Bigger Fish to Fry (10.15.09)

By: Maryjo M. Oster

Last weekend, I was sharing the latest in federal sex education funding news with my husband as we were driving about town. I informed him that while President Obama’s proposed budget eliminated funding for abstinence-only-until-marriage programs and redirected those monies toward evidence-based prevention programs, the Senate Finance Committee recently voted to reinstate $50 million for the abstinence-only programs.[1] Being married to someone “in the know” on these issues means he understands and appreciates the severity and complexities of adolescent sexual health promotion far more than the average Joe, but as I recounted these saddening details to him, he responded to them by saying, “I think the government has far bigger problems to deal with right now…”

Okay, I know. My issue is but one of millions of socio-economic concerns for the United States right now, so I conceded on that point. Teen pregnancy and STI prevention will unfortunately always take a backseat to big ticket issues like the economy, unemployment, and health care. The more I started to think about it, though, I realized that teen pregnancy and STI prevention are invariably linked to each of these issues. Allow me to explain.

I happen to be working on a doctoral dissertation right now on the topic of (you guessed it) sex education and one of the sections of my literature review is entitled “Dollars and Sense: Sex Education in Social and Economic Perspective.” (Pretty witty, right?) Anyway, in it, I review several cost analyses that have been done to put a price tag on the problems of teen pregnancy and STI acquisition. According to researcher Saul Hoffman, teen childbearing cost the United States $9.1 billion in the year 2006.[2] This figure compiles health care, welfare, and incarceration costs, as well as tax revenue losses (for teen mothers and their children) associated with teen childbearing. STI acquisition is not cheap either. One study indicated that in the year 2000, there were nine million new STI cases in the 15-24 year old age bracket and that the treatment costs for just these individuals was approximately $6.5 billion (in year 2000 dollars).[3] Based on my amateur consumer price index (CPI) conversion,[4] these two dollar amounts would equal a combined $17.8 billion in year 2008 dollars and just think…the teen birth and STI acquisition rates have only INCREASED since these figures were calculated.

Based on these dollar amounts, I have to ask myself why these issues are not higher on the governmental priority list. I completely understand that teen pregnancy and STI prevention seem like small potatoes next to our ailing economy and a health care debate that has everyone up in arms, but when you take a step back and really think about it, we can ameliorate both the economic and health care crises by addressing these issues head on. By now, we all know that prevention dollars save money in the long run, but reinstating $50 million for abstinence-only-until-marriage education will do no good in this arena. Congress’s own study demonstrated that for us in 2007.[5] Whether you agree with his politics or not, President Obama’s push for proven prevention programs makes good financial sense, so to the Senate Finance Committee I say this:

Please stop wasting our time and money on ineffective programs that will do nothing to reduce the health care, welfare, and incarceration costs and tax revenue losses associated with adolescent childbearing or the treatment costs associated with adolescent STI acquisition. If you do honestly have “bigger fish to fry,” then get on it and stop trying to make the situation worse.

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[1] Associated Press. (2009). “Panel votes to restore abstinence education money.” http://www.google.com/hostednews/ap/article/ALeqM5jLe8AnWYSH3OJyCX_3DtoPi5PgzwD9B1D2580
[2] Hoffman, S.D. (2006). “By the Numbers: The Public Costs of Teen Childbearing.” http://www.thenationalcampaign.org/resources/pdf/pubs/BTN_Full.pdf
[3] Chesson, H. W., Blanford, J. M., Gift, T. L., Tao, G., & Irwin, K. L. (2004). The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 36(1), 11-19.
[4] Consumer Price Index (CPI) Conversion Factors 1774 to Estimated 2019 to Convert to Dollars of 2008: http://oregonstate.edu/cla/polisci/faculty-research/sahr/cv2008.pdf
[5] Trenholm, C., Devaney, B., Fortson, K., Quay, L., Wheeler, J., & Clark, M. (2007). “Impacts of Four Title V, Section 510 Abstinence Education Programs.” http://www.mathematica-mpr.com/publications/pdfs/impactabstinence.pdf

The Great American Condom Debate (06.03.09)

By: Maryjo M. Oster

Holy Prophylaxis, Batman!

Last winter, my colleague and I facilitated a training on the Making Proud Choices! curriculum with one of our school district partners. Making Proud Choices! is a science-based safer sex focused teen pregnancy, HIV, and STI prevention program. The program heavily emphasizes condom use to reduce one’s risk of unintended pregnancy or HIV and STI transmission. One of the teachers at this training raised her hand and asked us, “Are there any places in our community where the students can go to get condoms for free?” As my colleague and I were deliberating about the existence of such locations in the area, the teacher followed up her question by adding, “I know our schools don’t make condoms available to the students and if this curriculum is, in fact, effective and the students want to use them, we want to be sure that they have access to them, or else what’s the point?!”

This teacher was absolutely right. What would be the point of advocating condom use if there are no condoms to use? Make no doubt about it, condoms do exist. Of this much I am sure. There is certainly not a shortage of latex in the world. This is not our problem. The issue is making them affordable and accessible to youth.

