1. Let’s Talk about Sex: The Sex Ed Debate Community Pediatrics Caroline Chang

2. Background 45% of teens 15-19 have had sexual intercourse (2002) Teens = 25% of the ever sexually active population, but nearly HALF of all new STDs. 15- to 19-year-old women had the highest rate of Chlamydia and Gonorrhea compared to any other age/sex group (2007), and it continues to increase

3. Background The US has the second highest teen pregnancy rate in developed countries Similar rate of teen sex, less use of contraception Recent decline in teen pregnancy rates are 72% (15-17 yo) and 99% (18-19 yo) due to increased use of contraception

4. New York Statistics 39% female/45% male high school students reported having sexual intercourse New York teens have sex with more partners, earlier, than the rest of the country. Nearly 40,000 teen pregnancies in New York Abortion rate for teenagers 15-19 second highest in the country. More than 10% of teens 13-19 diagnosed with HIV in 2005 are in NYC *2005 data

5. Sex Education Statistics 89% of public school children receive sex education at least once between 7-12 th grades However, the curriculum varies widely ~80% teens 15-19-educated prior to 18 on saying no to sex, 2/3 before 9 th grade ~65% of female/male teens 15-19-educated prior to 18 on methods of birth control, 40% before 9th grade *2002 Data

6. Parent Sex Education

7. Comprehensive Sex Ed Aka abstinence “plus” Curriculum includes information on both abstinence and contraception Still teaches abstinence as the preferred choice

8. Abstinence Only Abstinence has social, psychological, and health benefits Unmarried, school-age children are expected to abstain from sex Abstinence is the only certain way to prevent out-of wedlock pregnancy and sexually transmitted diseases A mutually faithful and monogamous married relationship is the standard for sexual activity Sexual activity outside marriage is likely to have harmful psychological and physical effects Out-of-wedlock childbearing is likely to harm a child, the parents, and society How to reject sexual advances and how alcohol and drug use increases vulnerability to them The importance of attaining self-sufficiency before engaging in sex *Source: Section 510 (b), Title V of Social Security Act.

9. Virginity Pledge Oral or written promise to refrain from sexual activity, usually until marriage Created in 1993 by an evangelical Christian organization  spread by other Protestant and Catholic groups By 1995, 13% of American adolescents reported having taken a virginity pledge US government uses virginity pledges as a measure of success of abstinence- only sex education programs

10. The Data Several studies have been performed using regression that showed that girls who took “virginity” pledges were less likely to have had sex 5 years after the pledge compared to non- pledgers BUT---did not control for other factors

11. More Data 2008--Rosenbaum performed a similar study, but controls were matched in age, religiosity, ideals and views on sex and birth control 5 years after the pledge -82% denied ever making a virginity pledge -no differences in premarital sex, age of first sex, STI’s -fewer of the pledgers used condoms/birth control over the past year

12. More Data 2002 Survey of Teens 15-19 showed having some type of sex education BEFORE first sex was associated with: MALES -71% less likely to have sex prior to age 15 -not having sexual intercourse (during the course of the study) -increased likelihood of using condoms at first sex FEMALES -59% less likely to have sex prior to age 15 -African American girls—91% Mueller TE, Gavin LE, Kulkarni A. The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. J Adolesc Health 42(1), 2008.

13. What is being used now Sex education is mandated in 20 states Kaiser Family Foundation Survey in 1999 found that sex education is taught in some form in 95% of public schools 58% -comprehensive 34% -abstinence only 81% of Americans feel that sex education programs should be comprehensive

14. Sex Education In New York NOT mandated by New York State. Local boards of education may choose to make sexuality education a local requirement. Local school districts encouraged to have advisory councils-- parents, school personnel, students, members of the faith communities, and other community-based organizations to make recommendations about sexuality education programs. Often omitted or abbreviated due to lack of mandate and funding.

