| 来源类型 | Journal Publication |
| 规范类型 | 其他 |
| Sex Education and Abstinence | |
| Douglas J. Besharov; Karen N. Gardiner | |
| 发表日期 | 1997 |
| 出版年 | 1997 |
| 语种 | 英语 |
| 摘要 | At least until the last few years, the proportion of teenagers who have had sex rose steadily. Not only were more teenagers having sex, but they were doing so with increasing frequency and at younger ages. The 1988 National Survey of Family Growth, for example, found that by age 18, 70 percent of females had had sex at least once, a 75 percent increase from 1970. The rate of increase was even more dramatic for younger teenagers. The proportion of 15-year-old females who reported having had sex increased fivefold between 1970 and 1988, from 5 percent to 26 percent (Forrest & Singh, 1990). Newly-released data, however, indicate that there may have been a recent decline in sexual activity among 15- to 19-year-olds (Abma et al., 1997). This is welcome news after the rate of sexual activity seemed to rise inexorably over the past two decades. The new data contained another positive finding: The proportion of sexually active teenagers using contraception rose dramatically. The new data may signal the start of a trend towards less sex and more contraceptive use among teenagers. Further analysis of the data, as well as additional studies, will be needed to draw a definitive conclusion. But even if these early suggestions of a turnaround in teenage sexual activity are valid, there is still much room for improvement. About half of male and female teenagers have had sex, including about 20 percent of 15-year-old females. And contraceptive use is far from perfect. As a result, each year there are about 1 million pregnancies resulting in approximately 400,000 abortions, 500,000 births, and 100,000 miscarriages. Of the births, over 70 percent are out of wedlock, putting those young mothers at risk of long-term welfare dependency. And about 3 million teenagers contract a sexually transmitted disease (STD) such as chlamydia, gonorrhea, and even AIDS. Just how to decrease the level of sexual activity (particularly among the youngest teenagers) and increase the level of contraceptive use among those who do have sex have become major policy issues. The new survey data will undoubtedly intensify the debate because it suggests that teenage behavior can change. Supporters both of sex education and abstinence programs will claim credit for the change in behavior suggested by the recent findings. Schools have been assigned the principal role in addressing teenage sexual activity, primarily through the provision of sex education and, to a lesser extent, through health clinics. Schools, after all, are the one institution with access to almost all young people. And sex education enjoys wide public support. A 1985 Harris poll, for example, found that 84 percent of parents agreed that “public high schools should include sex education in instructional programs.” As of 1995, according to the National Abortion and Reproductive Rights Action League, 22 states and the District of Columbia required sex education in at least some grades (NARAL, 1995). But even in the absence of a legal mandate, most communities provide it. A 1994 survey conducted by the Centers for Disease Control and Prevention (CDC), for example, found that 80 percent of schools offer sex education and 69 percent offer instruction on pregnancy prevention (Kann, 1997). An even larger proportion of adults, 94 percent, agrees that schools should teach about HIV and other STDs. In 1995, all states that required sex education also required HIV and STD education, and an additional 15 states required only HIV and STD (but not sex education) courses (NARAL, 1995). According to the CDC study, 86 percent of schools give HIV education and 84 percent give STD prevention education (Kann, 1997). In addition to sex education courses, many schools have tried to reduce teenage pregnancy and disease by making health care and contraceptives more accessible. In 1995, more than 500 junior or senior high schools had school-based or school-linked clinics, and over 400 schools provided condoms on campus (Kirby, 1997). The theory behind sex education is that inadequate knowledge can lead to unsafe sexual practices. Despite the fact that the majority of American teenagers receive some form of sex education, however, risky sexual practices continue, as evidenced by the high rates of pregnancy and STDs. Supporters of sex education contend that in the absence of such programs, pregnancy and STD rates would be higher. They are probably right, but the lack of a social experiment in which one group of adolescents is denied sex education makes proving their point difficult. The real issue for policy is whether sex education programs can be made more effective. Advocates argue that such programs would be more effective if they were “comprehensive”; that is, if they encouraged young people to avoid premature sexual activity and to explore their values and build self-esteem; if they addressed peer pressure; if they provided age-appropriate information about pregnancy, contraception, and STDs; and if they instilled the motivation to avoid pregnancy and prepare for future life. As of 1995, few states required such comprehensive programs. No one knows what effect those programs have had or could have on adolescent sexual behaviors. The few evaluations of programs containing elements of a comprehensive approach have shown mixed results in terms of delaying sex or decreasing rates of pregnancy or STDs. Sex education has always had its opponents. They have argued that the schools have no business in these matters, or that schools