Pre-teens sexual activity delayed by theory-based abstinence-only program

Penn study shows early intervention important to decrease STDs, HIV, pregnancy

A new study weighs in on the controversy over sex education, finding that an abstinence-only intervention for pre-teens was more successful in delaying the onset of sexual activity than a health-promotion control intervention. After two years, one-third of the abstinence-only group reported having sex, compared to one-half of the control group. The study by researchers at the University of Pennsylvania appears in the February 1 edition of the Archives of Pediatrics & Adolescent Medicine.

While abstinence-only intervention did not eliminate sexual activity all together, this is the first randomized controlled study to demonstrate that an abstinence-only intervention reduced the percentage of adolescents who reported any sexual intercourse for a long period, in this case two years, following the intervention.

"It is extremely important to find an effective intervention that delays sexual activity; the younger someone is when they have sex for the first time, the less likely they are to use condoms," said lead author John B. Jemmott III, PhD, professor of Communication in Psychiatry and of Communication at the University of Pennsylvania's School of Medicine and Annenberg School for Communication. "Abstinence-only interventions may have an important role in delaying sexual activity until a time later in life when the adolescent is more prepared to handle to consequences of sex. This can reduce undesirable consequences of sex, including pregnancy and sexually transmitted infections like HIV/AIDS."

There was a 33 percent reduction in self-reported sexual intercourse from the abstinence-only group, compared to the control group, by the end of the study. Of the students who reported that they were sexually active during the study, there were fewer reports of recent sexual activity from the abstinence-only intervention participants (20.6 percent) compared to the control participants (29.0 percent).

The authors cautioned that before any policy issues are discussed, more research is needed to determine the efficacy of abstinence-only education for different populations, including replication of a study like this in young African Americans. "Policy should not be based on just one study, but an accumulation of empirical findings from several well-designed, well-executed studies," said Dr. Jemmott.

A total of 662 African American students in grades 6 and 7 participated in this randomized controlled trial, which was held on Saturdays in classrooms at four public schools participating in the study. The students were randomly assigned to an 8-hour abstinence-only intervention, an 8-hour safer sex-only intervention, an 8- or 12-hour combined abstinence and safer-sex intervention, or an 8-hour health-promotion control group. Participants in the comprehensive intervention had reduced reports of multiple sexual partners compared with the control group (8.8 percent vs. 14.1 percent).

Researchers determined that none of the interventions had significant effects on consistent condom use or unprotected sex. For those who lost their virginity during the two year study, there was no difference in consistent condom use between the abstinence-only intervention and the control group.

The abstinence-only intervention was based on principles shown to be effective in reducing the risk of sexually transmitted infections (STIs), including HIV/AIDS, and did not use a moralistic tone or portray sex in a negative light. It encouraged abstinence as a way to eliminate the risk of pregnancy and STIs. During the 8-hour abstinence-only session, study facilitators used brief and interactive small group activities to build the pre-teens' knowledge of HIV and STIs, bolster beliefs supporting practicing abstinence, and improve skills and confidence to help negotiate abstinence and resist pressure to have sex.

The researchers noted that, in the United States, the consequences of early sexual involvement – including HIV, other STIs, and unintended pregnancies – are especially great among African American adolescents. An effective abstinence-only intervention could stave off unwanted consequences until adolescents mature and are prepared to handle the consequences of sex.

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