Critique of Abstinence-Only Education - Alex Ireland

Since 1981, with the enactment of the Adolescent Family Life Act “providing comprehensive health, education and social services to pregnant and parenting adolescents” the Federal government has spent more than $1.5 billion on abstinence-only education. Abstinence-only education teaches in accordance to eight descriptions of “abstinence education” established in Section 510(b)(2) of Title V of the Social Security Act; endorsing the concepts that abstaining for sexual activity outside of marriage is the only way to avoid unwanted pregnancies, sexually transmitted disease, and other associated health problems, including psychological and physical effects (Community Based Abstinence Education). Despite delegated funds for research, care, and prevention projects for abstinence promotion and sincere intentions to protect the well being of America’s youth, the Federal government’s own research concluded that its “long-term research has clearly shown that abstinence-only programs do not delay sexual initiation nor do they reduce rates of either teen pregnancy or sexually transmitted infections” (Howell).

Abstinence-only based education is a public health intervention of myriad flaws and misused theories and techniques. When developing an effective public health intervention, it is important to remember that complicated behaviors are not always simple personal choices but rather are deeply intertwined within a person’s human behavior and within a person’s environment. Abstinence-only education created a curriculum, but missed on success; invoking psychological reactance in adolescents, promoting fear-based advertising, and misusing the Health Belief Model. Promoting abstinence-only education programs is economically wasteful, inefficient, and ineffective.

The Rebellion of Psychological Reactance

As explained by Dr. Michael Siegel, psychological reactance theory is the fundamental idea that when people believe their freedom to choose an action is threatened they subsequently experience reactance, motivating the individual to engage in that particular behavior (Siegel, 11 April 2013). Social psychologist Jack Brehm additionally defines psychological reactance as “a threat to or elimination of a behavioral freedom impels the individual to restore the particular freedom that was threatened or taken away” (Brehm, J.). The abstinence-only curriculum’s motto “Just say no” is inadvertently invoking adolescents in abstinence-only education to rebel against the curriculum. The typically subconscious rebellion of psychological reactance transpires through a three-step process where (1) people perceive an unfair restriction on their actions, (2) a state of reactance is activated, and (3) the person must act to remove the reactance (Greece). Psychological reactance is ubiquitously entwined in abstinence-only education because adolescents are definitively told their only option to sexual activity is to abstain. In response, adolescents feel a greater need to defend their freedom, which could justify why study findings “show no overall impact on teen sexual activity” and “no differences in rates of unprotected sex” (Trenholm).

            Psychological reactance is the fundamental, simplistic notion that “we want what we can’t have” and is presumed to be naturally programmed in human behavior. In 1997, Sharon Brehm, wife of social psychologist Jack Brehm, tested psychological reactance theory by exposing two-year-old boys to different scenarios, involving (1) similar objects, one placed behind a large barrier and the other freely available, (2) dissimilar objects, one placed behind a large barrier and the other freely available, and (3) dissimilar objects, one placed behind a small barrier and the other freely available. The study concluded, boys preferred the dissimilar object only when the barrier was large; invoking the hypothesis that psychological reactance is experienced when an individual’s freedom is threatened (Brehm, S.).

Likewise, social and behavioral psychologists are aware that scare tactics do not work and contradictorily lead individuals toward the behavior. According to The Content of Federally Funded Abstinence-Only Education Programs, under the Special Investigations Division of the United States House of Representatives, “over 80% of the abstinence-only curricula, used by over two thirds of Special Programs of Regional and National Significance Community-Based Abstinence Education (SPRANS) grantees in 2003, contain false, misleading, or distorted information about reproductive health.” Including discrediting the efficacy of condoms in preventing sexually transmitted disease and unwanted pregnancies and that this popular claim is not supported by the data and that pregnancy still occurs with condom use one out of every seven times. This skewed or false information is used as a scare tactic, intending to instill fear from sexual activities, thus idyllically encouraging abstinence (Waxman). The unintentional consequence of imploring an abstinence-only approach induces psychological reactance by threatening adolescent’s freedom of choice, which is only exponentiated with falsified scare tactics.

