 |
| Become a Member of Medical Institute Online! |
The Medical Institute is pleased to announce the launch of their new website!
Become a subscribing member today and gain immediate access to the Medical Institute's collection of scientifically rigorous and easy-to-use sexual health resources.
As a member, you can enjoy downloadable educational resources, such as the Optimal Sexual Health collection of over 700 slides developed for presentation to teens and adults. You will be able to read MI responses to current issues in the press, similar to the virginity pledge article below. Many other resources developed by MI, like the sexual health terms glossary and STI fact sheets, are also available for download.
To find out more, go to our website at www.medinstitute.org and click on "Join Today"or click here. |
|
| Teens and Virginity Pledges |
A recent study by Rosenbaum in Pediatrics [1] concludes that the sexual behavior of virginity pledgers does not differ from that of closely matched nonpledgers, and pledgers are "less likely to protect themselves from pregnancy and disease before marriage." The media immediately pounced on the study results and concluded that abstinence education "does not work." All in spite of other reports that virginity pledges help delay sexual debut in adolescents.[2]
The Rosenbaum article states that the study results show no significant differences in sexual behaviors or sexually transmitted diseases (STDs) in pledgers and nonpledgers.[1] But general statements such as "virginity pledges are not effective" or "abstinence education programs do not work" are unwarranted conclusions from the results here. All the study results really show are that in a particular group of adolescents with religious, conservative attitudes and beliefs there were no significant differences amongst them in sexual behaviors and STDs; and pledges do not seem to have any added effect to the pre-existing beliefs and attitudes of that particular group.
Here are some points about the study that need to be considered carefully before drawing over-arching conclusions:
- According to the author, there were baseline differences between the pledgers and all nonpledgers, hence it was necessary to match pledgers with similar non pledgers. The pledgers were more religious, less sexually experienced, expected more negative and fewer positive effects of sex and birth control use, and had lower knowledge of birth control than non pledgers. Due to these baseline differences, the Rosenbaum study looked at only a sub-group of adolescents.
- The author matched pledgers and nonpledgers so there would be no baseline differences between the pledgers and nonpledgers in the study group. In fact, the author says that there were no significant differences seen when comparing 128 characteristics in the pledgers and nonpledgers. However, the author also says that about 5% significant differences are seen on average in any comparison. These two facts taken together suggest that there may have been some "over-adjustment" during the matching process - making the groups so similar that there may be no real differences at all.
- The biggest concern is the representativeness of the sample. The sample under study is not representative of all teens in the country - simply because the author looked at a very small group with specific characteristics. So the study results cannot be generalized to all US teens. This is also one of the study limitations the author acknowledges in the article.
- Pledgers are reported as less likely to use condoms/birth control as compared to nonpledgers. Although pledgers were less likely to use condoms over the last year, their condom use was not significantly different during last sex. The author also states that abstinence programs and pledges do not prepare the youth to "protect their health." Apparently those who did not pledge were also unable to "protect their health" since there was no difference in STDs in both groups. So how are virginity pledges specifically to blame for the health status of the study group?
- The author is quick to draw a causal inference from the data analysis results. The article states that pledgers may be less likely to use condoms/contraceptives because abstinence programs cause participants to develop negative attitudes about their effectiveness. Since the study does not look at youth who had participated in abstinence education programs vs. youth who did not participate in such programs, it is unclear how the author can say abstinence programs cause less condom/contraceptive use from her data and results.
- The article states that the study results are biased in favor of showing a "pledge effect" since the pledgers would be less likely to report sexual activity. It is also important to note that 82% of the pledgers did not remember they had pledged. If most of the youth do not remember having pledged at all, the sexual decisions or reporting of most of the pledgers could not possibly be driven by the pledge. And under-reporting of sexual activity is common in all adolescents due to social desirability bias (the desire to report what is perceived to be more socially acceptable). Religious and conservative teens would be as likely, if not more so, to under-report their sexual activity as well. In this case, under-reporting in both groups would not be likely to swing the results in either direction.
In fact, it may be that the results of the study were due to the underlying beliefs of the study group. Having taken a virginity pledge probably did not add anything to the sexual decision making of the youth in the study. It is thus a little far-fetched to conclude that abstinence education does not work if virginity pledges do not show an effect. First, not all abstinence education programs require virginity pledges. Second, a count of the number of virginity pledges is not a measure of the success or effectiveness of the program. Just like a count of the condoms distributed cannot be a measure of the success or effectiveness of a sex education program. Any program needs to be evaluated continually to obtain feedback on how the program can be improved. This means more than just providing a count of youth in the program or those involved in an event (eg, pledging) in the program.
