Effectiveness of Abstinence Education Programs
Annotated Bibliography of Recent Research
March 2008

HOW ABSTINENCE RELATES TO TEEN PREGNANCY AND OTHER OUTCOMES

Adolescent Depression and Suicide Risk: Association With Sex and Drug Behaviors. Authors: D. Hallfors et al. In American Journal of Preventive Medicine

, Vol. 27, No. 3 (October 2004): pp. 224–230. Available for a fee from Elsevier, Inc.
www.elsevier.com/wps/find/journaldescription.cws_home/600644/description#description

Based on their analysis of data from Wave I of the National Longitudinal Study of Adolescent Health (1994-1995), the authors of this study concluded that, compared to youth who abstained from risk behaviors, young people who drank, smoked, and/or engaged in sexual activity had significantly increased odds of depression, suicidal ideation, and suicide attempts.

An Analysis of the Causes of the Decline in Non-Marital Birth and Pregnancy Rates for Teens From 1991 to 1995. Authors: J. Mohn, L.Tingle, and R. Finger. In Adolescent & Family Health, Vol. 3, No. 1 (March 2003): pp. 39-47. Available for a fee from the Institute for Youth Development.
www.afhjournal.org/toc.asp?issue=0301

Researchers analyzed data from the National Vital Statistics Records, the National Survey of Family Growth, and the Alan Guttmacher Institute. The study shows that the decline in the proportion of sexually active adolescents ages 15 to 19 accounts for 67 percent of the decline in pregnancy among that age range between 1991 and 1995.

Association of Virginity at Age 18 With Educational, Economic, Social, and Health Outcomes in Middle Adulthood. Authors: R. Finger et al. In Adolescent & Family Health, Vol. 3, No. 4 (April 2005): pp. 164-170. Available for a fee from the Institute for Youth Development.
www.afhjournal.org/toc.asp?issue=0304

The authors analyzed data from interviews with 3,750 men and 3,620 women, conducted for the National Longitudinal Study of Youth (1979 to 2000). They found that women who were virgins at age 18 were, by middle adulthood (between ages 36 and 43), more likely than their peers to be debt-free and less likely to have used welfare benefits or to have experienced health problems. Both men and women who were virgins at age 18 attained more education than their peers and were half as likely to become divorced by middle adulthood. These findings held true when the authors controlled for ethnicity and measures of previous educational or economic disadvantage.

Can Changes in Sexual Behaviors Among High School Students Explain the Decline in Teen Pregnancy Rates in the 1990s? Authors: J. Santelli et al. In Journal of Adolescent Health, Vol. 35, No. 2 (August 2004): pp. 80-90. Available for a fee from the Society for Adolescent Medicine.
www.jahonline.org/article/PIIS1054139X0400134X/fulltext

This study investigated the reasons for the decline in pregnancy that occurred among 15 to 17 year olds between 1991 and 2001. The authors used data from the Youth Risk Behavior Survey, National Survey of Family Growth, and National Vital Statistics Survey. Their analysis attributes more than half the decline to decreased sexual experience and less than half to improved contraceptive use. However, the contribution of decreased sexual activity to the decline in pregnancy varied among adolescent subgroups. Decreased sexual activity accounted for 64 percent of the decline in teen pregnancy among white, non-Hispanic teens, 60 percent of the decline among African American teens, and none of the decline among Hispanic teens.

Dating Violence and Associated Risk and Pregnancy Among Adolescent Girls in the United States. Authors: J. Silverman, A. Raj, and K. Clements. In Pediatrics, Vol. 114, No. 2 (August 2004): pp. 220-225. Available free from the American Academy of Pediatrics.
pediatrics.aappublications.org/cgi/reprint/114/2/e220

Using data from the 2001 National Youth Risk Behavior Survey, the authors of this study found that approximately one of five sexually experienced U.S. adolescent girls (17.7 percent) reported being intentionally physically hurt by a date in the previous year. Among girls with no sexual experience, 1 of 25 (3.7 percent) reported such violence. Dating violence among sexually experienced adolescent girls was related to increased risks for both sexual risk behaviors (e.g., recent multiple sexual partners: odds ratio: 2.0; 95 percent confidence interval: 1.3-3.1) and pregnancy (odds ratio: 1.8; 95 percent confidence interval: 1.3-2.4). The researchers concluded that adolescent girls intentionally hurt by a date in the previous year were more likely to experience sexual health risks, including risks that increase vulnerability to HIV infection and other sexually transmitted infections, and to have been pregnant.

Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Contraceptive Use. Authors: J. Santelli et al. In American Journal of Public Health, Vol. 97, No. 1 (January 2007): pp. 150-156. Available for a fee from the American Public Health Association.
www.ajph.org

This study used 1995 and 2002 National Survey of Family Growth data to examine changes in pregnancy rates. In contrast with their conclusions in a 2004 study (see above), the authors report that 13 percent of the decreases in pregnancy risk for 15 to 19 year olds are attributable to abstinence, and 23 percent of the decrease for 15 to 17 year olds. The authors believe that the contrasting findings are the result of differences in age groups and time periods, inclusion of young people who are not in school, and more complete measurement of contraceptive use.

