- Sex education programs designed to delay adolescent sexual
activity, increase contraception use and reduce teen pregnancy fail to
do so -- and some may make the problem worse.
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- That's the conclusion of a new study by Canadian researchers
who analyzed more than two dozen earlier trials of sex education efforts
that targeted teens. They found that, overall, none made a dent in the
odds that girls or boys would put off having sex or would use birth control
when they did. None reduced the rate of teen births.
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- A separate analysis of four abstinence programs and one
school-based sex education program showed they had the unintended effect
of actually increasing the rate of pregnancies among the sex partners of
boys. President Bush ( news - web sites) has called for "abstinence-only"
sex education.
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- The findings, which other experts challenged, appear
in the June 15 issue of the British Medical Journal.
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- Alba DiCenso, a professor of nursing at McMaster University
in Hamilton, Ontario, and the lead author of the study, said it's too soon
to declare sex education irrelevant.
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- Most of the trials her group reviewed pitted novel interventions
against conventional programs. So the failure to find a difference might
merely mean that the newer programs work just as well as the old ones,
she added.
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- Still, DiCenso said, because teen pregnancy rates remain
high in the United States, Canada and other countries where the studies
were conducted, "we just haven't got it right yet."
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- The teen pregnancy rate in the United States has been
dropping steadily in recent years. It fell 5 percent alone between 2000
and 2001, marking the 10th straight year of decline and a record low. The
pregnancy rate for girls age 15 to 19 was 45.9 per 1,000 in 2001, off from
48.5 per 1,000 the previous year. The teen birth rate has plunged 26 percent
since 1991.
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- The reasons for the steep drop are murky -- doubly so
if sex education programs can't take credit. The booming economy of the
1990s might be one factor, DiCenso said. Others have said better contraception
and less sexual activity among teens is behind the trend.
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- Experts have emphasized the need for comprehensive approaches
to reducing teen pregnancies -- programs that focus on self-image, family
and community. And DiCenso's group did find one trial of such an initiative
that had a marked reduction in births among the girls who participated.
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- However, they said, girls in the comparison group appeared
to have problems that made it likelier they'd become pregnant, potentially
skewing the results.
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- Some experts disagreed with the conclusions of the Canadian
study. Douglas Kirby, of ETR Associates in Santa Cruz, Calif., a nonprofit
health education group, said lumping together so many studies diluted the
effect of interventions that do work -- and those do exist.
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- Kirby, several of whose own studies were cited in the
Canadian research, said he has found 10 components of sex education that
can reduce teen pregnancy and influence adolescent sex habits. He said
programs work when they use these approaches -- which include a focus on
sex, not relationships or gender roles, a clear message to avoid unprotected
intercourse, and a stress on abstinence as the best way to avoid sexually
transmitted diseases and pregnancy.
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- Others may fail because they don't employ these methods,
he added. Or it may be that they're not tried for long enough or in the
right group of teens, he said.
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- Convincing teens to put off having sex and increasing
the frequency with which they use contraception is "very difficult
business, and many programs don't work," said Bill Albert, spokesman
for the National Campaign to Prevent Teen Pregnancy, a Washington, D.C.-based
nonprofit.
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- But Albert said his group has found that some sex ed
initiatives can succeed -- though why isn't always clear.
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- Sometimes, efforts that make a difference don't target
sexual behavior at all. A study the group conducted last year, for example,
found that several community service programs that had teens cleaning parks,
visiting nursing homes, and performing other tasks helped reduce sexual
activity among the volunteers.
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- Again, Albert said, the reason for the effect wasn't
clear. It might have been something as simple as reducing the time teens
could have sex by filling their days with community work. Or it could have
been the presence of committed, caring adults.
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- Yet Albert said these kinds of programs can only be one
part of a larger strategy to drive down teen pregnancy.
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- "While they can be effective and are important,
it's unrealistic and unfair to believe that these sorts of programs alone
can make substantial progress in reducing teen pregnancy," he said.
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