Journal of Adolescent Health
Volume 38, Issue 1 , Pages 72-81 , January 2006

Abstinence and abstinence-only education: A review of U.S. policies and programs

  • John Santelli, M.D., M.P.H.

      Affiliations

    • Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York
    • Corresponding Author InformationAddress correspondence to: Dr. John Santelli, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, B-2, New York, NY 10032.
  • ,
  • Mary A. Ott, M.D.

      Affiliations

    • Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
  • ,
  • Maureen Lyon, Ph.D.

      Affiliations

    • Division of Adolescent and Young Adult Medicine, Children’s National Medical Center and Department of Pediatrics, George Washington University Medical Center, Washington, DC
  • ,
  • Jennifer Rogers, M.P.H.

      Affiliations

    • American College of Preventive Medicine, Washington, DC
  • ,
  • Daniel Summers, M.D.

      Affiliations

    • Mt. Sinai Adolescent Health Center, Mount Sinai School of Medicine, New York, New York
  • ,
  • Rebecca Schleifer, J.D., M.P.H.

      Affiliations

    • Human Rights Watch, New York, New York

Received 31 May 2005 ,Accepted 14 October 2005.

References 

  1. Schuster MA , Bell RM , Kanouse DE . The sexual practices of adolescent virgins (genital sexual activities of high school students who have never had vaginal intercourse) . Am J Public Health . 1996;86(11):1570–1576
  2. Goodson P , Suther S , Pruitt BE , Wilson K . Defining abstinence (views of directors, instructors, and participants in abstinence-only-until-marriage programs in Texas) . J Sch Health . 2003;73(3):91–96
  3. Social Security Administration . Social Security Act: Title V: Maternal and Child Health Services Block Grant. Separate Program for Abstinence Education . 2005; SEC. 510 [42 U.S.C. 710].
  4. Abma J , Martinez GM , Mosher W , Dawson BS . Teenagers in the United States (sexual activity, contraceptive use, and childbearing, 2002) . Vital Health Stat 23 . 2004;24:1–48
  5. Fields J . America’s Families and Living Arrangements (2003) . Washington, DC: U.S. Census Bureau; 2004;
  6. Centers for Disease Control and Prevention . Sexually Transmitted Disease Surveillance, 2003 . Atlanta, GA: U.S. Department of Health and Human Services; 2004;
  7. Institute of Medicine . The Best Intentions (Unintended Pregnancy and the Well-Being of Children and Families) . Washington, DC: National Academy Press; 1995;
  8. Henshaw SK . U.S. Teenager Pregnancy Statistics with Comparative Statistics for Women Aged 20–24 . New York, NY: The Alan Guttmacher Institute; 2004;
  9. Weinstock H , Berman S , Cates W . Sexually transmitted diseases among American youth (incidence and prevalence estimates, 2000) . Perspect Sex Reprod Health . 2004;36(1):6–10
  10. Donovan P . Testing Positive (Sexually Transmitted Disease and the Public Health Response) . New York, NY: Alan Guttmacher Institute; 1993;
  11. Curran JW , Jaffe HW , Hardy AM , et al.   Epidemiology of HIV infection and AIDS in the United States . Science . 1988;239:610–616
  12. Rosenberg PS . Scope of the AIDS epidemic in the United States . Science . 1995;270:1372–1375
  13. Office of National AIDS Policy . Youth & HIV/AIDS (An American Agenda) . Washington, DC: Office of National AIDS Policy; 1996;
  14. Valleroy LA , MacKellar DA , Karon JM , et al.   HIV prevalence and associated risks in young men who have sex with men . JAMA . 2000;284:198–204
  15. Centers for Disease Control and Prevention . Heterosexual Transmission of HIV—29 states, 1999–2002 . MMWR . 2004;53(6):125–129
  16. Alan Guttmacher Institute . Sex and America’s Teenagers . New York, NY and Washington, DC: The Alan Guttmacher Institute; 1994;