You probably see where I’m going with all of this…I’m going to say the one thing you’re not supposed to say in the discourse on adolescent sexuality. I suppose I could play nice and just keep my opinions to myself, but that really wouldn’t be my style. That’s just not how I roll…

So here goes:

Condoms should be available in every middle and high school in America.

Think I’m crazy? Think again. There is this all too prevalent fear that making condoms available to youth in schools will encourage sexual activity, but it is a fear that is not based on any real evidence. In fact, all of the evidence on this subject suggests that making condoms available in schools does not hasten the initiation of sex or increase its frequency. The only thing that increases when condoms are made available in schools is the frequency of protected sex.[1] Go figure, when kids are given access to affordable (i.e., free) contraception, they use it! It’s mind boggling, isn’t it?!

Okay, I’ll stop with the sarcasm now. Instead of being snarky, I’ll share an anecdote with you from my personal life. I was recently vacationing in Edinburgh, Scotland, where my husband and I met a couple from Sweden who were also there vacationing. Without fail, whenever and wherever I bring up my job, people immediately want to launch into a discussion about sex, sex education, teen pregnancy, their own experiences as kids, etc. I happened to find this particular conversation immensely more interesting than most, however, because when I mentioned that the name of my organization was the Pennsylvania Coalition to Prevent Teen Pregnancy, they both looked at me with such confusion on their faces. Finally, the woman asked, “Prevent teen pregnancy?” as if she had never heard of such a thing, which is not all too surprising considering that Sweden has among the lowest teen birth rates in the industrialized world.[2] “Isn’t contraception free for all teenagers?” she asked. I sighed and responded, “No, I wish…” She then asked me why this was not the case, and I unfortunately had no good response to offer her. The fact of the matter is that it is inexcusable in my opinion that such a blatantly beneficial public health practice is consistently rejected and written off, and that our only justifications for this rejection are based on unfounded fears as opposed to actual scientific evidence.

It is time we Americans wake up and smell the coffee. This conversation with my new Swedish friends made me realize just how behind the times we are as a nation with regard to our public health practices. I long for a day where the phrase “teen pregnancy” elicits looks of confusion among my fellow Americans as it did from my dinner companions in Edinburgh. Sometimes it seems too insurmountable a problem, but the Swedes reaffirmed my belief that it is only as complicated as we make it. We are capable of doing a better job of protecting our youth from unintended pregnancy and HIV and STI acquisition. We simply have to step up to the plate and do the thing that everyone is afraid of doing, to say that one thing that no one else will say.

Want to see our kids stop having kids? The answer really is this simple: Give them the knowledge and skills they need to make the right decisions and provide them with the resources they need to follow through on those decisions. Giving youth access to contraception in schools does not increase sex, but it does decrease pregnancies and HIV and STI transmission. Let’s conquer our fears with reason, because to be quite frank, I have pretty much had it with ideology getting in the way of the health and well-being of our young people.

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[1] Blake, S.M., Ledsky, R., Goodenow, C., Sawyer, R., Lohrmann, D., & Windsor, R. (2003). Condom availability programs in Massachusetts high schools: Relationships with condom use and sexual behavior. American Journal of Public Health, 93(6), 955-962.

[2] Lawlor, D.A. & Shaw, M. (2004). Teenage pregnancy rates: High compared with where and when? Journal of the Royal Society of Medicine, 97, 121-123.

Abstinence-Only-Until-Marriage Education: The Giant Elephant in the Room (03.28.09)

By: Maryjo M. Oster

In case you’ve been living under a rock for the past year or more, I have some bad news for you: the economy’s not doing so well at the moment. One of our new president’s major campaign promises was to go through the budget “line by line” and spend money more efficiently and cut spending for programs that do not work. The first time I heard then Senator Barack Obama make this statement, a chill of excitement ran down my spine and I thought, “Finally! The end of federal abstinence-only-until-marriage grant programs!” Here again, just in case you’ve been out of the loop for a while, I’ve got something else to share with you: abstinence-only-until-marriage programs are completely ineffective. The government commissioned study on these programs concluded that they had no effect on any measure of adolescent sexual behavior. However, even though this evaluation came out two years ago, the three major streams of federal abstinence-only-until-marriage funding (the Adolescent Family Life Act (AFLA) Section 510 of Title V of the Social Security Act, and Special Projects of Regional and National Significance – Community Based Abstinence Education (SPRANS-CBAE) program) continue to be reauthorized by Congress and in the case of the latter two streams, see repeated increases in funding.

As something of an “insider” in the world of teen pregnancy prevention and sex education, I hear a lot of talk about attempts to establish similar funding streams for medically-accurate, evidence based comprehensive sex education, but I really wonder sometimes if anyone watching the news! THERE ISN’T ANY MONEY LEFT! Further, I really do not think that the answer here is to try to put good money after bad. If we are really serious about balancing the budget and getting our economy back on track, I really do not envision a separate federal comprehensive sex education grant program in our near future. I do, however, think it makes complete and total sense that Congress acts in line with President Obama’s desire to eliminate funding for programs that do not work and NOT reauthorize the federal abstinence-only-until-marriage programs again in their current state.

