Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Saturday, December 8, 2007

Missing the Mark on Teen Sex Education: The Failure of Abstinence Only Sex Education-ER

Introduction

Abstinence only sex education policies for teens fail to prevent them from engaging in sexual behavior because the policies fail to use social science theory in considering what influences teens.

Many states are using abstinence-only sex education for adolescents in the hopes of preventing early sexual behavior and consequent increased early pregnancy and STDs. The programs teach abstinence until marriage. The reason that states teach abstinence-only sex education is mainly monetary. Title V 510 state abstinence education programs, implemented in 1996, provides funding from the federal government to states which provide abstinence until marriage sexual education(14). Nationwide, 700 title V section 510 programs receive up to 50 million dollars in federal funding annually for such programs(13). The few vigorous studies of abstinence-only curricula that have been completed up to date do not show any overall effect on sexual behavior or contraceptive use (8).

My criticism is that this policy, which influences schools to teach abstinence until marriage sex education programs, is not based on social science theory and therefore, fails to prevent adolescents from engaging in sexual behavior. The programs do not take into consideration the influence of perceived norms and parental and peer influences(Theory of Reasoned Action) and self efficacy(Social Cognitive Theory) on adolescent behavior. The Sexual behavior of adolescents will depend on their perception of what those most influential to them believe to be normal behavior.

Peer influence

Peers are one of the most influential groups that determine adolescent behavior. Teens want to fit in and emulate their peers, so their perception of what their peers consider normal and acceptable behavior is important to their intentions to act on certain behaviors, like whether or not they intend to engage in sexual behavior. One study found that 12-year-old students who initiated sexual intercourse were more likely than those who had not initiated sexual intercourse to perceive a high prevalence of sexual initiation among peers, social gains associated with early sexual intercourse, and younger age of peer’s sexual initiation. Students who never had sex were more likely to believe that sexually experienced 12-year old boys would be negatively stigmatized compared with students in the initiated group(6). Each group was influenced by whether they thought their peers were accepting of sexual intercourse or not. Another study found similar results, concluding some of the strongest predictors of sexual behaviors were social normative factors and the behaviors of peers (1). One study found perception of friends behaviors is strongly associated with adolescent own sexual behavior even after factoring in mother/caretaker disapproval(12). Thus, showing peer influence can be stronger than parental influence. It is clear that programs should take into consideration the effect of perceived peer norms on adolescent behavior when creating effective sex education programs.

Parental Influence

Another important influence on teen sexual behavior is the parental/caretaker attitude towards sex. Parental influence on a teen’s sexual behavior depends on both the parents’ attitude toward sex and the relationship between parent and child. The combination of strong parental values disapproving of teenage sexual activity, close parent-child relationship connected-ness, and appropriate child monitoring has an interactive effect in lowering the risk of teen pregnancy(10). One study found that perception of maternal disapproval of adolescent sexual behavior not only tended to be associated with less frequent intercourse, but was positively associated with consistent use of birth control(5).

The effect of parental influence is complicated by gender and the patient/child relationship. As relationship quality improves, girls are less likely to have sexual intercourse compared with boys. Girls who experience poorer quality relationships with parents and high barriers to communication with them about sexual topics are especially vulnerable to early sexual activity(10). The same correlation was not found in boys

A good relationship with parent who is casual in their attitude about sex, may lead an adolescent to have sex earlier and more often. If the child has a bad relationship with parent and the parent is disapproving of adolescent sexual activity that also may lead to increase ,earlier sexual behavior. Maternal disapproval has a higher association with age at first sex(12). Programs should engage parents and adolescents in communication about sex. Parents need to be made aware of their effect on their child’s behavior.

Media Influence

Due to the increased sexual content permitted in the media, adolescents are exposed to sexual content which influences how they perceive sexual norms in society. One study examined adolescents between the ages of 12-17. They concluded adolescents that viewed more sexual content at baseline were more likely to initiate intercourse and progress to more advanced non-coital sexual activities during the subsequent year. Exposure to TV that included only talk about sex was associated with the same risks as exposure to TV that depicted sexual behavior. Both affected perceived norms regarding sex and thus sexual behavior(3). Another study demonstrated that those adolescents who had heavy exposure to sexual content through watching TV, listening to music, reading magazines, and watching movies are more likely than those with lighter exposure to have engaged in sexual activity(2). This was more clearly shown in white adolescents than black adolescents.

