Choosing Excellence

The healthiest behavior choice for unmarried teens is abstinence. This involves not only avoiding sexual intercourse but also many of the behaviors that will directly lead to premature sexual involvement. If abstinence education makes sense to you, you will be able to successfully teach these skills to those teens in your care. If you are not sure, read the following pages for some very revealing evidence.

Teachers have proven themselves to be very effective at teaching healthy behaviors. Part of this effectiveness is due to teachers' high expectations for students. Teaching to the best standard will give the most hope for a bright future, especially to those struggling with difficult situations. Dysfunctional students who are crying for help should not be the basis for teaching skills to the whole class. Students are capable of self-control when taught age-appropriate, consistent, and clear messages.

For some time now education, social service, and health care professionals have been spending tremendous amounts of money and energy, trying to deliver the contraceptive message to teens. Teen sexuality problems should have been reduced if sexuality information and contraceptives were the answer, given all the promotion, funding, education, and community acceptance. But all this effort has, in fact, brought more problems for teens than before. The "contraceptive solution" has not worked.

The teenage population is experiencing higher school dropout rates, more pregnancies, more abortions, more sexually transmitted diseases, and now HIV. Unfortunately contraceptives and "safer sex" practices don't make teens safer; teens are poor contraceptive users.

As adults we are all responsible to model, teach, and encourage personal responsibility. Truly responsible behavior for teens is abstinence from all risky behaviors including drug use and premarital sexual activity.

What does work is abstinence. This involves more than just saying "no". A directive, fully developed abstinence program must give teens the multifaceted skills to avoid risks and to embrace the healthiest lifestyle.

Choose to Be Excellent

What do you believe is the healthiest sexual behavior for the majority of your class, especially today when HIV is in the picture? The latest statistics show that 10 to 20% of people with HIV/AIDS acquired their disease while they were teenagers.

Before making a decision on which sexuality or abstinence curriculum is to be taught, consider which sexual behaviors are the healthiest. Consider what is the best choice for the largest number of students.

· Do you as an educator want your students to be infected with a sexually transmitted disease?

If your answer is "no", find out how to get the desired results. Most educators tell us that they want the healthiest lifestyle - abstinence - for their students.

How Effective Are Teachers at Teaching to Behavioral Objectives?

Teachers are very effective at teaching healthy behaviors. Recent successes in the areas of teen drug, alcohol, and tobacco use testify to this fact. Teachers have played a major role in changing our entire society's attitude about smoking. When educators became single-minded, the entire society changed behaviors. This tenacious teaching stressed preventing children from beginning to smoke and encouraging them to stop if they had started. Confidence in the ability to help students avoid the health risks involved with smoking, even if their parents smoked, has never wavered. The impact of that teaching changed public opinion, and even legislated behavior changes which have affected both public and private buildings and businesses. Parents also have often converted through information and values children brought home. Hollywood and government bureaus such as the Federal Transportation Commission have responded as well.

In 1988 the National School Boards Association found that 95% of school districts have a written policy regarding smoking. Smoking bans in schools were felt to accomplish several goals: 1) they discourage students from starting to smoke; 2) they reinforce knowledge of the health hazards of smoking; and 3) they promote a smoke-free environment as the norm. Studies show that such instruction, as part of a comprehensive school health education curriculum, is effective in preventing initiation of smoking among children and adolescents.³

Success in the area of teen drug abuse can also be credited to teachers and other responsible adults in the community. Initial educational efforts failed, however, with messages such as, "Use only clean drugs", "Use drugs responsibly - Know your limits." Many felt that kids were going to use drugs, and that giving them information would result in "responsible drug use". A glimmer of success was finally achieved when the responsible adult world quit trying to reduce the consequences of drug use and attacked the root problem by pressing for total abstinence from the use of tobacco, alcohol, and drugs of all kinds. As school educational and motivational campaigns began giving a very clear "don't use drugs" message, teen substance abuse decreased.

Drugs vs. Sex

Studies also show that instruction in premarital sexual abstinence is highly effective in preventing premarital sexual activity (see below). Skeptics may challenge that changing health behaviors such as tobacco and drug use is not the same as changing sexual behaviors. But history records that the educational system has had a major impact on sexual decisions relating to family size. In public opinion and in the textbooks of the 1940's, the expected family size was four children. By the 1960's the ideal family size was portrayed as only two children. Partially due to these factors, by 1972 family size shrank to 2.0 children per family, which is below population replacement level.⁴

Educational efforts were shown to be working in regards to drug abstinence in a survey of 16- to 19-year-olds in Massachusetts done between 1986 and 1988. But this same survey showed that teens had actually increased sexual activity. Teens using drugs declined from 13% to 9%, and IV drug use declined from 1% to 0.1%; but teen sexual activity increased from 55% to 61%. Even though AIDS education in these schools increased from 52% to 82%, only 31% of "sexually active" teens regularly used condoms, 37% never used them, and 18% engaged in "unprotected" sex with multiple partners.

⁵From this study it appears that teens were indeed receptive to a drug abstinence message. With this kind of success in changing behavior regarding drugs, one must assume that the premarital sexual abstinence message was not given.