However, I think there is a better solution than simply eliminating the programs altogether. It is far more difficult to create new government programs from scratch than it is to amend existing ones. Because the issue here is how to spend our money more effectively and not let any of it go to waste, the best solution is to modify the abstinence-only-until-marriage funding streams to support comprehensive, medically-accurate, science-based sex education programs. By this point, it is quite apparent that the abstinence-only programs are clear wastes of taxpayer dollars, and we know that effective programming that can reduce the incidence of teen pregnancy and STI and HIV acquisition will save us money in the long term. A win-win situation!

America will not be broke forever. In time, the economic crisis will be resolved. In the meantime, though, I see a glaringly obvious elephant in the room that for some reason people are not acknowledging. Open your eyes Congress! Abstinence-only-until-marriage education is ineffective and the federal programs that support them are a huge waste of taxpayer dollars. It is time for us to look that elephant in the eye, tell it “No!” Fund programs that have demonstrated effectiveness in reducing teen pregnancy and STI and HIV acquisition and help put us on the road to economic recovery.

Can Schools be Everything to Everyone? (02.27.09)

By: Maryjo M. Oster

When we at PCPTP talk to educators about the need for longer term, comprehensive, medically accurate, and evidence based sex education programming in our schools, overwhelmingly teachers, administrators, nurses, and a variety of other school personnel echo our sentiments and are in complete agreement with us on this fact. However, what we hear in response as the biggest obstacle to good comprehensive sex ed is not controversy, as you might initially think, but rather time and resources. According to most educators, schools simply do not view Health and its accompanying subtopics to be a very high priority, particularly in the face of the immense demands placed on the schools by the No Child Left Behind Act, which makes me wonder:

Should schools make health more of a priority by any number of means, such as increasing the number of Health credits required for graduation, providing more professional development opportunities for Health teachers, holding students accountable for their performance in Health classes as they are in Math and English courses, etc. Or, are schools so busy trying to be everything to everyone that they end up sacrificing quality in all areas as a result?

The school as social panacea idea is by no means a new one. Since the Progressive Era in the early twentieth century, Americans have believed that schools were capable of curing any number of social ails. Beyond providing instruction in the traditional curriculum areas (e.g., mathematics, English, the sciences), schools provide our students with one, sometimes two, meals, medical treatment when necessary, opportunities for physical activity, and instruction on being good consumers, nutrition, and a variety of other aspects of overall health and well being. Do schools take on too much?

With budget crunches and constant anxieties around test scores, health is little more than an afterthought for most American public schools. On the one hand, perhaps it may be time to get back to basics and return to the core academic subjects upon which modern schooling is based, the 3 Rs as they are referred to (reading, writing, and arithmetic). In the process of trying to provide comprehensive health education, physical education, consumer science, media literacy, home economics, and the various other non-academic subject areas that schools have adopted, it is entirely possible that we are diverting resources and focus away from the core subjects and sacrificing quality in all subjects as a result. However, if, hypothetically, schools were to return to focusing solely on the core academic disciplines and eliminate all other endeavors in the process, would other institutions arise to take them on in the school’s stead? Is there any other venue by which young people would be exposed to accurate information about the dangers of alcohol, tobacco, and drugs, about how to avoid getting a sexually transmitted infection, about proper eating habits, about how to relieve stress and anxiety in a healthful way, and so on?

I contend that there is not. If schools do not provide this information to young people, they will likely not be getting it. Parents certainly convey some, if not most, of this information to their children, but consider that approximately 30% of all Americans are obese. Clearly the dietary and exercise habits that these individuals model for their children are not the ones the children should be getting. In the arena of teen pregnancy prevention, the data indicate that the daughters of teen mothers are far more likely to become teen mothers themselves. Again, as well intentioned as most American parents are, they are not professional educators and often young people are under-informed and/or misinformed.

I return now to my initial query: should schools make greater efforts to prioritize health or should they stop trying to be everything to everyone and focus solely on the core academic subjects? I argue that because we do not live in a perfect world and there are no alternative institutions to take health education on in the place of schools, the former option is the answer. Clearly the realities of making this prioritization happen are far more complex than I have room to explore in this blog, but hopefully I have at least gotten your wheels spinning and provided you all with some food for thought. Most teachers would probably hate me for this proposition, but perhaps the answer is year-long schooling. Year-long schooling is quite common in many parts of the world, would help many parents with their summertime day-care needs, and would allow three additional months each year for additional coursework. Regardless of how a reprioritization comes about, we must keep the words of Sammy Davis Jr. in mind, “Something’s Gotta Give.” We exist in a fixed system with limited resources and if we cannot be everything to everyone, let us think harder on what we can and should do and how best to do it well.

Welcome to "The Prevention Zone" (02.12.09)

Welcome to PCPTP's new blog, "The Prevention Zone." We will use this venue to share our thoughts on issues relating to teen pregnancy and adolescent sexual health. Please feel free to share your comments and make this an interactive venue for discussion and debate. You can also subscribe to this blog by clicking the RSS feed button. Thanks for stopping by and we hope you'll come and visit us again soon!