An Abstinence Program's Impact on Cognitive Mediators and Sexual Initiation

Research on Social Work Practice, 1999

A statewide evaluation of the Education Now and Babies Later (ENABL) program was conducted to assess its ability to increase adolescents'knowledge and beliefs about pregnancy prevention. ENABL is aimed at preventing teenage pregnancy through abstinence. Using a quasiexperimental research methodology, middle school students (N= 1,450) comprised a treatment group (n = 974) and a comparison group (n = 476). Subjects completed a pretest and posttest reflecting knowledge and beliefs about teenage pregnancy. ANCOVA revealed significant differences (F = 8.98, p < .001) on posttest scores between the two groups. The treatment group showed marked improvement from pretest to posttest scores, whereas the comparison group did not. These findings support the claim that the Postponing Sexual Involvement (PSI) curriculum is effective in affecting students' knowledge and beliefs about teenage pregnancy and illuminate the need for social work intervention at a variety of levels to address this multifaceted problem.

Journal of Adolescent Health

Purpose: To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation. Methods: Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.

2013

Abstinence until marriage has emerged as a primary policy goal in efforts to promote adolescent sexual and reproductive health—in the United States and increasingly world-wide. While few would argue with abstinence as a personal choice (no one should be forced to have sex), there are serious questions about whether government promotion of abstinence should be a public health goal. Marriage is not free of HIV risk. Early marriage— particularly of young women to older, sexually experienced men—carries a substantial risk of HIV infection. Around the globe, a young woman’s primary risk of HIV infection is often through sex with her husband [1]. Sexual intercourse is almost universally initiated during adolescence worldwide. By age 20, 77 % of young people in the US have initiated sex, and 76 % have had premarital sex [2]. By age 25, over 90 % people have had sex, with only about 3 % waiting for marriage. Over the past 40 years, the median age at first intercourse has dropped (and stabil...

AIDS Research and Treatment, 2012

income middle school youth in Houston, TX, USA. Analyses were carried out to investigate the degree to which a set of proposed psychosocial measures of behavioral knowledge, perceived self-efficacy, behavioral, and normative beliefs, and perceived risky situations, all targeted by the intervention, mediated the intervention's effectiveness in reducing initiation of sex. The mediation process was assessed by examining the significance and size of the estimated effects from the mediating pathways. The findings from this study provide evidence that the majority of the psychosocial mediators targeted by the IYG intervention are indeed related to the desired behavior and provide evidence that the conceptual theory underlying the targeted psychosocial mediators in the intervention is appropriate. Two of the psychosocial mediators significantly mediated the intervention effect, knowledge of STI signs and symptoms and refusal self-efficacy. This study suggests that the underlying causal mechanisms of action of these interventions are complex and warrant further analyses.

Kontakt

Aim: This study aims to determine the effect of comprehensive sexual education on improving knowledge, attitudes, and skills in preventing premarital sexual behavior. Design: Quasi-experimental pre-post-test design with a control group. Methods: The participants in this study were SMKN 1 Cibadak students. 60 respondents were divided into two groups (intervention group = 30 and control group = 30). The purposive sampling technique selected participants with the following inclusion criteria: grade 9 students who are already dating. In the intervention group, comprehensive sexual education was conducted for six sessions, consisting of six main topics. The research instrument was a knowledge, attitudes, and skills questionnaire which had previously been tested for validity and reliability using the Shapiro-Wilk and Levene test. The collected data were processed using SPSS version 25.0 and analyzed by univariate (frequency and percentage), bivariate (paired t-test and independent t-test), and multivariate (linear regression test). Results: Comprehensive sexual education significantly improved knowledge, attitudes, and skills in preventing premarital sexual behavior with a p-value = 0.000. The difference in each variable's mean and standard deviation significantly occurred between the intervention and control group with the results of knowledge (

Perspectives on Sexual and Reproductive Health, 2010

CONTEXT-Abstinence-only education has had little demonstrable impact on teenagers' sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers' reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention.

Journal of Adolescent Health, 2006

Journal of community health, 2000

Teen sexual problems in the U.S. are reaching enormous proportions. Attempts to prevent common problems, pregnancy and sexually transmitted diseases, are underway through the persistent efforts of community, health, academic and government organizations. Abstinence education is one of the current attempts. However, the lack of well defined theoretical frameworks and analyses of outcomes have limited progress in the study of abstinence education. This article describes a pilot program in abstinence-only education provided to six groups of young teens within an urban middle school. The framework for the program, cognitive social learning theory, is described and operationalized. Student pretest-posttest attitudes, open-ended written comments about the program and the researchers&#39; anecdotes about behavioral changes in the students are the outcome measures. Positive attitudes about premarital abstinence increased for all six groups; for four of the six groups the increase was statis...