In most "comprehensive" health programs, adolescents are assumed to be sexually active and receive the "contraceptive solution". Studies are showing that the clear message against drug usage worked. One must ask what would happen if all educators, sports figures, TV shows, Hollywood, local businesses, social service agencies, and law enforcement groups teamed up against precocious sexual activity in the same way that they have effectively teamed up against drugs.

The above study reported successes in helping teens to abstain from drugs. Another study by the Centers for Disease Control (CDC, a branch of the U.S. Public Health Service) found that, during the same time period while drug use was being reduced, more teenage girls indulged in premarital and promiscuous (more than one partner) sex. Between 1985 and 1988, the percentage of 15-year-old girls who were sexually active rose from 20% to 25.6%, and in 19-year-old girls it went from 70.7% to 75.3%. The study also showed that if a girl began sexual activity before age 18, 75% reported two or more partners and 45% had four or more. In contrast, among women who waited until age 19 before initiating sexual activity, only 20% had two or more partners and only 1% had four or more. ⁶

In contrast, among women who waited until age 19 before initiating sexual activity, only 20% had two or more partners and only 1% had four or more.

Kids Know More about Condoms Than Abstinence

We must recognize that most kids are being instructed more about condoms, with abstinence merely an afterthought, as a way to prevent AIDS and other sexually related conditions. In Canada, 7th and 8th graders were tested following a compulsory course in AIDS education. It was found that these students believed more in condoms than in abstinence as an effective measure in preventing the spread of AIDS.⁷

The Surgeon General and Abstinence Education

Dr. C. Everett Koop, the U.S. Surgeon General in office at the beginning of the awareness of HIV/AIDS, is specific on how educators (and other adults) should approach the topic of prevention with youngsters of school age. He stresses that young people still in school should be taught to abstain from sex, and abstain from drugs. He urges,

. . . sexual abstinence is a very good idea for youngsters of school age. Today - in the presence of the deadly AIDS epidemic - I think we, as adults, must step forward and help our children address the phenomenon of their own sexuality in a caring developmental way.⁸

For the rest of us (pause) me (pause) you (pause) your faculty (pause) abstinence may not be the behavior of choice. What then? Then the next best thing is monogamy (pause) one person, one mate; find someone to whom you can give your love and respect and trust (pause) someone who will give the same in return (pause) and stay with that person forever.⁹

What Are the Benefits of Abstinence Education?

Studies are showing that abstinence education has a very beneficial influence on teen values, character, and behavior.¹⁰Conversely, there is a growing collection of data indicating that contraceptive education of teens has no positive effect on pregnancy rates or continued usage of birth control. Birth rates are only slightly impacted. Contraceptive education exerts an adverse influence on behavior and physical and mental health.¹¹

From 1984 to 1986 the Teen-Aid abstinence program was taught without the mixed message of contraception at San Marcos Junior High School in California. In the school year before the introduction of the Teen-Aid program, 147 pregnancies were reported in 600 girls. In the year after the program, only 20 pregnancies were reported by faculty and staff!^{12, 13}

Secretary of Education, William J. Bennett, referred to this turn of events in his book, AIDS and the Education of Our Children, when he stated that the Teen-Aid abstinence program

. . .was used to reinforce the school's motto, "I am responsible for myself." The program has helped students strengthen their character as well as gain personal insight.¹⁴

This phenomenon is not unique to urban California. D'Ann Pierce of Spur, TX reported that in 1988 her rural school district had 11 pregnancies in a K-12 student body of 450. In 1990, after implementing the Teen-Aid program, the rate was down to only one pregnancy in her west Texas town.¹⁵

In Atlanta, Georgia, use of the abstinence, or directive, model again refuted the assumption "that adolescents have sex, smoke, drink, or use drugs because they lack knowledge about specific aspects of such behaviors and their harmful effects." The Grady Hospital staff considered the need to make age-appropriate lessons "promoting attitudes and skills that young adolescents can use until they gain more mature skills in managing their sexuality." By the end of eighth grade, students who had not participated in the program were as much as five times more likely to have begun having sex than those who had had the program.¹⁷

In South Carolina, The School/Community Program for Sexual Risk Reduction Among Teens noted a reduction in teen pregnancy rates (live births plus fetal deaths plus induced abortion). They stated, "The educational objective is to promote the postponement of initial voluntary intercourse as the positive, preferred sexual and health decision."

During the three years the program was in progress, the pregnancy rate decreased 58% while three comparison counties had an increase in the pregnancy rate.¹⁸

Teaching abstinence skills and values has been shown to cause a reduction in teen pregnancy. Our young people deserve a pure premarital abstinence message which has been shown to reduce teen sexual activity and pregnancy as much as tenfold.

Sexuality and Mental Health

The heart and soul of the Teen-Aid curriculum is training in a lifestyle of premarital sexual abstinence which contributes to the achievement of many physical and emotional rewards.

Adolescent premarital sexual activity is undesirable, for it is associated with numerous adverse physical and emotional results. Although the physical problems of teen pregnancy, abortion, STD's (including AIDS and cervical cancer), and infertility are covered more extensively in Teen-Aid curricula, it is important that we not overlook the impact on psychological development:

Negative effects on sexual adjustment - Premarital sex, especially with more than one person, have been linked to the development of difficulty in sexual adjustment. (Guilt has been found to be a pervasive problem in this regard.)^{19, 20}

Negative effects on martial stability – Marriage and family counselors report that those with more premarital sexual experience have, in future marriages, increased difficulty in relating on a deep interpersonal level with their spouse and an increased likelihood of marital instability.

