the frequency of events according to data
that has limited validity (11).
Unfortunately, a review of abstinence-only education requirements
does not show that these programs are directly required to address the impact
of the media (12). While some programs have included education pieces that
address the effects and inaccuracies of sexually driven media, many popular programs
(FACTS, Promoting Health Among Teens! Abstinence-Only, Making a Difference) do not
emphasize sex in the media leaving major gaps in the curriculum (13-15).
Portrayals of sex and sexuality in the media are
continuing to increase. In 1988, researchers estimated that teenagers viewed
nearly 15,000 sexual references, innuendos or jokes on television alone (1). More recently, the Kaiser Family
Foundation estimated that the number of sex scenes on TV nearly doubled from 1998
to 2005 (17). This influence is
overwhelming when we also consider the impact of sex-related material on the
internet and in magazines.
Research has shown that higher exposure to sexual media is directly
correlated with more frequent sexual behavior and higher likelihood of teen
pregnancy (18). Since
environmental factors are playing such a significant role in shaping youths’
beliefs about sex, abstinence-only programs that do not directly address this
influence are pointless, to some extent.
To be effective, these programs must attack skewed perceptions about sex
at their root cause. Without
ultimate control over what this “super peer” is teaching teens about sex, it is
important that educators help teens become well-equipped to separate reality
from the glamorized untruths projected by the media.
Critique argument 2: Decision-making in
context
Many abstinence-only education programs have segments
dedicated to decision-making; however, these portions of the programs do not
address decision-making in context.
In fact, most of the discussion centered on decision-making is
fact-based and describes the potential outcomes or consequences of making
certain decisions. Some programs merely provide participants with a laundry
list of statistics describing rates of STDs and unwanted pregnancies in hopes
that this will help guide better decision-making (13). In a “cold” or rational
state it is plausible that understanding “the facts” will help teens view
abstinence as an important way to promote healthy future relationships and
avoid unwanted pregnancy or disease. What this fails to do, however, is provide
participants with practical tools for actually making tough decisions when they
are in the “heat of the moment”, or “hot” states. This is especially important
since research has shown that individuals are less inclined to think
responsibly and rationally when aroused (19).
Ariely’s concept of hot vs. cold is an important point to
consider. In some cases, curricula will focus on making decisions to avoid
sexual situations and advances, but less information is provided on
decision-making in the “heat of the moment” a much more sensitive, yet relevant
topic. This includes the decision to be prepared and use protection. Of course, the goal of abstinence-only
education is to promote abstaining from sex until marriage. However, statistics
have shown that program participants are still engaging in sexual activity at
similar rates compared to non-participants and they are doing so with little to
no accurate knowledge of how to protect themselves (3, 20). This lack of knowledge in conjunction
with a lack of understanding of how hormones and emotions can inhibit one’s
ability to make good judgments is a dangerous combination. As a result, it is no surprise that numerous
reports have cited abstinence-only states as having the highest rates of teen
pregnancies and rising rates of STDs (21, 22).
Critique argument 3: The use of shame and
scare tactics
Many abstinence-only education curricula tend to focus on
the emotional drivers that influence teen sex such as the need to feel accepted
or loved. In addition to helping
participants understand these feelings, programs use scare tactics or so-called
“slut-shaming” methods to deter youth from wanting to have sex. For example, a well-known
abstinence-only lecturer, Pam Stenzel, admittedly employs negative messaging
throughout her program in order to scare students about sex (23). Other curricula include activities to
portray how sexual promiscuity will cause an individual to lose value in the
eyes of their future spouse. The Choosing the best PATH curriculum has
utilized the following activities:
“Mint
for Marriage”
· An unwrapped
peppermint patty is passed from student to student.
· Each student is
asked to hold it, examine it (maybe smell it) and then pass it to their
neighbor.
· After the patty
is passed around the room, the instructor offers it to the class to see if
anyone wants it.
· The instructor
asks the class “why is this peppermint patty no longer appealing?” invoking the
response that “it’s gross and nobody wants it anymore.”
· The instructor
then ties the activity to the idea that “no one wants food that has been passed
around and neither would you want your future husband or wife to have been
passed around.”
“A Rose with No Petals.”
· The instructor
holds up a rose and notes how beautiful it is, before passing it around to the
class.
· Each student is
asked to pull a petal from the rose before passing it on to the next person.
· When the rose is
nothing more than a stem, it is passed back to the instructor.
· The instructor
then asks “how much value does the rose have now?”(24)
While meant to illustrate the value of virginity, it is
hard to deny other ways of interpreting these activities. A main concern would be encouraging
feelings of shame which may inhibit sexually active teens from having
conversations about safe sex or getting tested for STDs.