should advocate sexual abstinence. But even many supporters of sex education have decided that comprehensive programs are not enough. The large annual number of teenage pregnancies have lead some to believe that sex education is no panacea. Others have noted with concern the growing sexual activity among young teenagers. While there is little consensus that sexual activity among 18- and 19-year-olds is harmful, most adults would agree that 15-year-olds are too young. The result has been increasing support for abstinence-oriented approaches. As of 1995, 26 states required abstinence education (NARAL, 1995). About three-quarters of schools teach about abstinence, according to the CDC study (Kann, 1997). Some abstinence programs are “abstinence-only.” Their sole message is the avoidance of sexual activity until a specified time, such as after high school graduation or until marriage. If contraception is mentioned, it is within the context of possible failures and health risks. Other programs are “abstinence-plus.” They offer a combined message: abstaining from sexual activity is the best course of action, but if one becomes sexually active, use contraception. Of the states that required abstinence education, 14 also included instruction on contraception. There have been even fewer rigorous evaluations of abstinence programs, but like those of sex education programs, they have shown only mixed results. The papers that follow were initially presented at an invitational conference held on October 29–30, 1996, at the American Enterprise Institute in Washington, D.C. The conference, “Evaluating Sex Education and Abstinence Programs,” was attended by 35 senior researchers, government officials, service providers, and foundation executives. (The appendix contains a list of participants.) We asked the authors to address four related questions: What is known about the nature, extent, and causes of the current high level of sexual activity among teenagers? What is known about the effectiveness of sex education and abstinence programs? How should such programs be designed to make them more effective? What is the best way to evaluate the effectiveness of such programs? On the basis of the conference discussions, the papers were edited and updated. They form three special issues of Children and Youth Services Review. The papers in this first, double issue (Volume 19, Numbers 5 & 6) explore trends in teenage sexual activity, theories about adolescent learning and development, findings from past evaluations of sex education and abstinence programs, and the new interest in abstinence programs. The papers in the third special issue (Volume 19, Number 7) aim to help researchers, policy makers, and program operators understand the elements of successful evaluations, that is, evaluations that might help explain what “works.” Adolescent Learning and Behavior The first step in designing an intervention should be to develop an understanding of the prevalence, causes, and consequences of the particular behavior. Because younger teenagers are less likely to be sexually active, for example, an intervention in a junior high school should probably differ from one in a senior high school. Likewise, since some groups of teenagers are more at risk of negative outcomes such as pregnancy and unmarried parenthood than others, interventions focused on them may need to be more intensive. Thus, one policy or intervention strategy is unlikely to suit the needs of all young people. Researchers have identified a myriad of antecedents to early sex and parenthood, including poverty, ignorance, exploitation, welfare, and the general propensity of adolescents to take risks. The first three papers in this volume describe how interventions should be grounded in knowledge and theories of adolescent development and behavior. Trends in Teen Sexual Behavior. Douglas Besharov, a resident scholar at the American Enterprise Institute, and Karen Gardiner, a research associate there, open the volume by describing two notable trends in nonmarital sexual activity by teenagers: more teenagers are becoming sexually active than in past years, and they are more likely to use contraceptives than their earlier counterparts. The authors report that by 1988, about 70 percent of unmarried 18-year-old females reported having had sex at least once, compared with 40 percent in 1970. Underlying this general trend has been an increase in sexual activity among subgroups. More young teens–ages 15 and under–are having sex, as are more middle-class and white teenagers. They note, however, that these trends can change. New survey findings suggest a downward trend in teenage sexual activity, even among the youngest teens. Besharov and Gardiner also report that contraceptive use at first intercourse increased during the 1980s and 1990s, probably because of the fear of AIDS and the increased sexual activity among white and middle-class teenagers. Because more teenagers were using contraceptives, the pregnancy rate per 1,000 sexually active teenagers actually declined, even as more teenagers were having sex. Still, the authors note, contraceptive use is far from universal, leading to high levels of abortion, sexually transmitted diseases, and nonmarital births. The authors conclude that the challenge for school-based programs is to pursue two simultaneous goals: lower the level of sexual activity and raise the rate of contraceptive use among those who have sex. The Impact of Family Structure and Social Change. Alice Rossi, professor emerita at the University of Massachusetts at Amherst, explores the broad social and evolutionary forces that have led to the increase in