Sexual Risk-Avoidance EducationBy Arina Grossu and Peter Sprigg Director, Center for Human Dignity
What is Sexual Risk-Avoidance Education?
Sexual Risk-Avoidance (SRA) education is an approach to sex education that focuses on risk-avoidance instead of Sexual Risk-Reduction (SRR) or "comprehensive sex education" when it comes to sexual activity. The term "Sexual Risk-Avoidance" is now used more commonly than the older term "abstinence." It communicates how this approach mirrors other public health models designed to encourage avoidance instead of reduction of risky behavior, such as underage drinking or the use of illegal drugs. SRA education teaches that avoiding sexual activity before marriage is the surest way to avoid its risks. It also encourages youth to pursue good decision-making skills.
What are the Risks of Sexual Activity?
- Out-of-wedlock pregnancy:Single mothers, especially teenaged single mothers, are much less likely to complete their education or achieve their career goals. They (and their children) are also much more likely to live in poverty. More than 6 in 7 teen births are to single girls, a circumstance which is a well-documented predictor for poverty. Just as condoms cannot provide complete protection against sexually transmitted diseases (STDs), no contraceptive device or method can provide complete protection against unplanned pregnancies.
- Sexually transmitted diseases: The effects of STDs can range from bacterial infections to death. The human papillomavirus (HPV) has been identified as the main cause of cervical cancer, which kills thousands of women each year. Other STDs like chlamydia can lead to infertility. The human immunodeficiency virus (HIV) can cause AIDS (acquired immune deficiency syndrome), which can kill by weakening the body's ability to fight other illnesses. Despite improved treatments which have extended the lifespans of many people with HIV or AIDS, thousands of Americans still die from HIV and AIDS every year.
- Detrimental psychological effects: Sexually active teenagers are more likely to be depressed and attempt suicide. One 2013 study found that overall, adolescent females with no sexual partners were significantly less likely to report measures of poor mental health than those who have had one, two, or three or more sexual partners. Similarly, girls who reported three or more partners were significantly more likely to report sadness, suicide ideation, suicide plans, and attempts than those with fewer partners.
- Lower academic achievement: Generally, sexually active teens have lower GPAs, more disciplinary problems, and were less likely to attend college. Compared with virgins, teens who have casual sex had lower GPAs, cared less about school and experienced more problems in school. Teens who have sex were at higher risk of being truant and dropping out compared with teens who don't have sex. A number of studies have shown that teenagers who abstain from sex are more likely to graduate from high school and attend college than their sexually active peers.
What are the Incidence, Prevalence, and Medical Costs of STDs in the U.S.?
The Centers for Disease Control estimates that there are 20 million new annual STDs, 110 million total infections with a total of $16 billion in medical costs. STDs among teens incur $4.5 billion in tax-payer funded expenses annually.
Taxpayers save up to $19,000 every time a teen chooses abstinence and avoids pregnancy and STDs, with the potential of a cumulative savings of $11 billion per year.
The following are some statistics on the incidence and rate of STDs from the 2012 Sexually Transmitted Disease Surveillance:
- In 2012, a total of 1,422,976 cases of chlamydia were reported to the Center for Disease Control and Prevention (CDC). This is the largest number of cases ever reported to CDC for any condition. In 2012, 1,002,692 cases of chlamydial infection were reported among persons under 25 years of age, representing 70% of all reported chlamydia cases. Chlamydia rates are highest among adolescents and young adults aged 15-24 years.
- In 2012, there were 334,826 cases of gonorrhea reported in the United States. Since 2009, the gonorrhea rate has increased slightly each year to 107.5 cases per 100,000 population in 2012, a 9.6% increase overall. In 2012, gonorrhea rates were highest among adolescents and young adults. In 2012, the highest rates were observed among women aged 20-24 years (578.5) and 15-19 years (521.2). Among men, the rate was highest among those aged 20-24 years (462.8).
- In 2012, a total of 15,667 cases of primary and secondary (P&S) syphilis were reported to CDC, 1,697 more cases than were reported in 2011. In 2012, the rate of P&S syphilis increased 11.1% from that in 2011. In 2012, the rate of P&S syphilis was highest among persons aged 20-24 years and 25-29 years.
