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CSU 23/2010: EFFICACY OF A THEORY BASED ABSTINENCE ONLY INTERVENTION OVER 24 MONTHS

Friday, 26th of February 2010 Print
CSU 23/2010: EFFICACY OF A THEORY BASED ABSTINENCE ONLY INTERVENTION OVER 24 MONTHS
  
Readers of Cochrane reviews on abstinence only intervention to delay age of first intercourse will be surprised by the results of  this randomized controlled trial among middle school Afro-American students in Philadelphia. A New York Times editorial on abstinence only education follows after the abstract.
 
For those who didn't see the relevant Cochrane review, it is at http://www.cochrane.org/reviews/en/ab005421.html
 
Good reading.  BD
 
 
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).
 
 
THE NEW YORK TIMES
 
Abstinence Education Done Right
 
Published: February 7, 2010

The ongoing debate over sex education has been rekindled by a provocative new study suggesting that teaching abstinence can delay the start of sexual activity among inner-city youngsters — if it is freed from the moralistic overtones and ideological restrictions that were the hallmark of abstinence-only programs under the Bush administration.

It would be a mistake to place too much importance on a single study of black middle-school students in Philadelphia, but the study appears to be sound and its findings are worth further exploration.

The study, published in the Archives of Pediatrics and Adolescent Medicine, a journal of the American Medical Association, was led by a husband-wife team at the University of Pennsylvania. They randomly assigned 662 African-American students in grades six and seven to one of four different programs — an eight-hour abstinence-only program stressing the benefits of delaying intercourse; an eight-hour safer-sex program stressing condom use; a comprehensive intervention that covered both abstinence and condoms; and a control group that offered health information unrelated to sexual behavior.

The only program that successfully delayed the start of sexual activity was the abstinence-only instruction. By the end of two years, only a third of the abstinence-only group had engaged in sexual intercourse compared with almost half of the control group.

Advocates of abstinence-only education have seized on the new findings as evidence that their approach works best. Some are urging the Obama administration to reverse course and restore federal support for abstinence-only education. That is a willful misreading of the implications of this study.

Under current federal law, supported by the Bush administration and conservatives in Congress, abstinence-only programs that seek federal support must meet several rigid requirements that essentially make them abstinence-until-marriage programs.

They must teach, for example, that abstinence from sexual activity outside of marriage is the “expected standard” for all school-age children. This new study would have failed that test. It did not advocate abstinence until marriage but urged students to wait until they were more mature. It encouraged abstinence as a way to eliminate the risk of pregnancy and sexually transmitted diseases, had youngsters draw up lists of the pros and cons of sexual activity, and taught strategies for resisting pressure to have intercourse.

The Obama administration, with Congressional acquiescence, has wisely eliminated funding for abstinence-only programs that meet the old ideological criteria and is supporting a range of programs to prevent teenage pregnancy, provided they are based on rigorous science. This study fits the new rubric, not the old.

The new study will need to be replicated in older teenagers and other ethnic groups to see if the findings are broadly relevant, and teenagers will need to be followed long enough to measure the effects in avoiding pregnancy and sexually transmitted diseases. No single approach will suffice to reduce sexual activity in all teenagers, but the new study suggests that there is a sensible, effective way to teach abstinence.

 

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