Advocacy in search of evidence

abstinence 01Back in March, we criticized some of the stories that came from a Centers for Disease Control and Prevention report that one in four teenage girls had a sexually transmitted disease. Many of the stories were thinly veiled advocacy pieces. They argued that this sad statistic was the result of a national policy of abstinence education.

Reporters had trouble, apparently, finding people who support abstinence education. Had they reported the story better, they might have discovered that there is no national policy of abstinence education. The federal government may throw significant money at abstinence education but they do so by providing grants. The abstinence message and materials are not uniform across the country or even in a given state. And places where a young person might receive abstinence education may also teach formal sex education. It’s difficult to do a quality analysis of the effect on sex education or abstinence education. If you’re going to turn a CDC report into advocacy journalism, you should know your limits.

Well that was March. The theme of the stories is fully ensconced in the collective consciousness. Supposedly we all know now that abstinence education is ineffective and gives young women STDs.

This week the Washington Post ran a story that described abstinence education as “controversial” and sex education as “comprehensive.” Just in case you didn’t know which side you should be on. The article is about a campaign being launched by abstinence advocates:

Congress is debating whether to authorize about $190 million in federal funding for such programs, which have come under increasing criticism because of a series of reports that concluded they are ineffective. Such criticism has prompted at least 17 states to refuse federal funding for such programs.

Well, let’s go back to that CDC study. The one that showed how ineffective abstinence education was. Not only was the advocacy theme ridiculous, so was the study! In an exhaustively reported piece for National Journal, Neil Munro shows that the study had serious shortcomings:

Rival Washington advocates pounced on the CDC’s startling statistic. One faction, led by Planned Parenthood and other groups that get federal grants, said the number shows that the Bush administration’s abstinence-promotion programs don’t work and that funding should be transferred to sex-education and condom-distribution programs. The rival faction, led by social conservatives, said that the one-in-four number demonstrates the failure of condoms and sex-education classes. . . .

But how useful or valid is that one-in-four number? Are 25 percent of America’s teenage girls really in imminent danger from HIV/AIDS, gonorrhea, and the human papilloma virus (HPV) that leads to cervical cancer?

A close examination of the CDC’s star statistic reveals several serious shortcomings that undermine its validity, as well as its usefulness to parents, legislators, health officials, and advocacy groups on the left and the right.

For instance, the study referred to infections (most of which never turn into diseases) but the media claimed 25 percent of teenage girls had diseases. The study actually included both girls as young as 13 and women as old as 19. Most strikingly to me, the number was culled from a database with only 600 females under the age of 20! Relevant to the policy discussions, Munro notes that the CDC’s news conference and materials didn’t put the numbers into context. Had they, the data would have shown that infection rates for the most serious diseases, including syphilis, gonorrhea and chancroid, are sharply below 1990 levels. And teenagers’ expoure to STDs had dropped because their sexual activity had declined 20 percent among girls and 40 percent among boys, according to a 2006 report.

STDsThe National Journal article is also telling for how the media just uncritically reported the CDC’s own spin:

CDC officials, including [John Douglas, director of the CDC's STD prevention division], announced the number in Chicago at the CDC’s biannual National STD Prevention Conference, which is attended by many experts, state officials, and reporters. The subsequent media reports and editorials generally echoed the recommendations of CDC officials, and their advocacy allies, for greater government-funded testing and intervention.

For example, the second paragraph of the 8:51 p.m. version of the March 11 AP article said, “Some doctors said the [infection] numbers might be a reflection of both abstinence-only sex education and teens’ own sense of invulnerability.” The AP article also quoted Planned Parenthood’s Richards as saying that “the national policy of abstinence-only programs is a $1.5 billion failure, and teenage girls are paying the real price.” Neither that dispatch nor The New York Times quoted advocates of abstinence-only programs.

The one-in-four figure immediately became fodder in the ongoing debate over whether the government should support comprehensive sex education or fund advocacy for sexual abstinence until marriage. Sex-education advocates were first out of the gate, announcing even before the press conference (in time for initial news reports) that funding should be transferred from “failed” abstinence-only programs to education that includes lessons on the use of contraceptives.