15. HIV/AIDS Education Regulated as a separate entity from sex ed CDC has been providing funding for HIV/AIDS education since 1988 $47 million in 2000 Is mandated by law in NY State

16. Funding Federal Funding State Funding

17. Federal Funding 1981-Adolescent Family Life Act- allocated $11 million to prevent premarital teen pregnancy by establishing “family-centered” programs to “promote chastity and self discipline.” Has been renewed annually giving $6-12 million a year

18. Then….. 1995, under Bill Clinton—Social Security Act, Title V, Section –dedicated 50 million dollars a year to states providing solely abstinence- only sex education. States required to match funds  $437.5 million to abstinence-only programs by 2002. Includes detailed definition of what federally funded programs are expected to teach

19. AND THEN…. 2001-Bush created program that gives additional 100 million a year for abstinence only education

20. BUT….. Up to 17 states (including New York) have refused federal funding, feeling that abstinence only programs do not work More than 90% of abstinence funding does not require that curricula be scientifically accurate!!! 2004 review found incorrect information in 11 of 13 federally funded abstinence programs, primarily about birth control and condom effectiveness

21. BUT…..THERE IS HOPE!

22. Barack Obama’s 2010 Budget Slashes Abstinence-Only Programs and Replaces them with Teen Pregnancy Prevention Initiative Eliminates $99 million for Community-Based Abstinence Education Programs (CBAE) and $50 million for Title V abstinence only programs. Creates Pregnancy Prevention Initiative-- $110 million to support "community-based and faith- based efforts to reduce teen pregnancy using evidence-based and promising models."

23. Drawbacks Focuses primarily on pregnancy prevention, leaving out STI prevention, building healthy relationships, etc.

24. Prevention First Act Contains REAL (Responsible Education About Life) Act, At-Risk Communities Teen Pregnancy Prevention Act of 2009 Introduced 3/09--authorizes federal funding for comprehensive, medically accurate, age-appropriate sex education Includes how to prevent pregnancy, protect their health and make responsible decisions. Also award grants for teenage pregnancy prevention programs and research.

25. State Funding Currently required to match federal sex ed funds, but no other comprehensive funding mechanism New York is one of the many states that has rejected federal abstinence-only funding

26. Healthy Teens Act First introduced in 2002, creates a competitive grant program, administered by the DOH for schools /communities to teach sex education Programs MUST be age-appropriate and medically accurate, and may not teach or promote religion.

27. Healthy Teens Act No mandated curriculum, but programs encouraged to include: -stressing abstinence and teaching that it is the only sure way to avoid pregnancy and STIs -providing information about different contraceptive and barrier methods to prevent pregnancy and STIs; -encouraging parent involvement and family communication; -teaching relationship negotiation skills and how drugs and alcohol affect responsible decision making.

28. Healthy Teens Act The grant awards would preference areas with higher teen pregnancy and STI rates. Has passed the assembly every year since introduction, but never got past state senate Now with a new pro-choice majority, there is hope that this may change, but may be vetoed by Governor Patterson due to budget constraints

29. What still needs to be done Passing Obama’s budget Healthy Teens Act Prevention First Act/REAL Act More research identifying programs that are shown to be effective in lowering pregnancy, STI rates Having funding for programs that work More universal and standardized requirements for sex education (unlikely)

30. What Can We Do? WRITE A LETTER!!! - To federal representatives to pass the Prevention First Act (currently in committee) -To federal representatives to support comprehensive sex education, to make sure the sex education funding in Obama’s budget is passed -To State Representatives to pass the Healthy Teens Act Be more thorough at your next teen WCC!! For other ways, visit Get the Facts NY: http://ga0.org/gtfny/home.html

31. References BMJ 2005;331:715 (1 October), doi:10.1136/bmj.331.7519.715-a Janet Elise Rosenbaum, PhD, AM Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers PEDIATRICS Vol. 123 No. 1 January 2009, pp. e110-e120 Mueller TE, Gavin LE, Kulkarni A. The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. J Adolesc Health 42(1), 2008. http://www.guttmacher.org/pubs/tgr/04/4/gr040404.html http://www.guttmacher.org/pubs/tgr/06/1/gr060106.html http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf http://www.rhrealitycheck.org/blog/2009/05/07/2010-budget-slashes-abstinenceonly-money-keeps- abortion-funding-restrictions http://www.rhrealitycheck.org/blog/2009/05/08/are-we-there-yet-comprehensive-sex-education-and- presidents-2010-budget http://www.kff.org/youthhivstds/upload/Sex-Education-in-the-U-S-Policy-and-Politics.pdf http://pediatrics.aappublications.org/cgi/reprint/123/1/e110 http://www.cdc.gov/std/stats07/adol-figs.htm http://www.nyclu.org/node/1817 http://www.fpaofnys.org/news/newsReleases/documents/PRHTARvW012209.pdf http://www.govtrack.us/congress/bill.xpd?bill=s111-21&tab=summary http://www.emsc.nysed.gov/sss/coordinatedschoolhealth/health.html http://www.natap.org/2009/newsUpdates/031109_03.htm