Abstinence and Abstinence-Only Education
2006; Elsevier BV; Volume: 39; Issue: 2 Linguagem: Inglês
10.1016/j.jadohealth.2006.04.001
ISSN1879-1972
Autores Tópico(s)Prenatal Substance Exposure Effects
ResumoThe January 2006 issue of the Journal of Adolescent Health included a Society of Adolescent Medicine position statement on abstinence education. Although the intention of the position statement is to promote adolescent health, it misrepresents abstinence education and adds little to the discussion on the relevance of abstinence to healthy adolescent outcomes.The statement fails to acknowledge the well-documented risks associated with sexual activity to the social, emotional and developmental aspects of adolescent health, including the association between early sexual activity, depression and substance use. For example, it states that “Mental health problems are associated with early sexual activity,” but “that sexual activity is a consequence not a cause of these mental health problems” [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar]. Yet recent research has found that teens who experiment with sex or drugs are up to three times more likely to be depressed a year later than teens who remain abstinent [[2]Hallfors D. Waller M.W. Bauer D. et al.Which comes first in adolescence—sex and drugs or depression?.Am J Prev Med. 2005; 29: 163-170Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar].The statement fails to adhere to the same standards of medical accuracy it requires of abstinence education programs. By calling “condoms and other contraceptive use…healthy alternatives to abstinence” [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar], the statement appears to create equivalence between the risks and benefits of abstinence and those of sexual behavior using contraception. Abstinence eliminates the risk of pregnancy and STDs. Contraception only reduces the risk. According to a 1995 Institute of Medicine report, almost half of all unintended pregnancies occur while women are using a reversible method of contraception [[3]Brown S. Eisenberg L. Institute of Medicine Report, The Best Intentions Unintended Pregnancy and the Well-Being of Children and Families. National Academy Press, Washington, DC1995Google Scholar]. Fifteen percent of couples who are using condoms for contraception “experience an unintended pregnancy during the first year of typical use” [[4]Hatcher R.A. Trussell J. Stewart F. et al.Chapter 16. Contraceptive Technology, 18th rev. edn. Ardent Media, New York, NY2004: 334Google Scholar]. Similar or greater failure rates are noted for STD prevention.Furthermore, in arguing that early reviews found little evidence of efficacy in delaying initiation of sexual intercourse, the statement ignores accumulating evidence suggesting that abstinence programs are effective from a number of important perspectives. Of note are recently published works such as Lerner’s evaluation of the Best Friends program and Borawski et al’s study of the long-term effects of teaching sexual abstinence to middle school adolescents [5Lerner R. Can abstinence work? An analysis of the Best Friends program.Adolesc Fam Health. 2005; 3: 185-192Google Scholar, 6Borawski E. Trapl E.S. Lovegreen L.D. et al.Effectiveness of abstinence-only interventions in middle school teens.Am J Health Behav. 2005; 29: 423-434Crossref PubMed Scopus (55) Google Scholar]. Many peer-reviewed evaluations presented at the 2005 Health and Human Services national conference, “Abstinence Education: Improving Programs through Evaluation,” also provide encouraging results. For example, an evaluation by John Tanner and Stacey Ladd documented that “…for the county with the longest period of intervention, the pregnancy rate declined from 34.8 per thousand among girls aged 13–17 in 1998 to 16.1 per thousand in 2002 [[7]Tanner J. Ladd S. Saturation Abstinence Education: An Application of Social Marketing. Evaluating Abstinence Education Programs: Improving, Implementation and Assessing Impact. 2005Google Scholar].”Finally, the statement asserts that government support of abstinence education programs is unethical, an assertion that is difficult to comprehend because abstinence is by far the healthiest behavior for adolescents. Implying that teen sexual activity is “integral to human nature and has many positive mental health consequences” is unethical [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar]. Stating that “…there are no scientific data suggesting that consensual sex between adolescents is harmful” is unethical [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar]. Giving young people a false sense of security and putting their futures at risk by implying that sex with a condom is safe sex is unethical. Those who care about the future of the nation’s youth should promote policies and programs that encourage the healthiest decisions and outcomes. The January 2006 issue of the Journal of Adolescent Health included a Society of Adolescent Medicine position statement on abstinence education. Although the intention of the position statement is to promote adolescent health, it misrepresents abstinence education and adds little to the discussion on the relevance of abstinence to healthy adolescent