Negative effects on happiness – Premarital sex, especially with more than one person, have been linked to the development of emotional illness.²¹

Loss of self-esteem – Premarital sex is particularly destructive to self-esteem in girls. The self –esteem scores were lower in boys and girls who had a history of sexually transmitted diseases.²²

Who Is Responsible for Teaching Personal Responsibility?

Every responsible adult has the duty to teach, model, and reinforce the healthiest lifestyle choices for all young people. Young people are the future. When the teenagers who will soon be running the world set a pattern of making poor choices today, the future prosperity of our community is threatened. A strong future is secured when young people are clearly and consistently directed towards healthy lifestyle decisions. Personal responsibility includes the little things like responsibilities at home and school as well as personal behaviors which impact the community.

Family members, teachers, and individuals in each community must model healthy behavior in their own lives. These important adults should be held responsible by their peers to teach the best prevention methods for all health decisions including drug usage and sexual activity.

Teens also need reinforcement from public messages. Responsible adults can make a profound difference on public policy through elections, etc. Adults influence responsible media messages through their viewing and buying habits. You, as one of those responsible adults, can clearly and consistently give and live the message you believe to be the healthiest.

Adults establish expectations for teens. Graduation night had traditionally become a night for drug and alcohol use. Responsible adults have intervened by modeling and providing drug-free activities such as "Grad Night". Community leaders might follow that example by turning prom night into a sex-free activity for teens.

Can Students Rise to Your Level of Expectation?

Students (for the most part) will rise to the level of expectation of their teacher. The less that is expected of them, the less effort they will put forth. If you believe abstinence from drugs and premarital sex is the most responsible and the healthiest choice for your students, then a student learning objective could be written to teach that concept. Perhaps it would read: At the completion of this lesson, 98% of the students will be able to list three to five reasons why it is healthy for teens to abstain from sexual involvement until marriage. Or: 98% of the students will be able to identify the most responsible means for preventing HIV infection and 95% of the students will make a personal commitment in class or to an adult/peer that they will abstain from drugs and postpone sexual involvement until marriage.

Knowledge Alone Does Not Change Behavior

Does abstinence education require the teacher to withhold information? No. If questions arise, those that require factual information can be answered and those of a more complicated nature having to do with values can be referred to the home or counselor.

It is important that we understand that knowledge alone does not influence teen behavior. Several authors attest to this fact.^{23, 24, 25}

Study of adolescent development shows that cognitive growth lags behind physical maturation. Until about the age of 16, adolescents are still using concrete thinking skills. But even after age 16, individuals revert to thinking at lower levels of abstraction when faced with stressful situations. As a result, especially young teenagers have limited ability to recognize the potential impact of their choices; they are less likely than older teenagers to think about the future and to consider the consequences of their actions.²⁶

Dr. Ralph DiClemente of the University of California reports that even in the area of HIV/AIDS virus infection, the level of knowledge alone did not motivate adolescents to adopt or maintain health-promoting behavior. Ironically, he noted,

Not only was AIDS knowledge not associated with positive behavior change, but those adolescents with lower levels of knowledge about disease transmission and prevention reported slightly less sexual risk-taking behavior.

More importantly, he noted that teen behavior was determined by what was "-their perception of normal, peer-group sanctioned behavior."²⁷

Another study on the effects of knowledge on behavior says, "When adolescents and their parents hold values that stress responsibility, the adolescents' chances of experiencing an out-of-wedlock childbirth are significantly reduced."²⁸

It seems clear that teens will respond behaviorally to what they perceive is expected of them by parents, teachers, peers, and other role models (but not necessarily in this order of importance).

Are Your Students Capable of Self-Control?

The majority of students are capable of controlling their physical desires. Students exercise control over their body daily - practicing for a particular sport even when it hurts, waiting for a drink of water, avoiding hitting someone who makes them angry, standing firm against the pressure to take drugs.

What about Age-Appropriate Messages?

What is the legal age of sexual consent within your state? Weren't the laws passed to protect children from the exploitation of their inability to make truly informed choices in serious matters? If the law's intent is to protect children, is anything you are teaching enabling teens to put themselves in danger? What messages do you give about respect for the law? In the area of reproductive health, many authorities see inconsistencies. These inconsistencies include: parental involvement, consent of minors, and advice given to young people that cause actions which are illegal or endanger health.

What You Don't Use - You Lose

An important component in education is the emphasis of waiting until "the right time" to teach skills. Think of the examples of reading, writing and basketball handling skills. Teachers watch for the "teachable moment" because it is the optimum time to teach and the appropriate time in the child's life to learn and utilize the information. Children are expected to practice and continually use information and skills as soon as they are given. Parents are encouraged to be a part of the learning and practicing process. Important information is repeated often. Educators know the meaning of "what you don't use - you lose."

Students are grouped in classroom settings according to their individual needs and situations. Children with special problems are handled with remediation. Concepts designed to help the most students with the best education are the guiding principles for curriculum content.