Proponents for abstinence and marriage programs countered that the CDC’s number demonstrates just the opposite. “The half [of the adolescents] that weren’t having sex did not have STIs,” said the Family Research Council’s Gaul. The CDC’s one-in-four number “represents a failure of contraceptive-based education,” Rep. Mark Souder, R-Ind., said at the Waxman hearing.

Munro shows that the CDC’s report won’t settle the debate because the study didn’t compare infection rates for teens in abstinence programs with other teens. He reports that the data’s complexity and small sample size mean that its relative standard error was greater than 30 percent. He shows that the CDC used the study to push for increased funding. And so on and so forth.

It is depressing beyond belief that of all the reporters who covered this story, only Munro was skeptical enough to dig into the dramatic subtexts at play here and expose the fraud. And who wants to bet that despite Munro’s tremendous reporting, we’ll still see reporters parrot this unreliable statistic and draw policy conclusions from it?

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  • Dave

    [...I]nfection rates for the most serious diseases, including syphilis, gonorrhea and chancroid, are sharply below 1990 levels.

    The moment I saw the one-in-four statistic, I figured it was because they’d included human papillomavirus. This is not the first “scare” stat from the feds, and the MSM just eat it up.

  • Michael

    While we probably disagree on the issue of government-funded sex education, I agree with Mollie completely on journalists being more skeptical of government studies. Except for maybe the GAO–and even they can do results-oriented research–and Inspector General offices, government research often is focused on a result. The Bush administration has proven that it can’t be trusted when releasing scientific research and Democratic administrations are no better.

    The CDC is never going to release a study that doesn’t mean more money for CDC work. HHS is not likely to ever release a study which doesn’t have the taint of the administration releasing it. While we know that the Heritage Foundation and the Discovery Institute and Planned Parenthood and the Center for American Progress aren’t going to release reports which counter their message, we should also be suspicious of research done by “non-partisan” researchers and even academics. We should always ask, “who is paying for this research.”

    Unfortunately, that often leaves us with meta-analysis that isn’t very helpful and fails to respond to current trends.

  • Jerry

    Mollie, Attacking a study’s statistical validity or media bias in reporting the story is what should be happening. But you went off a rhetorical cliff in a couple of places:

    no national policy of abstinence education. The federal government may throw significant money at abstinence education but they do so by providing grants.

    Since when does a policy have to come in a 10,000 page book. Policy is set by how money is spent. As Wikipedia put it A policy is a deliberate plan of action to guide decisions and achieve rational outcome(s). The plan of action is to support abstinence education and the deliberate plan is to fund such programs.

    the study referred to infections (most of which never turn into diseases)

    As wikipedia put it: An infectious disease is a clinically evident disease So are you really arguing that the infections were really sub-clinical? That’s not what I read as your intent.

  • Dan Crawford

    The MSM’s handling of the story provides further confirmation of what is evident every day in newspapers and on television and radio. Reporters tend to repeat what they have been fed – to do more would require that they might have to work.

  • Thomas

    I think it’s important to define terms: abstinence-only programs vs. comprehensive programs which also teach abstinence.

    Abstinence-only is indeed controversial. Many of the materials reviewed by non-partisan agencies found outright falsehoods and some seriously retrograde social commentary.

    http://atheism.about.com/b/2004/12/02/abstinence-programs-lie-to-teens.htm

    So, if you have a large, heavily funded “education” program that is providing false or no information to teens (who are not known for having good judgment at all times), it becomes a public health issue – and one upon which editorial commentary can and should be made.

  • http://worldcadaccess.typepad.com ralphg

    A news report yesterday on NPR was firmly against abstinence. The reporter noted that “some studies” show it doesn’t work — leaving a big gap in his story that there might be other studies showing it does work.

    The reporter’s only two quotes for his story were from disapprovers, including one from the head of Planned Parenthood, an organization with much to lose were teenagers to reduce their sexual “experimentation.”

