The Rights of Teenagers by H1a4PA5Z

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									Let’s Talk about Sex:
 The Sex Ed Debate
  Community Pediatrics
    Caroline Chang
                  Background
• 45% of teens 15-19 have had sexual intercourse
  (2002)
• Teens = 25% of the ever sexually active population,
  but nearly HALF of all new STDs.
• 15- to 19-year-old women had the highest rate of
  Chlamydia and Gonorrhea compared to any other
  age/sex group (2007), and it continues to increase
               Background
• The US has the second highest teen pregnancy
  rate in developed countries
• Similar rate of teen sex, less use of
  contraception
• Recent decline in teen pregnancy rates are
  72% (15-17 yo) and 99% (18-19 yo) due to
  increased use of contraception
             New York Statistics
• 39% female/45% male high school students reported
  having sexual intercourse
• New York teens have sex with more partners, earlier,
  than the rest of the country.
• Nearly 40,000 teen pregnancies in New York
• Abortion rate for teenagers 15-19 second highest in
  the country.
• More than 10% of teens 13-19 diagnosed with HIV in
  2005 are in NYC

*2005 data
             Sex Education Statistics
• 89% of public school children receive sex
  education at least once between 7-12th grades
• However, the curriculum varies widely
• ~80% teens 15-19-educated prior to 18 on saying
  no to sex, 2/3 before 9th grade
• ~65% of female/male teens 15-19-educated prior
  to 18 on methods of birth control, 40% before
  9th grade

•   *2002 Data
Parent Sex Education
        Comprehensive Sex Ed
• Aka abstinence “plus”
• Curriculum includes
  information on both
  abstinence and
  contraception
• Still teaches
  abstinence as the
  preferred choice
                     Abstinence Only
• Abstinence has social, psychological, and health benefits
• Unmarried, school-age children are expected to abstain from sex
• Abstinence is the only certain way to prevent out-of wedlock pregnancy
   and sexually transmitted diseases
• A mutually faithful and monogamous married relationship is the standard
   for sexual activity
• Sexual activity outside marriage is likely to have harmful psychological and
   physical effects
• Out-of-wedlock childbearing is likely to harm a child, the parents, and
   society
• How to reject sexual advances and how alcohol and drug use increases
   vulnerability to them
• The importance of attaining self-sufficiency before engaging in sex
*Source: Section 510 (b), Title V of Social Security Act.
                 Virginity Pledge
• Oral or written promise to refrain from
  sexual activity, usually until marriage
• Created in 1993 by an evangelical
  Christian organizationspread by
  other Protestant and Catholic groups
• By 1995, 13% of American adolescents
  reported having taken a virginity
  pledge
• US government uses virginity pledges
  as a measure of success of abstinence-
  only sex education programs
                  The Data
• Several studies have been performed using
  regression that showed that girls who took
  “virginity” pledges were less likely to have had
  sex 5 years after the pledge compared to non-
  pledgers
• BUT---did not control for other factors
                     More Data
• 2008--Rosenbaum performed a similar study, but
  controls were matched in age, religiosity, ideals and
  views on sex and birth control
• 5 years after the pledge
  -82% denied ever making a virginity pledge
  -no differences in premarital sex, age of first sex, STI’s
  -fewer of the pledgers used condoms/birth control
  over the past year
                                             More Data
• 2002 Survey of Teens 15-19 showed having some type of sex
  education BEFORE first sex was associated with:

• MALES
  -71% less likely to have sex prior to age 15
  -not having sexual intercourse (during the course of the study)
  -increased likelihood of using condoms at first sex
• FEMALES
  -59% less likely to have sex prior to age 15
  -African American girls—91%