premarital sexual activity by teenagers. She concentrates on the combination of earlier sexual maturation and later marriage. Programs that try to reduce the negative outcomes of teenage sex must recognize that the impulse to have sex–and reproduce–is built into human nature and not easily controlled. For that reason, argues Rossi, abstinence programs are impractical for all but the youngest teenagers. Just as one cannot curb the impulse of babies to stand on two feet and try to walk without adult support, Rossi believes it is not possible, or practical, to urge older adolescents to abstain from sex until marriage in their mid-20s. Rossi notes that attitudes toward marriage have changed and that the majority of Americans no longer believe children and marriage are necessary for a full and happy life. Many women are now economically independent. Reliable birth control enables couples to engage in recreational sex. Because sex and marriage are often separated by the larger society, Rossi argues that “just say no” programs that advise all teenagers to save sex for marriage will fail. She writes, “What is appropriate and desirable for a 6th grader is very different from what is appropriate and desirable for a 10th grader. Thus, while a purely abstinence approach to 10- to 12-year-olds may be appropriate, it is no longer appropriate for 15- to 17-year-old adolescents. By midadolescence, ignorance of contraception and abortion is not bliss, but a high-risk error that may lead to serious social problems and personal trauma.” The Role of Psychological Factors on Teenagers Who Become Parents Out-of-Wedlock . Although agreeing that changes in society and family structure have led to more sexual activity among teenagers, Marilyn Benoit, executive director of the Devereux Children’s Center in Washington, D.C., argues that psychological problems put some young people at an even greater risk of both early sex and parenthood. She argues that a steady decline in teenage parenthood will not come about unless pregnancy prevention efforts address a number of intrinsic psychological issues. According to Benoit, teenage mothers tend to share certain psychological and developmental characteristics: lack of emotional stability, the wish to appear as adults while simultaneously wanting to remain a child, denial of pregnancy risks and of the demands of babies, and the need to be taken care of by an ever-present and dependable care giver (thus the unconscious acceptance of dependency on the government.) Other intrinsic psychological issues include psychiatric illness, which may compromise a teenager’s ability to make thoughtful judgments, and sexual abuse. As for young males, fatherhood can represent the psychological attainment of manhood. Benoit argues that these psychological issues can be compounded by neighborhood norms that attach social status to teenage parenthood. Past Evaluations To date, hundreds of sex education and abstinence programs, as well as school-based clinics and condom distribution programs, have been evaluated. But there is a great deal of variation in the quality of the programs and their evaluations. As the next three papers describe, there are few scientifically rigorous evaluations of such programs, and those that have been conducted have documented only mixed success. School-based Programs to Reduce Sexual Risk-taking Behavior. The existing body of research does not reveal a “silver bullet” approach, note Douglas Kirby, director of research at ETR Associates, and Karin Coyle, associate director of research there. They assess the evaluations of 35 school-based programs that met three basic criteria: the evaluation employed an experimental or quasi-experimental design, measured program impact on specified behaviors, and was published in a peer-reviewed journal. Kirby and Coyle find that sex and HIV education programs seem to have no consistent impact on behaviors. While these programs increased knowledge about sexual matters, none of the evaluations found an impact on sexual activity or on the number of partners. Some, but not all the programs, affected condom or contraceptive use. Effective curricula shared a number of characteristics, including a clear focus on reducing certain behaviors, age-appropriate goals and teaching materials, and grounding in behavioral theory. The evaluations of school-based clinics, according to Kirby and Coyle, were also disappointing. The presence of a clinic did not seem to hasten the onset of sexual activity, and, at some clinics, contraceptive use increased. But it was unclear how much of this increase was due to a “substitution effect” by clinic users who previously went elsewhere for contraceptives. The few evaluations of condom distribution programs also found no increase in sexual activity, and evidence of increased condom use was mixed. With regard to abstinence-only programs, the authors found few evaluations that met all three criteria. As with the sex education evaluations, those that did reported no consistent and significant impact on sexual behavior. Youth Development Programs. Youth development programs offer an alternative to traditional sex education or abstinence programs. In their second contribution to the journal, Kirby and Coyle review the evaluation literature on a new generation of programs that seek to increase the motivation of teenagers to avoid early sex and parenthood. The authors assess the evaluations of eight youth development programs. Here they used two criteria to select the evaluated programs: the program did not focus specifically on sexual behaviors, and it provided at least minimal evidence of an impact of the program on sexual