Studies concluded that peers having sex was one of the strongest predictors of risk for early intercourse for teens and that such perceptions may also be influenced by the kind of media to which teen is exposed(3). So teens who see sexual content in the media may feel that if everyone on TV or in music lyrics is having sex than their peers must be, and therefore, feel that the teen should be having sex. Sexual content in the media needs to be addressed through stricter policies and more discussion of its effect on adolescents in the sex education programs.

Self-Efficacy

An adolescent’s perceived self efficacy, a concept of The Social Cognitive Theory, may influence their sexual behavior. Adolescents will have a difficult time remaining abstinent if they are not convinced they have the ability to remain abstinent, especially until marriage.

Having successful experiences in communicating with parents and peers about sex will build a strong perceived self efficacy for such communications, which increases the chance that the adolescent will attempt such communication in the future. Adolescents who doubt their self efficacy to communicate about sexual issues will expect themselves to fail at it, and will therefore, be less likely to attempt to talk to peers or parents about sexual issues(4). This may lead adolescents to inaccurately perceive increased sexual activity and acceptance of sexual behavior.

Some adolescents with low self efficacy may not feel comfortable communicating with a partner to refuse sexual advances. A sense of control and self-efficacy in sexual negotiation is central in determining which girls will take an active role in protecting themselves from unwanted pregnancy and infection(9). Girls who have high self efficacy have the confidence to make decisions for themselves no matter how their partner feels about the decision. Programs need to focus more on building girls self confidence and increasing skills to refuse sexual advances when they want to, but also give them the skills to demand condom use when they do want to have sex.

Our society has double standards for boys and girls. Engaging in intercourse reaffirms masculinity and adolescent boys obtain status from sexual experience(9). Our society views males having sex as being a “man” and women having sex as being a “bad” girl. The effect of self-efficacy may not always yield positive outcomes. In some circumstances self-efficacy may increase opportunities for risky sexual behavior among adolescents (7) So, for many boys ,a high self efficacy would increase their sexual behavior even if the programs taught abstinence.

Homosexuals may have low self efficacy with abstaining from sex until marriage. Federal law and regulations limit the definition of marriage within the meaning of federally funded abstinence-only programs to exclude same–sex couples. For homosexual adolescents, lifelong abstinence as an implied alternative holds them to an unrealistic standard markedly different from that of their heterosexual peers(11). Given the fact that many homosexuals will not have the opportunity to get married because marriage is not legal or accepted in their society, they may feel it is an impossible task to stay abstinent forever.

Conclusion

I have discussed several reasons why abstinence until marriage sex education policies/programs fail to address some of the real reasons why adolescence engage in sexual behavior. Perceived peer sexual norms, perceived parental sexual norms for adolescents, perceived social norms as presented by the media, and perceived self-efficacy all influence sexual behavior in adolescents. Programs which teach sex education need to address these issues when trying to create an effective program to decrease sexual behavior. Programs need to use peers to help teach programs because peer approval of decreased sexual activity may decrease sexual behavior in adolescents and change peer norms. Parents/caretakers need to be involved in the program so communication between adolescent and guardian is open and easy to help inform adolescents about sexual issues and parental attitude. Policies must address sexual content in the media and make stricter guidelines for which types of behavior are allowed to be portrayed. Behavioral issues must be addressed in sex education programs aimed at behavior modification so teens will know how to address sexual issues when faced with them. More research must be done on sexual adolescent decision making and campaigns to address societal norms which may influence sexual behavior. However, even under the best circumstances, some teens will choose sexual activity over abstinence. For that reason, a more comprehensive approach is needed which teaches abstinence, contraception, effective communication skills and confidence building skills, and the impact of substance use and abuse. Abstinence until marriage is not our societal norm so teaching this to adolescents just does not work. Teaching risk reduction is a better way to go so that when our adolescents decide to have sex, they will be informed and safely prepared.