There are two main issues with using negative messaging in
abstinence-only education curricula. First, research has shown that scare
tactics can have adverse effects by inducing rebellious behavior. In a study of Scared
Straight, an intervention designed to prevent youth from engaging in
criminal activity, researchers found that the program was not effective at
deterring criminal behavior, and in some cases, even promoted it by inducing
rebellious actions (25). Secondly, “slut-shaming” can facilitate bullying or
promote poor self-esteem (especially in young girls that have already been
promiscuous) which may lead to further risky sexual behavior (26). This tactic generally enforces the idea
that individuals who have sex before marriage are bad, dirty people. Students have publicly voiced
complaints about the use of “slut-shaming” messages implied by motivational
speakers aiming to promote abstinence (27). Overall, negative messaging has been shown to work against
the goals of abstinence-only education.
Proposed Alternative Interventions -
Recommendations
The proposed intervention would be a focus on three core
areas in order to boost the effectiveness of abstinence-only education programs. Rather than designing an entirely novel
intervention strategy, the proposed idea will build on and modify the existing approach.
Therefore, the following guidelines should be incorporated into the existing requirements
for approved programs under the Title V grant program.
1. Each curriculum
will have one segment dedicated solely to exploring the most important drivers
of what shapes our beliefs and values about sex. This can be in conjunction with modules regarding peer
pressure; however, there must be particular and sufficient coverage on media
literacy and the effects of sexual media.
2. While abstaining
from sex will continue to be the core message of abstinence-only education,
further requirements should include that portions of each curriculum should
address safe-sex practices.
3. Programs and
instructors will be restricted from employing extreme tactics that could
potentially inflict emotional harm and incite adverse reactions.
These recommendations will bolster abstinence-only
education programs by ensuring that the curriculum addresses key facets of sexual
behavioral learning. Additionally,
the programs will be more suited to meet the full needs of participants by
taking a more realistic approach which considers a broader set of decisions
teens will face regarding sex.
Moreover, the recommendations will ban harmful practices that have been
linked to promoting bad self-esteem, poor learning outcomes and rebellious
attitudes.
Articulation of the proposed
intervention: Supporting argument 1
According to the Theory of Reasoned Action, both
subjective norms and attitudes towards a behavior contribute to behavioral
intention. Abstinence-only education has not been proven to change teens’
attitudes and values towards premarital sex; however, movies, music and other
media have been shown to significantly influence these attitudes. In order to address a major disparity
in abstinence-only education, programs will be required to include modules on
media literacy and the effects of sexual media.
A recent study of over 900 adolescents who underwent media
literacy training provides sound evidence for this recommendation. Pinkleton et al indicated that “participants
who received media literacy training better understood that media influence
teens' decision making about sex and were more likely to report that sexual
depictions in the media are inaccurate and glamorized” (28). By helping teens
recognize the sexual fallacies projected by the media, they will be less
inclined to form distorted subjective norms about sex. Furthermore, the study
cited that participants who took part in the training were more likely than the
control group to believe that other teens practice abstinence. The experimental group also reported a
greater ability to resist peer pressure. Overall, the study provided solid
evidence of how media literacy can positively influence teens’ beliefs about
sex and logic-oriented decision-making process.
In another study, a teen-led media literacy curriculum
targeted primarily to middle school students was evaluated at 22 school and
community sites. The program
helped to correct media-driven misperceptions that overestimated sexual
activity among teens as the result of cognitive heuristic availability. Participants were also less likely to
expect social benefits from having sex or engaging in sexual behavior. These results further enforce the
promise of using media literacy training to influence or reshape adolescents’
attitudes and beliefs about sex. Requiring such training as part of
abstinence-only education would provide participants with a “cognitive
framework necessary to understand and resist the influence of media on their
decision making concerning sex” (29).
Articulation of the proposed intervention:
Supporting argument 2
Despite the overarching purpose to promote abstinence,
programs need to include a safe-sex module. The current model for abstinence-only education is
unrealistic because it does not consider that irrational behavior will still
occur and many teens will still choose to have sex. It is essentially a Health Belief Model-based approach. Basically,
by only focusing on decision-making as a means to prevent sexual activity, the
approach ignores an entire portion of its audience – adolescents that will
still have sex or are currently sexually active. It is important to remember that
for multiple Title V abstinence-only programs, control and program group youth
reported similar rates of sexual activity (4-7). Therefore, a safe-sex module that covers the use of
contraception and birth control should be required as part of approved curricula. More importantly, this learning segment
should also describe how emotional physical states affect our ability to make
decisions. Specifically, participants should be exposed to the concept of hot
vs. cold decision-making to further understand how their physiological
responses to sexual stimuli will significantly impact their decision-making
ability.