Mueller TE, Gavin LE, Kulkarni A. The association between sex education and youth’s engagement in sexual intercourse, age at first
     intercourse, and birth control use at first sex. J Adolesc Health 42(1), 2008.
       What is being used now
• Sex education is mandated in 20 states
• Kaiser Family Foundation Survey in 1999
  found that sex education is taught in some
  form in 95% of public schools
• 58% -comprehensive
• 34% -abstinence only
• 81% of Americans feel that sex education
  programs should be comprehensive
        Sex Education In New York
• NOT mandated by New York State.
• Local boards of education may choose to make sexuality
  education a local requirement.
• Local school districts encouraged to have advisory councils--
  parents, school personnel, students, members of the faith
  communities, and other community-based organizations to
  make recommendations about sexuality education programs.
• Often omitted or abbreviated due to lack of mandate and
  funding.
          HIV/AIDS Education
• Regulated as a separate entity from sex ed
• CDC has been providing funding for HIV/AIDS
  education since 1988
• $47 million in 2000
• Is mandated by law in NY State
                    Funding
• Federal Funding
• State Funding
             Federal Funding
• 1981-Adolescent Family Life Act- allocated $11
  million to prevent premarital teen pregnancy
  by establishing “family-centered” programs to
  “promote chastity and self discipline.”
• Has been renewed annually giving $6-12
  million a year
                     Then…..
• 1995, under Bill Clinton—Social Security Act,
  Title V, Section –dedicated 50 million dollars a
  year to states providing solely abstinence-
  only sex education.
• States required to match funds $437.5
  million to abstinence-only programs by 2002.
• Includes detailed definition of what federally
  funded programs are expected to teach
               AND THEN….
• 2001-Bush created program that gives
  additional 100 million a year for abstinence
  only education
                           BUT…..
• Up to 17 states (including New York)
  have refused federal funding, feeling
  that abstinence only programs do
  not work
• More than 90% of abstinence
  funding does not require that
  curricula be scientifically accurate!!!
• 2004 review found incorrect
  information in 11 of 13 federally
  funded abstinence programs,
  primarily about birth control and
  condom effectiveness
BUT…..THERE IS HOPE!
    Barack Obama’s 2010 Budget
• Slashes Abstinence-Only Programs and Replaces
  them with Teen Pregnancy Prevention Initiative
• Eliminates $99 million for Community-Based
  Abstinence Education Programs (CBAE) and $50
  million for Title V abstinence only programs.
• Creates Pregnancy Prevention Initiative-- $110
  million to support "community-based and faith-
  based efforts to reduce teen pregnancy using
  evidence-based and promising models."
                 Drawbacks
• Focuses primarily on pregnancy prevention,
  leaving out STI prevention, building healthy
  relationships, etc.
           Prevention First Act
• Contains REAL (Responsible Education About Life)
  Act, At-Risk Communities Teen Pregnancy Prevention
  Act of 2009
• Introduced 3/09--authorizes federal funding for
  comprehensive, medically accurate, age-appropriate
  sex education
• Includes how to prevent pregnancy, protect their
  health and make responsible decisions.
• Also award grants for teenage pregnancy prevention
  programs and research.
              State Funding
• Currently required to match federal sex ed
  funds, but no other comprehensive funding
  mechanism
• New York is one of the many states that has
  rejected federal abstinence-only funding
              Healthy Teens Act
• First introduced in 2002, creates a competitive grant
  program, administered by the DOH for schools
  /communities to teach sex education
• Programs MUST be age-appropriate and medically
  accurate, and may not teach or promote religion.
                Healthy Teens Act
• No mandated curriculum, but programs encouraged to
  include:
  -stressing abstinence and teaching that it is the only sure way
  to avoid pregnancy and STIs
  -providing information about different contraceptive and
  barrier methods to prevent pregnancy and STIs;
  -encouraging parent involvement and family communication;
  -teaching relationship negotiation skills and how drugs and
  alcohol affect responsible decision making.
           Healthy Teens Act
• The grant awards would preference areas with
  higher teen pregnancy and STI rates.
• Has passed the assembly every year since
  introduction, but never got past state senate
• Now with a new pro-choice majority, there is
  hope that this may change, but may be vetoed
  by Governor Patterson due to budget
  constraints
     What still needs to be done
• Passing Obama’s budget
• Healthy Teens Act
• Prevention First Act/REAL Act
• More research identifying programs that are shown
  to be effective in lowering pregnancy, STI rates
• Having funding for programs that work
• More universal and standardized requirements for
  sex education (unlikely)
                What Can We Do?
• WRITE A LETTER!!!
  - To federal representatives to pass the Prevention First Act
  (currently in committee)
  -To federal representatives to support comprehensive sex
  education, to make sure the sex education funding in
  Obama’s budget is passed
  -To State Representatives to pass the Healthy Teens Act
• Be more thorough at your next teen WCC!!
• For other ways, visit Get the Facts NY:
  http://ga0.org/gtfny/home.html
                                    References
•   BMJ 2005;331:715 (1 October), doi:10.1136/bmj.331.7519.715-a
•   Janet Elise Rosenbaum, PhD, AM Patient Teenagers? A Comparison of the Sexual Behavior of Virginity
    Pledgers and Matched Nonpledgers PEDIATRICS Vol. 123 No. 1 January 2009, pp. e110-e120
•   Mueller TE, Gavin LE, Kulkarni A. The association between sex education and youth’s engagement in sexual
    intercourse, age at first intercourse, and birth control use at first sex. J Adolesc Health 42(1), 2008.
•   http://www.guttmacher.org/pubs/tgr/04/4/gr040404.html
•   http://www.guttmacher.org/pubs/tgr/06/1/gr060106.html
•   http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf
•   http://www.rhrealitycheck.org/blog/2009/05/07/2010-budget-slashes-abstinenceonly-money-keeps-
    abortion-funding-restrictions
•   http://www.rhrealitycheck.org/blog/2009/05/08/are-we-there-yet-comprehensive-sex-education-and-
    presidents-2010-budget
•   http://www.kff.org/youthhivstds/upload/Sex-Education-in-the-U-S-Policy-and-Politics.pdf
•   http://pediatrics.aappublications.org/cgi/reprint/123/1/e110
•   http://www.cdc.gov/std/stats07/adol-figs.htm
•   http://www.nyclu.org/node/1817
•   http://www.fpaofnys.org/news/newsReleases/documents/PRHTARvW012209.pdf
•   http://www.govtrack.us/congress/bill.xpd?bill=s111-21&tab=summary
•   http://www.emsc.nysed.gov/sss/coordinatedschoolhealth/health.html
•   http://www.natap.org/2009/newsUpdates/031109_03.htm

								
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