The Impact of Abstinence-Only Sex Education Programs in the United States on Adolescent Sexual Outcomes

Though there are many evaluations of abstinence-only sex education programs in the United States, there is a relatively small body of literature exploring the programs’ impact specifically on adolescent sexual behavior. Thus, the purpose of this literature review is to examine the impact of abstinence-only sex education programs on adolescent sexual outcomes. The phrase “sexual outcomes” refers to attitudes, behaviors, and experiences of adolescents as a result of their sex education. After an overview of sex education in the United States, I discuss three major themes found in the most recent literature: abstinence and delaying the initiation of sex, consequences of the lack of contraceptive use, and lastly, the perspectives and experiences of LGBTQ+ youth. Overall, abstinence-only sex education programs are found to have no beneficial or harmful impact on rates of abstinence, STDs, and unintended pregnancies. Additionally, strong evidence suggests that abstinence-only programs adversely impact LGBTQ+ youth, largely due to the lack of relevant information and the heteronormative framing. I conclude with a brief discussion of how these findings relate back to the current policy debate, as well as suggestions for future research

Role of dorsomedial striatum neuronal ensembles in incubation of methamphetamine craving after voluntary abstinence

Abstract We recently developed a rat model of incubation of methamphetamine craving after choice-based voluntary abstinence. Here, we studied the role of dorsolateral striatum (DLS) and dorsomedial striatum (DMS) in this incubation. We trained rats to self-administer palatable food pellets (6 d, 6 h/d) and methamphetamine (12 d, 6 h/d). We then assessed relapse to methamphetamine seeking under extinction conditions after 1 and 21 abstinence days. Between tests, the rats underwent voluntary abstinence (using a discrete choice procedure between methamphetamine and food; 20 trials/d) for 19 d. We used in situ hybridization to measure the colabeling of the activity marker Fos with Drd1 and Drd2 in DMS and DLS after the tests. Based on the in situ hybridization colabeling results, we tested the causal role of DMS D1 and D2 family receptors, and DMS neuronal ensembles in "incubated" methamphetamine seeking, using selective dopamine receptor antagonists (SCH39166 or raclopride) and the Daun02 chemogenetic inactivation procedure, respectively. Methamphetamine seeking was higher after 21 d of voluntary abstinence than after 1 d (incubation of methamphetamine craving). The incubated response was associated with increased Fos expression in DMS but not in DLS; Fos was colabeled with both Drd1 and Drd2 DMS injections of SCH39166 or raclopride selectively decreased methamphetamine seeking after 21 abstinence days. In Fos-lacZ transgenic rats, selective inactivation of relapse test-activated Fos neurons in DMS on abstinence day 18 decreased incubated methamphetamine seeking on day 21. Results demonstrate a role of DMS dopamine D1 and D2 receptors in the incubation of methamphetamine craving after voluntary abstinence and that DMS neuronal ensembles mediate this incubation. SIGNIFICANCE STATEMENT: In human addicts, abstinence is often self-imposed and relapse can be triggered by exposure to drug-associated cues that induce drug craving. We recently developed a rat model of incubation of methamphetamine craving after choice-based voluntary abstinence. Here, we used classical pharmacology, in situ hybridization, immunohistochemistry, and the Daun02 inactivation procedure to demonstrate a critical role of dorsomedial striatum neuronal ensembles in this new form of incubation of drug craving

"Abstinence Unless Married" Education

States that use abstinence unless married federal funds must follow the federal restrictions in spending federal dollars. While this spending rule is not particularly controversial, federal law typically does not delineate what can and can not be taught locally. The abstinence unless married initiative does not offer states the authority they have come to expect in an era of devolution. While state authority is prescribed, states are offered new money. The 1996 initiative makes nearly $500 million available over five years in federal and matching state funds.The federal law was enacted even though there is no research providing clear evidence that abstinence-unless-married education helps reduce sexual activity or birth rates. Implementation and evaluation of the new abstinence-unless-married program have become highly politicized around the country. Further, while some opinion polls suggest the public may view abstinence unless married education as too narrow to effectively address adolescent pregnancy prevention, an active conservative coalition is dedicated to ensuring an even more restrictive interpretation. While the definition of abstinence education in the new law is extremely narrow, states still have the opportunity to address a variety of policy choices.This fact sheet reviews the 1996 federal law, the controversy surrounding the abstinence provision, state plans and implementation, as well as on-going state policy choices such as whether to seek federal funds, who to grant funds, and which activities to support

