new study demonstrates efficacy of abstinence-only programs

[kc8tbe]

A new study by the (I'm sure totally unbiased ) Heritage Foundation finds that fewer of those 6th and 7th graders enrolled in abstinence-only programs had sex in the next 2 years compared to subjects in conventional or abstinence+conventional programs. The Washington Post goes on about how the study "...could have major implications for U.S. efforts to protect young people against unwanted pregnancies and sexually transmitted diseases."

From the article:

The Obama administration eliminated more than $170 million in annual federal funding targeted at abstinence programs after a series of reports concluded that the approach was ineffective. Instead, the White House is launching a $114 million pregnancy prevention initiative that will fund only programs that have been shown scientifically to work -- a program the administration on Monday proposed expanding to $183 million.

"This new study is game-changing," said Sarah Brown, who leads the National Campaign to Prevent Teen and Unplanned Pregnancy. "For the first time, there is strong evidence that an abstinence-only intervention can help very young teens delay sex."

The study itself can be found here.

I'm curious what everyone thinks about this in light of the existing scientific evidence that abstinence-only sexual education results in more STD transmission and teen pregnancy. What (political) impact will this have on sexual education programs nationwide?

A few holes in the study I noticed from the outset:

• All participants are African American. That's not a representative sample of all teens.
• Sexual activity is self-reported. If abstinence-only education makes subjects feel guilty about sex, then perhaps they are less likely to report honestly than the controls.
• No mention is made of STDs or pregnancy. Even if abstinence-only education does forestall sex, it may still result in higher rates of STDs and pregnancy.

Apologies in advance if this is already posted somewhere!

[Alan Bolte]

No mention is made of STDs or pregnancy. Even if abstinence-only education does forestall sex, it may still result in higher rates of STDs and pregnancy.

This bugs me as well, but supposedly:

The abstinence program had no negative effects on condom use, which has been a major criticism of the abstinence approach.

Of course, this would also be self-reported.

[Liberty]

I read elsewhere and heard on NPR that the abstinence-only curriculum that was used was not the typical moral-based "abstinence until marriage" program. Rather, it asked the children to wait until they were ready to have sex and had them think about how sex, pregnancy, stds, etc, would impact their life goals and where they want to be five or ten years in the future. Basically, it's the kind of stuff that should be taught as part of comprehensive sex ed anyway. Respect yourself, don't do it just because others are, wait until you're ready, think about your life goals, etc. So it's not really representative of abstinence only programs in general.

And - did you say it was funded by the Heritage Foundation? The HF is a right wing think tank. I'm curious want impact that has on the validity of the study.

[General Zod]

I read elsewhere and heard on NPR that the abstinence-only curriculum that was used was not the typical moral-based "abstinence until marriage" program. Rather, it asked the children to wait until they were ready to have sex and had them think about how sex, pregnancy, stds, etc, would impact their life goals and where they want to be five or ten years in the future. Basically, it's the kind of stuff that should be taught as part of comprehensive sex ed anyway. Respect yourself, don't do it just because others are, wait until you're ready, think about your life goals, etc. So it's not really representative of abstinence only programs in general.

And - did you say it was funded by the Heritage Foundation? The HF is a right wing think tank. I'm curious want impact that has on the validity of the study.

Most abstinence only programs seem to put way too much of an emphasis on "Don't have sex until you're married, mkay?". It's really not that big of a shocker though, make something taboo for teens and they'll probably wind up doing it anyway just to see what the fuss is about.

[Alyrium Denryle]

Results 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.

I dont have access to the journal yet because it is that new but...

In other words, the "Just use condoms" group did not prevent sexual activity vs abstinence only because it was not designed to do so. No shock there. The comprehensive sex education was not significantly different from the abstinence only group. Unless they did not compare between treatment groups.

[Edi]

Salon.com has a good article on this.

It points out the lack of moralizing, but also that the sample size is rather small and there are unaccounted for factors. In addition, the study focused on 6th and 7th grader African-Americans, instead of including older teens as well.

That alone should tell you quite a lot about how much this is applicable to kids a few years older, when they really become sexually active.

[kc8tbe]

OK, so I was dubious about the condom claim and took a closer look at the full-text article. I mean how would the abstinence-only subjects know what a condom is, let alone use one consistently?

Well, it turns out that 67.1% of subjects reported using a condom consistently going into the study! This alone, in my mind, invalidates the results. Sure, subjects received abstinence-only education in the study, but their extracurricular sexual education has clearly been more comprehensive.

Moreover, baseline condom use was actually highest (92.9%) in the abstinence-only group and lowest (28.6%) in the safe-sex-only group. I would not automatically fault the researchers for this discrepancy due to the small sample size, but on the other hand, I do fault them for failing to account for this in their calculations. True, there is no difference in condom use between the different groups at the study's conclusion. But doesn't this signify considerable improvement over baseline for the safe-sex-only group and a corresponding lack of improvement for the abstinence-only group?

