Abstinence-only Research Articles

Battling a ‘sex-saturated society’: The abstinence movement and the politics of sex education

The abstinence movement in the USA, as a sector of the Christian Right, advocates abstinence before marriage and links abstinence to Evangelical Christian morality, sexual purity, and heterosexual marriage. A number of single-issue abstinence groups have formed over the past 10 to 15 years in the USA; their political success in advocating a ‘values-based’ response to sexuality and the current scope of abstinence education is unprecedented in US politics. With the election of President Obama, however, the movement faced the loss of the majority of its funding and powerful elite allies. Using in-depth interviews with directors of four groups that comprise the core of the movement, this article analyzes the movement’s agenda and strategies at this critical juncture in its history.

Assessing Capacity to Promote Science-Based Programs: A Key Informant Study of State Teen Pregnancy Prevention Organizations

The purpose of this qualitative study was to identify significant external and internal challenges that state organization leaders face in promoting science-based teen pregnancy prevention programs within their states. The state organization administrators were chosen because their organizations were funded by the U.S. Centers for Disease Control and Prevention (CDC) to promote science-based prevention programs between 2005 and 2010. Given a recent federal infusion of $155 million to replicate science-based programs nationwide, this study is timely. Data reported in this article were collected annually over three years (2006–2009) using semi-structured interviews. External factors influencing success include the states’ socio-political climate, including the impact of abstinence-only programs; internal factors include infrastructure, recruitment, and retention of key partners, organization, board, and staff management and financial sustainability.

The Practical Problems and Progress of Western Mainstream Sex Education Models

Abstract: The contemporary western mainstream sex education models are “Abstinence -Only Sex Education” and “Comprehensive Sex Education”. Reflection of the two models’ practices in China reveals that Abstinence-Only Sex Education, by means of “moral bundling”, tend to employ the old morality to repress adolescents’ sexuality; Comprehensive Sex Education is inclined to the “sexual abetting” with indulgment in the teaching and adjustment of sexual knowledge and sexual psychology. To solve the practical difficulties between the two models, it is necessary to establish a new sex education model based on the morality which integrates the advantages of the two models. Key words: Sex Education Models; Moral Bundling; Sexual Abetting; Morality

Beyond faith-based organizations: using comparative institutional ethnography to understand religious responses to HIV and AIDS in Brazil.

Religious institutions, which contribute to understanding of and mobilization in response to illness, play a major role in structuring social, political, and cultural responses to HIV and AIDS. We used institutional ethnography to explore how religious traditions--Catholic, Evangelical, and Afro-Brazilian--in Brazil have influenced HIV prevention, treatment, and care at the local and national levels over time. We present a typology of Brazil's division of labor and uncover overlapping foci grounded in religious ideology and tradition: care of people living with HIV among Catholics and Afro-Brazilians, abstinence education among Catholics and Evangelicals, prevention within marginalized communities among Evangelicals and Afro-Brazilians, and access to treatment among all traditions. We conclude that institutional ethnography, which allows for multilevel and interlevel analysis, is a useful methodology.

Translating abstinence education theory into practice: A case study of the implementation challenges of operationalizing logic models in federal demonstration projects

Federally financed programs designed to address social ills, including unwanted pregnancies, sexually transmitted diseases and substance abuse, among other health concerns, increasingly have been required to anchor their design in an underlying theory and research base, and their evaluation in methodologically rigorous, outcomes-based approaches. These approaches have included experimental design, randomization, and power analysis. At the same time, the implementation of federally financed programs increasingly has moved from government offices to small, nonprofit community agencies, and more and more has been based in public schools. This article focuses precisely on the challenges to faithful program implementation posed by the peculiarities of the school setting and by the limited capacities of most community agencies, as reflected in the case of one federal demonstration project, the Family Life Abstinence Program (FLAP). We begin with a brief description of the FLAP federal demonstration project, whi...

ESTEEM and FACTS: Creative Ways to Teach Healthy Lifestyles to Youth from Diverse Backgrounds

Two health education programs illustrating different ways to engage youth from racially and ethnically diverse backgrounds in positive youth development lessons and activities are described for practitioners in schools and community agencies. Both programs were developed in collaborative efforts between public school health teachers and community organizations and resulted in abstinence education curricula suitable for use in either schools or community agencies. Both programs were effective with youth from different racial and ethnic backgrounds in promoting setting wholesome personal goals, developing prosocial and healthy relationships, and avoiding risky behaviors such as premature sexual activity or abuse of alcohol and illegal drugs. Federal programs designed to prevent teen pregnancy facilitated the development and evaluation of both programs. ESTEEM was developed in Texas at the Longview Wellness Center and FACTS was developed in Oregon by Northwest Family Services.

