Wednesday, December 31, 2008

Sending messages to kids

Only one radio station so far has really pushed this "if you teach birth control, kids get the wrong message" idea. In fact, over 90% of parents, and even Sarah Palin, say kids should learn birth control in schools. Afterwards I looked at their webpage, which has a button at the very top for a "Babes Page", and an ad immediately after this segment had a couple of adults making sexual innuendo before going to a home improvement store. What kind of message is that sending to kids?

I don't mean to be all "This is a feminist bookstore; we have no humor section.", but which one is more salacious: the Maxim Hot 100 or a condom demonstration in the style of an airline instructional video?

The officially religious contexts are at least consistent. The Southern Baptists have no Babes Page.

(Btw, an amusing Israeli one for the Hebrew speakers.)

Tuesday, December 30, 2008

Media interviews

1. Radio interviews are much more heuristic than press interviews and bckground interviews for TV. The press and TV actually do care exactly why your study is different from the others. The radio just wants you to give relevant 15 second quotes, so you end up talking about things that may have nothing to do with your study at all; they're just relevant to what the radio interviewer is thinking about. In every radio interview I find myself saying that parents need to talk about sex with their kids, which is pretty much what everyone says in response to this type of study.

And on the late night talk radio, I got to mention that graham crackers were invented to prevent masturbation. The host was upset. He eats them every day.

Average length of a press interview: 25 minutes. One of the best press interviews was 17 minutes with the New Scientist in London; I was impressed how efficiently he got the information compared with the other press who were about 10 minutes longer.

Radio interviews are at most 5 minutes. Very convenient that they are after the press interviews, so the press talking points can be narrowed down.

I have my first TV interview tomorrow, and then another next week.

2. It's hard to come up with good quotes just from talking. I wrote down the technical parts so that I could describe it accurately in an easy to understand way, but I left non-technical parts to ad lib. I didn't remember that it was even more important to write down my conclusions in an easy quote until the articles came out. My quotes in the Washington Post interview were very weak, and they would have been stronger if I had written out the quotes I wanted to appear in print in advance. The process of going from oral to writing is hard.

E.g., the following is the kind of thing I wish I had said in one sentence: "Parents should teach their kids how to use condoms. It doesn't cause them to have sex any earlier, but it could save their future health and fertility." But this type of sentence doesn't come out of your mouth so concisely if you're speaking off the cuff. At least, it doesn't come out of my mouth.

3. The news cycle goes so fast. I was in transit between Chicago and Baltimore from 7 am until 2 pm, and people weren't calling my cell phone (though they had before), so I missed USA Today, CBS Radio (national or DC, not sure), and possibly another.

Today's coverage

My study was named one of the most obvious sex stories of 2008. The others are funnier, like that attractive people have more sex and that teen boys learn about sex from pornography.

Time Magazine Q and A

I can kind-of understand the headline of this story from Brazil.

Monday, December 29, 2008

Criticism of my pledge study

A blogger called Outside the Beltway writes about the validity of the study, and unleashes an intelligent barrage of comments from his readers about the methodology because he assumed I was doing standard regression analysis instead of matching. It's amazing how many methodological details people are able to pull from the media reports, and it's neat to see a political argument turn into a discussion of internal validity. I'm curious whether the phrase "parametric assumptions" will appear.

A few people --- Investors Business Daily and Valerie Huber cited at the end of the Post article --- have made accusations of ideological bias, which is a particularly ridiculous accusation to make about a statistician. If studies were determined by ideological bias, statistics would suddenly become much easier, and entire subfields of statistics such as procedures to adjust for multiple comparisons could disappear.

Ideological bias is also funny to raise about me, in particular. I vote straight blue and am firmly pro-choice, but I'm also frustratingly moderate. In discussions with reproductive health researchers, I stick up for the abstinence folks whenever it's warranted, and I read evangelical sex and dating books to the point that I know these better than some evangelical clergy, and I've even recommended evangelical dating books to friends.

The IBD editorial is particularly funny because it refers to the "fat wallet" of Mayor Bloomberg as having financed my study, which was not financed at all beyond the grants that paid for my PhD education, and then it links my study to the psilocybin study at Bayview, and repeats the same fallacy correlating teen pregnancy decline with rise of abstinence-only education.

They do get in a good line, "Abstinence-ed can't work as a one-night stand."

Apparently I can speak Italian!

Someone sent me myself in Italian, but somehow the link got deleted. I'll add it back.
an article that quotes me as saying, "Sembra che l'astinenza debba derivare da una convinzione personale piuttosto che dall'adesione a un programma." Exactly.

Here's more coverage:
WebMD: I had a really enjoyable interview with them in 2006 and they wrote a great article. This article is just based on the paper's abstract.

This blog is wrong: pledgers and non-pledgers have anal sex at the same rates. I bet the writer just wanted to include the phrase "unprotected anal sex" and quote Dan Savage's column from this week. I don't blame him. It was a funny column.