[kc8tbe]

In other words, the "Just use condoms" group did not prevent sexual activity vs abstinence only because it was not designed to do so. No shock there. The comprehensive sex education was not significantly different from the abstinence only group. Unless they did not compare between treatment groups.

Exactly. The control group received "health" education that covered cholesterol, blood pressure... everything but sex. It's no huge surprise that some sex education would turn out to be better than none. The small sample size prevents direct comparison between the comprehensive and abstinence-only groups. I wonder if HF limited the sample size of the study on purpose so that abstinence-only wouldn't come out looking bad.

Meanwhile, it looks like the media (or at least FOX and its ilk) will trumpet this as evidence that abstinence-only should be federally funded.

[Edi]

Did you fucking check the age group? 6th to 7th graders, so that would be 12-13 year olds if they started school at 6-7 years old, and sexual activity starts ramping up from age 14-15 and up. The study is worthless.

[Lord of the Abyss]

Any links to where it is said that the study is funded by the Heritage Foundation, and that "67.1% of subjects reported using a condom consistently going into the study"? I want to cite that elsewhere.

[General Zod]

Any links to where it is said that the study is funded by the Heritage Foundation, and that "67.1% of subjects reported using a condom consistently going into the study"? I want to cite that elsewhere.

I can't find anything saying that they funded it, only that they reviewed the findings. Doesn't mean the study is any less useless, of course.

[kc8tbe]

Any links to where it is said that the study is funded by the Heritage Foundation, and that "67.1% of subjects reported using a condom consistently going into the study"? I want to cite that elsewhere.

From the Washington Post article:

"I think we've written off abstinence-only education without looking closely at the nature of the evidence," said John B. Jemmott III, a professor at the University of Pennsylvania who led the federally funded study. "Our study shows this could be one approach that could be used."

Mea culpa! Although the authors are frequently cited by the HF, the are not affiliated with the HF and the study was, apparently, federally funded and took place at the University of Pennsylvania.

As for the 67.1% figure, refer to Table 1 of the paper, the column labeled "Total" and the row labeled "Consistent condom use in past 3 mo". Note that the 67.1% who use condoms is out of the 12% of subjects who were sexually active leading up to the study. The remaining 88% who were celibate in the 3 months before the study, I assume, were not using condoms at that time. (FYI: 76.6% of subjects were virgins prior to the study and we might extrapolate that 66% were still virgins afterwards.)

[wolveraptor]

This raises the question: should the goal of sex ed be to delay sexual activity, or to lower STD/pregnancy rates?

[General Zod]

This raises the question: should the goal of sex ed be to delay sexual activity, or to lower STD/pregnancy rates?

Delaying sexual activity doesn't help much if they breed like rabbits as soon as they're married. You want to educate people on why shitting out 20 kids one after another is a bad idea. Overpopulation, health risks to the mother, financial hardship, etc.

[Oskuro]

This raises the question: should the goal of sex ed be to delay sexual activity, or to lower STD/pregnancy rates?

Should the goal of driving education be to delay driving, or to teach people to not kill themselves or others while doing it?

Contrary to actual driving, no one has a right to prohibit consensual sexual activity to anyone (even between minors), so the goal sould be to have people understand their sexuality and be responsible, rather than try to supress it.

[Alyrium Denryle]

Alright, so I dissected the paper. Here are my findings. A sample size of 662 people is actually not low, all things considered. It is on the upper end of something a psychologist could get outside of phone interviews which would be inappropriate for this sort of work.

The problem is not sample size. It is the fact that the whole sample is non-random. They targeted black inner city kids from four public schools in low income areas. I have never seen a human sample so poor for generalizing to the rest of the population. There is also a response bias because of how they did their recruitment.

The abstinence only treatment was also not comparable to anything used in the US. It consisted of social psychologists manipulating the kids (which is not, bad, but lets remember that in a course taught at a school, the people doing the teaching will not have made manipulating people their stock and trade)

Their analysis of condom use is useless. They did not statistically test for initial differences between their treatment groups . Here is what I mean.

Consistent condom use in past 3 mo (percents in parentheses)


Total:51/76 (67.1) 12 Hr comp:10/14 (71.4) 8 hr comp:10/14 (71.4) Condom use only:4/14 (28.6) Abstinence only: 13/14 (92.9) Control:14/20 (70.0)

I just had to run a chi squared test for this bitch. Got a Chi squared value of 22.09. which gives me a sickeningly low P value.

So their analysis of condom use is worthless.

They used an inappropriate measure in order to measure (and discard instances of) social desirability bias.

The statistical power of their tests (and they did not specify what test they used in order to test for differences between risk ratios, at least not that I saw), was low. 80% to detect a 16.8% difference. It should have been much better in order to detect differences between treatments that were that fucking huge.

In other words... I would have editorially rejected this paper.