Summary of “Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy,” Kohler et al., Journal of Adolescent Health, April 2008.
Pamela Kohler and Lisa Manhart of the University of Washington’s Center for AIDS and STD and William Lafferty of UW’s Department of Health Services examined the effect of formal sex education programs on the risk of pregnancy and sexually transmitted infections by analyzing data from 1,150 teenage girls and 1,121 teenage boys ages 15 to 19 who responded to the National Survey of Family Growth’s general questionnaire and special adolescent interview. The sample was restricted to participants who were heterosexual and had never been married.
To determine what type of education the participants received, the researchers asked whether the teens ever received “any formal instruction at school, church, a community center or some other place about how to say no to sex” before age 18. A follow-up question asked about receiving instruction on birth control methods. Those who reported receiving both education about birth control and education that emphasized a “say no to sex” approach were classified as having participated in comprehensive sex education. Those who reported only receiving sex education about how to say no to sex were classified as having received abstinence-only sex education.
The researchers excluded respondents who reported exposure to sex education that taught only birth control without discussing abstinence, those who did not answer sex education questions or those who reported an age of first intercourse younger than 10. They also excluded those who reported having had sex before they received formal sex education. Characteristics associated with risky behavior among teens — including age, household income, race or ethnicity, geographical residence and “intactness” of the family unit — were assessed as potential variables.
Findings
Of the 1,719 teens included in the study, 47.4% were female respondents, and the median age was 17. In addition, 76.7% of the participants were classified as white, and 14% were classified as black. About half of household incomes reported were less than $40,000 annually, and a little more than half of the participants resided in a central city. About 41.3% of the participants reported a “nonintact” family unit. Overall, 9.4% reported not having received any formal sex education, 23.8% reported abstinence-only sex education, and 66.8% said they had received comprehensive sex education. Those who had not received formal sex education tended to be black, from rural areas and from low-income, nonintact families. Participants receiving abstinence-only education were typically younger and from low- to moderate-income, intact families. Those who reported having received comprehensive sex education were somewhat older, white and from higher-income families in more urban areas.
Almost half of the respondents reported having engaged in sex by the time of the survey. After adjusting for other predictors, the researchers found that abstinence-only sex education was not significantly associated with a teenager ever engaging in intercourse. However, comprehensive sex education was associated with slightly reduced reports of engaging in intercourse. Among all the respondents, 7.3% reported a pregnancy. After adjusting for other variables, abstinence-only sex education was not significantly associated with reported teen pregnancy, compared with those who had received no formal sex education. Teenagers who reported having had comprehensive sex education were significantly less likely to report a teen pregnancy, compared with those who had not received sex education. In addition, comprehensive sex education was associated with a 50% lower risk of teen pregnancy compared with abstinence-only education. The study also found that neither abstinence-only nor comprehensive sex education programs were significantly associated with risk of STIs, compared with no sex education.
Conclusions
The researchers noted that abstinence-only programs have no significant effect on “delaying the initiation of sexual activity or in reducing the risk for teen pregnancy” and STIs. They added that when compared with no sex education or abstinence-only education, comprehensive sex education programs were associated with a significantly reduced risk of pregnancy. Comprehensive sex education also was associated with a marginally reduced likelihood of a teen becoming sexually active, when compared with no sex education. In addition, the report showed a “strong relationship” between a family’s “intactness” and whether teens’ received sex education. Teenagers from intact families were more likely to have received formal sex education, compared with those from nonintact families.
The researchers noted that because the findings indicated a decreased likelihood of pregnancy among teens who received comprehensive sex education, adolescents who received abstinence-only education might “engage in higher-risk behaviors once they initiate sexual activity.” Although further research is needed to examine the effects of formal sex education, the study’s findings “suggest that formal comprehensive sex education programs reduce the risk for teen pregnancy without increasing the likelihood that adolescents will engage in sexual activity,” the researchers write, adding that the findings “confirm results from randomized controlled trials that abstinence-only programs have minimal effect on sexual risk behavior.”