  17. US House of Representatives, Committee on Ways and Means, Democrats. Steep decline in teen birth rate significantly responsible for reducting child poverty and single- parent families [cited 2004 Apr 28]. Available from: http://www.teenpregnancy.org/about/announcements/pdf/Ways&MeansReport.pdf
  18. Anda RF , Chapman DP , Felitti VJ , et al.   Adverse childhood experiences and risk of paternity in teen pregnancy . Obstet Gynecol . 2002;100:37–45
  19. Koenig MA , Zablotska I , Lutalo T , et al.   Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda . Int Fam Plan Perspect . 2004;30(4):156–163
  20. Rickert VI , Wiemann CM , Harrykissoon SD , et al.   The relationship among demographics, reproductive characteristics, and intimate partner violence . Am J Obstet Gynecol . 2002;187(4):1002–1007
  21. Chen YW , Stiffman AR , Cheng LC , et al.   Mental health, social environment, and sexual risk behaviors of adolescent service users (a gender comparison) . J Child Fam Stud . 1997;6(1):9–25
  22. Woodward LF , Fergusson DM . Early conduct problems and later risk of teenage pregnancy in girls . Dev Psychol . 1999;11(1):127–141
  23. Adler NE , David HP , Major BN , et al.   Psychological factors in abortion (a review) . Am Psychol . 1992;47(10):1194–1204
  24. Adler NE , Ozer EJ , Tschann J . Abortion among adolescents . Am Psychol . 2003;58(3):211–217
  25. Zabin LS , Hirsch MB , Emerson MR . When urban adolescents choose abortion (effects on education, psychological status, and subsequent pregnancy) . Fam Plann Perspect . 1989;21:248–255
  26. Quinton WJ , Major BN , Richards CL . Adolescents and abortion (are minors at greater risk?) . Psychol Public Policy Law . 2001;7(3):491–514
  27. Chang J , Elam-Evans LD , Berg CJ , et al.   Pregnancy-related mortality surveillance—United States, 1991–1999 . MMWR . 2003;52(SS02):1–8
  28. Strauss LT , Herndon J , Chang J , et al.   Abortion surveillance—United States, 2001 . MMWR . 2004;53(SS09):1–32
  29. Albert B . American Opinion on Teen Pregnancy and Related Issues 2003 . Washington, DC: National Campaign to Prevent Teen Pregnancy; 2004;
  30. Dailard C . Sex education (politicians, parents, teachers and teens) . Issues Brief (Alan Guttmacher Inst) . 2001;(2):1–4
  31. Solomon-Fears C. Reducing teen pregnancy: adolescent family life and abstinence education programs. Congressional Research Service. The Library of Congress, #RS20873. Updated April 13, 2005.
  32. Dailard C . Abstinence promotion and teen family planning (the misguided drive for equal funding) . The Guttmacher Report on Public Policy . 2002;5(1):
  33. Haskins R , Bevan CS . Abstinence education and welfare reform . Child Youth Serv Rev . 1997;465–484
  34. Carrier P. Maine turns down sex-ed funds. Portland Herald Press. September 20, 2005 [cited 2005 Sep 28]. Available from: http://pressherald.mainetoday.com/news/state/050920funding.shtml
  35. United States House of Representatives Committee on Government Reform—Minority Staff . The content of federally funded abstinence-only education programs . 2004;
  36. Republican Study Committee. Federal abstinence programs: policy brief 2003 [cited 2005 Jul 29]. Available from: https://johnshadegg.house.gov/rsc/abstinence1.pdf
  37. Administration for Children of Families. Fiscal Year 2005 Abstinence Education Formula Grant Program (Section 510) to Title V Social Security Act [cited 2005 Jul 25]. Available from: http://www.acf.hhs.gov/programs/fysb/absfund-anncmt.htm
  38. Smith TE , Steen JA , Spaulding-Givens J , et al.   Measurement in abstinence education. Critique and recommendations . Eval Health Prof . 2003;26(2):180–205
  39. Kirby D . Emerging Answers (Research Findings on Programs to Reduce Teen Pregnancy) . Washington, DC: National Campaign to Prevent Teen Pregnancy; 2001;
  40. Manlove J , Romano-Papillo A , Ikramullah E . Not Yet (Programs to Delay First Sex among Teens) . Washington, DC: National Campaign to Prevent Teen Pregnancy; 2004;