Fear-Based Advertising Theory:

In addition to the Psychological Reactance Theory, the traditional public health paradigm of the Advertising Theory attempts to frame positive health behaviors around what individuals should want. The abstinence-only curriculum embodies the idea that people should want to avoid unwanted pregnancies and sexually transmitted infections and disease by abstaining from sexual intercourse until marriage. What the Advertising Theory of the traditional public health paradigm does not consider is that there is a substantial difference in what people should want and what people actually do want.

The familiarity of continuous failure from the Drug Abuse Resistance Education, simply referred to as D.A.R.E., comes as no surprise to the everyday American. Since founded in 1983, the D.A.R.E. campaign uses police officers to lead classroom lessons, teaching kindergarten through K-12 students how to resist peer pressure and live productive drug and violence-free lives; by giving them the skills they need to avoid involvement in drugs, gangs, and violence and to “Just say no!” (About D.A.R.E.). Unfortunately, the campaign officers inappropriately use intimidation, scare tactics, and fear-based advertising in attempts to reduce rates of drug use and violence. In the study ‘Fear Appeals: Amelioration of Ethical Suspicion’ conducted by Dr. Ritika Jain, fear-based advertising “is a specific type of social marketing that employs scare tactics or other anxiety-producing mechanisms to highlight the dangers of engaging or not engaging in a certain practice” (Ritika, J.) In conjunction, Communication Theory has shown that using a fearful message, instilling trepidation in the audience actually has the opposite effect of what it intends. Inadvertently causing adolescents to tune out and to disregard the message entirely, despite reasonable intentions and practical messages (McGuire).

In respect to the abstinence-only education, inducing fear and anxiety about sex and sexual health and behaviors may inadvertently foster interests and promote sexual activity. Additionally, by endorsing false benefits of condom and contraception use, adolescents may form a fatalistic mindset. In this case, fatalism would refer to the idea that the risk of getting a sexually transmitted infection or disease or accidentally getting pregnant is so great that it is therefore inevitable. By focusing on total risk elimination, or abstinence, rather than a more reasonable and attainable risk reduction strategy, the message lays out unrealistic goals and essentially sets the stage for the individual to fail (Siegel, 11 April 2013).

The empirical evidence that instilling fear and using scare tactics in children and adolescents is an inadequate and ineffective way to promote healthy behavior, as seen in the D.A.R.E. program and in the abstinence-only education.

Abstinence-only Education & The Health Belief Model (Theory to Reason for Action)

As with many health education curriculums, abstinence-only education is built upon the psychological and behavioral theory known as the Health Belief Model. At the individual level, the Health Belief Model “suggests that a person’s belief in a personal threat of illness or disease together with a person’s belief in the effectiveness of the recommended health behavior or action will predict that likelihood the person will adopt the behavior” (Behavioral Change Models). The model is comprised of two principal components; first is the desire to avoid illness or get well if already ill, and the second is the belief that a specific health action will prevent, or cure, illness (Behavioral Change Models). This straightforward and seemingly reasonable theory contradictorily holds major caveats. The Health Belief Model does not account for social and environmental factors that affects health nor does is consider that intentions do not always lead to healthy behavior.

In the book Predictably Irrational, the author Dan Ariely and colleague George Loewenstein conducted a study to understand the degree to which rational, intelligent people in a normal, or “cold” state, could predict how their attitudes will change when they are in an impassionate, or “hot” state (Ariely). The study was conducted to determine associations between decision-making and sexual arousal. The study premise was for male college students to answer a series of questions regarding predicted personal sexual activities and preferences when in a “cold”, rational state. Later, these same men were asked to answer the same series of questions regarding personal sexual activities and preferences when in a “hot”, sexually aroused state. Ariely and Loewenstein compared the answers of the “cold” and “hot” states and concluded that all participants overwhelmingly under-predicted the amount to which sexual arousal contradicts or depreciates the conscious, rational mind; and when emotions of arousal and passion are paramount, “boundaries blur between what is right and what is wrong” (Ariely).

