The Dallas Morning News, January 30, 2005

Abstinence programs: lessons in futility?

Classes aren't changing Texas teens' sexual habits, researchers say

Abstinence-only programs - the hallmark of the Bush administration's federal sex education policy - seem to have little impact on the behavior of Texas teenagers.

The first evaluation of programs used throughout the state has found that students in almost all high school grades were more sexually active after abstinence education. Researchers don't believe the programs encouraged teenagers to have sex, only that the abstinence messages did not interfere with the usual trends among adolescents growing up.

"We didn't find what many would like for us to find," said researcher Buzz Pruitt of Texas A&M University. He and his colleagues discussed their data this week with state health authorities in Austin, who sponsored the research.

The study has its flaws, and Dr. Pruitt and others cautioned against overarching conclusions. But scientists welcome the fact that Texas is contributing to a field lacking in solid data. The federal government will spend $131 million this year on a smorgasbord of abstinence-only education programs. Many public health experts are concerned that no one really knows what the government is buying.

Among the findings in the Texas study: About 23 percent of the ninth-grade girls in the study had sexual intercourse before they received abstinence education, a figure below the state. After taking an abstinence course, the number among those same girls rose to 28 percent, a level closer to that of their peers across the state.

Among ninth-grade boys, the percentage who reported sexual intercourse before and after abstinence education remained relatively unchanged. In 10th grade, however, the percentage of boys who had ever had sexual intercourse jumped from 24 percent to 39 percent after participating in an abstinence program.

"We didn't find strong evidence of program effect," said Dr. Pruitt. The results are based on a 10-page questionnaire - the product of two years of preliminary research - filled out anonymously by junior high and high school students. The ongoing A&M study examined five programs in more than two dozen schools.

To be funded as abstinence education, programs cannot provide instruction in birth control, outside "factual information about contraceptive methods, such as the failure rates that are associated with the different methods," according to documents from the U.S. Department of Health and Human Services. Among other things, the law also dictates that an abstinence program must have "as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity."

Dr. Pruitt readily acknowledges that studies like his are inherently problematic. For example: the A&M study lacks a comparison group. Ideally, researchers would like to overlay two sets of data: one from students receiving abstinence education and another from a group similar in every other way but with no abstinence education.

Without such direct contrasts, researchers can't say whether the teenagers would have shown an even greater increase in sexual activity had they not had abstinence education. The Texas researchers began with a comparison group, but it fell apart before the study's end. (During the project, the scientists realized too many members of the supposed reference group were hearing the abstinence messages.)

Nonetheless, public health experts say these and other data may eventually help fashion abstinence-only approaches that can make a difference. No-sex-until-marriage has been a major emphasis in Washington, and funding has increased in kind: The $131 million the federal government set aside represents an increase of $30 million over 2004, according to the Senate Appropriations Committee.

Little data to be had

But is the money making a difference? "We're using a bunch of programs, and we don't know what their effectiveness is," said Mike Young of the University of Arkansas in Fayetteville. Abstinence instructors have sprouted up across the country, he said, all claiming, often with scant or no scientific support, that they can successfully influence teenagers facing temptation.

Dr. Young and his colleagues have developed a curriculum called Sex Can Wait, which is one of the most studied abstinence programs in the country, and one of the few that has documented at least a short-term influence on teenage behavior. His program emphasizes abstinence in youth as an integral component of a successful life, and not a goal by itself. Students who can envision the long-term, he believes, are less likely to gamble their futures by engaging in sex.

The program has been recognized five times for Outstanding Work in Community Health Promotion by the U.S. Department of Health and Human Services. But not even the blessing of the federal government has improved the chances of Sex Can Wait getting into Arkansas schools. The state's Department of Health has yet to fund any grants based on this approach, choosing other programs with less scientific merit.

Who gets funding?

"Funding should be contingent on a very solid evaluation program," Dr. Young said, "and future funding should be dependent on past results."