EFFECTIVENESS OF ABSTINENCE EDUCATION

An Abstinence Program’s Impact on Cognitive Mediators and Sexual Initiation. Authors: S. Weed et al. In American Journal of Health Behavior, Vol. 32, No. 1 (January/February 2008): pp. 60-73. Available free from Teen-Aid Inc.
www.teen-aid.org/01JanFeb0608Weed1FINAL.pdf

Researchers examined the impact of a school-based abstinence education program on the initiation of sexual intercourse by virgin adolescents. They also sought to determine the program’s impact on adolescent social cognitive factors linked to adolescent sexual initiation. The researchers concluded that the program achieved its goal of reducing the rate at which adolescents initiated sexual intercourse. Adolescent virgins who participated in the program were approximately one-half as likely as nonparticipants to initiate sexual activity after one year (P<.05).

Can Abstinence Work? An Analysis of the Best Friends Program. Author: R. Lerner. In Adolescent & Family Health, Vol. 3, No. 4 (April 2005): pp. 185-192. Available free (with online registration) from the Institute for Youth Development.
www.afhjournal.org/toc.asp?issue=0304

The author found that adolescent girls who participated in a Washington, DC, abstinence education program were significantly less likely to have ever had sex (by eighth grade, 91.5 percent of participants were virgins, compared to 66.8 percent of nonparticipants). The program was implemented in a neighborhood with higher rates of teen pregnancies and out-of-wedlock births than other areas of the city. Participants in the program were also less likely to begin smoking, drinking, and using illegal drugs.

Effectiveness of Abstinence-Only Intervention in Middle School Teens. Authors: E. Borawski et al. In American Journal of Health Behavior, Vol. 29, No. 5 (September/October 2005): pp. 423-34. Available for a fee from PNG Publications.
www.ajhb.org

Researchers at Case Western Reserve University examined the effectiveness of an abstinence education program in increasing abstinence beliefs and intention, reducing early sexual experimentation, and encouraging renewed abstinence among teens already sexually active. Their nonrandomized controlled evaluation involved 2,069 middle school students in the Greater Cleveland, Ohio, area. The authors found that program participants demonstrated an increase in knowledge and in abstinence beliefs and a decrease in intentions to have sex. Follow-up revealed that sexually active participants had fewer sexual encounters and partners than those who did not participate in the program.

An Evaluation of the Heritage Keepers Abstinence Education Program. Authors: S. Weed, I. Ericksen, and P. Birch (paper presented at “Strengthening Abstinence Education Programs Through Scientific Evaluations” conference, November 3–4, 2005). Available from Heritage Community Services.
www.heritageservices.org

The authors found that 1 year after participating in the Heritage Keepers abstinence education program, virgin middle school students were about one-half as likely to initiate sexual activity as the comparison group, whose members did not participate in the program (p<.001). Roughly one-half of the sample was African American, for whom the program effect was equally as strong as for young people overall (p<.001).

Impact Evaluation of the “Not Me, Not Now” Abstinence-Oriented, Adolescent Pregnancy Prevention Communications Program, Monroe County, New York. Author: A. Doniger. In Journal of Health Communications, Vol. 6, No. 1 (January-March, 2001): pp. 45-60. Available for a fee from Taylor & Francis Group.
www.gwu.edu/~cih/journal

Researchers evaluated the “Not Me, Not Now” community intervention in Monroe County, New York. The intervention involved both abstinence education programs and a media campaign. Approximately 95 percent of the target audience reported seeing an ad from the campaign. Following the intervention, researchers observed a drop in the rate of sexual activity among 15 year olds in the county from 47 to 32 percent, based on Youth Risk Behavior Survey data, and a drop in the pregnancy rate for girls aged 15 to 17 from 63.4 to 49.5 pregnancies per 1,000 girls. This decline in the teen pregnancy rate outpaced the decline in the rest of Upstate New York by a statistically significant amount.

Impact of an Adolescent Sex Education Program That Was Implemented by a Medical Center. Authors: P. Sulak et al. In American Journal of Obstetrics & Gynecology, Vol. 195, No. 1 (July 2006): pp. 78-84. Available for a fee from Elsevier, Inc.
www.ajog.org/article/PIIS0002937805026888/abstract

The authors describe how a Texas abstinence education program involving approximately 25,000 adolescents resulted in a shift in attitude toward delaying sexual activity. At the end of the 2-week program, 90 percent of the students, up from 81 percent before the program, agreed that sex was not a safe activity for adolescents. In addition, the number of students who said they would wait to have sex (whether or not they had already had sex in the past) also increased by 9 percent.

Effects of a Parent-Child Communications Intervention on Young Adolescents' Risk for Early Onset of Sexual Intercourse. Authors: S. Blake et al. In Family Planning Perspectives, Vol. 33, No. 2 (March-April 2001): pp. 52-61. Available from the Guttmacher Institute.
http://www.guttmacher.org/pubs/journals/3305201.pdf

Researchers found that parent-child homework activities designed to increase communications and reinforce standard school-based pregnancy, HIV, and STD prevention curricula can enhance prevention effects among children. In all significant comparisons, the direction of the findings favored adolescents who received the enhanced abstinence curriculum. Results presented in this article were quite positive and support the potential for parent-child homework interventions to have an additive effect on school-based prevention curricula.

The Effects of an Interactive, Computer-Based, Abstinence Education Curriculum on Selected Student Outcomes. Authors: K. DiFiore et al. In California Journal of Health Promotion, Vol. 5, No. 1 (2007): pp.55-61. Available from California State University Chico.
http://www.csuchico.edu/cjhp/5/1/055-061-difiore.pdf

The authors of this journal article examined the effects of the Choice Game, an abstinence-until-marriage education program, on students in five outcome areas: knowledge, family communication, attitude toward abstinence, behavioral intent, and abstinence until marriage. Compared to control group participants, students in the program showed significantly greater gains in all five outcomes.

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