    Amoung our three children (aged 17 – 21), our parental suggstions that they avoid sex seems to be working. It makes sense to them that they might want to avoid too-early pregnencies, sexually-transmitted diseases, and the psychic scarring that can come from being too intimate too casually too soon.

  • http://www.getreligion.org Mollie

    Jerry,

    I may have been unclear. What I meant is that it’s not like teenagers in America are receiving only abstinence education. Many (most?) aren’t even receiving abstinence education. Of those who do, they’re also receiving other sex education. So it’s not like we can point to some supposed change (that later turns out not to even have been true) as evidence of the failure of abstinence education. If every teenager in America were receiving abstinence education and began getting busy in record droves, that would be another thing.

    As for the infection vs. disease thing, you should read the National Journal article. The CDC and related scientists say that there is difference between sexually transmitted infections (most of which never turn into disease) and sexually transmitted diseases.

    Thomas,

    I’m not saying that abstinence education programs aren’t controversial. But you have to be high to think that, well, every sex education program for kids isn’t controversial. It’s the nature of the beast. Calling abstinence education controversial but not ascribing the same to a program that teaches 13-year-olds how to put on a condom is biased.

  • Jerry

    Mollie, I went to the article as you suggested.

    The distinction between infections, which are invasions of the body by pathogenic microorganisms such as viruses and bacteria, and diseases, which cause damage to the body, is especially relevant to HPV infections.

    I’ll leave it to physicians to say whether or not HPV actually causes damage to the body, but I think the way you used it is a “distinction without a difference”. Whether or not HPV causes a disease is not relevant to the discussion of whether or not abstinence works. The rate of HPV infection is a sufficient measure of the problem.

  • http://www.getreligion.org Mollie

    Jerry,

    Actually, I agree that it’s something of a distinction without a difference. As you pointed out, both are transmitted through sexual contact.

    I was just summarizing the article’s excellent case against the report and subsequent media treatment.

  • Thomas

    Mollie says:

    Calling abstinence education controversial but not ascribing the same to a program that teaches 13-year-olds how to put on a condom is biased.

    It’s not biased when the general consensus seems to be that thirteen year olds NEED to learn how to put on a condom.

  • http://vjmorton.wordpress.com Victor Morton

    It’s not biased when the general consensus seems to be that thirteen year olds NEED to learn how to put on a condom.

    General consensus among whom? Presupposing a NEED for what?

    And quite frankly … I didn’t realize it was that difficult. Do English women need to be taught how to put on a tea cosy?

  • Thomas

    @Victor Morton – it is the general consensus among parents of school-age kids, presupposing a need to prevent pregnancy in the rather likely event that the kid disobeys the parents and has sex. (Data source provided upon request.)

    I don’t know about tea cosys (cosies?), but it is possible for an amatuer to mess up condom application. This is particularly true of teenagers who have never seen one, like the unfortunates whose school districts have abstinence-only sex ed classes.

  • Dave

    Victor Morton asks:

    Do English women need to be taught how to put on a tea cosy?

    In the normal course of events, an English girl will see how her mother puts on a tea cosy. In the normal course of events, a 13-year-old girl will not see her parents putting on a condom.

    As to need: These are not just kids, but future adults. Sex education, like all education, is preparation for adult life. Whether 13 is the ideal age may be debated, but whatever age is chosen, some conservatives will think it’s too young and some liberals will think it’s too old.

    Which gets back to Mollie’s point that comprehensive sex ed is no less controversial than abstinence sex ed.

    Diverting back to the main point, (a) the bottom line of the survey seems to be that sex education, period, is failing to prevent STDs, and (b) classifying infection with the HPV virus as having an STD inflates the numbers.

  • Chris Bolinger

    Yes, Thomas, please provide us with more of those unbiased, neutral, mainstream “data” sources such as Austin’s Agnosticism/Atheism Blog. We wait with bated breath.

    it is the general consensus among parents of school-age kids

    LOL…When it is your child and your family that will deal with the consequences, who should be responsible for the education: detached bureaucrats who don’t know or love the child, or parents who do? It’s a no-brainer, which means that the obvious answer is lost on most in Washington and in the MSM, who always know better than Joe Six-Pack.