activity, contraceptive use, and pregnancy or birth rates. Many of the programs suffered from poor evaluation designs; thus the evidence of their impact on behavior was limited. Still, Kirby and Coyle note, all but one study suggested that focusing on education, employment, life options, or all three may reduce pregnancy rates. The authors note that the programs can be expensive but that they have the potential to decrease a number of risk-taking behaviors in addition to unprotected sex, such as drug use and school failure. Three programs were found to reduce school failure and dropout rates. The authors conclude, however, that additional research is needed to determine the components of youth development programs that are most critical to reducing risky behaviors. Overall, Kirby and Coyle find that the poor evaluation designs of many studies may have obscured any program impacts. This is a serious problem, which has stymied policy development–especially since so many program operators and advocates believe that their programs “work.” Why Don’t We Know More? is the question that Sarah Brown, director of the National Campaign to Reduce Teenage Pregnancy, addresses in the next paper. She argues that there are at least four reasons why research has been unable to show “what works”: (1) a good evaluation costs a considerable amount of money, and there has been a preference for using scarce funds on program services; (2) sex education and abstinence programs do not lend themselves to easy evaluations, and research has been limited by methodological difficulties; (3) research on fertility-related topics has been controversial and has discouraged public funding of studies; and, finally, (4) private sector funds for evaluations of abstinence programs have been limited because of possible prejudice against the abstinence message. Brown concludes that all these issues must be addressed if there is to be a rich base of information on sex education and abstinence programs. The New Interest in Abstinence Programs In the mid-1990s, a number of factors combined to increase interest in abstinence programs. Lack of solid evidence that sex education programs, school-based clinics, and condom distribution programs were successful fueled disenchantment with these approaches. In addition, policy makers and the public alike were alarmed by reports that sexual activity among younger teenagers increased dramatically during the 1980s. At the same time, a program for eighth graders in Atlanta that focused on abstinence while including information about contraception showed modest results in delaying first intercourse, as well as increasing contraceptive use among those that did become sexually active. Add to this mixture the 1994 election of a conservative Congress committed to instilling traditional family values, and the policy atmosphere was ripe for a greater focus on abstinence education. Abstinence Education under Welfare Reform . The most visible commitment to this program area was the inclusion of a five-year, $50 million annual appropriation for abstinence education in the 1996 welfare reform law. Ron Haskins, staff director of the Subcommittee on Human Resources of the House Ways and Means Committee, and Carol Statuto Bevan, professional staff member for the subcommittee, recount the considerations that led to its passage and describe how they think Congress intended the funds to be spent. Haskins and Bevan believe that Congress set aside one-quarter of a billion dollars (over five years) as a direct response to what many legislators saw as a “pro-sex” government policy of providing contraceptive services to low-income and young women through the Title X clinic program. They describe how many legislators felt “duped” by the Title XX Adolescent and Family Life Act, which was intended to finance abstinence programs but in actuality funded a range of programs, including those that combine an abstinence message with information about contraception. Thus, the new law limits its funding to abstinence-only programs. Even abstinence-plus approaches seem to be excluded. Only a program that “teaches that abstinence from sexual activity outside of marriage as the expected standard for all school age children” will be eligible to receive these new federal funds. Haskins and Bevan acknowledge that there is little research evidence on the effectiveness of abstinence programs. Instead, they argue, Congress wanted to promote a specific behavioral norm. Haskins and Bevan conclude by describing the possible evaluation options of abstinence programs and encouraging them to be pursued. Using Behavioral Theories to Design Abstinence Programs . The states, as the beneficiaries of this new federal abstinence money, should develop their programs with care, warn Kristin Moore, executive director of Child Trends, Inc., and Barbara Sugland, senior research associate there. A simple “just say no approach” will not be sufficient. Instead, abstinence programs, like other risk-reduction programs, must be age appropriate and based on a theory of behavior. Moore and Sugland agree that the increasing prevalence of sexual activity, pregnancy, and sexually transmitted diseases among teenagers makes abstinence programs a desirable–and viable–policy option. They contend, however, that despite the appeal of such programs, little is known about how to persuade adolescents to abstain from sex. Many interventions have been ad hoc in nature, based more on hunches than theory. Instead, urge the authors, programs should be grounded in behavioral theories, such as the social learning theory, the health belief model, or the opportunity cost perspective. The