Sex Education: Scientific Evidence and Public Policy

1. Sex Education: Scientific Evidence and Public Policy The Institute for Research & Evaluation April 29, 2009

2. Introduction • Problem: Adolescent sexual activity and its consequences: • Teen Pregnancy • STDs (1 in 2 Black teen girls) • Dating violence • Emotional harm

3. Common Perceptions “There is substantial evidence that CSE programs are effective.” “AbEd programs are a proven failure. We are wasting our tax dollars and putting kids at risk.” “CSE programs can do what AbEd programs do, but also provide protection for those who are or soon will be sexually active.”

4. What is Effectiveness? Four Criteria • A. Intended settings & populations: School-based success cannot be measured using clinic-based results. • B. Sustained results:12 months, from school year to school year. • C. Broad-based impact: acrossall intended participants, not just subgroups. • Maximized protection: improvement on behaviors that are the most protective.

5. Outcome Behaviors Primary: Abstain from Sexual Activity a. Means delay or discontinue sex b. Total Prevention: Pregnancy, STDs, emotional harm Secondary: Consistent Condom Use (CCU) a. Means correct use every time sex occurs b. Reduces risk of pregnancy, HIV & STDs, but impact on dating violence & emotional harm is unknown

6. Consistent Condom Use (CCU) CCU is the behavior that is required in order to provide the partial protection offered by condoms. It is the standard by which the condom’s capacity for partial prevention of STDs is measured. “inconsistent use, e.g., failure to use condoms with every act of intercourse, can lead to STD transmission because transmission can occur with a single act of intercourse” (CDC, 2003). “Irregular condom use was not protective against HIV or STD and was associated with increased gonorrhea/Chlamydia risk.” (Ahmed, et.al., 2001).

7. Reviewing the Evidence • 119 sex education studies covering the past 20 years: • Screened for adequate research rigor • Included in two comprehensive reviews of the extant research over 20 years

8. Actual Effects of CSE in Schools Behavioral effects of school-based CSE programs (effects for any length of time, for any subgroup, and for any outcome) :

9. 4 criteria of Effectiveness: 12-mo. Results on Protective Outcomes CSE programs with 12-month main program effects on protective behaviors:

10. The One CSE Study Showing 12-month “Improvement” in CCU was Actually a Decline(See Villaruel, et.al (2006) Figure 4) N=107 Program N=137 Control

11. Evaluating the Claims “CSE is effective, AbEd is a proven failure?” “In light of numerous reports showing that abstinence-only programs are ineffective, we believe it is inappropriate to fund these discredited programs” – Rep. Hodes, Letter to House Sub-Committee on Labor (4/2/09)

12. Program Failure Rates:Number and % of Programs Showing No Full Program Effect on Abstinence or CCU after 12-month Time Period 73% 64% Note: 14 AbEd studies and 22 CSE studies measured either abstinence or CCU effects 12 months after the program. 5 of the 6 CSE program effects were effects on abstinent behavior. Four of these were different studies of the same curriculum.

13. Patterns of Evidence: AbEd12 mo, sexual initiation rates, school setting, program (main) effects N=550 OR=.41 N=318 OR=.53 N=1,469 OR=.47

14. Conclusions from the Evidence When judged by reasonable standards of effectiveness the evidence does not support: A) a conclusion that school-based CSE programs work and should be widely disseminated, B) abolishing ABED or 3) requiring that ABED include an emphasis on condom promotion that is not working in CSE. There is some good evidence that school-based abstinence programs can be effective at producing substantial reductions (50%) in rates of sexual initiation for sustained periods of time. There is some limited evidence that school-based CSE can produce a sustained reduction in teen sexual activity but no evidence that they have been effective at increasing consistent condom use, despite the apparent greater emphasis on condom promotion over abstinence which is common to CSE. Teens can be persuaded to abstain from sex. In the words of a nationally known evaluator of comprehensive sex education, “It may actually be easier to delay the onset of intercourse than to increase contraceptive practice [for adolescents].”

15. Recommendations 1. A strong abstinence message should be the focus of sexuality prevention programs in the schools. Youth should be taught to “Say No” to sex as they have been taught to say no to alcohol, drugs, and violence. Funding should continue for abstinence education in the schools, including a strong evaluation requirement. 2. These data call for policy-makers to question the concept of “comprehensive” sex education in the schools. It should not receive further funding until it has demonstrated a meaningful and sustained increase in CCU by sexually active teens accompanied by a substantial positive impact on abstinence behavior. 3. Information about STD and pregnancy prevention through consistent condom use, if provided, should be given in a separate setting from that of the abstinence message/program. Mixing the messages together has not produced sustained results on both behaviors in the same program.

16. Jemmott III JB, Jemmott LS, Fong GT. (2006). Efficacy of an abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Oral abstract session: AIDS 2006 - XVI International AIDS Conference: Abstract no. MOAX0504. Jemmott III JB, Jemmott LS, Fong GT. (2006). Efficacy of an abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Oral abstract session: AIDS 2006 - XVI International AIDS Conference: Abstract no. MOAX0504. Jemmott III JB, Jemmott LS, Fong GT. (2006). Efficacy of an abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Oral abstract session: AIDS 2006 - XVI International AIDS Conference: Abstract no. MOAX0504. References Jemmott III JB, Jemmott LS, Fong GT. (2006). Efficacy of an abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Oral abstract session: AIDS 2006 - XVI International AIDS Conference: Abstract no. MOAX0504. Kirby D. (2007). Emerging Answers 2007. Washington DC: National Campaign to Prevent Teen and Unplanned Pregnancy. Weed SE, Anderson NA, Ericksen IH, et al. (2008). What kind of abstinence education works? Comparing outcomes of two approaches. Salt Lake City: Institute for Research & Evaluation. Weed SE, Ericksen IE, Lewis A et al. (2008). An Abstinence Program’s Impact on Cognitive Mediators and Sexual Initiation. Am J Health Behav; 32(1):60–73. Weed SE, Ericksen IH, Birch PJ. (2005). An evaluation of the Heritage Keepers Abstinence Education program. In Golden A (ed.) Evaluating Abstinence Education Programs: Improving Implementation and Assessing Impact. Washington DC: Office of Population Affairs and the Administration for Children and Families, Department of Health & Human Services 2005:88–103.