  41. Rector RE . The Effectiveness of Abstinence Education Programs in Reducing Sexual Activity Among Youth. The Backgrounder #1533 . Washington, DC: The Heritage Foundation; 2002;
  42. Kirby D . Do abstinence-only programs delay the initiation of sex among young people and reduce unintended pregnancy? . Washington, DC: National Campaign to Prevent Teen Pregnancy; 2002; [cited 2005 Jan 23]. Available at: http://www.teenpregnancy.org/resources/data/pdf/abstinence_eval.pdf
  43. Hauser D . Five Years of Abstinence-Only-Until-Marriage Education (Assessing the Impact) . Washington, DC: Advocates for Youth; 2004;
  44. Devaney B , Johnson A , Maynard R , Trenholm C . The Evaluation of Abstinence Education Programs Funded Under Title V Section 510 (Interim Report to Congress on a Multi-Site Evaluation) . Princeton, NJ: Mathematica Policy Research, Inc; 2002;
  45. Maynard RA , Trenholm C , Devaney B , et al.   First-Year Impacts of Four Title V, Section 510 Abstinence Education Programs . Princeton, NJ: Mathematica Policy Research, Inc; 2005;
  46. Trussell J . Contraceptive efficacy . In:  Hatcher RA ,  Trussell J ,  Stewart FH , et al. editor. Contraceptive Technology . 18th edn.. New York, NY: Ardent Media, Inc; 2004;p. 773–846
  47. Pinkerton SD . A relative risk-based, disease-specific definition of sexual abstinence failure rates . Health Educ Behav . 2001;28(1):10–20
  48. Haignere CS , Gold R , McDanel HJ . Adolescent abstinence and condom use (are we sure we are really teaching what is safe?) . Health Educ Behav . 1999;26(1):43–54
  49. Bearman PS , Bruckner H . Promising the future (virginity pledges and first intercourse) . Am J Sociol . 2001;106:859–912
  50. Bruckner H , Bearman PS . After the Promise (the STD consequences of adolescent virginity pledges) . J Adolesc Health . 2005;36:271–278
  51. Rector RE, Johnson KA. Adolescent virginity pledges, condom use, and sexually transmitted diseases among young adults. Presented to the National Welfare Research and Evaluation Conference of the Administration of Children and Families, Washington, DC, June 14, 2005.
  52. Ellenberg J. Sex and significance: how the Heritage Foundation cooked the books on virginity [cited 2005 Jul 29]. Available from: http://slate.msn.com/id/2122093/
  53. American Academy of Pediatrics . Sexuality education for children and adolescents . Pediatrics . 2001;108(2):498–502
  54. American Medical Association . H-170.968 Sexuality Education, Abstinence, and Distribution of Condoms in Schools . Chicago, IL: American Medical Association; 2004;
  55. American Public Health Association . 2003-14 Support for Sexual and Reproductive Health and Rights in the United States and Abroad . Washington, DC: American Public Health Association; 2003;
  56. Henry Kaiser Family Foundation. Texas Board of Education approves health textbooks that promote abstinence-only education [cited 2004 Nov 8]. Available from: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=2&DR_ID=26615
  57. The National Coalition against Censorship . Abstinence Only Education? A Joint Statement . New York, NY: The National Coalition against Censorship; 2002;
  58. Human Rights Watch . Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Programs in the United States. Texas: A Case Study . New York, NY: Human Rights Watch; 2002;
  59. Kick R. Bush administration removes health info from federal websites [cited 2005 Jul 29]. Available from: www.thememoryhole.org/health/healthsites-scrub.htm
  60. Letter from Rep. Henry A. Waxman to Secretary Michael O Leavitt dated July 13, 2005 concerning the 4parents.gov website [cited 2005 Jul 29]. Available from: http://www.democrats.reform.house.gov/story.asp?ID=888.
