Paper Title
The limits of abstinence-only in preventing sexually transmitted infections
Keywords
- abstinence-only
- sti prevention
- public health policy
- adolescent health
- sexual education
- comprehensive sex education
- risk reduction
- epidemiologic causality
- sexual behavior
- virginity pledge
- longitudinal study
- add health
- behavioral interventions
- safe sex practices
- condom use
- public health interventions
- sexual risk-taking
- youth sexuality
- health education
- reproductive health
- teen pregnancy prevention
- policy analysis
- moral agendas
- religious influence
- sexual abstinence
- failure rate
- simulation studies
- longitudinal research
- prevention strategies
- sexual decision-making
- epidemiology
Article Type
Research Article
Journal
Research Impact Tools
Publication Info
Volume: 36 | Issue: 4 | Pages: 269–270
Published On
April, 2005
Downloads
FULL PDF
Abstract
Over the past century, public health approaches to sexually transmitted infections (STIs) have come from 1 of 2 camps. Although specific policies certainly reflected the times in which they arose, the debate over STI prevention today is surprisingly similar to that of the early 20th century [1]. One camp advocates comprehensive education and skills. The other focuses only on eliminating adolescent sexual activity. Today, national as well as state and local public health policy is driven increasingly by an abstinence-only-until-marriage prevention approach. Although supporters of this approach to policy may have varied religious and moral agendas, abstinence is promoted by them as unambiguous, safe, and 100% effective. These claims are based on a common sense foundation of epidemiologic causality: sexual activity is a necessary and sufficient cause for infection transmission when 1 partner is infected. However, despite traditional appeal and logical relevance, public health policy based solely on abstinence has not been shown to be effective. One deficiency of the abstinence-only argument is its failure to distinguish between abstinence as a personal choice and abstinence as a public health intervention. As a personal choice, abstinence is always 100% effective for STI prevention because, logically, abstinence cannot simultaneously be nonabstinence. However, as a public health intervention used at a population level, abstinence almost certainly will have a failure rate, even if it is successful in a larger sense. For example, simulation studies suggest that abstinence appears to be about as good as condoms for the prevention of STI [2]. Furthermore, potentially adverse effects of abstinence-only interventions have not been addressed systematically [3,4]. The assumption that abstinence-only interventions are without negative consequences has not been tested in careful, longitudinal research. The study by Brückner and Bearman [5] in this issue of the Journal of Adolescent Health begins to address these issues. Data for the study were obtained from the National Longitudinal Study of Adolescent Health (Add Health). Methodologic details of the Add Health study are described in detail in the article and are available publicly [6]. The current article contains a methodologic innovation that deserves attention. Add Health respondents were asked on 3 different occasions whether they had ever taken a virginity pledge. Those who consistently reported never making a virginity pledge were classified as nonpledgers. Those who consistently reported making a virginity pledge were classified as consistent pledgers. Participants who reported making a pledge at some earlier date but subsequently reported never having made a virginity pledge were classified as inconsistent pledgers. This methodologic innovation is important because it allows us to examine pledging effects among adolescents who may be assumed to have different levels of commitment to pledging.
View more »