These conventional educational methods work and are followed except in the area of life-changing reproductive health teaching. It is inappropriate to give explicit sexual information (not to be confused with puberty and hygiene) in anticipation of when the child will begin puberty and need the information. Another inconsistency is that the standard parental permission then becomes exclusionary - the parent must sign a note so that the child will NOT attend the school activity.

Only in the area of reproductive matters are medical services dispensed without parental permission. Information is given to all children based on the needs of the most physically developed and the most socially or sexually precocious. Those students who are least likely to have the self discipline to consistently bring a pencil to class are expected to consistently use contraceptives.

Often parents suggest that they don't want their son/daughter to be given information on contraceptives because they don't expect abstaining teens to need to use them. These parents are then given the educationally inconsistent response that teens are taught birth control methods, "but of course, the teens are not really expected to practice this skill until they are ready/older/married." Yet, we all know the "what you don't use - you lose" theory.

When an educator teaches to an age-appropriate goal, a higher percentage of the students are able to achieve that goal.

Age-Appropriate Objectives

It is appropriate to teach students of the many advantages of premarital abstinence and postmarital monogamy. In a speech by the Surgeon General,

The message about AIDS does have a nasty clinical side to it. But a thoughtful educational program dealing with sexuality and AIDS prevention should also touch upon some non-clinical concepts, such as sex with responsibility (pause) sex with caring (pause) sex with justice (pause) and sex with self-respect and with mutual respect.²⁹

The age-appropriate lesson for those in elementary, junior high, and high school is that sexual abstinence is the healthiest lifestyle. This is a remarkably realistic choice for people of this age - for they either are already abstinent (in the majority of cases) or have spent the majority of their life in this lifestyle. It is not an impossible task, and very much worth the energy expended. They only need some encouragement from adults to set goals and strive for them!

What About the Students Who Are Already Sexually Active?

Most educators agree that abstaining is the best choice, and that early sexual activity is unhealthy and dangerous for the individual, family, and society as a whole. In no other subject do educators teach to the student who is displaying destructive behavior. In sex education policy it is best that we not place the spotlight (and the glamour?) on those teens who are having illicit sex and putting themselves, their future children, and society at risk. If we want our students to adopt appropriate healthy behavior, our education must be directed to that goal. Healthy behavior must become the norm, and it must be modeled.

Teachers are effective at teaching to behavioral objectives. The classroom is the place to teach those healthy and attainable objectives. Students need to understand that each individual is responsible for the consequences that befall those around them if they make the decision to be sexually active. Sadly, students are often unaware that they have the permission or the right to say no to sexual advances, although in some states students, males and females, are taught that it is inappropriate to make sexual advances.

Premarital sexual activity has many possible consequences, particularly for those teens with multiple partners. This curriculum systematically informs teens of the emotional, social, and physical consequences. Even for the most routine medical procedures patients are given the possible consequences to the option they are choosing.

Once consciousness of the abstinence choice is raised, teens, and adults, should be presented with the many advantages of premarital abstinence. The teen's freedom to pursue dreams and goals in life often has more impact than a discussion of the negative consequences.

As the awareness of freedom gained by abstinence dawns, teens may ask about contraceptives which were previously held up as the ticket to freedom. Questions should be answered considering contraceptive failure rates, and comparing those to the "failure" rates for refraining adolescents. Answering questions with correct terminology while still embracing abstinence as the healthy choice for unmarried teens allows for honest dialogue.

Cognitive questions about contraceptives should be answered, including failure rates, and using age-appropriate language. This is far different than a "value-less" presentation of what contraceptive methods the student has to choose from. When presenting material, we must realize it is not what the teacher says or even means which is of paramount importance, but what the student hears. The student must hear that the teacher believes in abstinence and has confidence that the student can achieve that goal. Presenting backup measures for those who "are unable to control their urges" is a not-so-subtle message that the presenter believes the teens will fail. Therefore students doubt their ability to be successful and begin to equip themselves for sex.

Answering exclusively informative questions is different than giving opinions on value questions. For example, answering, "Why don't you get pregnant on the pill?" is different than "Mr./Ms. --, do you think I should use the pill?" Questions about contraceptives and birth control issues lend themselves to an open examination of how to regain the advantages of abstinence and avoid the risks associated with precocious sexual activity.

Refraining again, or secondary virginity, is not a physiological regaining. Rather, it is an attitude of having the ability to make a new decision. Teens who are disillusioned, who have been exploited by sexual abuse, or who want to start enjoying the advantages of abstinence can develop confidence in their ability to maintain self-control. More information on how to develop these skills is presented in Me, My World, My Future and Sexuality, Commitment & Family.

Good teaching can accomplish much, but some students will still feel that they want to be sexually active. Individualized instruction or directive one-on-one counseling for those teens can be productive, but it takes time.

Sexual attraction is a normal emotion. However, premarital sex is a function out of control, and much early adolescent sexual behavior is actually not sexually motivated! Many young people in their early teens use sex as a cry for help, as an act of rebellion, as a method of gaining peer approval, as an escape from one's life situations, as a self-destructive act, or in a misguided search for real love.³⁰This is a dysfunctional view of sexuality!