underlying theory will influence the program’s content. A program based on the culture of poverty theory will differ from one based on an opportunity cost model. The authors also note that abstinence programs should be clear about the focus of the intervention. For instance, it may make sense to begin speaking to elementary school children before risk-taking behaviors set in. Older siblings and adults might also be targeted. Equally important when designing an intervention is the manner in which information is delivered. Should it be an information-based lecture or more interactive? Should the message be positive or punitive? Should teachers or older peers deliver the message? Another issue is the length of the intervention. Moore and Sugland conclude that short-term interventions have short-term effects. If the goal is more long-term, such as delaying sex until a certain age or until marriage, then the intervention needs to last for a much longer time. We hope the papers in this volume will help researchers, policy makers, and program operators understand what is known about the effectiveness of sex education and abstinence programs and how such programs might be redesigned to be more effective. The next special issue will examine impact evaluations–those evaluations that test whether a program had the desired outcomes. The key issue that must be addressed is the counterfactual, that is, what would have happened in the absence of the program. Take one example: A state that has a “family cap” policy that denies additional cash benefits to women who have children while on welfare, for example, may see a decline in the number of births to unmarried women in ensuing years. It would be tempting to attribute the decline to the policy. There must be a benchmark for a comparison, however. Perhaps births to women on welfare declined nationwide, and the individual state was only part of a national trend. In that case, the policy’s influence would be dubious. The following volume of Children and Youth Services Review will explore various methods of measuring the counterfactual. References Abma, J.C., Chandra, A., Mosher, W., Peterson, L., & Piccinino, L. (1997). “Fertility, Family Planning, and Women’s Health: New Data from the 1995 National Survey of Family Growth.” National Center for Health Statistics Vital Health Statistics 23(19). Forrest, J. D. & Singh, S. (1990). The Sexual and Reproductive Behavior of American Woman, 1982–1988. Family Planning Perspectives 22(5), pp. 206–214. National Abortion and Reproductive Rights Action League. (1995). Sexuality Education in America: A State-by-state Review. Washington, D.C.: NARAL Foundation. Kann, L. (1997). Telephone interview with author. April 24, 1997. Kirby, D. (1997). No Easy Answers. Washington, D.C.: National Campaign to Reduce Teenage Pregnancy. Appendix Evaluating Sex Education and Abstinence Programs Participants Rebecca Anderson Executive Director Community of Caring Program Joseph P. Kennedy, Jr. Foundation Elayne Bennett Director Best Friends Marilyn Benoit Medical/Executive Director Devereux Children’s Center Douglas Besharov Resident Scholar American Enterprise Institute Susan Besharov Social Worker Private Practice Carol Statuto Bevan Professional Staff Member House Ways and Means Committee Subcommittee on Human Resources Sarah Brown Director The National Campaign to Prevent Teen Pregnancy Phoebe Cottingham Senior Program Officer Smith Richardson Foundation Deborah Delgado Program Officer The Annie E. Casey Foundation Barbara Devaney Deputy Project Director Mathematica Policy Research, Inc. Mark Dynarski Senior Researcher Mathematica Policy Research, Inc. Steve Eidelman Executive Director Joseph P. Kennedy, Jr. Foundation Karen Gardiner Research Associate American Enterprise Institute Ellen Gross Assistant Director Community of Caring Program Joseph P. Kennedy, Jr. Foundation Ron Haskins Staff Director House Ways and Means Committee Subcommittee on Human Resources Ann Guthrie Hingston National Program Director Best Friends Paul Jellinek Vice President Robert Wood Johnson Foundation Amy Kahn Program Assistant Smith Richardson Foundation Betty King Director of Administration, Communication and Child and Adolescent Health The Annie E. Casey Foundation Douglas Kirby Research Director ETR Associates James Knickman Vice President Robert Wood Johnson Foundation Alan Melchior Deputy Director and Senior Research Associate Center for Human Resources Brandeis University Charles Metcalf President Mathematica Policy Research, Inc. Kristin Moore Executive Director Child Trends, Inc. Theodora Ooms Executive Director Family Impact Seminar Adele Richardson Ray Governor and Trustee Smith Richardson Foundation Peter L. Richardson President Smith Richardson Foundation Alice Rossi Professor Emeritus University of Massachusetts Peter Rossi Professor Emeritus University of Massachusetts Eunice Kennedy Shriver Executive Vice President Joseph P. Kennedy, Jr. Foundation Freya Sonenstein Director, Population Studies Center The Urban Institute Isabel Sawhill Senior Fellow The Urban Institute Marin Strmecki Vice President Smith Richardson Foundation Edward Zigler Sterling Professor of Psychology Yale University |
| 主题 | Poverty Studies |
| 标签 | besharov ; sex |
| URL | https://www.aei.org/research-products/journal-publication/sex-education-and-abstinence/ |
| 来源智库 | American Enterprise Institute (United States) |
| 资源类型 | 智库出版物 |
| 条目标识符 | http://119.78.100.153/handle/2XGU8XDN/209054 |
| 推荐引用方式 GB/T 7714 | Douglas J. Besharov,Karen N. Gardiner. Sex Education and Abstinence. 1997. |
| 条目包含的文件 | 条目无相关文件。 | |||||
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