Tuesday, February 2, 2010

Annals of Obvious:
Abstinence Programs Prevent Sex In Teens Too Young to Have Sex Anyway

File this under You've got to be fucking kidding me: This week's hulabaloo about a supposedly effective abstinence program demonstrates, yet again, how loath reporters are to read beyond an article abstract. I can't believe that after the Guttmacher data came out last week about the increase in teen pregnancy during the Bush years that anyone is even still fucking testing abstinence programs.

But I digress. Researchers at Penn and the University of Waterloo (Canada) this week published an article in the Archives of Pediatric and Adolescent Medicine demonstrating the middling effectiveness of a:
"theory-based abstinence-only intervention that would not meet federal criteria for abstinence programs and that is not vulnerable to many criticisms that have been leveled against interventions that meet federal criteria." (pg. 158)

What was so good about it that it wouldn't meet the brain-exploding federal guidelines? It didn't moralize about how sex will make God hate you and did not disparage the use of condoms (or, presumably, talk about how condoms don't protect your heart).

Perpetual fuddy duddy Sarah Brown, president of the National Campaign to Prevent Teen and Unplanned Pregnancy, had this to say:

"This new study is game-changing. For the first time, there is strong evidence that an abstinence-only intervention can help very young teens delay sex."
Memo to Sarah Brown: All teens are "delaying" sex. Until they have it, that is.

The study randomized more than 600 African American 6th and 7th graders into 5 different intervention groups, two of which were "comprehensive" in their approach, one of which focused only on condom use, one which was abstinence-only, and a control group that focused on other, nonsexual health behaviors.

In short, teens who were in the abstinence-only group were the least likely to have initiated sex in the 24 month follow up period. Of the participants in the safer sex only group, 52% had initiated sex at the end; 33% of the abstinence-only had debuted. Forty two percent of those in the "comprehensive" groups initiated sex by the end. (p. 156) A heartening finding, though, is that roughly 75% of those who had had sex across all intervention groups used condoms consistently. So, that's good news. (ibid)

Since the study's design was a randomized, control trial, in theory it meets the "gold standard" of public health research. However, the length of the programs (4 hours on 2 or 3 Saturdays, for a total of 8 or 12 hours) raises questions about their longer term efficacy: the most effective prengancy prevention programs are years long, after school type interventions that really keep their hooks in teens for a long time.

Study participants were young--6th and 7th graders--and all African American, so the population isn't generalizable. Also, while participants were followed for 24 months following the intervention, the majority of teens don't initiate sex until after 9th grade, which would have been the latest participants would have been followed. The study authors say:

"Unlike many risk behaviors (eg, cigarette smoking, drug use), sexual intercourse is an age-graded behavior; the expectation is that people will eventually have sexual intercourse." (p. 153)
Or, as I am wont to say, teen virginity is like the Titanic: it's going down. Considering the inconsistency which teens may have access to sex, I think the best abstinence vs. comprehensive trial is going to incorporate educational interventions followed by guaranteed access to sex which study participants will either accept or abstain from. I'm not sure how else we could really measure the success of these interventions because some people are, you know, circumstantially abstinent and not avoiding sex by choice. Such teens inflate the success rate of abstinence programs by virtue of their social awkwardness, not because of any effectiveness of the program per se.

I also question the ethical nature of research that discusses STIs, particularly HIV, and fails to provide information to participants about how to prevent infection. That seems a clear violation of the ethical obligation of medical researchers to, at a minimum, provide the currently accepted standard treatment to all participants**.

The researchers say:

"The ideal abstinence intervention would incorporate principles of efficatious HIV/STI risk reduction behavioral interventions." (p. 153)

The only "efficatious HIV/STI risk reduction" method that I know of is USING FUCKING CONDOMS. Teaching teenagers about STIs/HIV and failing to teach them about condoms seems like a clear violation of ethics. Just sayin'.

**Remember Tuskeegee? That was another "study" that enrolled only African American participants and declined to offer them any treatment or prevention just to see what would happen in late stage, untreated syphilis. (Results: it eats your brain) At the time, penicillin was known to cure syphilis and was already in use. After the public outcry when the study came to light in 1972, the Tuskeegee Experiment was the impetus for Institutional Review Boards and ethical standards in human subjects research that mandate that the standard treatment be given to everyone.