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Wednesday, June 1, 2016

Where is the evidence for Obama's "evidence-based" sex ed approach?

Valerie Huber
I recently met at the US Capitol with Members of Congress and my friend and colleague Valerie Huber, President of the sexual risk avoidance education group ASCEND.
Ascend (formerly the National Abstinence Education Association) champions youth to make healthy decisions in relationships and life by promoting well being through a primary prevention strategy, and as a national membership and advocacy organization that serves, leads, represents and equips the Sexual Risk Avoidance field.
At our meeting at the Capitol, Valerie explained how the Obama administration disfavors the sexual risk avoidance education that parents favor, opting instead for the so-called "comprehensive" sex ed approach. "Comprehensive" sex ed programs expect teens to engage in sex and focus on the mechanics of sex and prophylactic measures.

Teens' tendencies thwart condom strategy

The comprehensive sex ed approach depends heavily on condom instruction. Yet as the FDA notes, the effective use of condoms depends on consistency, carefulness and rationality. Teenagers, by contrast, are often inconsistent, reckless and irrational. Studies of the brain offer evidence that the ability to rationally anticipate consequences and adapt behavior accordingly often does not fully develop until after the teen years.

Exposing the flaws in the "evidence"

ASCEND has released a statement entitled, "The HHS List of "Evidence-Based" Sex Ed Programs Presents Dubious Claims of Effectiveness." It explains how the administration continues to promote "comprehensive" sex ed despite a dearth of reliable scientific evidence:
Since 2009, the Department of Health and Human Services has provided revisions and additions to a list of Teen Pregnancy Programs they claim are “evidence-based.” The touted list is treated as a seminal guide for those who implement programs across the country to reduce teen pregnancy.
Spring 2016 saw yet another expansion of the so-called “approved” list increasing the total number of programs to 44. To earn a place on the list, a rigorous criteria for research design and implementation is set forth.
However, for many programs, a closer look shows serious breaches of many established research protocols.
And yet, these programs are presented as “national models,” meaning that when implemented the same positive results can be expected. So what has a closer look revealed?

"Model" programs are actually making matters worse 

For a program to be deemed a “national model,” at least one replication, with the same results, must be achieved. But only 16% of the programs on the list have even been replicated.
Of those that have, dubious and even dangerous results were reached.
Of the seven programs that have been replicated, six showed either “no change” or worse. Three programs demonstrated students faring worse than students who did not receive the program at all by being more likely to have sex, have more sexual partners, or less likely to use contraception.
And, disturbingly, these are offered as  “models” of programs designed to reduce teen pregnancy. 
Another concern includes the implication that positive findings from a program conducted in a clinical setting, for instance, can also be expected for those in a classroom setting.  However, such a generalization of findings from one setting to an entirely different setting is a violation of the most elementary research protocols.

Whatever happened to truth? 

The fact of the matter is the much celebrated “evidence-based” list of programs are not national models and should not be promoted as such.
They simply do not meet the expected standard of replication to be so deemed. Communities and schools across the country need to know the truth. 
Those who care about teen pregnancy and the growing epidemic of STDs among youth deserve research that produces honest information. We have some. But it is important that we do not say what we cannot say.
It is time for honest research to inform our efforts in working with teens on this most important issue. It is time to stop promoting approaches to sex education that have more to do with political and ideological agendas than with the health and well-being of youth.

Congress steps in

Thankfully, the current Congress is cognizant of the benefits of sexual risk avoidance education and has allocated funding for it. Accordingly, the US Department of Health and Human Services (HHS) last week released a Funding Announcement for a new Sexual Risk Avoidance (SRA) Education Program. As ASCEND explains:
The new SRA program is the result of Ascend’s work with Congress to bring more sex education choice to communities. The FY 2016 federal budget contains $10 million for a sex education approach that is focused solely on giving youth the skills to avoid all of the risks associated with teen sex.
The goal of the new programs is to “implement sexual risk avoidance education that teaches participants how to voluntarily refrain from non-marital sexual activity ... and teach the benefits associated with self-regulation, success sequencing for poverty prevention, healthy relationships, goal setting, and resisting sexual coercion, dating violence, and other youth risk behaviors such as underage drinking or illicit drug use without normalizing teen sexual activity.”
The award process for the  FY2016 SRA Education program allows for annual awards over a 3-year project period as funds are available. 
As pending legislation, the Healthy Relationships Act, notes, 
The unambiguous message that postponing sexual activity is the optimal sexual health behavior for youth must be the primary emphasis and context for each topic covered by the education. The education must be age appropriate, medically accurate, and evidence based.
If Congress continues to fund sex education, the requirements of this legislation seem quite reasonable, especially given the serious health and emotional consequences of teen sexual activity.

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