Is Abstinence Education Effective?
How would abstinence education stack up against comprehensive sex education if they were evaluated in a deliberate and controlled way? That is the question that Dr. Christine Markham and her colleagues at the University of Texas Health Science Center, School of Public Health in Houston are trying to answer in an ongoing study among middle school students funded by the Centers for Disease Control and Prevention (CDC). Preliminary results from the study were presented at a national meeting of public health professionals in November 2009.1
Researchers developed two curricula- a risk avoidance (RA) curriculum and a risk reduction (RR) curriculum. Both include comparable information on puberty, reproduction, sexually transmitted infections (STIs), HIV, pregnancy, healthy relationships, and parent-child activities. The curricula were delivered in similar ways, using comparable settings, formats, and durations of classes.
The curricula differ in several key areas, though. The risk avoidance curriculum focuses on character education and beliefs about marriage, and it meets the Title V Section 510 A-H criteria. The risk reduction curriculum focuses on respecting self/others and addresses condom and contraceptive skills.
The study randomly assigned 15 middle schools to implement one of the two curricula in the spring semester of the 7th and 8th grade years. Students who participated in the study’s sex education classes were given a follow up survey several months later, and their answers were compared to control students from other schools who did not participate in either the RR or RA program.
Interestingly, preliminary results show that the 7th and 8th grade students in both the RA and the RR programs had increased positive beliefs about abstinence. Furthermore, they all reported increased knowledge of STIs and HIV, when compared to the control students. However, other survey questions detected differences between the students in the RA and RR programs. In the RA program, both 7th and 8th grade students had significantly greater intent to abstain from vaginal sex for the next year, throughout high school, and until marriage, when compared to the control students. Students in the RA program also reported significantly less exposure to risky situations, reduced vaginal sex intentions, and less permissive parental sexual beliefs. In the RR program, 7th grade students had significantly greater intent than control students to abstain from vaginal sex for the next year and until marriage, but 8th grade students showed no significant change from control students concerning their intention to abstain from vaginal sex for any period of time. Also, only the 8th grade RR program participants demonstrated a significantly greater self-reported knowledge of condoms and greater confidence in their ability to use condoms.
The researchers concluded that neither program appeared to have a negative impact on the students’ reported beliefs, intentions, knowledge, or relationship expectations. Further, they observed positive psychosocial results that they hope will lead to positive behavioral results as the students enter 9th grade.
Although these findings are promising, it is important to note the limitations of this study. First, these are preliminary data, and further evaluation of study results are expected over the next 2 years. Second, while it is good for knowledge and intentions to improve after an educational intervention, it is important to ensure that these translate to behavior changes and improved health outcomes. Therefore, behavioral results forthcoming in the next several years will be important to consider when evaluating these programs. Third, only one school district was included in this study. Further evaluation may be necessary to observe the effects of these programs in other school districts and in different populations. Lastly, all of the results from these preliminary data compare the RR and RA program participants with control students. No comparisons have been made between the participants in the RR program and the RA program. Therefore, these preliminary data are not meant to prove the superiority of one program over the other, rather to show how these programs compare to the standard education that middle school students in nearby areas were receiving prior to and outside of the study.
The Medical Institute continues to support a risk avoidance message for youth, encouraging them to stay healthy and to focus on their life goals free of risky activity and its consequences. Continued evaluation of sexual health programs will ensure that educational strategies employed in schools are effective to achieve these goals, ultimately improving the health of our youth.
1. Markham C, Thiel M, Addy R, et al. Making the grade: Preliminary psychosocial results from two sexual health education curricula for middle school youth. Oral presentation at the 137th American Public Health Association Annual Meeting and Expo, Philadelphia, PA, November 7-11, 2009.
Reviewed: January 2010.