  61. Centers for Disease Control and Prevention. School health policies and programs study, 2000 [cited 2004 Nov]. Available from: www.cdc.gov/shpps
  62. Darroch JE , Landry DJ , Singh S . Changing emphases in sexuality education in U.S. public secondary schools, 1988–1999 . Fam Plann Perspect . 2000;32(5):204–211
  63. Dailard C . Title X program announcement articulates new priorities for nation’s . The Guttmacher Report on Public Policy . 2003;6(5):
  64. [Office of the] Federal Register . In: 2004 Federal Register . 69: Washington, DC: National Archives and Records Administration; 2004; (115).
  65. Human Rights Watch . Access to Condoms and HIV/AIDS Information (A Global Health and Human Rights Concern) . New York, NY: Human Rights Watch; 2004;
  66. Human Rights Watch . The Philippines. Unprotected: Sex, Condoms, and the Human Right to Health . New York, NY: Human Rights Watch; 2004;
  67. Brindis CD , Ott MA . Adolescents, health policy, and the American political process . J Adolesc Health . 2002;30(1):9–16
  68. Garofalo R , Wolf C , Kessel S , et al.   The association between health risk behaviors and sexual orientation among a school-based sample of adolescents . Pediatrics . 1998;101:895–902
  69. Sturdevant M , Remafedi G . Special health care needs of homosexual youth . Adolesc Med . 1992;3:359–371
  70. Kempner ME . Toward a Sexually Healthy America (Abstinence-Only-Until-Marriage Programs that Try to Keep Our Youth ’Scared Chaste’) . New York, NY: Sexuality Information & Education Council of the United States; 2001;
  71. Garofalo R , Katz E . Health care issues of gay and lesbian youth . Curr Opin Pediatr . 2001;13:298–302
  72. Garofalo R , Cameron Wolf R , Wissow LS , et al.   Sexual orientation and risk of suicide attempts among a representative sample of youth . Arch Pediatr Adolesc Med . 1999;153:487–493
  73. Freedman LP . Censorship and manipulation of reproductive health information . In:  Sandra Coliver editors. The Right to Know (Human Rights and Access to Reproductive Health Information) . Philadelphia, PA: University of Pennsylvania Press; 1995;p. 1–37
  74. International Covenant on Civil and Political Rights. Adopted December 16, 1966, entered into force March 23, 1976, G.A. res. 2200A (XXI), 21 U.N. GAOR Supp. No. 16 at 52, U.N. Doc. A/6316 (1966), article 19. 1966.
  75. Convention on the Rights of the Child. Adopted November 20, 1989, entered into force September 2, 1990, G.A. res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49, (1989) article 13. 1990.
  76. Committee on Economic Social and Cultural Rights. General Comment 14: The Right to the Highest Attainable Standard of Health, 22nd Sess. 2000.
  77. Committee on the Rights of the Child. General Comment No. 3 (2003a) HIV/AIDS and the rights of the child, 32nd Sess. (2003), para. 13. 2003.
  78. International Covenant on Economic, Social and Cultural Rights. Adopted December 16, 1966, entered into force January 3, 1976, GA Res. 2200A (XXI), 21 UN GAOR, 21st Sess., Supp. No. 16, at 49, UN Doc. A/6316 (1966), art. 12. 1966.
  79. Office of the United Nations High Commissioner for Human Rights and UNAIDS HAaHR. International Guidelines, U.N. Doc. HR/PUB/98/1, paras. 38(g), 38(h). 1996.
  80. United Nations . Report of the International Conference on Population and Development . 1994; (Cairo, 5-13 September 1994). New York; Report No.: A/Conf.171/13.
  81. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research . The Belmont Report (Ethical Principles and Guidelines for the Protection of Human Subjects of Research) . Washington, DC: Department of Health, Education, and Welfare Government Printing Office; 1978; publication no. (OS) 78-0012,

PII: S1054-139X(05)00467-2

doi: 10.1016/j.jadohealth.2005.10.006

Journal of Adolescent Health
Volume 38, Issue 1 , Pages 72-81 , January 2006