In regards to abstinence-only education, understanding capricious sexual emotions could give insight to the inefficiencies of abstinence-only education. Ariely states,

“Many parents and teenagers, while in a “cold”, rational state tend to believe that the mere promise of abstinence is sufficient protection against sexually transmitted diseases and unwanted pregnancies. Assuming that this levelheaded thought will prevail even when emotions reach the boiling point, the advocates of “just saying no” see no reason to carry a condom with them. But as our study shows, in the heat of passion, we are all in danger of switching from “Just say no” to “Yes!” in a heartbeat; and if no condom is available we are likely to say yes, regardless of the dangers.”

Ultimately, an individual's course of action often depends on the person's perceptions of the benefits and barriers related to health behavior (Behavioral Change Models). It is imperative to understand adolescent’s perception and motives in a “hot”, passionate state, rather than inefficiently educating them on abstinence-only while in a “cold”, rational state.

Despite good intentions the obvious, ubiquitous, and serious problems in abstinence-only education must be addressed and the curriculum is imploring to be transformed. The inability to understand adolescents’ behaviors or the proper use psychological reactance, the Health Belief Model, and Advertising Theory may  “help explain why these programs have not been shown to protect adolescents from sexually transmitted diseases and why youth who pledge abstinence are significantly less likely to make informed choices about precautions when they do have sex “(Waxman).

Proposed Interventions

In a Guttmacher Institute study, Trends in Premarital Sex in the United States 1954-2003, 95% of respondents had sex before marriage and even those who abstained from sex until at least age twenty still have premarital sex 84% of the time. Director of the Guttmacher Institute study, Lawrence B. Finer claimed, “Premarital sex is a normal behavior for the vast majority of Americans, and has been for decades.” Calling into question the efficacy of the abstinence-only curriculum. Sex education demands great changes and teaching that abstinence is just as important as the option to have sex. We are failing our adolescents and young adults by not providing a comprehensive sex education. Three methods of obtaining this goal would be (1) to provide comprehensive sex education to avoid inducing psychological reactance in adolescents, (2) use Social Network Theory to change attitudes at the group based, social level model for improvement in risky sexual behaviors, and (3) proper use of Marketing Theory.

Escaping Psychological Reactance:

            As we know, psychological reactance is naturally encoded in human behavior, and is ultimately the idea that “we want what we can’t have.”  Therefore, we need to change abstinence-only education to comprehensive sex education, making abstinence just as important as choosing to engage in sexual activity. Comprehensive sex education can be implemented in a complete and factual way, while fostering morale, autonomy and control over ones decisions.

            First and foremost, comprehensive sex education should indisputably provide accurate, up-to-date information about all varieties of sexual activities and health. This includes (1) providing the true efficacy of condom use in preventing unwanted pregnancies and sexually transmitted disease and infections, (2) educating adolescents on the true efficacy of different contraception methods, (3) providing photos and information about the average signs and symptoms of sexually transmitted disease and infections; not the most extreme, grotesque photos available, (4) showing what a health relationship looks like and how to communication with a partner, (5) what consent looks like, and (6) by providing accurate and trustworthy sexual health resources where the adolescents can find additional information, including welcoming health professionals whom they can talk to outside the sex education curriculum.

            Another way we can encourage adolescent’s autonomy and control over their sexual health is by providing adolescents with a series, or checklist, of sex-related questions in which they could answer to determine if they are ready to have sex. Questions would include: Do you have a partner? Do you trust each other and feel safe together? Listen to one another? Have you talked about having sex together? Have you talk about a contraception method or getting checked for sexually transmitted disease or infections? Are drugs and/or alcohol needed to engage in sexual activities? Do you both feel ready to do it? Do both of you want to have sex? Nobody is pressuring the other? If adolescents answer “yes” to all of these questions, then they may be ready to engage in sexual activity.