Federal officials acknowledge the concerns about funding untested programs are "a fair criticism," said Harry Wilson, associate commissioner of the Family and Youth Services Bureau. Each agency, he says, must balance the cost of funding programs against the cost of study. "How much do we evaluate, and how much public money should go to fix the issue?"

The government is paying for a large, multiyear study of several abstinence programs, which when published will be the most comprehensive evaluation yet. The price: $4.5 million per year. The interim data were supposed to have been released already but remain unpublished. Mr. Wilson said the final report will be out by 2006.

Lacking objective information about a program's effectiveness, Mr. Wilson said, the government looks at other barometers, such as community needs, the educators' experience and ties to the community. "You do the best you can with what you know," he said.

Dr. Young and other researchers say they don't want their criticism to be misinterpreted: "I think we need to encourage young people to wait, and I don't think there's anything wrong with the government putting money into those efforts."

What bothers him are self-styled educators who he believes mold their content to meet the official federal definition of "abstinence" and aren't held accountable for accuracy or measurable results. "This combination translates into abstinence education programming which often deliberately provides inaccurate information in a misguided attempt to scare young people into choosing abstinence," he wrote in the current issue of the American Journal of Health Studies, in an article titled "What's Wrong With Abstinence Education."

Charged topic

The field has become so mined with emotion and ideology that many researchers studying abstinence programs fear that science is losing to politics. One Arkansas state legislator upset by Dr. Young's work physically threatened him; an anti-abortion group once labeled the program "godless" - about the same time Dr. Young was ordained as a deacon in the Southern Baptist Church.

"We need to get over our fear of research," said A&M's Dr. Pruitt. "It does bother me that we don't have the kind of respect for research and evaluation that this area deserves. There seems to be a political fear of the truth."

Scientists have an ally in Dr. Joe McIlhaney. Founder of the Medical Institute for Sexual Health in Austin, Dr. McIlhaney has long championed abstinence-only education for adolescents. Dr. McIlhaney, who retired from a successful practice as an obstetrician/gynecologist, founded the organization in 1992 to combat teen pregnancy and sexually transmitted diseases.

He said he realizes that some of his fellow supporters of abstinence education have spurned research. He disagrees with them. "I think it's mandatory to do these evaluations," said Dr. McIlhaney. He doesn't believe, however, that abstinence education efforts should stall while scientists hash out the best approach. "For almost any issue you don't wait until you have results to institute a program," he said. "I think it's very important to institute abstinence education programs" while research is under way.

And he warns against hasty conclusions. The Texas study didn't find an effect, he says, but "it'd be a mistake to conclude that this research shows that abstinence programs don't work." As the researchers did themselves, he pointed out the study's lack of comparison group.

Texas has now joined about a dozen other states that have evaluated their abstinence education programs. "By and large they got no changes in behavior," said Debra Hauser, vice president of the non-profit group Advocates for Youth, which has conducted studies that support more comprehensive sex education programs that include contraception.

Research has shown that knowledge and intention alone cannot dissuade teenagers from having sex, and that studies that simply ask teenagers' attitudes are not always meaningful. "If you tell them for five weeks you want them to abstain, and then you ask them if they intend to abstain, they are going to say yes," she said. "Intention is necessary, but it's not sufficient."

Bill Albert of the nonpartisan Campaign to Prevent Teen Pregnancy agrees that early research of abstinence education has not been promising but says the value of abstinence education is still unclear. "What we have said now for several years is that the jury is still out on the effectiveness of abstinence-only programs," he said. "Most of them won't work, but most programs of any stripe don't work."

Health education researchers are eager to see the federally funded report. Still, that analysis alone will not provide a definitive answer. Dr. Pruitt predicts it may further inflame both sides.

"We need to all get in the same room, and we need to share information and ideas," he said. "We need to engage each other in conversation. We need to talk about kids instead of talking about politics."

E-mail lbeil@dallasnews.com

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