Just say no

Abstinence-only programs are sweeping the nation. Two years ago Massachusetts jumped on the bandwagon. Is it working?

by Kristen Lombardi

This month, the Massachusetts Department of Public Health (DPH) intends to release its most recent abstinence-affirming message directed at teenagers and parents -- a parent-education video designed to spark family discussion and aid parents in helping "your child say 'No' to sex." The video, which will air on cable-access channels, is only the latest message put out by the state's Abstinence Education Media Campaign, a two-year-old effort to "reduce teen pregnancy and delay the onset of sexual activity." Paid for by $739,000 in federal funds, as well as $500,000 in matching state funds, the DPH abstinence campaign trumpets the Nancy Reagan-esque slogan NO SEX, NO PROBLEM on radio and television ads aimed at youth aged nine to 14, teaching them the importance of building self-esteem and placing their futures before sex. Older teens, aged 15 to 17, are encouraged to remain chaste with similar ads declaring YOU DON'T HAVE TO DO IT! The slogans have been printed on posters, stickers, and even shoelaces that are handed out to the teens. One of the campaign's pamphlets offers such advice as "My future can't wait but sex can" and "Choosing to wait is the best protection you have against pregnancy and disease."

Nearly everyone in the public-health field agrees that something must be done to curb adolescent sexual activity, which can lead to pregnancy and the spread of sexually transmitted diseases (STDs). More than one million American adolescent girls become pregnant each year -- our national teen birthrate is as much as 10 times higher than that of other industrialized countries. And three million more teens end up contracting HIV or some other STD annually. In Massachusetts, 44 percent of all high-school students had intercourse in 1999. Students are beginning to experiment sexually at a shockingly young age; as many as 14 percent of blacks and 11 percent of Latinos engage in sex before age 13, as do seven percent of Asians and four percent of whites. By 12th grade, 61 percent of all students have had sex.

People disagree, however, on how exactly to prevent these problems. The DPH media campaign has received almost no press attention since its inception -- even though it's tied to a controversial crackdown on teen sex, called "abstinence-only education," that's sweeping the nation. Proponents argue that giving kids an unambiguous message -- don't have sex -- is the best way to prevent difficulties related to early sexual behavior. It's better, they say, than the mixed messages presented in some schools, where abstinence is taught as a method of preventing pregnancy and disease, yet condoms are made available for students in the nurse's office. But opponents of abstinence-only programs say the approach is unethical and negligent because it keeps crucial information -- about how condom use can help stop the spread of HIV, for example -- from kids.

Institutional enthusiasm for the "just say no" message stems from the 1996 welfare-reform legislation in which Senator John Ashcroft, a conservative Republican from California, and others tucked away $50 million to give to states over a five-year period for abstinence-only initiatives. Some 700 schools, public-health agencies, and community groups in 48 states have snatched up the money; the resulting programs vary widely, but the federal government has dictated specific guidelines. For one, no pregnancy- or STD-prevention technique other than abstinence can be mentioned in these programs. Abstinence must be presented as the "only certain way" to avoid possible health problems. Premarital sex, too, has to be cast as "likely to have harmful physical and psychological effects."

While the national debate continues to rage -- and GOP presidential candidate George W. Bush, an ardent abstinence proponent, has already pledged not only to take the issue to the campaign trail, but also "to elevate abstinence education from an afterthought to an urgent priority" -- Massachusetts, with its little-known media campaign, has become one of the few states to take these restrictive abstinence-only funds and use them to create a program that looks reasonable. But will it work?

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In the new video, the 23-minute It's Time To Talk, parents from Boston, Worcester, and Springfield convene for frank conversation about "sexuality and abstinence." They discuss how they learned about sex, how tough it is to broach the topic, and how much they want their children to hold off on sex until marriage. Parents, the video advises, must share their values to help kids say no to sex.

So how do teenage girls respond to this message? On a Wednesday afternoon earlier this month, the Phoenix gathered 10 black and Latina girls, aged 13 to 16, at the Dorchester House community center to weigh in on an advance copy of the video. Dressed in full urban-youth regalia -- the weighted chains, the hoodies, and the ringlets -- they sat with chins in palms. As they watched, some shouted comments like, "Yo, you're ugly!" Others clicked their tongues at statistics showing high pregnancy rates among black and Latina adolescents. Less than halfway through the video, one black girl, a spitfire of a 14-year-old, hollered, "Dang! This is one long-ass show!"

Ana-Alicia Neal, 16, a petite, soft-spoken Dorchester resident, says abstinence slogans such as NO SEX, NO PROBLEM aren't realistic for teens. Sex is "out there," she says, on the streets and in the schools. It's not uncommon for girls in sixth grade -- in the city, anyway -- to get propositioned by boys crassly asking, "You wanna fuck?" Even those who aren't sexually experienced know the drill.

"You cannot walk down the hall without being harassed," Neal says. Being reminded you don't have to have sex, she adds, "is nice, but is way too simplistic."

Javale Jean-Pierre, a tall, shapely 14-year-old from Mattapan, thinks that the media campaign's slogans, which were tested and modified by teens before being aired, are so simple they're boring. "They go through one ear and out the other," she says. Jean-Pierre stresses that she remains a virgin, if only because her mother would "kill me" otherwise. She adds, "Some commercial telling me to say no isn't going to affect me."

Fifteen-year-old Dorchester resident Victoria James, meanwhile, responds to the ads like a typical teenager: "It just makes me wanna go out and do it because I'm hardheaded. Nobody tells me what to do."

