Efficacy of a Theory-Based Abstinence-Only Intervention Over 24 Months
A Randomized Controlled Trial With Young Adolescents
John B. Jemmott III, PhD; Loretta S. Jemmott, PhD, RN; Geoffrey T. Fong, PhD
Arch Pediatr Adolesc Med. 2010;164(2):152-159.
Objective: To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents.
Design: Randomized controlled trial.
Setting: Urban public schools.
Participants: A total of 662 African American students in grades 6 and 7.
Interventions: An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex–only intervention targeted increased condom use; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.
Outcome Measures: The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.
Results: The participants’ mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.
Conclusion: Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.
Trial Registration: clinicaltrials.gov Identifier: NCT00640653
Author Affiliations: School of Medicine and Annenberg School for Communication (Dr J. B. Jemmott), and School of Nursing Science (Dr L. S. Jemmott), University of Pennsylvania, Philadelphia; and Department of Psychology, University of Waterloo, and Ontario Institute for Cancer Research, Waterloo, Ontario, Canada (Dr Fong).
In order for you to read and understand the abstract above, you will need some significant training in scientific technique, so let me give you some brief summaries of what it says above. First, it is some good news for advocates of abstinence-only education. The above is an abstract of an article published in the journal called The Archives of Pediatric & Adolescent Medicine. You can go there and pay if you wish to read the full article. OK, so, in brief, what does it say?
Second, it says that the study was conducted in an urban area. It was among over 600 African-American students in grades 6 & 7. To me the shocker was that the mean age was 12 years old. I must admit that, though I intellectually know better, it still hits me when I realize that we now have to make sure our children have a sound education on sexual issues by age 12 in order to make sure that we have a chance to catch them before they become sexually active. Some are saying that it already needs to drop to grades 5 & 6.
Third, it says that participants were followed for 24 months. And, it says that those who were taught in an abstinence-only program had a lower rate of loss of virginity and sexual activity than those in the control group. But, please note that abstinence-only training also included training in other health issues. That is, the program was not simply a “no, no, no” program, it also included additional training in “targeted health issues unrelated to sexual behavior.” That is, the program tried to be a comprehensive program that dealt with more than one of the risk factors facing urban youth. And, there were also follow-up “interventions” which probably is what made the program additionally successful.
Some are already trumpeting that this study is a breakthrough study that undermines all the claims of those against abstinence-only education. OK, now here is the bad news. It is not. And, I think we need to stop using that type of language whenever a study comes out that appears to support a viewpoint with which we agree. This study is extremely valuable, but let me word it for you in the way in which a scientist would carefully word it. This study shows that a carefully crafted abstinence-only program, that includes other components than just “sex-ed”, and that includes some targeted follow-up works among urban youth who are at high-risk will work. This study does not show that any abstinence-only education program will always work better than any other type of “sex-ed” program in every population at every time. Moreover, some further studies would need to be done to know whether urban high-risk youth respond better to a comprehensive health program based on abstinence-only than suburban middle and upper class youth. Nevertheless, here is a quote from an article reviewing the study:
The results were telling: at the end of the two-year program, 32.6% of teens in the abstinence-only program reported ever having sex, compared to 51.8% of students in the “safer” sex program. Teens in the abstinence program also had fewer sexual partners and were less likely to have unprotected sex.
What we can take away from this study is the necessity to carefully craft the abstinence-only program to the target population. It should be no surprise to any of us that a one-size-fits-all approach is probably not anywhere near as effective as a targeted approach. This calls us to do the work that is needed to target our programs rather than simply buying a pre-developed national program and applying it with a broad brush. This also says that there need to be people willing to stay with the youth through the necessary follow-up period. In other words, youth need a reliable support community around them. This cannot simply be the pastor in a youth group situation. It must involve the family, other adults, and peer youth. And, it probably says that if our health educational efforts focus only on “sex-ed” then we will not be as effective as an overall approach to health-related youth issues. Why did I say probably in the previous sentence?