Remediation should be available for those who, for whatever reason, deviate from the best choice, but it is absolutely essential that this be done in private individual counseling and not in the classroom. It is unwise and unfair to allow the sexually dysfunctional faction of students to set the standard for developing district-wide programs. Classroom discussions for these students may degenerate into sensational exhibitions creating negative peer pressure.

Individual counseling can help to determine possible motives for sexual activity. Sexual behavior at this stage may be motivated by the need for love and acceptance or a perceived peer or adult pressure that everyone is having sex so they must, too. Adolescents may feel a need to live up to the perception portrayed in the media. Some cultural messages make teens feel that sex brings power or that they need to be in control or be the aggressor. This may be in the form of manipulation of a partner or date rape. Others feel that sex is a commodity to buy and sell or use to pay a debt (i.e., for being taken out to a nice dinner). Even those who view early sexual involvement as a commitment to the other person need a rational look at their capability of handling the consequences or the possible risks they might be exposing themselves and others to. Referrals for emotional and family dysfunctions should be made as needed. This type of counseling is beyond the scope of sex education programs.

Realizations made clear in counseling can help open the way for postponing immediate physical gratification. None of the above situations will be corrected by technology, the mere dispensing of a prescription. Personal needs require personal solutions. Casually handing out contraceptives in these cases is like giving a hungry, starving child a diet pill. Momentarily the feeling of hunger goes away but the real cause of the hunger, the need for food, has not been met. It may appear to meet the immediate desire, but eventually will cause long-term damage if the true needs are not met.

Only after a qualified adult, in private, skillfully addresses the benefits of abstinence, the consequences of early sex, the options for refusal and regained abstinence, and explores possible personal needs, should conception control measures be discussed. Information about contraception is available through local agencies and at any library or magazine rack. Students need to know first that you, as a responsible adult, consider sexual activity to be an adult behavior, accompanied by adult responsibilities, to be exercised only in a marital relationship. The prospective bride and groom should seek medical counsel from a physician for an appropriate health history and examination (including STD detection) and/or consideration of conception control measures.

What Are Mixed Messages?

As you teach abstinence skills, whether it be Teen-Aid or another abstinence program, you will want to stick to the subject. When you want teens to abstain, stop sexual activity, and/or reduce the number of partners in their lifetime you can't give confusing signals and then expect good results.

Equate the confused signals about sex with giving a dieter a gift of the recipes and ingredients for gourmet desserts. For those of you who have seriously dieted you know that this gift would be cruel and destructive. Giving our teens the choice of being sexually active when we know the consequences is just as cruel. Unless we give a clear and directive message, teens may mistakenly hear the message that we don't expect them to succeed at being abstinent.

A complicating factor is that most adolescents feel invincible, that nothing can harm them. "If harm does come, everything will be OK - Mom and Dad can fix anything, like always." Suggesting contraceptives affirms a sexually active lifestyle; we must ask ourselves if it's fair to give children choices if they can't live with the consequences of those choices.

Many curricula begin with an abstinence message, but then they erroneously believe that most teens are going to be sexually active, so a great deal of time is spent explaining the use of contraceptives. Teen-Aid finds that presenting abstinence and then presenting contraceptives (or condoms) gives students a mixed message. Following are some examples of mixed messages:

The Mixed Message

But just in case you are not able to control yourself and smoke, here are filter-tip cigarettes so that you can smoke and reduce your risk of lung cancer.

But since we know that many of you are going to shoot-up, here are clean needles so that you can shoot-up and reduce your risk of getting AIDS.

But in case you are not able to control yourself, here are condoms so that you can have sex with lots of partners and postpone getting pregnant and getting AIDS.

While advising the adolescent to abstain from tobacco, drugs, or promiscuous sex, we then say (or at least imply) that we don't expect them to succeed. This message is very destructive to success. No one would advocate Mixed Message #1 or #2, yet many are advocating Mixed Message #3.

Does Contraceptive Education Prevent Teen Sexuality Problems?

There are no reliable studies that show that contraceptive sex education reduces adolescent sexual activity, pregnancy, or abortion. Data indicates the opposite to be true!

Data from the 1984 National Longitudinal Survey of Work Experience of Youth were analyzed in a report by Marsiglio and Mott. It showed that teenage girls who are exposed to contraceptive education are more likely, than those who are not, to initiate sexual activity, especially if exposed in the younger ages.³¹

In 1986, the Planned Parenthood organization commissioned Louis Harris and Associates to conduct a poll of American teenagers- "American Teens Speak: Sex, Myths, TV, and Birth Control".³² They investigated what impact various types of sex education (or lack thereof) had on teen sexual activity. The results were a surprise to many. Sex education was defined as "comprehensive" if it usually included discussions of birth control. They found that those teens who had "comprehensive" sex education had a much higher rate of sexual intercourse (46%) than teens who had no sex education (34%). The lowest rate of sexual intercourse was in teens who had sex education that was not "comprehensive" (19%),i.e., it was less likely to contain information about contraceptives/birth control! It is important to note that no analysis was made of those teenagers who received abstinence based sex education!

