Abstinence Education Program Successfully Delays Sexual Debut

Early sexual involvement can lead to serious consequences in adolescents such as sexually transmitted infections (STIs) and unintended pregnancies. According to the CDC, African American adolescents are a highly vulnerable population, representing only 17% of 13-19 year olds in the US but accounting for 72% of the HIV/AIDS cases in this age group in 2007.1 Understanding the severity of the problem, Drs. John and Loretta Jemmott designed a study to evaluate several different sexual health educational interventions with the primary objective of delaying sexual initiation in young adolescents.2 The randomized controlled trial included four different educational interventions: an 8-hour abstinence-only intervention, emphasizing risk avoidance; an 8-hour safer sex-only intervention, emphasizing condom use for reducing the risk of pregnancy and sexually transmitted infections (STIs); and two comprehensive interventions, one 8-hour and one 12-hour, emphasizing both abstinence and condom use. Additionally, the researchers included an 8-hour health-promotion class that emphasized health issues unrelated to sexual behavior to serve as a control.

Participants included 662 African American students in grades 6 and 7 from 4 public middle schools who agreed to attend the weekend educational sessions. The participants were randomly assigned to one of the intervention groups or the control group. Questionnaires were used to collect the self reported sexual behavior data of the adolescents several times up to 24 months after the intervention.

After 24 months, only the abstinence-only intervention was effective in preventing adolescents from engaging in sexual intercourse, with 33% fewer students initiating sexual intercourse in the abstinence intervention than in the health-promotion control group. None of the other interventions showed a significant decrease in the number of students initiating sexual intercourse when compared to the control students. A second important finding from the research study was that the abstinence-only intervention participants did not differ from the control group in the use of condoms when they did initiate sexual intercourse. And, lastly, several interventions were associated with a decrease in multiple partners. Both the 8- and 12-hour comprehensive interventions were associated with a significant reduction in reports of multiple partners compared with the control group. Also, students in the abstinence-only and 12-hour comprehensive interventions who received follow-up educational and counseling sessions significantly decreased multiple partners compared to controls.

The researchers concluded that the abstinence-only intervention had the most dramatic effect on the prevention of adolescent sexual involvement. However, some limitations of the trial should be highlighted. The population that was targeted with these interventions was African-American middle school students in 4 public schools who were willing to attend educational classes on the weekend, limiting the generalizability of the findings to other populations, other age-groups, and even other students within this community. Also, the data were collected using self reports, which make it vulnerable to inaccuracy due to lack of memory or untruthful responses. However, the researchers took measures to encourage honest and accurate responses. They also performed a statistical analysis of the results for evidence of biased answers and found none.

Despite these limitations, this research has yielded some promising results that suggest abstinence-based education may play an important role in preventing early adolescent sexual involvement. Through rigorous design, implementation, and program evaluation, the researchers demonstrated that their “abstinence-only” intervention was the only intervention that significantly delayed sexual debut, outperforming both of the comprehensive education interventions. It is important to note, though, that the success of this educational intervention may not be representative of the outcomes in other abstinence programs. Since the abstinence education program used in the study was tailored to the target population, it was not designed to meet federal CBAE and Title V criteria for an abstinence education program suggesting that this intervention may have some inherent differences from other current abstinence education programs. Also, this sexual health program was not school-based. Like many other effective sexual health programs that have been detailed in scientific publications to date, this educational intervention took place outside of the typical classroom setting and used a format that may not be replicable in many schools.

However, these results do clearly emphasize the need for 1) rigorous evaluation of abstinence-based and comprehensive sexual health programs, 2) meticulous sexual health program planning tailored to the target population, and 3) maintenance programs that reinforce the primary messages of the sex education intervention, whether abstinence or comprehensive, for increased efficacy. As always, any sex education program for our youth should convey objective, scientifically accurate information. The Medical Institute’s message remains unchanged that risk avoidance is the most effective option for preventing the emotional and physical consequences of risky sexual behavior. Providing our youth with evidence-based information can help them make the healthiest life choices.

References:

1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance in Adolescents and Young Adults (through 2007) Slide Set. Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/index.htm. Accessed 2010 Feb 4.
2. Jemmott JB, Jemott LS, Fong GT. Efficacy of a theory-based abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents. Arch Pediatr Adolesc Med 2010;164(2):152-9.

Reviewed: February 2010.

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