REFERENCES

1. Bachanas, Pamela J. et al. Predictors of Risky Sexual Behavior in African American Adolescent Girls: Implications for Prevention Intervention. Journal of Pediatric Psychology 2002; 27 (6) 519-530.

2. Brown, Jane D. et al. Sexy Media Matter: Exposure to Sexual Content in Music, Movies, Television, and Magazines Predicts Black and White Adolescents’ Sexual Behavior. Pediatrics Apr. 2006; 117(4):1018-1027.

3. Collins, R.L et al. Watching Sex on television Predicts Adolescent Initition of Sexual Behavior. Pediatrics Sept. 2004; 114(3)e280-e289.

4. Halpern-Felsher,B.L. et al. Adolescents’ Self-Efficacy to communicate About Sex: Its Role in Condom Attitudes, Commitment, and Use. Adolescence fall 2004. 39(155)443-456.

5. Jaccard,J. et al. Maternal correlates of Adolescent Sexual and Contraceptive Behavior. Family Planning Perspectives 1996; 28(4): 159-165&185.

6. Kinsman, S.B. Early Sexual Initiation: The role of Peer Norms. Pediatrics Nov. 1998; 102(5): 1185-1192.

7. Ludwig, K.B. et al. Adolescent prosocial Values and Self-Efficacy in relation to Delinquency, Risky Sexual Behavior, and Drug use. Youth and Society 1999; 30(4): 461-482.

8. The National Campaign to Prevent Teen pregnancy. Summary. Emerging Answers : Research Findings on programs to reduce Teen Pregnancy. http://teenpregnancy.org/resources/data/report/summaries/emerginganswers .

9. Pearson, P. Personal Control, Self-Efficacy in Sexual Negotiation, and contraceptive Risk Among Adolescents: The Role of Gender. Sex Roles 2006; 54: 615-625.

10. Rose, A. et al. The influence of Primary Caregivers on the Sexual Behavior of Early Adolescents. Journal of Adolescent Health 2005; 37:135-144.

11. Santelli,J. et al. Abstinence and Abstinence-only education: A Review of U.S. Policies and Programs. Journal of Adolescent Health Jan 2006; 38(1): 72-81.

12. Upadhyay,U. et al. Do Perceptions of Friends’ Behaviors affect Age at First Sex? Evidence from Cebu, Philippines. Journal of Adolescent Health 2006;39:570-577.

13. U.S. department of Health and Human Services. HHS Factsheet. Report Released on FourTitleVAbstinenceEducationPrograms.http://aspe.hhs.gov/hsp/abstinence07/factsheet.shtml.

14. U.S. Department of Health and Human Services. FY 2007 Program Announcement: Section 510 Abstinence Education Program. Administration for Children and Families, Administration on Children, youth, and Families, Family and Youth Services Bureau, aug. 2006.

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23 Comments:

  • At December 10, 2007 at 4:11 PM , Blogger Andrew Robinson said...

    Interesting article. I agree whole-heartedly with your premise regarding what changes teen behavior.

    You may be interested to read a study that will be published in the January/February 2008 issue of the American Journal of Health Behavior (AJHB), titled, “An Abstinence Program’s Impact on Cognitive Mediators and Sexual Initiation.”

    In this case an abstinence program targeted many of the variables you listed and successfully influence initiation.

    Best,

    Andrew Robinson
    www.andrewrobinsonsblog.com

     
  • At December 12, 2007 at 9:52 AM , Blogger Victoria said...

    Groups at my college posted signs in the dorms stating that most students drink responsibly (despite what students believed their peers were actually doing). I was reminded of that when I read your paper; it seems like there is a lot of misperception among adolescents/young adults about what behaviors their peers are actually engaging in. Have there been attempts to show the government studies about abstinence-only education?

     
  • At December 12, 2007 at 1:28 PM , Blogger Andrew Robinson said...

    Yes, there have been a number of studies that demonstrate effectiveness in abstinence education programs. (Keep in mind that not all programs are the same, of course. The highly publicized Mathmatica study was conducted on old methods and programs that have since revamped their approach.) The study I mentioned above gives a brief overview of these studies.

    I hope that helps.

    Andrew
    www.andrewrobinsonsblog.com

     
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