The only 100% effective way to avoid an STD is by avoiding the risk. The CDC says, "The most reliable ways to avoid transmission of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), are to abstain from sexual activity or to be in a long-term mutually monogamous relationship with an uninfected partner."
Does Sexual Risk-Avoidance Education Work?
SRA education reduces teen sexual activity by approximately 50%. SRA education decreases sexual initiation, increases abstinent behavior among sexually experienced teens, and/or decreases the number of partners among sexually experienced teens.
A 2010 study demonstrated that SRA education intervention among sixth and seventh graders was by far the most effective type of sex education in reducing sexual initiation among young teens, had no deterrence on the use of condoms, and reduced numbers of sexual partners in contrast to other sex-ed interventions in the same study:
Only 33% of those in the SRA education self-reported to have initiated sexual activity in the 24 month follow-up period. In contrast, about 47% in the general health intervention, 51.8% in the "safer sex" intervention, and about 42% in the "comprehensive sex ed" interventions self-reported to have initiated sexual activity in the 24 month follow-up period.
A majority of young people aged 15 to 17 have not had sex-and the percentage of teens who are abstinent has been growing for at least two decades. Between 1988 and 2010, the percentage of girls in that age group who had never had sexual intercourse rose from 63% to 73%, while the percentage of boys who were abstinent rose from 50% to 72%. Additionally, about 70 percent of parents agreed that it is "against [their] values for [their] adolescents to have sexual intercourse before marriage" and over 60 percent of adolescents believe that sex should be reserved for marriage.
What's the President's FY 2015 Proposed Budget for Sex Education?
In 2014, only 18% of funds were designated for SRA education and 82% for SRR education. In 2015, no funds are designated for SRA education. Instead, 100% of funds are designated for SRR education.
The following provisions for sex education policy and funding were proposed in the President's FY 2015 budget:
- Proposed eliminating all funding for SRA programs including:
- $5 million Competitive Abstinence Education (CAE) program.
- $50 million Title V Abstinence Education state block grant, signed into law under President Clinton, as a part of the Welfare Reform Act.
- Proposed continuing funding for all SRR contraceptive-focused programs:
- Proposed funding for the Teen Pregnancy Prevention (TPP) program at $101 million.
- Requested 5-year reauthorization of Personal Responsibility Education Program (PREP) mandatory sex education state block grant for $75 million per year.
Arina Grossu is Director for the Center for Human Dignity and Peter Sprigg is a Senior Fellow for Policy Studies at the Family Research Council in Washington, D.C.
 Elizabeth Wildsmith, Megan Barry, Jennifer Manlove, Brigitte Vaughn, "Teen Pregnancy and Childbearing," Adolescent Health Highlight (Child Trends, December 2013), accessed on March 31, 2014,
 R.I. Lerman, "Impacts of marital status and parental presence on the material hardship of families with children," Urban Institute, July 1, 2002, accessed on March 31, 2014, http://www.urban.org/publications/410538.html.
 "Effectiveness of Family Planning Methods," Centers for Disease Control and Prevention, accessed on March 31, 2014, www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Contraceptive_methods_508.pdf.
 "Treatments and Drugs," Sexually Transmitted Diseases, Mayo Clinic; accessed on April 8, 2014, http://www.mayoclinic.com/health/sexually-transmitted-diseases-stds/DS01123/DSECTION=treatments-and-drugs.
 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2010 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013, accessed on April 8, 2014, www.cdc.gov/uscs.
 "Chlamydia-CDC Fact Sheet," Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, March 13, 2014, accessed on April 8, 2014, http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm.
 "HIV Surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areas, 2011," vol. 23, Table 11a, pp. 40-41, Centers for Disease Control and Prevention, accessed April 8, 2014, http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_23.pdf#Page=40.
 Robert Rector, Kirk A. Johnson, and Lauren Noyes, "Sexually Active Teenagers Are More Likely to be Depressed and to Attempt Suicide," The Heritage Foundation, June 3, 2003, accessed on March 31, 2014, http://www.heritage.org/research/reports/2003/06/sexually-active-teenagers-are-more-likely-to-be-depressed.
