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Let’s Talk about Sex: The Sex Ed Debate. Community Pediatrics Caroline Chang. Background. 45% of teens 15-19 have had sexual intercourse (2002) Teens = 25% of the ever sexually active population, but nearly HALF of all new STDs.
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Let’s Talk about Sex: The Sex Ed Debate Community Pediatrics Caroline Chang
Background • 45% of teens 15-19 have had sexual intercourse (2002) • Teens = 25% of the ever sexually active population, but nearly HALF of all new STDs. • 15- to 19-year-old women had the highest rate of Chlamydia and Gonorrhea compared to any other age/sex group (2007), and it continues to increase
Background • The US has the second highest teen pregnancy rate in developed countries • Similar rate of teen sex, less use of contraception • Recent decline in teen pregnancy rates are 72% (15-17 yo) and 99% (18-19 yo) due to increased use of contraception
New York Statistics • 39% female/45% male high school students reported having sexual intercourse • New York teens have sex with more partners, earlier, than the rest of the country. • Nearly 40,000 teen pregnancies in New York • Abortion rate for teenagers 15-19 second highest in the country. • More than 10% of teens 13-19 diagnosed with HIV in 2005 are in NYC *2005 data
Sex Education Statistics • 89% of public school children receive sex education at least once between 7-12th grades • However, the curriculum varies widely • ~80% teens 15-19-educated prior to 18 on saying no to sex, 2/3 before 9th grade • ~65% of female/male teens 15-19-educated prior to 18 on methods of birth control, 40% before 9th grade • *2002 Data
Comprehensive Sex Ed • Aka abstinence “plus” • Curriculum includes information on both abstinence and contraception • Still teaches abstinence as the preferred choice
Abstinence Only • Abstinence has social, psychological, and health benefits • Unmarried, school-age children are expected to abstain from sex • Abstinence is the only certain way to prevent out-of wedlock pregnancy and sexually transmitted diseases • A mutually faithful and monogamous married relationship is the standard for sexual activity • Sexual activity outside marriage is likely to have harmful psychological and physical effects • Out-of-wedlock childbearing is likely to harm a child, the parents, and society • How to reject sexual advances and how alcohol and drug use increases vulnerability to them • The importance of attaining self-sufficiency before engaging in sex *Source: Section 510 (b), Title V of Social Security Act.
Virginity Pledge • Oral or written promise to refrain from sexual activity, usually until marriage • Created in 1993 by an evangelical Christian organizationspread by other Protestant and Catholic groups • By 1995, 13% of American adolescents reported having taken a virginity pledge • US government uses virginity pledges as a measure of success of abstinence-only sex education programs
The Data • Several studies have been performed using regression that showed that girls who took “virginity” pledges were less likely to have had sex 5 years after the pledge compared to non-pledgers • BUT---did not control for other factors
More Data • 2008--Rosenbaum performed a similar study, but controls were matched in age, religiosity, ideals and views on sex and birth control • 5 years after the pledge -82% denied ever making a virginity pledge -no differences in premarital sex, age of first sex, STI’s -fewer of the pledgers used condoms/birth control over the past year
More Data • 2002 Survey of Teens 15-19 showed having some type of sex education BEFORE first sex was associated with: • MALES -71% less likely to have sex prior to age 15 -not having sexual intercourse (during the course of the study) -increased likelihood of using condoms at first sex • FEMALES -59% less likely to have sex prior to age 15 -African American girls—91% Mueller TE, Gavin LE, Kulkarni A. The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. J Adolesc Health 42(1), 2008.
What is being used now • Sex education is mandated in 20 states • Kaiser Family Foundation Survey in 1999 found that sex education is taught in some form in 95% of public schools • 58% -comprehensive • 34% -abstinence only • 81% of Americans feel that sex education programs should be comprehensive
Sex Education In New York • NOT mandated by New York State. • Local boards of education may choose to make sexuality education a local requirement. • Local school districts encouraged to have advisory councils-- parents, school personnel, students, members of the faith communities, and other community-based organizations to make recommendations about sexuality education programs. • Often omitted or abbreviated due to lack of mandate and funding.