Elaine Theodore, who teaches sexuality education to girls in and around Boston for the Boston Institute for Arts Therapy, says the new wave of abstinence-only education that the video represents is "cheating kids." She adds, "It would be great if slogans like NO SEX, NO PROBLEM worked, and they may for some. But they don't take into account the teen environment."

Several days after the screening of It's Time To Talk, Theodore sits, Indian-style, before the 10 girls who shredded the video with their comments. Beside her is a wooden penis and a Tupperware container full of contraceptive devices -- tools not associated with the DPH campaign. She wastes no time in being up-front and personal with these teens -- and neither do they with her.

"Here's a hypothetical," she poses. "You're with your man and feeling all excited, and he wants to go further. What do you say?"

One girl offers, "I'd tell him I'm gonna cut his thing off."

"Oh, really?" Theodore asks. "Use your heads, girls."

Another girl raises her arm. "I'd say, I really don't want to do this and you're supposed to respect my decision."

"Check it out," Theodore approves. The girl smiles wide and proud. "That's a good way to put it."

Study after study shows that this type of frank acknowledgment of reality is actually the most effective way to reduce teen sex. Research has found that comprehensive sexuality education doesn't, as conservative critics charge, prompt teens to start having sex. And teens who do have sex after taking sex-ed classes are more likely to use contraceptives.

Meanwhile, abstinence-only programs have yet to prove effective. So far, six published studies have shown the approach had neither consistent nor significant effects on delaying teen sexual activity. One recent $5 million California initiative actually resulted in more students having intercourse.

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Despite this evidence, the $250 million federal abstinence-until-marriage program has altered sex education nationwide. Since its inception in 1998, the program has inspired all but two states -- California and New Hampshire -- to seize the funds. Twenty states, including Massachusetts, have used the money to launch new media campaigns.

Five states have gone further, mandating that abstinence-only programs be taught in all schools. In Texas, for instance, classes steeped in Christian values teach kids that "virginity is a gift to give away." It's a message that appears everywhere from candies emblazoned with SEX IS MINT FOR MARRIAGE to pledge cards kids fill out forswearing sex.

The federal program has invited far more interest in abstinence-only education than ever before. "We, as a country, are very uncomfortable with adolescent sex," says Monica Rodriguez of the Sexuality Information and Education Council of the United States (SIECUS), in New York City. "Now people can latch on to abstinence as the appropriate message."

There is little question that Massachusetts DPH officials regard abstinence to be a worthy, even realistic, message. Diane Hagan, the director of the DPH office of adolescent and youth development, which runs the media campaign, says that encouraging teens to hold off on sex merely fulfills their desire for parental guidance. "In the past," she notes, "prevailing attitudes have been that adolescents will be adolescents and there isn't much we can do. Yet we know teens, especially preteens, want more help from us."

That adolescents have criticized this aid -- at least in its media-slogan form -- doesn't faze Hagan. Although the DPH has convened groups to test its ads, and although teens themselves invented some of the slogans, Hagan agrees that the mottoes, on their own, are often simplistic. They are, after all, supposed to be catchy enough for folks to remember. "Tag lines," she says, "aren't meant to stand alone. Value comes from discussion around the messages."

That said, though, the state DPH, unlike other organizations, does not present its abstinence media campaign as some magic-bullet solution to the perennial problems surrounding teen sex. Officials dismiss the notion that it marks a shift away from comprehensive methods. "The campaign," Hagan insists, "is not an end to itself." Instead, it's intended to complement an array of DPH-funded prevention programs including mentoring, peer leadership, community service, and sex education. The DPH, in addition, supports a teen-pregnancy fund that provides services to 40,000 or so youths in 17 high-birthrate communities, including Boston.

Even abstinence-only opponents praise the DPH for the "responsible" and "intelligent" manner in which it's used the highly restrictive federal funding. By using the money to fund a campaign that bolsters existing prevention initiatives, Massachusetts separates itself from other states that have focused solely on abstinence-only programs. And so, says University of Minnesota professor Michael Reisnick, an expert on teen pregnancy, the DPH media campaign "can avoid being like other well-intentioned yet ineffective 'just say no' campaigns."

This isn't to say that media campaigns are futile. Take one 1990s Maryland project designed to prevent teen pregnancy. The campaign, which ran for eight years, featured TV commercials, radio spots, bus ads, and billboards advising parents to "teach your child that virgin isn't a dirty word," among other things. Researchers analyzing the effort couldn't decipher whether kids altered their sexual behavior as a result of being exposed to the slogans. But they did determine that the campaign led to a "substantial" increase in parents and adolescents discussing sex. And this, in turn, is what probably affected teen sexual activity enough for Maryland to watch its teen-pregnancy rates plummet.

As Gary Lewis, a Johns Hopkins University researcher who helped evaluate the campaign, concludes, "The media campaign was effective. It just depends on your definition of success."

Recently, the state DPH hired an independent evaluator to measure the efficacy of slogans such as NO SEX, NO PROBLEM, and it remains to be seen whether the number of Massachusetts teens having sex will go down as a result of the campaign. But if the reaction of the 10 girls who watched the latest video is any indicator, it probably won't.

Still, DPH officials have at least achieved something not many states using the federal funds have -- they've come up with a reasonable abstinence-only project. As Hagan points out, "We're trying to put our dollars into a campaign that really aims to increase the [parent-youth] discussion about sex."

Kristen Lombardi can be reached at klombardi[a]phx.com.