Here's the rundown of what I've seen so far.

My favorite so far is a note from a virginity pledger which amazingly says what I speculated about in some interviews today:

As a 28-year-old Christian, I made my pledge more than 10 years ago, but that didn't stop my mother from educating me about sex (of all kinds) condoms and what happens when the "hose meets the flower" (she was a lot less delicate about it -- but I won't say what she actually said in print). I don't even think that she expected me to stay a virgin this long (she actually supports a little sexual experimentation before I marry), but the decision was mine from the beginning -- and the decision has to be your teen's as well. If you pressure them to make a decision that they are not ready for -- they won't keep it, they will lie to you about their activity and then you might be wondering why a bundle of joy is calling you Grandma.

Reflections on my study from a parent: conclusion: advocate abstinence, teach birth control, and try to keep open communication. Right on! she asked really good and thorough questions, and so far, this is the most thorough article. I'm glad that it worked out because I was interviewed in the car on the way from Indiana to Chicago, and I found the corn fields slightly distracting.

One blog post on the study is interesting, and I want to think about it.

Virginity pledges portray premarital sex as a sin. We tend to sneak around or be impulsive about things that make us feel guilty. We tend to take more reasonable approaches to things that don’t make us feel guilty.

What this study didn’t control for (and what I don’t think can be controlled for) is whether or not the pledge takers would have approached premarital sex with a high level of guilt and the same aversion to birth control even if they hadn’t take a pledge. What comes first? The view that premarital sex is a sin? Or the pledge?

The reasoning about not using birth control because of guilt is entirely the blog poster's. I didn't look at that. I am inclined to say that guilt isn't the intermediate variable, and instead having been taught inaccurate information about birth control, but it's an interesting question.

The big report was, of course, the Washington Post's and the

The Today Show really impressed me because they were able to cover the study so succinctly in the 5 minute segment. I know it was a written script and the psychologist wasn't improvising her answers on the spot, so that's why it could go so quickly, but it was still impressive that they fit so many details in.

One report referred to "The Rosenbaum study" and "Her team’s conclusions". The UK Daily Mail calls me "Miss Rosenbaum" and it's also slightly inaccurate: it's 15-18 year olds; no 14 year olds in my study.

Dan Savage quotes someone named Atrioson my study.

While the fact that virginity pledges and abstinence-only sex "ed" don't stop teens from having sex is unsurprising, I doubt that even proponents are particularly surprised. They aren't interested in abstinence, really, they're interested in making sure "bad girls" get punished for having sex by being subject to the appropriate consequences. So it actually works as designed.

I've read Dan Savage's column since I was in high school, and I often agree on his sex advice. On this count, I completely disagree with Atrios. The virginity pledge was an attempt by adults to make abstinence cool. I've not seen any evidence that anyone wants to demonize anyone else. Incidentally, from a health standpoint, it makes sense to focus more on girls: they are more vulnerable to STDs.

Health Day: part of ABC news?.


One article describes me as "the researcher in charge of the study". We're a pretty small operation here: me and my computer.

One article has the baffling headline "Teenage self discipline as effective as promiscuity".

Okay, that's enough for now. Somewhat disorganized.

Today's media requests

I'll post links from what was published today later, but for now:

- Reuters
- ABC TV in Columbus, OH: referrals to local experts. Take bets on whether they choose the statistician or the pediatrician.
- Sacramento radio KFBK: wanted me to go on this morning 2 hours after their call, but I was on a plane.
- Time magazine: Online Q and A to be published tomorrow.
- USA Today
- Family News in Focus
- Ellen Goodman
- WJZ TV Baltimore scheduled interview
- World Health News Today: will schedule interview

Ellen Goodman asked great questions, and was particularly interested by the phenomenon of "forgetting" the pledge, though she asked lots of questions.

USA Today had an immediate deadline for this morning, while I was on a plane, but perhaps later.

Sunday, December 28, 2008

Virginity pledge paper expected media coverage

My virginity paper's embargo from the journal Pediatrics ends Monday morning, Dec. 29 and judging from the press I've spoken with, I expect coverage on some of the following:

- NBC's Today Show, Monday Dec. 29 ~7:30 am.
- Washington Post
- Bloomberg News
- and maybe
- Health News
- Maybe New Scientist of London
- British Medical Journal
- Baltimore Sun
- Chicago Tribune


Tuesday, December 23, 2008

Open letter to the virginity pledge creators

For my research, I got some useful information from the creators of the virginity pledge. I don't know if I am the only virginity pledge researcher to contact them, but they were extremely helpful and responsive to my requests for information. I have a great deal of sympathy for their goals to encourage abstinence, and I wanted to update them on the outcome of my research so that they heard it from me rather than from the media to maintain open relations.

I sent them the following note.

Dear Rev. Hester and Rev. Ross,

Thank you for your help with my virginity pledge research. My study is coming out on Dec. 29 in the journal Pediatrics and also received an award from the public policy association APPAM. The results are positive about the behavior of evangelical Christian teenagers, but not positive for the virginity pledge itself. I wanted to let you know a productive angle that you can take if you are asked about the study.

