Compendium of Christian Projects Addressing the Diseases of Poverty
Project/Program name:
Undergirding Abstinence Within a Sexuality Education Program
(Results from a U.S.-based Survey)
Presented at Teen Pregnancy Prevention Conference,
Pennsylvania State University, State College, PA October 21, 2001 by Mary
Nora Dennehy, Hanna Klaus and Jean Turnbull
Summary
The efficacy of the Teen STAR Program, a proactive educational
program in human sexuality to undergird virginity and/or facilitate a return
to chastity has been reported previously. The 1999-2001 cohorts are similar
to previously reported cohorts. The 8-month program joins experiential
learning of fertility signs to a developmental didactic curriculum plus
regular teacher-student interaction. Our U.S. study population from 5 sites
consisted of 822 males aged 12-17 years; 71 were sexually active, 41 virgins
(5.4%) transitioned to sexual activity, while 39 (35%) discontinued activity.
Of 496 females aged 12 -16 years 16 (3.2%) were sexually active, before
the program, 14 (2.9%) transitioned while 19 (63%) discontinued activity.
The rate of discontinuation among females (63%) was more than double the
rate of the general population (26%), while the males’ rate(35%) was 20%
higher than the 27% rate of the general population.
Responses were stratified by early, middle and late adolescence
and tabulated by virgin/non-virgin status. Both virgins and non-virgins identified
chastity, the consequences of sex: unwanted pregnancy and STD’s, and self-knowledge
as the most important thing(s) they learned and remembered about the program.
A previously validated Likert scale measured behavioral parameters: speaking
about the program with parents, with friends, greater control of emotions,
greater empathy with others, overall helpfulness of the program and reasons
for maintaining or returning to chastity. In middle and late adolescence
non-virgins generally presented at the lower end of the scale in all parameters,
lending support to Erikson’s theory of identity foreclosure or at least delay
as a result of participation in adult tasks before emotional maturity has
been reached, while early adolescents were equally enthusiastic, and predominantly
returned to chastity. The fact that at least half of locus of control responses
indicated an internal locus may indicate progress toward growing up. Failure
to discontinue intercourse was associated with contraceptive use by 72% of
the males and 43% of the females.
Conclusion: Tracking of fertility patterns
joined to discussion of their meaning correlates positively with maintaining
virginity as well as a return to chastity. The overall 41% discontinuation
rate exceeds that of the general population and can be an important tool
for prevention of STD and premarital pregnancy.
Introduction
Despite recent declining rates in adolescent pregnancy
in this country, more than four in ten teenage girls still get pregnant at
least once before age 20. About two-thirds of all students have sex before
graduating from high school, potentially exposing themselves to STDs. And
one in four sexually experienced teens do contract an STD each year, some
of which are incurable, including HIV, which is terminal or at least life-threatening
(Kirby, 200l).
Yet the percentage of adolescents primarily or secondarily
abstinent may be increased at least in the short term by well-designed programs
adeptly implemented in a community of receptive teens. Parental involvement,
solid theoretical grounding, reinforcement of appropriate social norms, as
well as teaching the interpersonal skills necessary to remain abstinent appear
promising for program success (Thomas, 2000).
The concept of abstinence embraces both primary abstinence;
that is, refraining from sexual intercourse by an individual who has never
experienced it, and secondary abstinence, the discontinuation of sexual intercourse
by those already experienced (Thomas, 2000).
It is believed that abstinence provides buffering from
the psychosocial and emotional harm resulting from premature sexual relationships
(Orr et al, 1991; Billy et al, 1988).
A University of Minnesota statewide survey of adolescent
health that included 26,023 students in Grades 7 through 12 in 1988 found
some interesting emotional correlates to delayed sexual intercourse. Among
adolescent females aged 13-14 years, those with lower symptoms of depression
were less likely to have initiated intercourse. Male youth who were concerned
about issues within their communities (alcohol, drugs, violence, and hunger)
were less likely than peers to initiate early sexual intercourse. Females
who likewise expressed social concerns were also less likely to have early
intercourse than peers. The same was true, but less strong, for those who
reported themselves as more religious. The likelihood that females or males
with higher school performance would have initiated sexual intercourse was
more than half that of peers with lower school performance (Lammers et al,
2000).
Several abstinence-based programs, as well as my own experience,
suggest that adolescents are not able to understand fully the implications
of their sexual experimentation, nor to deal with the consequences of such
activity. According to the work of Marion Howard at Grady Memorial Hospital
in Atlanta, Georgia, the needs that teenagers seek to meet through sexual
intercourse could best be met in other ways. Moreover, teens are often pressured
into sexual behaviors in which they do not want to engage. They require
preparatory awareness of sexual pressures and the skills needed to resist
them (Howard & McCabe, 1990).