  • http://vjmorton.wordpress.com Victor Morton

    This is particularly true of teenagers who have never seen one, like the unfortunates whose school districts have abstinence-only sex ed classes.

    LOL

    How on earth did people learn how to use condoms in the dark ages before SIECUS?

    On what current planet does the only exposure to condoms occur in schools?

  • Susan Peterson

    Abstinence, if practiced, definitely works.

    Condoms don’t completely prevent the spread of sexually transmitted disease. It doesn’t cover the whole genital area. A lot often happens before the condom goes on. And they often slip off afterwards.

    To my mind, disease prevention is only a small part of why people too young to marry should not have intercourse or engage in intimate acts which result in sexual release. I think by engaging in such acts without commitment, they break the somewhat fragile connection between physical intimacy and emotional bonding. I think this is ultimately harmful to their ability to bond emotionally with a marriage partner. When a marriage partner is the only person with whom you have experienced sexual release, your attachment to that person is very strong, and engaging in sexual acts with anyone else is almost unthinkable. This is especially true for women of course, as men will “think” such things without willing them just by seeing other women. But between that an actually having such a relationship will be a wide gap of unthinkability. Chastity before marriage also encourages marriage, and is a strong factor in preventing selfish young men unwilling to grow up and commit to a relationship and parenthood. It is the right plan for human beings..and surprise surprise, God says so too! It should be taught to teenagers because it is the truth. And, since it is the truth, it will make them happier , and very incidentally, healthier, lifelong.
    Susan Peterson

  • Thomas

    Chris, honestly? Your breath smells like bait.

    Try this: http://www.religiousconsultation.org/News_Tracker/editorials_on_abstain-only_sex_ed.htm

    The polls in the linked editorials are rather significant. The only people that find comprehensive sex ed “controversial” are religious fundamentalists who think ignorance is bliss.

    As for who knows best: it is clear that MOST parents want their children to know the facts, it’s obvious to me that Joe and Jane Six-Pack are directing the “detached bureaucrats” and MSM that you so contemptuously dismiss. Some of those “detached bureaucrats” are actually in the business of education because they care about kids and our society, BTW.

    You’re free to opt out, of course, and teach your own kids how to use birth control, or not. Some people do choose the latter course. And then they wonder why Suzie’s knocked up and Johnny has herpes.

    What you don’t get to do is deny a well-established public consensus on how best to handle sex education in public schools.

  • Jay

    Michael (#2):

    government research often is focused on a result. The Bush administration has proven that it can’t be trusted when releasing scientific research and Democratic administrations are no better.

    You have the causality wrong. The bureaucracies are largely autonomous and out of control, so they go off and do what they want without regards to who is in power.

    The incentives are perfectly aligned for any bureaucracy to exaggerate a problem to get more money. Since this is something any poli sci student (or political reporter) knows, it’s shocking that the reporters don’t probe here. Unless, of course, the reporters see their mission as effectuating societal change rather than reporting the truth. Ya think?

  • http://onlinefaith.blogspot.com C. Wingate

    Thomas, I made a brief scan of the materials to which you linked (and not to be combative about it, but The Religious Consultation on Population, Reproductive Health & Ethics is a liberal advocacy group, not a neutral party), and it doesn’t seem to me that they support anyone’s claims. For example, I see that the congressional study found “no difference” between traditional comprehensive sex ed and abstinence-only programs. That’s a problem on both ends, not only for the traditionalist faction. It argues against the claims that groups like Planned Parenthood make about how bad abstinence-only programs are– if they aren’t any better in outcome than comprehensive programs, they also aren’t any worse.

    The more obvious conclusion to be drawn is that sex ed isn’t working– at least, not to prevent promiscuity. Of course, who knows? maybe if modern kids didn’t have sex ed, they would be even more promiscuous. I think it would be exceedingly difficult to make such a study these days, but that’s a bit beside the point. Maybe “better” sex ed would work better, but that’s plainly speculation.

    Personally, I can’t imagine how talking about condoms in prevention of a disease which they don’t notice and presents no more than some vague risk down the road is going to be particularly effective in a world where kids continue to take up smoking. But then, that’s a running problem here: the epidemiology keeps getting run over by the moral biases of all concerned.