The Guttmacher Institute’s “The Impact of Abstinence and Comprehensive Sex and STD/HIV Education Programs on Adolescent Sexual Behavior” study, conducted in 2008, compared the success rates of abstinence-only education with comprehensive sex education. It reported that, “about two thirds of comprehensive programs showed strong evidence that they positively affected young people’s sexual behavior, including both delaying initiation of sex and increasing condom and contraceptive use among important groups of youth. Based on this review, abstinence programs have little evidence to warrant their widespread replication; conversely, strong evidence suggests that some comprehensive programs should be disseminated widely” (Kirby).

By changing abstinence-only education to comprehensive sex education curriculum, we can empower adolescents to make positive sexual health choices and help them navigate sex in a positive, healthy way. By giving them control over their actions we can greatly diminish and even eliminate psychological reactance.

Use of Social Network Theory

We can also use Social Network Theory to our advantages as another way to advertising abstinence or healthy sex behaviors, such as using condoms. Social Network Theory is a theory “explaining the influence of social networks on individual and group health behaviors” (Siegel lecture #13). We can accomplish and implement Social Network Theory through one of two different methods. First, we can find an adolescent at the social epicenter of a school or network that is in compliance with abstaining from sexual activity until in a relationship and promoting safe sex. Another way to use Social Network Theory would be by replacing teachers and adult facilitators of abstinence-only program to relatable, peer health educators. Dressing peer health educators in similar clothing to their adolescent audience and using similar language would be another great way to successfully promote safe sex.

In a 2005 study conducted by Paul J. Silva, ‘Deflecting Reactance: The role of similarity in increasing compliance and reducing resistance’ concluded that, “interpersonal similarity can reduce reactance by increasing compliance and by reducing resistance.” It continued on to say, “When the communicator was highly similar to the participant, people agreed strongly, regardless of threat. Similarity increased the force toward persuasion by increasing liking, and it decreased the force toward resistance by making the message seem less threatening” (Silva).

Using popular adolescents and relatable peer health educators to the target population of adolescents would encouragingly synchronize attitudes and acceptability towards safer sex and positive sexual health. Therefore, applying Social Network Theory to the development and implementation of a comprehensive sex education curriculum would result in a more successful health campaign than the previous abstinence-only education presented by unrelatable teachers and facilitators.

Use of Marketing Theory

            A great alternative to the hackneyed individual level Health Belief Model would be the use of the group level Marketing Theory. Marketing Theory differs from the traditional public Health Belief Model by selling or packaging a product or behavior that people do want, instead of a product that people should want. In regards to abstinence-only education, the Marketing Theory would tailor its curriculum to what adolescents do want. Packaging a product, also known as “branding”, is a fundamental element to the Marketing Theory because it brands an important core value around adolescents’ needs and wants. 

The “truth” campaign is a unique, anti-smoking movement whose philosophy and goal of is not to focus on the pro-smoker or anti-smoker individual, but rather to expose the malevolent and practically criminal product, research and advertising manipulations created by the tobacco industries (truth). The success of the “truth” campaigns came from its advertising strategy encouraging sensation-seeking teens to rebel against the tobacco industry. The campaign used striking images, one or two straightforward statistics representing the atrocities of cigarettes, and most importantly, sensation-seeking teens rebelling against the tobacco industry (Vallone). The “truth” campaign brands core values such as rebellion, freedom, and control to its marketing scheme to encourage adolescents to break the rules and rebel from the tobacco companies wicked and habituated addiction scheme.

When designing a Marketing Theory for comprehensive sex education, we would want to create a curriculum that is appropriately comparable to the “truth” campaign. The curriculum would have to embody significant and important core values, such as control and freedom, in which we would support and package our core values with facts, simple statistics, and powerful images. In conjunction, we want to make adolescents feel secure in the information they are receiving without sounding preachy and without condemning those who may already have had sex.

By implementing the proposed interventions combining empowering adolescent to take control over their sexual health and behavior, eliminating psychological reactance, using popular adolescents and relatable peer health educators, and creating positive rebellion marketing campaign by can promote delayed and safer sex we will be providing adolescent with the information necessary to make informed health decisions about their sexual health. According to the Guttmer Institute, research shows that by changing abstinence-only education to comprehensive sex education and giving adolescents accurate information actually “delays the age that they start having sex and lowers pregnancy rates and sexually transmitted infections” (Dreweke).