In one poll, 12 to 17 year olds identified the pressure
to have sex as the number one threat to their well being (Worldwide, 1994).
A poll of 1000 adolescent girls in an adolescent clinic in Atlanta found
the topic most desired to have discussed, 84% of those polled, was how to
say no to a boyfriend’s request to have sex without losing the boyfriend
or hurting his feelings (Howard & McCabe, 1990).
Implications can also be found in a number of studies
for consideration in developing prevention of high-risk behaviors among adolescents.
For example, if peers are a significant influence, efforts to reduce adolescent
pregnancy, AIDS, and other STDs should account for peers in prevention strategies.
Providing adolescents with roles in prevention efforts may increase the likelihood
that peer reinforcement will work in prosocial ways (DiBlasio & Benda,
1990).
Increasing education, awareness, and involvement of parents
in sexual issues of their children may be effective, as adolescents considered
positive and negative consequences of their actions in the light of parental
reactions. For example, high school students in the DiBlasio and Benda study
(1990) reported that greater supervision and discipline by parents would
reduce their sexual frequency. Additionally, creation of a normative climate
by youths and adults that makes it popular to postpone sexual intercourse
until adulthood may influence adolescents in the direction of attitudes and
beliefs against early sexual involvement.
Reduction or prevention of teenage pregnancies is a high
priority due to the high risk of physical, emotional, and social problems
for mother and child. The more prevalent approach is the provision of contraception.
The continuing high rates of both teen pregnancy and abortion, however, testify
to the less than universal efficacy of the contraceptive approach. The effectiveness
of an oral contraceptive is high, but it appears that in spite of powerful
public information campaigns, teenagers do not accept them, or fail to use
them consistently (Klaus et al, 1987).
My seven year experience of teaching prenatal and parenting
education to a group of pregnant and/or parenting teens at an alternate school
for low income high school drop outs or truants conducted by CORA SERVICES,
Inc., a children and family resource center in Philadelphia, the agency where
I am employed, (MND) gave me personal experience of this. Most of the young
women in these classes had experienced physical and/or emotional side effects
or failure from various contraceptives, with little understanding or patience
from the medical community or their partners.
Neither the provision of contraception nor the exhortation
to preserve chastity serves adolescents’ need to integrate their now-present
biological capacity to procreate into their operational self-concepts. The
Teen STAR program utilizing experiential learning about fertility to facilitate
the integration of biologic maturity with adolescent emotions, cognition,
capacity, life goals and behavior was developed to address this need (Klaus
et al, 1988).
Contraception dichotomizes sex and procreation, thus facilitating
fragmented, often solely or largely genital, relationships, which do not
lead to growth. While teens are often exposed to exhortation to moral (chaste)
behavior, many have not yet reached the level of personal integration to
accept this teaching, even when disposed to do so, because they are immersed
in the adolescent personality task of establishing their ego identity. This
requires at least a theoretical distancing from the “parental ego” in order
to discover which values are their own, and which are passively incorporated
from their parent(s). These adolescents cannot “hear” adults when they say
that genital union can only have its full meaning within marriage, because
they still need to master the preliminary adolescent personality tasks.
A high priority for teens is to understand their sexuality as well as their
procreative capacity. It seems that until youth can “own” their fertility
more than just intellectually they cannot integrate their sexuality and become
more mature. Only after coming to terms with the fact that one is now biologically
capable of becoming a mother or a father, can awareness of this capacity
be integrated into choices about present behavior which are consistent with
future life goals (Klaus, l988).
The original Teen STAR pilot program was designed to discover
whether young women could be taught to recognize their fertility patterns
by mucus self-detection, to monitor the effect of understanding their fertility
on their sexual behavior in the context of gender-specific value-oriented
curricula, and to monitor the effect of parental involvement on client continuation
and behavior (Klaus, 1988).
It has been my experience in working with adolescent girls
most of my professional life that even those who intellectually accept sexual
abstinence as a value, without further instruction, they are less likely
to maintain this stance under pressure. A knowledge and experience of charting
their own fertility patterns, the cyclic rise and fall of hormones with their
effect on one’s moods, plus concrete ways of responding to these emotional
changes and pressures is empowering to the adolescent girl and reinforcing
of abstinence outside of a totally committed relationship. I have also learned
that instruction in fertility awareness enables the adolescent to come to
a new and deeper understanding of what it means to be a woman. Developing
a healthy feminine identity and full acceptance of ones’ sexuality is part
of adolescent development.