2021

Imagine you're a high school student in the U.S. with questions about sexual wellness. "How do I talk to my partner about sex?", "How do I talk abxout expectations and what I'm comfortable with?", "How do I know what kind of birth control to use?" are some questions you might be curious about. But, when you try to find someone to answer these questions at your school, you're met with a tenuous sexual education curriculum and few in-school sexual wellness resources. For many students, this scenario isn't hypothetical: as of 2020, only thirty states require sexual education in schools; among those, twenty-two require that this information is medically accurate ("State Policies on Sex Education"). Though rates of sexual activity have gradually decreased among youth aged 15-17 in recent years (Abma and Martinez 4), teens who are sexually active are at risk of transmitting or developing an STD/STI or having an unintended pregnancy (Szucs et al. 12). Sexual education programs serve a pivotal role in delaying sexual activity-which reduces the number of sexual partners and decreases the risk of both STDs and unintended pregnancy ("Comprehensive Sexuality Education" 1)-and empowering youth to actively care for their sexual wellbeing. But, not all sexual education programs are created equal. Though Anderson 2 there are numerous works that debate the morality of certain sexual education programs, I have deliberately chosen to evaluate each type of program based on whether it inspires statistically significant changes in the attitudes, intentions, and behaviors of participants. Successful sexual education programs influence not only attitudes but also intentions and behaviors (Leung et. al 3; Akers et al. 2; Shepherd, Sly, and Girard 2), and they must fundamentally consider the totality of the environment in which they're implemented (Coyle et. al 84). Further, these programs are especially effective when they convey information that is inclusive of all participants-especially those from highly stigmatized groups, such as the LGBTQ+ community, and those who are already sexually active (Realini 316). Abstinence-only programs have been widely adopted across the United States with the central goal of promoting abstinence as the only option for youth (Santelli et. al, 2006, pg. 73). These programs virtually uniformly emphasize the supposed value of abstaining from sex outside partners. This shift toward heightened self-efficacy following the program is a strong indicator of sexual confidence and wellness in future relationships and sexual activity.

Journal of Adolescent Health, 2004

To examine sexual possibility situations (SPS) and protective practices associated with involvement in intimate sexual behaviors and the initiation of sexual intercourse among young adolescents and to determine if protective factors moderate the relationship between SPS and sexual behaviors. Methods: Data for these analyses were obtained from the baseline assessment for adolescents conducted as part of an HIV prevention study called "Keepin' it R.E.A.L.!" The study was conducted with a communitybased organization (CBO) in an urban area serving a predominantly African-American population. In addition to items assessing SPS, intimate sexual behaviors, and initiation of sexual intercourse, adolescents provided information on the following protective factors: educational goals, self-concept, future time perspective, orientation to health, self-efficacy, outcome expectations, parenting, communication, values, and prosocial activities. Background personal information, including age and gender, was also collected. The analyses were conducted on data from 491 predominantly African-American adolescents, 61% of whom were boys. Variables were combined to form SPS and protective indices that were used in the first set of regression analyses. In a second set of analyses, the indices were unbundled and individual variables were entered into regression analyses. Results: Both SPS and protective indices explained significant portions of variance in intimate sexual behaviors, and the SPS index explained a significant portion of variance in the initiation of sexual intercourse. The regression analysis using the unbundled SPS and protective factors revealed the following statistically significant predictors for intimate sexual behaviors: age, gender, time alone with groups of peers, time alone with a member of the opposite sex, behavior self-concept, popularity self-concept, self-efficacy for abstinence, outcome expectations for abstinence, parental control, personal values, and parental values. A similar regression analysis revealed that age, time alone with a member of the opposite sex, and personal values were significant predictors of initiation of sexual intercourse. Conclusions: These results provide evidence for the important role of protective factors in explaining early involvement in sexual behaviors and show that protective factors extend beyond personal characteristics to include both familial and peer factors.

Journal of Adolescent Health, 2006

Abstinence from sexual intercourse is an important behavioral strategy for preventing human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), and pregnancy among adolescents. Many adolescents, including most younger adolescents, have not initiated sexual intercourse and many sexually experienced adolescents and young adults are abstinent for varying periods of time. There is broad support for abstinence as a necessary and appropriate part of sexuality education. Controversy arises when abstinence is provided to adolescents as a sole choice and where health information on other choices is restricted or misrepresented. Although abstinence is theoretically fully effective, in actual practice abstinence often fails to protect against pregnancy and STIs. Few Americans remain abstinent until marriage; many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents. Although abstinence is a healthy behavioral option for teens, abstinence as a sole option for adolescents is scientifically and ethically problematic. A recent emphasis on abstinence-only programs and policies appears to be undermining more comprehensive sexuality education and other government-sponsored programs. We believe that abstinence-only education programs, as defined by federal funding requirements, are morally problematic, by withholding information and promoting questionable and inaccurate opinions. Abstinence-only programs threaten fundamental human rights to health, information, and life.