outcomes. The statement fails to acknowledge the well-documented risks associated with sexual activity to the social, emotional and developmental aspects of adolescent health, including the association between early sexual activity, depression and substance use. For example, it states that “Mental health problems are associated with early sexual activity,” but “that sexual activity is a consequence not a cause of these mental health problems” [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar]. Yet recent research has found that teens who experiment with sex or drugs are up to three times more likely to be depressed a year later than teens who remain abstinent [[2]Hallfors D. Waller M.W. Bauer D. et al.Which comes first in adolescence—sex and drugs or depression?.Am J Prev Med. 2005; 29: 163-170Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar]. The statement fails to adhere to the same standards of medical accuracy it requires of abstinence education programs. By calling “condoms and other contraceptive use…healthy alternatives to abstinence” [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar], the statement appears to create equivalence between the risks and benefits of abstinence and those of sexual behavior using contraception. Abstinence eliminates the risk of pregnancy and STDs. Contraception only reduces the risk. According to a 1995 Institute of Medicine report, almost half of all unintended pregnancies occur while women are using a reversible method of contraception [[3]Brown S. Eisenberg L. Institute of Medicine Report, The Best Intentions Unintended Pregnancy and the Well-Being of Children and Families. National Academy Press, Washington, DC1995Google Scholar]. Fifteen percent of couples who are using condoms for contraception “experience an unintended pregnancy during the first year of typical use” [[4]Hatcher R.A. Trussell J. Stewart F. et al.Chapter 16. Contraceptive Technology, 18th rev. edn. Ardent Media, New York, NY2004: 334Google Scholar]. Similar or greater failure rates are noted for STD prevention. Furthermore, in arguing that early reviews found little evidence of efficacy in delaying initiation of sexual intercourse, the statement ignores accumulating evidence suggesting that abstinence programs are effective from a number of important perspectives. Of note are recently published works such as Lerner’s evaluation of the Best Friends program and Borawski et al’s study of the long-term effects of teaching sexual abstinence to middle school adolescents [5Lerner R. Can abstinence work? An analysis of the Best Friends program.Adolesc Fam Health. 2005; 3: 185-192Google Scholar, 6Borawski E. Trapl E.S. Lovegreen L.D. et al.Effectiveness of abstinence-only interventions in middle school teens.Am J Health Behav. 2005; 29: 423-434Crossref PubMed Scopus (55) Google Scholar]. Many peer-reviewed evaluations presented at the 2005 Health and Human Services national conference, “Abstinence Education: Improving Programs through Evaluation,” also provide encouraging results. For example, an evaluation by John Tanner and Stacey Ladd documented that “…for the county with the longest period of intervention, the pregnancy rate declined from 34.8 per thousand among girls aged 13–17 in 1998 to 16.1 per thousand in 2002 [[7]Tanner J. Ladd S. Saturation Abstinence Education: An Application of Social Marketing. Evaluating Abstinence Education Programs: Improving, Implementation and Assessing Impact. 2005Google Scholar].” Finally, the statement asserts that government support of abstinence education programs is unethical, an assertion that is difficult to comprehend because abstinence is by far the healthiest behavior for adolescents. Implying that teen sexual activity is “integral to human nature and has many positive mental health consequences” is unethical [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar]. Stating that “…there are no scientific data suggesting that consensual sex between adolescents is harmful” is unethical [[1]Society for Adolescent MedicineAbstinence-only education policies and programs a position paper of the Society for Adolescent Medicine.J Adolesc Health. 2006; 38: 83-87Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar]. Giving young people a false sense of security and putting their futures at risk by implying that sex with a condom is safe sex is unethical. Those who care about the future of the nation’s youth should promote policies and programs that encourage the healthiest decisions and outcomes. Abstinence-only education policies and programs: A position paper of the Society for Adolescent MedicineJournal of Adolescent HealthVol. 38Issue 1PreviewAbstinence from sexual intercourse represents a healthy choice for teenagers, as teenagers face considerable risk to their reproductive health from unintended pregnancy and sexually transmitted infections (STIs) including infection with the human immunodeficiency virus (HIV). Remaining abstinent, at least through high school, is strongly supported by parents and even by adolescents themselves. However, few Americans remain abstinent until marriage, many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents. Full-Text PDF
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