Estrogens release endorphins, making us feel good, even
tempered and outgoing. After ovulation the metabolite of progesterone, allopregnanolone.
(Rapkin et al. 1997) is anxiolytic, that is, releases anxiety. Women become
more inward looking and introspective, arty.( How often do we hear from parents
of adolescent girls complaints about how much time their daughters spend
in their room, more than likely during the progesterone phase of their
cycle.)
When both estrogen and progesterone drop, the low level
of androgen in women can become dominant. Ordinarily, the female level of
testosterone is one-tenth of what it is in the male. Testosterone, generally
associated with energy and aggression in the male, becomes apparent three
or four days before the menstrual period in women. At this time she is more
apt to become impatient or have a short fuse, as teens are likely to report.
For example, the behavior of a younger sibling well tolerated during most
of the cycle can become an irritant at this time. This phase can be expressed
inwardly as depression or outwardly as aggression (Hanna Klaus, M.D., Personal
communication 6/12/0l.)
Does this mean that the adolescent girl or woman is a
victim of her hormones? Not so if she is aware of her cycling hormones and
their influence on her moods. She can be challenged to decide how they will
effect her behavior, putting her in charge.
Likewise, many adolescent girls can feel a lack of control
about menstruation and its’ timing. With an appreciation of fertility awareness,
she can learn when to predict it, giving her a feeling of being more in
control.
Teens also learn the effect of hormones as well as other
factors on their sexual desire. As one girl explained to me, “I almost went
all the way but stopped as I remembered what you said, ‘It’s not true love;
it’s the hormones.’” I don’t recall using those exact words, but the young
woman got the message correctly.
Being as self invested as teens are, this knowledge of
factors involved in their emotional state proves of great interest to adolescent
girls, and boys I might add. Some girls may even be attracted to Teen STAR
because of the psychological self-knowledge involved. Once into the program,
however, they appreciate this information but experience and learn so much
more in the process.
Other areas covered by the curriculum include:
1) Psychosexual differences between men and women.
2) Dating – boy/girl relationships – the purpose of dating,
appropriate dating behavior, including assertive refusal techniques.
3) Evaluating sexual attitudes presented on TV & other media.
4) STDs.
5) Consequences of premarital sex.
6) The meaning of a totally committed relationship.
Methodology
In an effort to determine the effect of premature intercourse
on the psychological maturation of adolescents, outcome data from the anonymous
exit questionnaires from the 1998-2000 Teen STAR programs in the U.S. were
analyzed comprising data obtained 1999-2001. Responses of 496 female and
822 male subjects were grouped by gender, virgin/non-virgin status, and level
of psychosexual development. Early adolescence – 11 to 13 years of age,
middle adolescence – 14 to 15 years of age, and late adolescence – 16 to
17 years of age. Non-virgins represented only 10 – 13 % of the study groups.
(Tables 1A and 1B)
Results
There were considerable differences in the responses of virgins and non-virgins across all three groups.
1) Female and male virgins in middle adolescence
anticipated future abstinence more frequently than non-virgins. In late
adolescence, males had no expectations, while 2/3 of females were hopeful.
(Tables 2 A&B)
2) All early adolescents gained on the question of greater
control of emotions, while the gain was higher among virgins than non-virgins.
(Tables 3A&B)
3) Early adolescent non-virgin females and middle adolescent
non-virgin males lagged behind other groups on empathy with others. (Tables
4A&B)
4) Early and middle virgin females rated the program higher for over-all helpfulness.(Tables 5A&B)
5) About half of early and mid-adolescent males, whether
virgin or not, spoke with their parents about the program, other than to
request permission to participate, while about one third of other male groups
did so. More early and late adolescent female virgins talked with their
parents about the program than did female non-virgins. A higher percentage
of middle adolescent female non-virgins, although small in actual number,
spoke with their parents about the program than did the percentage of middle
adolescent female virgins.(Tables 6A&B)
6) A greater percentage of middle and late adolescent
virgin males spoke with their friends about the program while a greater percentage
of early adolescent male non-virgins spoke with their friends about the program
than did early adolescent male virgins. The opposite was true for females,
with more early adolescent virgins and a greater percentage, though small
in actual number, m middle and late female non-virgins talked to their friends
about the program. (Tables 7A&B)
7) Virgins of course had higher response rates for reasons
for remaining, (or returning to) abstinence than non-virgins; they also had
a much higher rate of responses which reflected an internal locus of control,
indicating movement toward maturity. (Tables 8A&B) Table 9 identifies
the questions and their loci. There was little difference between what students
remembered most from the course (Tables 10 A&B) and what they considered
most important. (Tables 11 A&B) All listed chastity, consequences of
sex and self-knowledge. Girls added knowledge of their fertility cycle.