Applications in Bridging the Gap: A Community-Campus Partnership to Address Sexual Health Disparities Among African-American Youth in the South

Risky sexual behavior among African-American youth increases risks for sexually transmitted diseases and unintended pregnancy. This article describes a community-academic partnership to assess The 2 HYPE Abstinence Club, a program combining abstinence education with stress management and creative arts promotion for African-American youth ages 12-18. Bi-directional learning and communication systems were established to facilitate culturally relevant evaluation approaches, quality assurance in data collection, and action-based protocols for on-going improvement. Assessment tools included self-administered surveys and focus groups to gauge intervention effectiveness and perceptions regarding abstinence, sexual peer norms and intervention characteristics. Statistically significant increases in the understanding of abstinence benefits and sexual activity risks were observed and youth identified goal-setting and refusal skills as most important program components. Youth-instructor relationships and the integration of hip-hop were reasons cited for sustained participation. This assessment partnership represents a rapport with minority youth and a participatory evaluation approach adding programmatic and evidence-based value to intervention efforts.

Evaluation Exemplar: The Critical Importance of Stakeholder Relations in a National, Experimental Abstinence Education Evaluation

This piece describes Mathematica’s abstinence education evaluation, provides interviews with the evaluation’s two lead authors (Trenholm and Devaney), and offers reflections on the study.

Government Influence and Community Involvement on Abstinence-Only Programs in 1999 and 2003

In this study, we compare federal government influence on abstinence-only programs in 1999 and 2003 to better see how shifts in the federal government's sex education polices impacted other government and community actors. Using data from the Sex Education in America Surveys (SEAS), we find that changes in federal policy, particularly after the year 2000, significantly altered the influence of state and local governments and the involvement of other community actors on school sex education programs. As federal influence increased, the number of abstinence-only programs continued to grow. The influence and involvement of other key actors declined, changing the face of sex education.

Hold the sex, please: the discursive politics between national and local abstinence education providers

There are many assumptions made about the beliefs behind abstinence-only until marriage (AOUM) sex education, yet comparatively little research examining the views of abstinence education providers. Drawing on in-depth interviews with 21 abstinence grantees throughout New York State, I examine how individuals working in abstinence organizations conceive of AOUM education and understand their work in the broader spectrum of sex education efforts. I contrast these understandings with the national-level abstinence discourse, using data collected from two national, government-sponsored conferences for federal abstinence grantees. The comparative focus reveals a disjuncture between the national agenda and the varied understandings that local abstinence organizations bring to abstinence education. While the national movement frames abstinence using a discourse of scientific morality, local providers resist this framing. Local providers express ambivalence around AOUM education and manage contradictory feelings by discursively repurposing abstinence education in ways that better reflect the needs of their communities. This local level variation underscores the importance of contextualizing research on sex education.

Feeling abstinent? Feeling comprehensive? Touching the affects of sexuality curricula

This interpretive study draws on interdisciplinary scholarship on affect and knowledge to ask: toward what feelings do abstinence-only and comprehensive sexuality education curricula direct us? A methodology that is attuned to double exposures is discussed, and one abstinence-only sexuality education curriculum and one comprehensive sexuality education curriculum are reviewed. The interpretation provides an alternative to the usual representation of these curricula as oppositional. Both of the curricula direct knowers to feel sure, optimistic, and free. Both curricula evidence longings for stable knowledge and guaranteed meanings. Finally, learners are directed to feel that knowledge can solve all problems smoothly and happily. Mistakes, negativism, and confusion are excluded from both sets of sexual knowledge. Implications of this interpretation for changing sexuality education are discussed.

Acting Out Abstinence, Acting Out Gender: Adolescent Moral Agency and Abstinence Education

This article explores faith-based, performance-oriented abstinence education through the lens of feminist theology by drawing on fieldwork with an urban, young adult dance and drama team whose mission is to promote abstinence through performances at high schools and church rallies. Through observation of performances and interviews with performers and program leaders, I examine abstinence education by looking at the way gender is performed both on stage and in everyday life. I argue that the performances observed in this setting can provide a space by which to examine the gendered nature of abstinence pledges. I then ask how the gendered nature of abstinence-only education affects limitations of agency as I argue that the gender roles present within faith-based abstinence education programs could be the greatest obstacle in encouraging a delay of sexual debut among adolescents and young adults.