There are studies that show that abstinence-only, by itself, did not have the effect desired. There are studies that show that abstinence-only did have the effect desired. Some of the studies showed a switch in sexual behaviors away from coitus towards other forms of gratification. Those studies need to be looked at again. I do not think the studies which did not show a good result for abstinence-only education were mistaken, nor were they biased (which is the bomb we love to lobby whenever we disagree with a study). Rather, I suspect that if all the studies are looked at again, in the cases where they did not do well the abstinence-only programs may not have been well-planned. (An additional possibility is that the programs were good, but did not have the outside-the-classroom support which was needed.) Do you remember how boring health classes were when you were a child? I suspect that some of the state initiated abstinence-only programs were every bit as boring and badly planned, with the local coach being forced into the teaching of them. Meanwhile, though I do not agree with Planned Parenthood, I must say that they do put out interesting brochures and programs. A boring program is a boring program, whether moral or not. Badly taught or planned abstinence-only education will not win over well taught and planned “responsible” sex education.
I think that this study is great. But, it is also a wake-up call for us. If we bore our youth in Sunday School and youth group, we should not be surprised if they run the other way when they reach an age of independence. If we present badly planned and presented abstinence-only education, we should not be surprised if it does not have the results we wish. Let’s look at this study and get some ideas about how to correctly plan a program, how to correctly surround the youth with support, how to correctly plan a comprehensive program that covers more than just “sex-ed”, and how to correctly follow-up in a gentle manner that encourages youth to be honest with us and us honest with them.
Regarding the age: We are not that far from the time when people got married at age 12. And the vast majority of our ancestors (yours and mine) were married far younger than we like to imagine. Our culture’s unnatural fixation and a) youth and b) a naive and victorian conception of “childhood innocence” and c) the idea that we need to “wait” for marriage and “enjoy” our salad days are, in no small way, responsible for setting this up. I’m with Frederica Matthewes Green on this one: after a good education… the best solution to early sex is early marriage.
Having a 21 year old daughter who is a virgin and has had 4 young men break up with her because she wouldn’t “put out” and then come back begging at her feet because they miss her presence so much (she doesn’t have much use for them at that point!!) and who has had peers who are pushing her to have a sexual experience and just don’t get it when she says that a-she cares for herself more than to have casual sex just because and b-sex is not just about “getting it on” or an issue of simple morality or lack thereof but is about a commitment of not only body but also mind, soul, emotions, psychology of being, and the Divine and c-she will not give her body to anyone who will not treasure her as she is meant to be treasured and that means more that a short-term “but I love you, baby” mentality, I think we have gone way beyond the pale as a society. Somehow we have lost the idea that sex is more than some kind of “high” or a way to say thanks for the great evening. The deeper meaning of sexuality in a spiritual context is seen as old fashioned and dull, dumb and boring.
I remember sex-ed and it was BORING, but I was a good girl back in the Ozzie and Harriet days and would not have even thought of sex as a casual thing. The 60’s did away with that notion and we haven’t put the genie back in the bottle yet. I do not know how we do so.
My two oldest daughters are in committed and permanent relationships but not legally married. Their stance is that a legal piece of paper is not necessary and cannot bind two people together, but can bind a person to their abuser. They are not religious either. Both of those things are the fallout of them seeing my spouse, a Baptist Minister almost kill me in front of the children and having his church back him (after the third time, I pressed charges and fled with the children in fear of my life) saying if I was a good wife, he wouldn’t have had to hit me (At this point in time, I was the sole support of the family as the church was small and not paying him, was chronically ill and at times wheelchair bound, and doing 100% of the child raising and household chores as well as helping out at the church).
We as human beings all bear the scars of a society run amuck and the scars get passed down through the generations. The healing is not as easy as any program, though those scars can be ameliorated somewhat by good education and community support in all facets of responsible living. I see our communities as fragmented and our families as scattered and not able to support each other. In my opinion, it is more about community building and family building.
I have found the makings in my church of such a community as well as a small family in the community theatre I work for. It is up to each of us to reach out in our own spaces where we work and play and BE family and community. As a dear friend always says to me,”Suit up and show up.”
Alix
“In other words, youth need a reliable support community around them.”
If I may be so bold, this is part of a solution to ALL of our problems. If everybody were surrounded with a multitude of people willing to steer each other back on course, many things wouldn’t be so bad. How to make that happen is the large problem. The “just say no” from afar isn’t the best help.
LOL, you are so right!