Of course, it may take some persuading to include a “safe
sex” module into an abstinence-only curriculum. However, highlighting the scientific basis for irrational
decision-making would help to make a strong case. Social Cognitive Theory is
considered more advanced in comparison to the Health Belief Model because it
considers irrational behavior as it contributes to irrational decision-making. Requiring a safe sex component of the
curricula will enable abstinence-only education programs to become better
aligned with more modern (accurate) theories of social and behavioral
processes.
Articulation of the proposed intervention:
Supporting argument 3
Based on the risks involved with negative messaging,
programs that include scare tactics and so-called “slut-shaming” should not be
funded under Title V. Instead, more evidence-based methods should be employed. One
particular approach that has been correlated with the lowest risk for STDs is
the promotion of self-efficacy. In fact, perceived self-efficacy, or a belief
in one’s ability to exert control over his or her sexual behavior, has been
identified as one of the best predictors of sexual risk-taking (30). At the
risk of leaning towards a comprehensive strategy, self-efficacy skills should
be taught for both abstinence and safe sex. More specifically, sexual self-efficacy skills may include
how to negotiate sexual activity and/or use contraception such as condoms or
birth control (31).
By removing negative messaging from abstinence-only
curriculums, a more conducive environment for promoting self-efficacy can be
developed. Further research is needed to develop more concrete recommendations
regarding which types of self-efficacy skills are most effective.
Conclusions
Abstinence-only education is not working and evidence
highlighting its flaws far outweighs the evidence-base for supporting its
effectiveness. Upon applying
well-known social behavioral theories, it is clear that gaps in abstinence-only
education programs are creating barriers to preventing unwanted pregnancies and
the transmission of STDs. Therefore, enhanced curriculum guidelines should
include required media literacy training as this type of intervention has shown
to directly influence adolescents’ attitudes and beliefs about sex.
Additionally, ensuring that curriculums provide a broader approach to
decision-making is critical. Learning about decision-making beyond the context
of abstinence is important because teens are more likely to make irrational
decisions in sexual situations. Also, restricting the use of negative messaging
tactics is necessary to create a positive environment where more effective
educational methods, such as self-efficacy training, can be implemented.
Overall,
applying these intervention strategies to the current framework for
abstinence-0nly education will increase the effectiveness of these programs.
1. Martinez G, Copen CE, Abma JC.
Teenagers in the United States: Sexual activity, contraceptive use, and
childbearing, 2006–2010. National Survey of Family Growth. National Center for
Health Statistics. National Vital Health Stat. 2011;23(31).
2. Solomon-Fears C. Teenage Pregnancy
Prevention: Statistics and Programs. Congressional Research Service. April 15, 2013.
3. Centers for Disease Control.
Sexual Risk Behavior: HIV, STD, & Teen Pregnancy Prevention. Atlanta, GA :
Centers for Disease Control and Prevention . Atlanta,GA. http://www.cdc.gov/HealthyYouth/sexualbehaviors/
4. Trenholm C et al. Impacts of Four
Title V, Section 510 Abstinence Education Programs (final report). Mathematica Policy Research, Inc., April
2007.
5. Jemmott JB, Jemmott LS, Fong GT. Efficacy
of a Theory-Based Abstinence-Only Intervention Over 24 Months. Archives of Pediatrics
and Adolescent Medicine 2010; 164, no. 2:152-159.
6. Kohler PK, Manhart LE, Lafferty
WE. Abstinence-Only and
Comprehensive Sex Education and the Initiation of Sexual Activity and Teen
Pregnancy. J Adolesc Health. 2008 Apr;42(4):344-51.
7. Toledo, C. Abstinence-only
education does not lead to abstinent behavior, UGA researchers find. UGA Today.
November 29, 2011. http://news.uga.edu/releases/article/abstinence-only-education-does-not-lead-to-abstinent-behavior/
8. Brown J. D. , Halpern C. T. , & L'Engle , K. L. Mass media as a sexual super
peer for early maturing girls . Journal of Adolescent Health 2005; 36:420-427.
9. Strasburger, VC. Adolescents and
the Media: Medical and Psychological Impact. Developmental Clinical Psychology
and Psychiatry, Volume 33.
Thousand Oaks, CA : Sage Publications, Inc. 1995.
10.
Bryant
J and Oliver M.B. Media effects: Advances in theory and research. New York, NY:
Routledge, 2009.
11.Tversky A and Kahneman D. Judgment
under Uncertainty: Heuristics and Biases. Science, New Series 1974;185:1124-1131.
12.
Title V State Abstinence Education Grant
Program Fact Sheet. Washington D.C.: Family and Youth Services Bureau. April 6,
2012. http://www.acf.hhs.gov/programs/fysb/resource/aegp-fact-sheet
13.