Question 11, Table 5-4, Harris, American Teens Speak: Sex, Myths, TV, and Birth Control

Type of Sex Education

Type of Sex Education	Percent Who Had Sexual Intercourse
"Comprehensive" Sex Education	46
No Sex Education	34
Sex Education But Not "Comprehensive"	19

The Institute for Research and Evaluation has performed extensive analyses on the effects of "family-planning" programs on adolescent pregnancy rates, abortion rates, and birth rates. They reviewed the medical literature from 1971 through 1985, compiled and exhaustively analyzed data from the National Center for Health Statistics, the Centers for Disease Control (CDC), Alan Guttmacher Institute, the 1970 and 1980 U.S. census, etc. They found that involvement in comprehensive family-planning (contraceptive) programs was associated with statistically significant higher teenage pregnancy rates, and lower live birth rates because of increased usage of induced abortion.³³

Johns Hopkins University researchers, Zelnik and Kantner, found, "Although more teens are practicing contraception and doing so consistently and early, premarital pregnancies continue to rise-."³⁴

Does Contraceptive Education Prevent School Dropouts?

In Baltimore, a study was done trying to evaluate the effectiveness of birth control education, clinic services, and referrals (abortion rate not accounted for) to all black students.³⁵One junior high and one senior high school were chosen to be the "program" schools. Another junior high and senior high school served as the "control" schools. Students from both schools were comparable - all black, from the inner city, of low socioeconomic status. What differed was the type of sex education and services delivered.

Students at the program schools received presentations in each homeroom by clinic staff describing services available. These staff members were available for several hours each day in the school health room for individual or group counseling. In the afternoon these same staff people provided services in a special clinic which was situated across the street from one program school, and a few blocks from the other.

In this clinic, program students were given birth control instruction, pregnancy testing, and "referrals for other reproductive matters." Students at the control schools did not receive any of these services.

The very important data on school dropout rates were collected. The dropout rate for the program (clinic) schools was approximately three times that of the control schools! Over the 2 1/2 to 3 years of this study the dropout rates were:

In light of these experiences, it seems doubtful that school based clinics provide a beneficial service. They may, in fact, prove to be another part of the teenage sexuality problem.

Teacher Note About Statistics: As we consider teenage reproductive health statistics, it is important to note that:

some authors fail to define the term "being sexually active." The reader should determine if this means having had intercourse once, or if teens are continually sexually active and at risk.

some authors don't differentiate between sexual activity between married adult teens and those unmarried age 17 and under.

some authors misunderstand the difference between the outcomes of "out-of-wedlock" births and births to married teen parents.

some authors may report a reduction in "pregnancy rate" when it is, in fact, the "live birth rate." To give a true picture of pregnancy reduction, one must also take into account those pregnancies that were terminated before live birth (i.e., abortion rate).

How Good Are Teenagers at Using Contraceptives?

The data indicate that adolescents do not respond to the contraceptive message in the same way as mature individuals. Put another way, adolescents are very poor contraceptors, and it appears that contraceptive education results in minimal (if any) improvement in effective contraceptive use. What we do see is a significant increase in sexual activity.

The classic study of teen contraception was reported by Gordis et al. in 1970. This program included an intensive effort to involve and maintain 268 sexually active adolescents on oral contraceptives by a team of pediatricians, gynecologists, public-health nurses, social workers, psychiatrists, clinical psychologists, dentists, and parents. In spite of this effort, two years later, only 25% of the 268 were apparently making use of the readily available birth control.³⁶

One year after being given oral contraceptives, Emans found that only 44% of single women age 23 or less were still contraception effectively.³⁷

Studies at Stanford University found that even though an effective contraceptive was prescribed, 45% of teenagers became pregnant six to 12 months later. Abortion was chosen by 64% of these girls.³⁸

Even after a first pregnancy, increasing the accessibility of birth control does not significantly reduce the rate of second pregnancy in adolescents, according to Dr. Joanne Cox of Harvard Medical School.³⁹

How Effective Is Teen Contraceptive Use?

Responsible educators need to consider that teaching teens to use contraceptives usually results in an increase in sexual activity and thereby an increased risk of pregnancy and infection with STD's, including HIV and cervical cancer! Encouraging the use of condoms and other contraceptives may even be harmful if it gives a false sense of security⁴⁰ (emphasis added).

Every method of birth control has failures, and teens experience much higher rates of failure than married couples. Do we want to be responsible for recommending methods that we know will fail?

About one-third of families beginning with a teen birth receive public assistance. Nationally, it is estimated that each of these families will cost taxpayers approximately $50,000 by the time its first-born child reaches age 20. It is estimated that 40% of these costs could be saved if the first birth were delayed until the mother was in her 20's.⁴¹

Not all teens are sexually active. Only about 34% of white and 48% of black women age 15 - 17 have ever experienced premarital sexual intercourse. Not all of these women are having ongoing sexual encounters. (This report did not specify if some of those encounters were involuntary or molestations.)

Spending the most time, money, and instruction on abstinence only seems logical. A closer examination of the data showed the following abstinence rates for all races:⁴²

Are Condoms Effective and Reliable?

If you knew that someone was infectious with the AIDS virus (HIV), would you have sex with that person? Would you recommend that your son, your daughter, or your students place their trust in condoms? Would you trust a condom when condoms have been shown to be ineffective in preventing pregnancy or disease, to break, and even with proper usage, to allow the transmission of HIV?