Reducing Sexual Risk with Practice of Periodic Secondary Abstinence

Objective: Test a novel intervention to help sexually experienced girls increase abstinence behaviors and attitudes. Design: A quasi-experimental repeated measures design using qualitative and quantitative data. Setting: Two alternative public schools. Participants: Thirty-three females whose mean age was 16 and who were 79% African American participated. Most (79%) had experienced a pregnancy. Intervention: A 6 session, weekly, interactive intervention was delivered. Data were collected at baseline, last session, and at 5 and 7 month follow-ups. Main Outcome Measures: Measured outcomes related to abstinence included participants’ reasons, behaviors, stages of change, and attitudes. Results: The most common reason for abstinence was not wanting to have sex. At each postintervention data collection point, most participants (greater than or equal to 74%) reported that they had purposefully avoided sex. Duration of consecutive days of abstinence increased although only significantly at 5 month follow-up. Abstinence behaviors increased with the largest change from first to last session. Stage of change advanced from preparation to action by 7 month follow-up. Attitudes toward abstinence became more favorable. Conclusion: Effective sexual risk reduction interventions are critically needed to promote safety. Nurses may assist young women to decrease their sexual risks by teaching them to practice periodic abstinence

Voluntary temporary abstinence from alcohol during “Dry January” and subsequent alcohol use

Objective: Temporary abstinence from alcohol may convey physiological benefits and enhance well-being. The aim of this study was to address a lack of information about: (1) correlates of successful completion of a planned period of abstinence, and (2) how success or failure in planned abstinence affects subsequent alcohol consumption. Methods: 857 British adults (249 men, 608 women) participating in the “Dry January” alcohol abstinence challenge completed a baseline questionnaire, a one-month follow-up questionnaire, and a 6-month follow-up questionnaire. Key variables assessed at baseline included measures of alcohol consumption and drink refusal self-efficacy (DRSE). Results: In bivariate analysis, success during Dry January was predicted by measures of more moderate alcohol consumption and greater social DRSE. Multivariate analyses revealed that success during Dry January was best predicted by a lower frequency of drunkenness in the month prior to Dry January. Structural Equation Modelling revealed that participation in Dry January was related to reductions in alcohol consumption and increases in DRSE among all respondents at 6-month follow-up, regardless of success, but these changes were more likely among people who successfully completed the challenge. Conclusions: The findings suggest that participation in abstinence challenges such as “Dry January” may be associated with changes toward healthier drinking and greater DRSE, and is unlikely to result in undesirable “rebound effects”: very few people reported increased alcohol consumption following a period of voluntary abstinence

Abstinence Only vs. Comprehensive Sex Education: What are the Arguments? What is the Evidence?

Responding to the continuing health threats of HIV, STIs and unplanned pregnancy among young people, the widely respected Institute of Medicine of the National Academy of Sciences recently recommended eliminating congressional, federal, state and local "requirements that public funds be used for abstinence-only education." And surveys consistently show that the public wants schools to deliver strong abstinence messages alongside information about self-protection for young people who find themselves in sexual situations. The vast majority of parents support sex education in the schools, including the provision of information about contraceptive and condom use.Unfortunately, federal policy is grossly out of step with the wishes of most parents and students, as well as the scientific research. Since the early 1980s, Congress has devoted significant resources to abstinence-only programming. Partly as a result of federal policy and funding changes, public schools are increasingly supporting abstinence-only curricula that are less likely to include information about birth control, STD prevention and sexual orientation. The evidence tells us that these trends represent a dangerous disservice to America's younger generation

State Abstinence Education Programs and Teen Fertility in the U.S.

Title V, section 510 of the Social Security Act, passed in 1996 and implemented in 1998, appropriates funding to states for the purpose of educating minors on the benefits of abstinence before marriage. Despite considerable research on the impact of abstinence education on teen fertility outcomes, good quality population-level studies on state abstinence education using panel data are absent. This paper uses state-level data to analyze the impact of abstinence education on the birth rates for teens 15-17 years by evaluating the Title V, section 510 State Abstinence Education (SAE) program. For an average state, increasing spending by $50,000 per year on SAE can help avoid approximately four births to teenagers.

Understanding Sexual Abstinence in African American Teens

Purpose: To explore the perspectives of teenage girls on how life contexts influenced sexuality and sexual abstinence. Study Design and Methods: A qualitative descriptive study with a convenience sample of 14 sexually abstinent African American adolescent females who were interviewed to obtain their life histories. Narrative analysis was used to identify unique and common experiences and to develop themes. Results: For these participants, being abstinent was a way to demonstrate their emerging identities as adult women. They described themselves as faithful, unique persons who defied negative stereotypes, avoided risky situations, wanted to be strong women like their mothers and grandmothers, and were selective about their friends. The primary challenge to abstinence was their degree of vulnerability to sexual harassment, romantic partner pressure, and female peer pressure. Clinical Implications: Abstinence is a complex state of being that is influenced by a variety of contexts, develops over time, and is consciously chosen. Maintaining abstinence requires effort and a variety of skills. While these young women were cognitively familiar with reasons why they should refrain from sex, nurses may still assist youth with being abstinent by providing ongoing teaching and specific dialogue on how to refrain from sex