 Tyree Oredein and Christine Delnevo, "The Relationship between Multiple Sexual Partners and Mental Health in Adolescent Females," Journal Community Medicine & Health Education 3 (2013): 7, accessed on April 8, 2014, http://omicsonline.org/the-relationship-between-multiple-sexual-partners-and-mental-health-in-adolescent-females-2161-0711.1000256.php?aid=21466.
 Bill McCarthy and Eric Grodsky, "Sex and School: Adolescent Sexual Intercourse and Education," Social Problems, Vol. 58, No. 2 (May 2011), pp. 213-234, accessed April 8, 2014, http://sociology.ucdavis.edu/people/bmccarth/pdf/SexandSchool.pdf.
 Daniel I. Rees, "The Effect of Sexual Abstinence on Educational Attainment," Working Paper Series No. 07-02, July 2007, accessed April 1, 2014, http://www.ucdenver.edu/academics/colleges/CLAS/Departments/economics/Documents/Rees_WP_07-02.pdf.
 "CDC Fact Sheet: Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States," National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, accessed March 31, 2014, http://www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf.
 "Wise Investment For a Positive Outcome," The National Abstinence Education Association, accessed March 31, 2014, http://www.thenaea.org/docs/4_NAEA_Wise_Investment_vF.pdf.
tp:// Transmitted Diseases 8.
 CL Satterwhite, E Torrone, E Meites, EF Dunne, R Mahajan, MC Ocfemia, J Su, F Xu, and H Weinstock, "Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008," Sexually Transmitted Diseases 40, no. 3 (Mar 2013):187-93, http://www.ncbi.nlm.nih.gov/pubmed/23403598.
 SE Forhan, SL Gottlieb, MR Sternberg, F Xu, SD Datta, GM McQuillan, SM Berman, and LE Markowitz, "Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States," Pediatrics 124, no. 6 (Dec 2009): 1505-12, http://www.ncbi.nlm.nih.gov/pubmed/19933728.
 "Condoms and STDs: Fact Sheet for Public Health Personnel," National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, accessed on March 31, 2014, http://www.cdc.gov/condomeffectiveness/latex.htm.
 "Abstinence Works 2010 - Abstinence-Centered Programs that Reduce Teen Sex," National Abstinence Education Association, February 2010, accessed on March 31, 2014, http://www.abstinenceassociation.org/docs/naea_abstinence_works_2010_preview.pdf. "Abstinence Works" is a compilation of independent, peer-reviewed abstinence-centered research that details numerous studies showing positive behavioral impact among students who participate in abstinence education classes.
 John and Loretta Jemmott, and GT Fong, "Efficacy of a theory-based abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents." Archives of Pediatrics & Adolescent Medicine, 164 no.2 (2010): 152-9, accessed March 31, 2014, http://www.abstinence.net/pdf/contentmgmt/abstinence.pdf.
 Gladys Martinez, Casey E. Copen, Joyce C. Abma, "Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2006-2010 National Survey of Family Growth," National Center for Health Statistics. Vital and Health Statistics 23, no. 31 (Oct 2011): Table 1, p. 14, accessed on March 31, 2014, www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf.
 "National Survey of Adolescents and Their Parents: Attitudes and Opinions about Sex and Abstinence," Administration for Children and Families, U.S. Department of Health and Human Services, February 26, 2009, accessed on April 3, 2014, http://www.acf.hhs.gov/sites/default/files/fysb/20090226_abstinence1.pdf.
 "Fiscal Year 2015 Budget of the U.S. Government," Office of Management and Budget, Executive Office of the President of the United States, Page 155, accessed April 1, 2014, http://www.whitehouse.gov/sites/default/files/omb/budget/fy2015/assets/budget.pdf.
 "The Budget for Fiscal Year 2015: Department of Health and Human Services" Office of Management and Budget, Executive Office of the President of the United States, Page 481, accessed April 1, 2014, http://www.whitehouse.gov/sites/default/files/omb/budget/fy2015/assets/hhs.pdf.
 Ibid. Page 490.
 Ibid. Page 481.