Non-virgins presented at the lower end of the scale in all
parameters, lending support to Erikson’s theory of identity foreclosure or
at least delay, as a result of participation in adult tasks before
emotional maturity has been reached. Failure to discontinue intercourse
was linked to contraceptive use in all three age groups. This was more pronounced
among males (72%) than females (43%). (Table 12.)
Conclusion
Tracking of fertility patterns joined to discussion
of their meaning correlates positively with maintaining virginity as well
as a return to chastity. The high level of continuing virginity, as well
as the overall 37.2% discontinuation of sexual activity exceeds that of the
general population and can be an important tool for prevention of STD’s and
premarital pregnancy. (Klaus, 2001)
Appendix
At an international meeting of Teen STAR held in Krakow,
Poland, July 9-12, 2000, teachers from 17 countries were able to identify
22 program strengths. Among those related to the topic at hand were:
1) Students can be themselves, become more mature and self-directed.
2) Teen STAR demands self-discipline, which is counter-cultural.
3) Teen STAR moves girls from being victims of their hormones to being in control.
4) Teen STAR encourages students to think ahead and to make decisions ahead of crisis.
5) The program offers methods to reject peer as well as media pressure.
6) Teen STAR enhances movement from middle to late adolescence, thereby enhancing students’ level of ego development.
7) Teen STAR affirms the youth’s right to know about their own sexuality and helps them find answers (to their questions).
References
Billy J, Landale N, Grady W, Zimmerle D.
Effects of sexual activity on adolescent social and psychological development.
Soc Psych Q 1988, 51:190-212.
DiBlasio, F.A., Benda, B.B. Adolescent Sexual Behavior:
Multivariate Analysis of a Social Learning Model. J Adol Research 1990;5:414-429.
October.
Howard, M, McCabe JB. Helping teenagers postpone sexual involvement. Fam Plann Perspectives; 1990;20:21-6.
Kirby, D. Emerging Answers: Research Findings on Programs
to Reduce Teen Pregnancy. National Campaign to Prevent Teen Pregnancy. Washington,
DC. May, 2001.
Klaus H., Teen STAR News. July/August, 200l. Bethesda, MD.
Klaus H, Fagan MU., Bryant ML. Dausman S, Dennehy N,
Begley M, Monmonier H, Martin JL, Teen STAR: Sexuality Teaching in the
Context of Adult Responsibility. Regier G, Ed., Values and Public Policy.1988.
Family Research Council, Washington, D.C.,
Klaus H, Bryan, LM, Bryant ML, Fagan MU, Harrigan MB,
Kearns F. Fertility Awareness/Natural Family Planning for Adolescents and
their Families: Report of Multisite Pilot Project. Internat J Adol Med &
Health.1987;3:2:101-119. Listed in Kirby, D. see above
Lammers C, Ireland M, Resnick, M, Blum, R. Influences
on Adolescents’ Decision to Postpone Onset of Sexual Intercourse: A survival
Analysis of Virginity among Youths Aged 13 to 18 Years. J Adol Health. 2000;
26:42-48. January.
Orr D, Bexter M, Ingersoll G. Premature sexual activity as an indicator of psychosocial risk. Pediatrics, 1991; 87: 41-7.
Thomas, MH. Abstinence-Based Programs for Prevention of Adolescent Pregnancies: A Review. J Adol Health, 2000; 26:5-17.
Worldwide, Roper Starch. Teens Talk About Sex: Adolescent
Sexuality in the 90’s. New York: Sexuality Information and Education Council
of the United States, 1994.
Youth Risk Behavior Survey, United States, 1999. Centers for Disease Control, DHHS.
Acknowledgements: Program data were contributed
by: Liz Heyne and Bertha Moreno, Dallas, TX:; Mary Ann Fennell and her group
from Fairfax, VA;, Jean Turnbull, Philadelphia, PA; Tom and Chiquita Seesan,
Massillon OH; Lorraine Leonard, St. Andrew’s, Andrews AFB, MD. Irene Arevalo
performed data entry and analysis.
For further information contact:
Hanna Klaus, M.D., Teen STAR Program
8514 Bradmoor Drive, Bethesda, MD 20817-3810 USA
Tel. 301-897-9323, Fax 301-571-5267, email: hklaus@dgsys.com
Website: www.teenstar-international.org