Abstinence can mean different things to adolescents than to adults. That's one reason why abstinence-only programs do not have strong effects in preventing teenage sexual activity, according to new University of Washington research.
"Interventions that have been created to encourage abstinence have treated abstinence and sexual activity as opposites. However, teenagers say they don't think of them as opposites," said Tatiana Masters, lead author of a new study and UW doctoral student in social work. "These interventions are less likely to work than more comprehensive sex-education programs because they are not meeting adolescents where they are, and they are speaking a different language."
The study showed that attitudes and intentions about sex were more powerful than attitudes and intentions about being abstinent.
"This paper demonstrates that increasing abstinence intention does not lead to less sex. In fact, when abstinence intention and sex intention interact with each other a teenager is more likely to have sex," said Masters.
Rather than being an either or choice, she said, a teenager's decision to become sexually active can be likened to getting on an escalator. At first, adolescents don't think about sex very much. Once they step on the escalator the first step is abstinence. Then as they begin to be aware of sex, there are other steps and choices to be made that eventually lead to having intercourse.
The study involved 365 adolescents – 230 girls and 135 boys – recruited from community centers, youth programs and after-school programs for a larger research project testing an intervention to reduce HIV risk behavior among young teenagers in Seattle.
The participants filled out questionnaires before starting the larger HIV intervention, eight weeks later when the intervention was completed, and then six and 12 months later. The questionnaires assessed the adolescents' attitudes and intentions about being abstinent and having sex and also asked about their sexual activity in the previous six months.
At the start of the study, 11 percent of the boys and 4 percent of the girls had had sexual intercourse. Those numbers increased to 12 percent of the boys and 8 percent of the girls six months later and 22 percent of the boys and 12 percent of the girls one year later.
Currently there is no federal funding for any comprehensive sex-education program in the country, but funding for abstinence-only programs has mushroomed, increasing from $9 million in1997 to $176 million in 2007.
In the paper, however, the researchers conclude that "our findings raise serious concerns about the abstinence-only approach as a risk-reduction method for adolescent sexual behavior."
Masters added: "The United States has the highest teen pregnancy rate among developing nations, and rates of sexually transmitted diseases in this country are high. The risks are real, and if people want to keep teens safe from the negative outcomes of sex, abstinence-only programs are not the way to go. More comprehensive programs that include abstinence as one choice are much more likely to have the outcomes we want – that teenagers eventually will be in a positive and fulfilling sexual relationship."
She said the study was not an evaluation of abstinence-only programs, noting that others studies have shown they don't have an effect on delaying sexual activity. Part of the problem is the way abstinence is taught.
"Abstinence-only programs often only look at the negatives of sex, not the positive. This is especially important for young women who need to have control over having sex and having safe sex," Masters said. "With these programs you often hear 'sex just happens' and adolescents are having less safe sex. This detracts from adolescents having a choice, and this leads to more dangerous sex with more sexually transmitted diseases and pregnancies."
The National Institute of Child Health and Human Development and the National Institute of Mental Health supported the study published in the current issue of the journal Perspectives on Sexual and Reproductive Health. Co-authors of the paper are Blair Beadnell and Marilyn Hoppe, UW School of Social Work research scientists; Diane Morrison, UW professor of social work; and Mary Gillmore, director of the Arizona State University School of Social Work. Gillmore was at the UW when the research was conducted.
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