FACTS
Curriculum. Portland, OR: Northwest Family Services. http://www.nwfs.org/empowering-youth/facts-curriculum.html
14.
Promoting
Health Among Teens!-Abstinence Only Version (Overview). New York, NY: Select
Media Inc. http://www.selectmedia.org/programs/phatab.html
15.Making A Difference! (Overview).
New York, NY: Select Media Inc. http://www.selectmedia.org/programs/difference.html
16.
Harris
L and Associates. Sexual Material on American Network Television During the
1987–88 Season. New York, NY: Planned Parenthood Federation of America, 1988.
17.
Kunkel
D et al. Sex on TV 4. Washington D.C.: Kaiser Family Foundation. 2005. http://kff.org/other/event/sex-on-tv-4/
18.
Chandra
A et al. Does Watching Sex on Television Predict Teen Pregnancy? Findings From
a National
Longitudinal Survey of Youth. Pediatrics 2008;122;1047-1054.
19.
Ariely
D. Predictably Irrational : The Hidden Forces That Shape Our Decisions.
New York, NY: Harper Collins Publishers. 2008.
20.
US House of Representatives Committee on
Government Reforms – Minority Staff, Special Investigations Divisions. The
Content of Federally Funded Abstinence-Only Education Programs. Washington,
D.C. 2004. http://www.apha.org/apha/PDFs/HIV/The_Waxman_Report.pdf
21.
Ferguson
D. States with ‘abstinence-only’ sex ed programs rank highest in teen
pregnancies. The Raw Story. April 11, 2012. http://www.rawstory.com/rs/2012/04/11/states-with-abstinence-only-sex-ed-programs-rank-highest-in-teen-pregnancies/
22.
Nicholson,
E. Faced With Rising Teen STD Rates, County Health Officials Lobbying DISD to
Jettison Abstinence-Based Sex Ed. The Dallas Observer. March 19, 2004. http://blogs.dallasobserver.com/unfairpark/2013/03/teenagers_volatile_bundles_of.php
23.
Pam
Stenzel: Review. Community Action Toolkit. http://www.communityactionkit.org/index.cfm?fuseaction=page.viewpage&pageid=1002
24.
Kempner
M. They’re Baaaaaack: Abstinence-Only Programs Rely on Scare Tactics and
Humiliation to Spread Misinformation. RH Reality Check. October 28, 2009. http://rhrealitycheck.org/article/2009/10/28/they%E2%80%99re-baaaaaack-abstinenceonly-programs-rely-scare-tactics-and-humiliation-spread-misinformation/
25.
Petrosino
A, Turpin-Petrosino C, Buehler J. “Scared Straight” and other juvenile
awareness programs for preventing juvenile delinquency [Cochrane review]. In:
The Cochrane Library. Issue 4. Chichester, United Kingdom: John Wiley &
Sons, Ltd, 2004
26.
Ethier KA. Self-esteem, emotional distress and
sexual behavior among adolescent females: Inter-relationships and temporal
effects. Journal of Adolescent Health 38 (2006) 268–274.
27.
Owens E. High schoolers complain, tweet about
slut-shaming during abstinence-only assembly. The Daily Caller. April 12, 2013.
http://dailycaller.com/2013/04/12/high-schoolers-complain-tweet-about-slut-shaming-during-abstinence-only-assembly/
28.
Pinkleton
B, Weintraub Austina E, Yi-Chun C, Cohenc M. The Role of Media Literacy in
Shaping Adolescents' Understanding of and Responses to Sexual Portrayals in Mass
Media. Journal of Health Communication: International Perspectives 2012;17:460-476.
29.
Pinkleton B, Weintraub Austina E,
Yi-Chun C, Cohenc M, Fitzgeraldd E.
Effects of a Peer-Led Media Literacy Curriculum on Adolescents' Knowledge and
Attitudes Toward Sexual Behavior and Media Portrayals of Sex. Health Communication 2008;23:462-472
30.
Bandura
A. Self-efficacy beliefs of adolescents (pp. 307-337). In F. Pajares & T.
C. Urdan (Eds.) Guide for constructing self-efficacy scales. Greenwich, CT:
Information Age, 2006.
31.
Kali S. Van Campen et al. “I Have What?”: How Sexual
Self-Efficacy and Sexuality Education Are Associated with STD Risk in
Adolescence. Francis McCelland Instisute. http://mcclellandinstitute.arizona.edu/sites/mcclellandinstitute.arizona.edu/files/I%20Have%20What%20How%20Sexual%20Selfefficacy%20and%20Sexualtiy%20Education%20are%20Associated_VanCampenToomey.pdf
No comments:
Post a Comment