Journal of Adolescent Health, 2010

Purpose: This study tested the effects of a theory-based, middle-school human immunodeficiency virus, STI, and pregnancy prevention program, It's Your Game: Keep it Real (IYG), in delaying sexual behavior. We hypothesized that the IYG intervention would decrease the number of adolescents who initiated sexual activity by the ninth grade compared with those in the comparison schools. Methods: The target population consisted of English-speaking middle school students from a large, urban, predominantly African-American and Hispanic school district in Southeast Texas. Ten middle schools were randomly assigned either to receive the intervention or to the comparison condition. Seventh-grade students were recruited and followed through ninth grade. The IYG intervention comprises 12 seventh-grade and 12 eighth-grade lessons that integrate group-based classroom activities with computer-based instruction and personal journaling. Ninth-grade follow-up surveys were completed by 907 students (92% of the defined cohort). The primary hypothesis tested was that the intervention would decrease the number of adolescents who initiated sexual activity by the ninth grade compared with those in the comparison schools. Results: Almost one-third (29.9%, n ¼ 509) of the students in the comparison condition initiated sex by ninth grade compared with almost one-quarter (23.4%, n ¼ 308) of those in the intervention condition. After adjusting for covariates, students in the comparison condition were 1.29 times more likely to initiate sex by the ninth grade than those in the intervention condition. Conclusions: A theory-driven, multi-component, curriculum-based intervention can delay sexual initiation up to 24 months; can have impact on specific types of sexual behavior such as initiation of oral and anal sex; and may be especially effective with females. Future research must explore the generalizabilty of these results. Ó

Journal of Adolescent Health, 2001

To examine the role of self-efficacy, outcome expectancies, and perception of peer attitudes in the delay of onset of sexual activity among 13-through 15-year-old adolescents. We also explored the role of self-efficacy, outcome expectancies, and perception of friends' condom use behavior in explaining the use of condoms among sexually active adolescents. Methods: This study was part of a larger cross-sectional study to evaluate personal characteristics and maternal factors associated with early initiation of sexual intercourse. Mothers and adolescents were recruited from a community-based organization that offered afterschool and summer programs for youth. Enrollment was limited to adolescents aged 13-15 years and their mothers. Mothers and adolescents completed separate interviews. For adolescents, the interviews included the assessment of the variables in the present study. Each interview lasted about 60 min and was conducted by a trained interviewer. Data were analyzed using descriptive statistics and regression analysis. The average age of the 405 adolescent participants was 13.86 years, and approximately 30% of them had engaged in sexual intercourse. Slightly more than half (56%) of participants were male, and 82% were African-American. Results: Participants who were less likely to believe that their friends favored intercourse for adolescents and who held more favorable attitudes about the personal benefits of abstaining from sex were less likely to have initiated sexual intercourse. Among sexually active adolescents, those who expressed confidence in putting on a condom, and in being able to refuse sex with a sexual partner, and who expressed more favorable outcome expectancies associated with using a condom were more likely to use condoms consistently. Conclusions: Human immunodeficiency virus and pregnancy prevention programs should emphasize peer influences in both the initiation of sexual intercourse and the use of safer sex practices among sexually active adolescents, as well as personal attitudes about consequences to self and confidence in negotiating safer sex practices with one's partner.

Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2013

The effectiveness of a theory-based educational intervention on intension for sexual abstinence among female university students was evaluated. Female students were recruited from humanity sciences department through cluster sampling. Educational intervention was applied for four 90-min sessions and by application of cognitive theories during 4 weeks. One hundred and nine female students with mean age of 20.74 ± 1.57 years took part in the study. Despite the similarity of two groups of intervention (n = 53) and control (n = 59) at baseline, there were significant differences between the two groups in mean scores of the variables, knowledge (4.62 ± 1.38 vs. 3.53 ± 1.61), perceived susceptibility (14.05 ± 1.51 vs. 12.37 ± 2.11), and perceived benefits (28.41 ± 2.14 vs. 27.51 ± 3.05), at follow-up time after 3 months (P &lt; 0.05). Additionally, these variables were observed with improvement over 3 months in the intervention group (P &lt; 0.05). However, this study showed no significan...

PLOS ONE, 2011

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.