The underlying belief system of the youth (possibly from their families) had a protective effect as compared to youth outside the study group. These youth had fewer sexual partners and later age of sexual debut. As reinforced by these results, families and parents play an important role in helping adolescents avoid risky sexual behaviors.
In conclusion:
- It is important to ensure rigorous implementation and evaluation of any sex education (including abstinence education) program to see how a prevention message can be delivered effectively.
- Parents need to talk to their children about sexual health issues and guide them toward the healthiest sexual decision making.
References:
1. Rosenbaum JE. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers. Pediatrics. 2009 Jan;123(1):e110-20.
2. Martino SC, Elliott MN, Collins RL, Kanouse DE, Berry SH. Virginity pledges among the willing: delays in first intercourse and consistency of condom use. J Adolesc Health. 2008 Oct;43(4):341-8. Epub 2008 Jun 5.
|
|
| Condom Effectiveness in Teens & Young Adults |
A recently published study in Archives of Pediatrics and Adolescent Medicine reports on the use of condoms in 715 African American females aged 15-21. Participants who had engaged in intercourse within the last 14 days were asked how frequently they had used condoms. Vaginal fluid from the participants was then tested for evidence of sperm. Of the 186 participants who reported 100% condom use, 63 (34%) had evidence of sperm in their vaginal fluid. The authors note that their study did not try to explain why so many of the participants who reported consistent condom use had evidence of sperm in their vaginal fluid. Some possible reasons that the authors suggested were misreporting condom use, incorrectly using condoms, or wanting to give a socially desirable response.
To read the abstract of this article, click on the following link: http://archpedi.ama-assn.org/cgi/content/abstract/163/1/61
|
|
| Enjoy Great Savings with the Parent Package |
MI knows how important parents are in the lives of youth. To assist parents and parenting adults as they guide children toward a healthy future, MI has assembled the Parent Package and priced it to fit the family budget!
The package includes the newly released book Hooked, the widely popular book Questions Kids Ask About Sex, and the Tell Me NOW Complete Set. For a limited time, the package is available for $49.99! That is $29.99 off of the list price! Go to www.medinstitute.org to order this incredible resource for parents.
As a nonprofit organization, we rely on the generosity and commitment of people like you. Contributions to the Medical Institute are a tax-deductible way to invest in the future of our children. To support us click the button below.
|
|
|
|
|
| Message from the President |
 |
It's hard to believe that almost 17 years have passed since the day I received a phone call from Dr. Joe McIlhaney, asking if I would help him form a non-profit that would confront the epidemic of STDs that was severely impacting the health of our nation. That non-profit came to be known as the Medical Institute for Sexual Health (MI). MI's goal rapidly expanded into one of helping people enjoy the greatest possible degree of health, hope and happiness, by guiding them towards making the healthiest sexual behavior choices.
Not everyone has wanted MI to spread this message and the battle has been fierce. Today the need for MI is greater than ever, as illustrated by the two studies discussed in this Newsletter. The Rosenbaum study which purports to conclude that virginity pledges are not only of no value, but are even detrimental, is just plain bad science. This study suggests that decreased condom use may be due to abstinence education teaching condom failure rates, thereby causing lack of confidence in condoms and decreasing their use. This is contrary to what previous studies have concluded- that youth who receive abstinence training are not any less likely to use condoms than are those not receiving such training. The study equates, without evidence, taking a virginity pledge with undergoing abstinence education. Even if this is so, does the study suggest, then, that we should not disclose the well documented truth about condom failure in actual use so that kids will be more likely to use them? That makes about as much sense as not telling a sky diver that his parachute will only work some of the time. The limited effectiveness of condoms in actual use is well documented by the second study presented in this Newsletter reporting discordance in about 34% of cases where condoms were reported to have been consistently used! Doesn't everyone deserve to know all the facts of the risk involved?
Following in the footsteps of Drs. McIlhaney and Rose as President of MI is an awesome responsibility. But the need is great, and the stakes are high, and I am honored to have the opportunity to serve. I would like to see our research and behavioral recommendations continue to give guidance to people across the country and around the world, and to help others maintain scientific integrity as they work in the sexual health area. The latest research coming from MI shows that the risks of early sexual involvement and multiple partners include not only STDs and pregnancy, but also emotional baggage that can affect one's happiness and interpersonal relationships for years. I earnestly solicit your support and involvement as we move forward in this battle. Together we can make a difference.
Sincerely,
Arthur H. Coleman
|
|