  • Harris

    “Fraud” seems too strong a word. Munro also plays games. He calculates that women 15-17 have a six percent infection rate using infection rate from first-time encounters. As other data suggest that sexually active teens will have an average of three partners by graduation, the six percent is certainly a low-balling of the number.

    The difficulty in the reporting arises in two areas. First there is a time factor. As Munro and others note, rate of sexual activity grows with time from middle school to late teendom/adulthood. Where the set of sexually active women and women generally approach identity, then the one-in-four number may in fact be right.

    But a second area of confusion (or perhaps “controversy”) rests with the two aims of sex education, one public health oriented (how to prevent STD and STI, and how to avoid pregnancy), the other more ethically oriented. Abstinence-only (A-O)programs clearly fall principally in the latter, and if evaluated in that context succeed in delaying the onset of sexual activity by 18 months.

    The rub, is that when A-O is engaged, the public-health questions nonetheless remain. Those who engage in sexual activity (research indicates A-O perhaps cuts onset by 50% in middle schoolers) are then at risk of the STD, STI and pregnancy, but without extra information.

    Why A-O remains controversial is that data suggest the time-shift in ethical behavior while real, does not translate to reduced public health dangers: by 17 the kids are as likely as their peers to be sexually active.

    So the question for A-O is the same as for the CDC study: What is measured? When? A real look at sex education may need to split the data sets more precisely between young, mid- and late-teens. More data, please!

  • Dan

    Further to Susan Peterson’s point, there are (largely unreported on) good reasons to suspect that sex outside of marriage is linked to depression. The CDC’s third National Health and Nutrition Examination Survey, which compares the mental health status of men between the ages of 17 and 39, has some interesting findings in this regard in that, unlike most studies of this type, it includes those who reported being virgins. According to the study, by almost all standards of mental well being — suicide ideation, depression, etc. — male virgins were substantially better off than males engaged in sexual activity. For example, male virgins have a suicide attempt rate that is just .28 of that of sexually active heterosexual males and the rate of major depression among virgin males is just .38 of the rate for sexually active heterosexual males. As other studies have found, the rate of depression and suicide is very high among homosexual males. The CDC study found that homosexual males have a suicide rate that is 19 times that of virgins (5.36 times that of sexually active heterosexual males). One might surmise that this high rate of mental distress is associated with promiscuity.

    In short, there is reason to believe that inappropriate sex threatens not just physical health but mental health also. Significantly, this information came to me not from a newspaper or other news source but from a relatively obscure (but excellent) book called “After Ascetism” (which deals with the sex abuse crisis in the Catholic Church). The press seems to endorse the claim of advocates of “sex education” that it is important to disseminate information about how to avoid the negative consequences of sex. That the issue of the pyschological consequences of sex is always left out of the discussion suggests that, whether conscious or not, the real agenda of “sex education,” and the press’s support of it, is to ensure that the “education” brings about ever greater availability of sex.

  • Dave

    Dan:

    A study report of the sort you cite is much more convincing if it includes the actual occurrence of pathology, rather than simply comparative data. Eg, male virgins have only 0.28 times the suicide rate of sexually active males, but what is the actual rate of occurrence for each? (That would be something like 1 in 100,000 or whatever the actual rate is.) Without the actual occurrence rates, we have no way of knowing if the differential is large enough to justify influencing public policy.

    Of course, the last conclusion might be considered subjective, but without actual occurrence rates we can’t even form a subjective judgement — unless we are panicked into a decision by a dramatic comparison statistic that actually doesn’t tell us much.

    This is a question I ask whenever I encounter statistics referring to a socially controversial topic; they are almost always presented as comparison rates, and the actual occurrence rates are almost always withheld. Enough to make an old man permanently skeptical.

  • Dave

    Then there’s the question of whether correlation is causalisty, and which way the causality points. In this case, perhaps suicidal men are driven to promiscuity as a form of risk-taking behavior, so the suicidal ideation may produce the sexual activity rather than vice versa.

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