In one study of heterosexual couples where one partner is HIV infected, over an average of two years of sexual exposure if latex condoms were relied upon there was still a 10 to 23% risk of transmission of HIV infection even with training and proper use.⁴³

A meticulous review of condom effectiveness was reported by Dr. Susan Weller in 1993. She found that condoms were even less likely to protect people from HIV infections. Condoms appear to reduce the risk of heterosexual HIV infection by only 69%.⁴⁴

The failure rate for condoms (breakage or slippage rate) is higher than most people think. During vaginal intercourse condoms have been reported to break or slip off 14.6%⁴⁵ of the time, and a large family planning clinic found that 52% of respondents had experienced condoms bursting or slipping off in the previous three months.⁴⁶ Between male homosexuals, condoms have been shown to fail 7.3%⁴⁷, 8%⁴⁸, and 25.5%⁴⁹ of the time.

A Rutgers University study found that barrier contraceptives apparently do not afford adequate protection against chlamydia. Infection rates were similar regardless of the contraceptive used. User infection rates were: diaphragm - 44%, condom - 36%, oral contraceptives - 37%, and no contraception - 44%.⁵⁰

Although studies indicate that the human immunodeficiency virus has a low rate of infectivity with a single sexual contact, it appears that it may take only one contact with infected bodily fluids to contract the virus. In one artificial insemination clinic, the semen of a symptomless carrier of the AIDS virus was deposited, without trauma, into the healthy vaginas of eight women. Four of them became infected.⁵¹

If condoms are not reliable, wouldn't relying on them be like the insane "game" of Russian roulette? A cartridge is loaded into one of the six chambers of a revolver. The first "player" spins the cylinder, points the gun to his/her head and pulls the trigger. He/she has only one in six chances of being killed. But if one continues to perform this act, the chamber with the bullet will ultimately fall into position under the hammer, and the game ends as one of the players die.

Condoms are like Russian roulette. Condoms do not prevent pregnancy, STD's or AIDS; they only delay them. Theoretically, the longer one relies on them, they will fail and the "game" is over.

Failure Rates for Contraceptives?

The various birth control methods differ in effectiveness. Contraceptive performance is usually determined by expressing what percentage of individuals experience pregnancy after one year of usage.

Basically two factors influence the overall effectiveness of a birth control method; (1) method failures and (2) patient failures. Mature, married couples experience low failure rates, while single adolescents consistently prove to have high failure rates, even after extensive training and follow-up (see below). Perhaps there is a fundamental difference between post-marital family planning and pre-marital birth control.

Pregnancy Rates During the First Year of Contraceptive Use

Studies show that unmarried adolescents consistently experience higher contraceptive failure rates for pregnancy.

	Method failures	Married adult	Unmarried adolescent
Oral Contraceptives	0.2%⁵²	2.9%⁵³	11⁵⁴-18%⁵⁵
Intra-Uterine Devices	2%⁵⁶	6.0%⁵⁷	10.5%⁵⁸
Diaphragm	2.4%⁵⁹	17.2%⁶⁰	31.6%⁶¹
Condom	4%⁶²	14.1%⁶³	18.4%⁶⁴
Foam & Suppositories	3-8%⁶⁵	22.1%⁶⁶	34.0%⁶⁷

What About Promoting "Safer Sex" Practices?

Chuck Talburt, a microbiologist and a popular speaker to teens, denounces those who say education about sex and health must be taught free from any values. This is, of course, impossible as values are always taught in sexuality education. Consider the value judgments in the terms "safe sex" or "safer sex". From a public health viewpoint, use of these terms is not appropriate, especially among adolescents. The "safer sex" message is too abstract and confusing for teens as it tends to encourage teens to engage in sexual behavior because they erroneously believe their risks to be low.⁶⁸

Dr. Robert Noble, Professor of Medicine at the University of Kentucky College of Medicine, thinks that "safe sex" is a "dumb idea", and that "safer sex" is not "truth in advertising."⁶⁹

Studies have been done on sexually active adolescents and condom usage. One was completed in October 1986 in San Francisco. The authors noted:

In San Francisco, information about AIDS prevention (including use of condoms) via television, newspapers, billboards, and on buses, some aimed specifically at teenagers, has increased in past years. The San Francisco Unified School District (SFUSD) began teaching a one-class segment on AIDS in the middle and high schools in academic year 1985-86 with teachers free to discuss AIDS in the lesson plan as they chose.

After one year of intensive promotion, they noted that only 2.1% of teen girls and 8.2% of teen boys reported that they used condoms every time they had intercourse during the year. Also, paradoxically they learned that, in spite of the knowledge that condoms "prevent" AIDS and other STD's, the boys had less intention to use them one year later!⁷⁰

Similar findings were noted in New Jersey. In spite of a high level of AIDS-specific knowledge among sexually active young people (mean age 16.3 years), more than 66% engaged in sex, without contraceptive usage, with partners whose sexual history was unknown. These authorities concluded that AIDS knowledge alone is unlikely to reduce sex-risk behavior in adolescents.⁷¹

Studies from England have similar findings. Drs. Pamela Gillies and Ann Stork of the University of Nottingham found that even though young teenagers can improve knowledge of AIDS transmission, "the materials had small impact upon attitudes and behavioral intentions."⁷²It would appear that the teaching of values may be essential to reduce risky behavior.