Talking to Teens about Sex: Mothers Negotiate Resistance, Discomfort, and Ambivalence

Abstinence-only sex education is based in part on the premise that parents are their children’s best sex educators. In-depth interviews with 40 mothers of teenagers suggest, by contrast, that these mothers experience numerous challenges around talking to their children about sexuality. In this paper, I examine three of the most common barriers in mothers’ accounts of “the talk.” First, mothers perceive their teenagers as highly resistant to these conversations. Second, they experience embarrassment and discomfort around talking to their teens about sex and sexuality. Third, they expressed ambivalence about when, what, and how much to say to their children about these topics. I argue that these obstacles are shaped by cultural anxieties and contradictions around parenting, sexuality, and adolescence that are fueled by debates, policies, and programs over the past 30 years that have promulgated a danger discourse of child and teen sexuality. The conclusion discusses the social policy implications of this research.

Abstinence-only education modestly delays initiation of sexual activity

Abstinence-only education modestly delays initiation of sexual activity

IMPROVING ACCESS TO OPIATE ADDICTION TREATMENT FOR PRISONERS

Larney highlights the limited evidence base regarding the impact of opiate substitution therapy (OST) in prisons on injection drug use (IDU), IDU-related human immunodeficiency virus (HIV) risk behaviors and HIV outcomes, calling for new research on this important topic [1]. Given that nearly all heroin injectors nation-wide are incarcerated at some point during their lives, the correctional setting provides an important opportunity to treat a hard-to-reach population with proven, evidence-based pharmacological therapy [2]. We recently conducted a nation-wide mixed-method survey of state and federal prison medical directors about OST prescribing attitudes and practices; our findings help to explain several of the complex factors underlying this limited evidence base [3]. We found that in spite of the proven health, social and economic benefits of providing OST [4–8], only 55% of prisons in the United States provide methadone to inmates in any circumstance, and most provide only to pregnant women [3]. Only 14% of prisons provide buprenorphine to prisoners while incarcerated [3]. While this represents a marked improvement in access to OST in correctional settings since 2002 [9], only a minute fraction of the estimated 200 000 incarcerated individuals with opiate dependence have access to OST [3]. Moreover, our survey found that the overwhelming majority of prisons also do not offer referrals to OST providers and programs to inmates upon release because of preferences for drug-free detoxification over pharmacological treatment of opiate dependence and limited partnerships with community providers, among other reasons [3]. Many prisons adopt abstinence-only policies because of philosophical opposition to pharmaceutical treatment of opiate dependence and preference for abstinence-only programs for incarcerated individuals [3]. These policies reflect a common misconception that opiate dependence is cured when drug use and withdrawal symptoms cease and ignores empirical evidence demonstrating high rates of relapse and alarmingly high rates of opiate overdose among people recently released from prison [10,11]. Other factors also play a role in limiting OST in correctional settings; even medical directors receptive to providing OST often face administrative and budget constraints that limit implementation of OST programs [3]. Moreover, other research finds that security concerns and philosophical opposition to OST by correctional staff can impede expansion of OST in correctional settings [12]. We have a 20-year history of collaborating with the Rhode Island Department of Corrections and have managed to overcome many of these barriers. However, collaborating has required significant time and commitment from both parties. This collaboration has resulted in numerous federally funded research and service grants which have greatly benefited hundreds of opiate-dependent individuals leaving the correctional setting. Building the evidence base about the health, social and economic benefits of providing OST in correctional settings will probably require more than simply financing new research studies. Advancing OST research and programs in correctional settings will require educating medical directors and administrators about the social, medical and economic benefits of OST; overcoming administrative and political opposition to pharmacological treatment of opiate dependence; understanding and successfully addressing the security concerns of prison officials and staff; and overcoming severe budget constraints. Amy Nunn receives consulting fees from Mylan Inc. This paper was supported by grant numbers 1K24DA022112-01A from the National Institute on Drug Abuse, National Institutes of Health (NIDA/NIH); grant number P30-AI-42853 from the National Institutes of Health, Center for AIDS Research (NIH/CFAR); grant number P30DA013868 of the Tufts Nutrition Collaborative, a Center for Drug Abuse and AIDS Research; grant number 1R01DA018641-01 from the National Institute on Drug Abuse, National Institutes of Health (NIDA/NIH); and training grant number 5T32DA13911 from the National Institute on Drug Abuse, National Institutes of Health (NIDA/NIH). None of the aforementioned agencies had any role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Abstinence and teenagers: prevention counseling practices of health care providers serving high-risk patients in the United States.

Abstinence-only education has had little demonstrable impact on teenagers' sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers' reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention. In 2005, a qualitative study with 31 clinicians serving low-income, at-risk patients was conducted. A semistructured interview guide was used to ask clinicians about adolescent pregnancy, HIV and STD prevention counseling, and when they include abstinence. Thematic content analysis was used to examine the content of the counseling and the techniques used in different situations. Providers reported offering comprehensive counseling, presenting abstinence as a choice for teenagers, along with information about contraceptives and condoms. Several providers mentioned that with young, sexually inexperienced teenagers, they discuss delaying sexual activity and suggest other ways to be affectionate, while giving information on condoms. Providers explained how they assess whether teenagers feel ready to be sexually active and try to impart skills for healthy relationships. Some described abstinence as giving teenagers a way to opt out of unwanted sexual activity. Many support abstinence if that is the patient's desire, but routinely dispense condoms and contraceptives. Overall, providers did not give abstinence counseling as a rigid categorical concept in their preventive practices, but as a health tool to give agency to teenagers within a harm reduction framework. Their approach may be informative for adolescent policies and programs in the future.