HIV/AIDS Education • Regulated as a separate entity from sex ed • CDC has been providing funding for HIV/AIDS education since 1988 • $47 million in 2000 • Is mandated by law in NY State
Funding • Federal Funding • State Funding
Federal Funding • 1981-Adolescent Family Life Act- allocated $11 million to prevent premarital teen pregnancy by establishing “family-centered” programs to “promote chastity and self discipline.” • Has been renewed annually giving $6-12 million a year
Then….. • 1995, under Bill Clinton—Social Security Act, Title V, Section –dedicated 50 million dollars a year to states providing solely abstinence-only sex education. • States required to match funds $437.5 million to abstinence-only programs by 2002. • Includes detailed definition of what federally funded programs are expected to teach
AND THEN…. • 2001-Bush created program that gives additional 100 million a year for abstinence only education
BUT….. • Up to 17 states (including New York) have refused federal funding, feeling that abstinence only programs do not work • More than 90% of abstinence funding does not require that curricula be scientifically accurate!!! • 2004 review found incorrect information in 11 of 13 federally funded abstinence programs, primarily about birth control and condom effectiveness
Barack Obama’s 2010 Budget • Slashes Abstinence-Only Programs and Replaces them with Teen Pregnancy Prevention Initiative • Eliminates $99 million for Community-Based Abstinence Education Programs (CBAE) and $50 million for Title V abstinence only programs. • Creates Pregnancy Prevention Initiative-- $110 million to support "community-based and faith-based efforts to reduce teen pregnancy using evidence-based and promising models."
Drawbacks • Focuses primarily on pregnancy prevention, leaving out STI prevention, building healthy relationships, etc.
Prevention First Act • Contains REAL (Responsible Education About Life) Act, At-Risk Communities Teen Pregnancy Prevention Act of 2009 • Introduced 3/09--authorizes federal funding for comprehensive, medically accurate, age-appropriate sex education • Includes how to prevent pregnancy, protect their health and make responsible decisions. • Also award grants for teenage pregnancy prevention programs and research.
State Funding • Currently required to match federal sex ed funds, but no other comprehensive funding mechanism • New York is one of the many states that has rejected federal abstinence-only funding
Healthy Teens Act • First introduced in 2002, creates a competitive grant program, administered by the DOH for schools /communities to teach sex education • Programs MUST be age-appropriate and medically accurate, and may not teach or promote religion.
Healthy Teens Act • No mandated curriculum, but programs encouraged to include: -stressing abstinence and teaching that it is the only sure way to avoid pregnancy and STIs -providing information about different contraceptive and barrier methods to prevent pregnancy and STIs; -encouraging parent involvement and family communication; -teaching relationship negotiation skills and how drugs and alcohol affect responsible decision making.
Healthy Teens Act • The grant awards would preference areas with higher teen pregnancy and STI rates. • Has passed the assembly every year since introduction, but never got past state senate • Now with a new pro-choice majority, there is hope that this may change, but may be vetoed by Governor Patterson due to budget constraints
What still needs to be done • Passing Obama’s budget • Healthy Teens Act • Prevention First Act/REAL Act • More research identifying programs that are shown to be effective in lowering pregnancy, STI rates • Having funding for programs that work • More universal and standardized requirements for sex education (unlikely)
What Can We Do? • WRITE A LETTER!!! - To federal representatives to pass the Prevention First Act (currently in committee) -To federal representatives to support comprehensive sex education, to make sure the sex education funding in Obama’s budget is passed -To State Representatives to pass the Healthy Teens Act • Be more thorough at your next teen WCC!! • For other ways, visit Get the Facts NY: http://ga0.org/gtfny/home.html
References • BMJ 2005;331:715 (1 October), doi:10.1136/bmj.331.7519.715-a • Janet Elise Rosenbaum, PhD, AM Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers PEDIATRICS Vol. 123 No. 1 January 2009, pp. e110-e120 • Mueller TE, Gavin LE, Kulkarni A. The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. J Adolesc Health 42(1), 2008. • http://www.guttmacher.org/pubs/tgr/04/4/gr040404.html • http://www.guttmacher.org/pubs/tgr/06/1/gr060106.html • http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf • http://www.rhrealitycheck.org/blog/2009/05/07/2010-budget-slashes-abstinenceonly-money-keeps-abortion-funding-restrictions • http://www.rhrealitycheck.org/blog/2009/05/08/are-we-there-yet-comprehensive-sex-education-and-presidents-2010-budget • http://www.kff.org/youthhivstds/upload/Sex-Education-in-the-U-S-Policy-and-Politics.pdf • http://pediatrics.aappublications.org/cgi/reprint/123/1/e110 • http://www.cdc.gov/std/stats07/adol-figs.htm • http://www.nyclu.org/node/1817 • http://www.fpaofnys.org/news/newsReleases/documents/PRHTARvW012209.pdf • http://www.govtrack.us/congress/bill.xpd?bill=s111-21&tab=summary • http://www.emsc.nysed.gov/sss/coordinatedschoolhealth/health.html • http://www.natap.org/2009/newsUpdates/031109_03.htm