Dr. Remafedi at the University of Minnesota's Adolescent Health Program also feels that "learning about AIDS is most likely to effect behavioral change when accompanied by other programs to build social supports, self esteem, and positive identity."⁷³ The Teen-Aid curricula include these matters and facilitate the development of positive values.

In a study performed in Canada, freshman college students knew more about HIV/AIDS than other STD's. In spite of this knowledge, only 25% of the men and 16% of the women always used a condom during sexual intercourse. Incredibly, among those students with ten or more sexual partners, regular condom use was reported by only 21% of the men and 7.5% of the women!⁷⁴

What Level of Risk Are We Willing to Recommend to our Students?

In discussions of HIV and other sexually transmitted diseases, we encounter the concepts of "high-risk" and "low-risk" behavior. It is much more important to consider another topic, however - "no-risk" behavior. This curriculum stresses the advantages of, and the means of attaining, the "no-risk" lifestyle.

No one recommends engaging in "high-risk" sex. This curriculum deems it wise that we also recommend avoiding “low-risk” sexual behavior, and teaches the "no-risk" lifestyle of premarital abstinence. Once again, given enough time, many who engage in "low-risk" behavior will experience pregnancy, STD's, or HIV infection.

What Is the "Bottom Line"?

Teaching to objectives can modify behavior through presenting knowledge, provoking mature thought processes, directing teens toward healthy values, and modeling appropriate "no-risk" choices. Is it possible for teens to abstain from IV drugs? Can teens be taught no-risk behavior regarding sex? Are you convinced that abstinence really is the 100% effective prevention? Is it possible for them to postpone sex? When are the dangers of sex eliminated? Isn't faithful marriage the only responsible answer? If you're not convinced, neither wills your students be able to grasp the need to learn how and why to abstain.

Reinforcing positive behavior in students takes less work than extinguishing or changing behavior in students who are acting out dangerous choices. Most students 17 and under are not currently sexually active. Of those who have experienced intercourse, many have no current partners or plans. A study done between 1982 and 1988 showed that 20% of teenagers with sexual experience were no longer currently involved in a sexual relationship.⁷⁵ The number of teens who see the advantages of "secondary virginity" can be significantly increased after learning the skills taught in Teen-Aid curricula.⁷⁶

Abstinence Is Reasonable

Abstinence until marriage is a reasonable expectation since society is encouraging only a short delay, not a lifetime "without", as in the case with tobacco and drugs. Since most teens are currently abstaining, or have only recently begun experimenting, the lifestyle of abstinence is just an extension of what they are already doing - or not doing.

In education we expect children to practice every skill that we have taught them. When we teach reading we expect them to read any and everything from here on out. We wait to teach teens about driving until they are just about ready to get their license. Driver's Ed teachers then encourage their students to practice. However, students who may be tall enough or even old enough are not allowed to practice driving without a legal permit even though they "look" ready.

Since the beginning of their education students have been encouraged to practice what they are learning. It is only in sex education that we give them information that we don't want them to use until later, and we don't even clue them in that we're changing the rules. If teaching to clear objectives works, at what level do we want the majority of the class to be formally introduced to and begin practicing contraceptive usage? Or do we want to reaffirm abstinence? Do we want to assist those sexually active teens in regaining the advantages of abstinence?

Teens Can Abstain

Be encouraged! The data indicate that adolescents can be successfully taught to abstain from drugs and from premarital sex. We as adults and teachers have the tools at hand to make a very positive impact for teenagers, and for society!

Medical authorities see a continuing toll of sickness and death by HIV/AIDS, and they are calling for changes in sexual behavior.⁷⁷ A popular "solution" one frequently hears is the cry that people must be given more condoms, and condom/AIDS education,⁷⁸ an effort that has proven to fall far short of expectations.⁷⁹ Instead of massive efforts being directed toward the condom, motivational and educational efforts should stress the many advantages of, and train in the skills to achieve, a rewarding life free from premarital and extra-marital sex.

For teens, we must reinforce their current behavior-abstinence-not only from drugs, tobacco, and alcohol, but also from premarital sex. It is vital that we teach them to abstain. It is bizarre to give our teens needles, heroin, cocaine, cigarettes, and beer, and then try to teach them how to "shoot up, smoke, and drink" responsibly. Likewise, we should not give them an assortment of contraceptives which enables them to have sex, and hope that there would be fewer STD's, AIDS, pregnancies, abortions, and emotional casualties!

The emphasis in the media on condoms for protection against HIV infection has diluted an important message; for those who are abstinent or (pause) monogamous, (pause) AIDS presents no problem.⁸⁰

The Challenge

Which will be more compassionate - intervention after teens have experienced the consequences of sexual activity and/or the use of tobacco, alcohol, and drugs of all kinds, or prevention of these problems?

Will you be courageous and take the high ground - medically, socially, and morally?

Expect the best! We will all benefit from the strong character which is developed as a result of abstinence and self-control.

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Table of Contents

The Bottom Line