References

1.     About D.A.R.E. (2012). Drug Abuse Resistance Education. Retrieved: http://www.dare.com/home/default.asp

2.     Ariely, Dan (2008). Predictably irrational. HarperCollins Publisher; New York, p. 119-129.

3.     Behavioral Change Models (2013). Health belief models. Boston University School of Public Health. Retrieved: http://sph.bu.edu/otlt/MPH-Modules/SB/SB721-Models/SB721-Models2.html

4.     Brehm, Jack W. (1989). “Psychological reactance: theory and applications.” Associations for Consumer Research 16, p. 72-75. Retrieved: http://www.acrwebsite.org/search/view-conference-proceedings.aspx?Id=6883

5.     Brehm, S., Weinraub, M. (1997). Physical barriers and psychological reactance: 2-yr-olds’ responses to treats of freedom. Journal of Personality and Social Psychology 35(11), p. 830-836. Retrieved: http://psycnet.apa.org/psycinfo/1979-28160-001.

6.     Community Based Abstinence Education. Catalog of Federal Domestic Assistance. Retrieved: https://www.cfda.gov/?s=program&mode=form&tab=step1&id=a3b6c649224b2cad3b2470fbd5dd34d8.

7.     Dreweke, Joerg (2008). Review finds no evidence to support funding of rigid abstinence-only programs. Guttmer Institute. Retrieved: http://www.guttmacher.org/media/nr/2008/09/16/index.html

8.     Greece, Jacey (2012). “Theories of Motivation” SB721. Boston University, Boston. 10 Oct. 2012. Lecture.

9.     Howell, K. (2007). The history of federal abstinence-only funding. Advocate for Youth. Retrieved: http://www.advocatesforyouth.org/publications/429.

10.  Kirby, Douglas B. (2008). The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior. Sexual Research and Social Policy, 5(3), p. 18-27. Retrieved: http://link.springer.com/article/10.1525%2Fsrsp.2008.5.3.18.

11.  McGuire, W.J. (2001). Input and output variables currently promising for constructing persuasive communications. Public Communication Campaigns.

12.  Ritika, J. (2013). Fear appeals: amelioration of ethical suspicion. Indian Journal of Applied Research 3(4), p. 330. Retrieved: http://www.theglobaljournals.com/ijar/file.php?val=MTMzMQ==

13.  Seigel, Michael. “Social Network Theory, Maslow’s Hierarchy of Needs, the Law of Small Numbers, and Optimistic Bias and the Illusion of Control.” SB721. Boston University, Boston. 25 April 2013. Lecture.

14.  Seigel, Michael. “Social Expectations Theory and Psychological Reactance Theory” SB721. Boston University, Boston. 11 April 2013. Lecture. 

15.  Silva, Paul J. (2005). Deflecting Reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology, 27, p. 277-284. Retrieved: http://libres.uncg.edu/ir/uncg/f/P_Silvia_Deflecting_2005.pdf

16.  Trenholm, C., Devaney B., Fortson, K, et al. (2007). Impacts of four title V section 510 abstinence education programs. Mathematica Policy Research, Inc. p. 59. Retrieved: http://www.mathematica-mpr.com/publications/pdfs/impactabstinence.pdf

17.  Truth campaign (2013). Retrieved: http://www.thetruth.com/about/.

18.  U.S. Department of Human and Health Services, Office of Population Affairs. The Title XX Adolescent Family Life Program. Retrieved: http://www.hhs.gov/opa/familylife/strategicplanning/overview_v6.html

19.  Vallone, D. Evaluating the Truth Campaign. American Legacy Foundation. Retrieved: http://www.kff.org/entmedia/upload/EvaluatingthetruthCampaignDonnaVallone.pdf.

20.  Waxman, H. (2004). The content of federally funded abstinence-only education programs. United States House of Representatives Committee on Government Reform. Retrieved: http://www.apha.org/apha/PDFs/HIV/The_Waxman_Report.pdf.