Reasons for and Challenges of Recent Increases in Teen Birth Rates: A Study of Family Planning Service Policies and Demographic Changes at the State Level

After declining for over a decade, the birth rate in the United States for adolescents aged 15-19 years increased by 3% in 2006 and 1% again in 2007. We examined demographic and policy reasons for this trend at state level. With data merged from multiple sources, descriptive analysis was used to detect state-level trends in birth rate and policy changes from 2000 to 2006, and variations in the distribution of teen birth rates, sex education, and family planning service policies, and demographic features across each state in 2006. Regression analysis was then conducted to estimate the effect of several reproductive health policies and demographic features on teen birth rates at the state level. Instrument variable was used to correct possible bias in the regression analysis. Medicaid family planning waivers were found to reduce teen birth rates across all ages and races. Abstinence-only education programs were found to cause an increase in teen birth rates among white and black teens. The increasing Hispanic population is another driving force for high teen birth rates. Both demographic factors and policy changes contributed to the increase in teen birth rates between 2000 and 2006. Future policy and behavioral interventions should focus on promoting and increasing access to contraceptive use. Family planning policies should be crafted to address the special needs of teens from different cultural backgrounds, especially Hispanics.

Sex education and contraceptive use at coital debut in the United States: results from Cycle 6 of the National Survey of Family Growth

Background The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents. Methods This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Contraceptive use and type used were compared among sex education groups [abstinence only (AO), birth control methods only (MO) and comprehensive (AM)]. Analyses also evaluated the association between demographic, socioeconomic, behavioral variables and sex education. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. Results Of 1150 adolescent females aged 15–19 years, 91% reported formal sex education (AO 20.4%, MO 4.9%, AM 65.1%). The overall use of contraception at coitarche did not differ between groups. Compared to the AO and AM groups, the proportion who used a reliable method in the MO group (37%) was significantly higher (p=.03) (vs. 15.8% and 14.8%, respectively). Conclusions Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche.

Beyond abstinence-only: relationships between abstinence education and comprehensive topic instruction

In the United States, a debate exists as to whether abstinence-only or comprehensive sexuality education strategies are most beneficial for school-age youth. Despite abstinence being a fundamental component of comprehensive education, the two are often characterized as polar opposites. Few studies have examined overlaps between the approaches. The purpose of this study was to examine relationships between abstinence education and comprehensive topic instruction among sexuality education teachers. Data came from public school teachers (n = 199) in Florida. Abstinence instruction was measured using the Section 510 A–H guidelines. Comprehensive topic instruction was measured using the Sexuality Information and Education Council of the United States' guidelines. Logistic regression analyses measured relationships between abstinence and comprehensive topic instruction. Nearly one-half of teachers taught all eight A–H guidelines, and the majority taught most comprehensive sexuality education topics. The odds of teaching comprehensive sexuality education topics generally increased as teachers taught more of the federal government's abstinence guidelines. This suggests that abstinence instruction, a core element of comprehensive sexuality education, may increase alongside instruction on other comprehensive topics. We discuss the relevance our findings have for understanding the nature of both abstinence and comprehensive sexuality education.

Sexuality education policies and sexually transmitted disease rates in the United States of America

The aim of the study was to test for relationships between state-level sex educational policies and sexually transmitted disease (STD) rates. We analysed US case reports of gonorrhoea and chlamydial infection for 2001-2005 against state policies for abstinence coverage in sexuality education, using the proportion of the population per state who identified as black (aged 15-24 years) as a covariate. We also tested for effects on 15-19 year olds versus 35-39 year olds and tuberculosis rates (the latter to ensure findings applied only to STD). States with no mandates for abstinence had the lowest mean rates of infection among the overall population and among adolescents. States with mandates emphasizing abstinence had the highest rates; states with mandates to cover (but not emphasize) abstinence fell in between. Rates in some states covering abstinence changed faster than in others, as reflected in sharper declines (gonorrhoea) or slower increases (chlamydial infection). These effects were not shown for tuberculosis or 35-39 year olds. Having no abstinence education policy has no apparent effect on STD rates for adolescents. For states with elevated rates, policies mandating coverage may be useful, although policies emphasizing abstinence show no benefit.