The year before taking the pledge, pledgers are more religiously and socially conservative than non-pledgers, and would be predicted to abstain more even without the pledge, so I compared pledgers only with similar non-pledgers rather than the American adolescent population as a whole. I found that pledgers and similar non-pledgers do not differ in sexual behavior, but unmarried virginity pledgers are less likely to use condoms and birth control. The difference in condom use may be because other studies have found abstinence programs present information that is not supported by scientific evidence and cause participants to have negative views of condom effectiveness. I use the same data as the original pledge studies, but an improved statistical method, so my results likely mean that the earlier studies' findings were due to the pre-existing differences between pledgers and non-pledgers rather than the pledge itself. My conclusion is that all adolescents should be taught accurate information about birth control and condom use. [The evidence indicates teaching birth control does not contradict an abstinence message; every well-designed study that I'm aware of has found that presenting birth control information does not affect students' sexual behavior, and in fact the only programs ever found in well-designed studies to cause teens to delay intimacy are programs that teach birth control.]

You do have two pieces of good news to report on the research, and I wanted to make sure you knew them.

1. The paper finds that the religious and conservative lifestyle of the both pledgers and similar non-pledgers includes much more conservative sexual behavior than the general American adolescent population. For example, they wait until an average of 21 to initiate sex as opposed to about 17 in the general population, although a majority do have premarital sex.

Quoting from the results section of the paper, "The pledgers and matched nonpledgers together are a highly religious group of adolescents and would be expected to be more sexually conservative. Pledgers and matched nonpledgers together reported substantially more conservative sexual behavior at wave 3 than the general population of adolescents --- with fewer reporting premarital vaginal sex, oral and anal sex, birth control and condom use, and multiple sex partners and more reporting being married --- but did not differ in 2 of the 3 STD tests: fewer had positive test results for Neisseria gonorrhoeae but did not differ in the proportion testing positive for Chlamydia trachomatis or Trichomonas vaginalis compared with the general adolescent population in Add Health wave 3 (data not shown)."

2. Earlier studies that found pledgers were substituting other sexual activities for intercourse are not upheld in this study. This study uses more rigorous statistical methodology than the previous studies, and finds no important difference in any sexual behavior.

Thanks again for your help. Like many researchers of adolescent health, I consider delaying intimacy as distinctly preferable to safer sex for teenagers for health and perhaps psychosocial reasons. It seems that the virginity pledge does not encourage teens to delay intimacy, but some abstinence-plus programs have been found effective in causing teens to delay and also teach the information that many of them need; hopefully such proven-effective programs can be adopted to be acceptable and appropriate for the wide range of traditional religious communities that comprise our country.

I hope you and your families have a happy Christmas.

Janet Rosenbaum, Ph.D.
Postdoctoral Fellow, Johns Hopkins Bloomberg School of Public Health

Friday, December 19, 2008

Condoms during oral sex: the hidden danger

Women inhales condom during fellatio

Indian J Chest Dis Allied Sci. 2004 Jan-Mar;46(1):55-8.
Accidental condom inhalation.
Arya CL, Gupta R, Arora VK.

Jaswant Rai Speciality Hospital, Meerut, India.

A 27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve. A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe. Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed the presence of a condom. Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio.

It's an old paper, but perhaps not well-publicized enough.

I can't really picture how this would happen.

Tuesday, December 9, 2008

"Imagine no religion" campaign

The Freedom From Religion Foundation has a new billboard campaign asking viewers to imagine no religion. They erected one billboard in the town with the headquarters of Focus on the Family, which I do find kind-of funny. Though funny in the same way that I find the abstinence billboards in neighborhoods with high teen birth rates.

The campaign has encouraged umpteen editorials with the standard secularist messianic thinking: fewer wars, no terrorism, no abstinence-only education, more title V family planning funding.

How about "Imagine No Extremists"? Not only would pragmatic compromise become easier, but perhaps there wouldn't be evangelical atheists and their billboards either.

Framing abstinence

People see issues differently depending on how they are framed.
This article looks at framing in the abstinence debate, specifically how using abstinence as the subject of a sentence instead of adolescents takes away adolescents' agency. That sounds abstruse, but it's an important difference both for advocates and sex educators (including abstinence educators.)

That is, saying "Abstinence is the only way to 100% prevent STDs and pregnancy." puts abstinence as the main idea, rather than adolescents, and makes the statement needlessly abstract. Adolescents thinking about having sex themselves would probably not feel any personal identification with that statement even while accepting the statement logically as a correct proposition.

Likewise, they don't use this example, but I think it applies equally: statements of "should" such as "Adolescents should wait to have sex." also take agency away and simultaneously add moralism, which is easy to tune out.

The article proposes using language that put adolescents back in the agency role, "Waiting to have sex..." or "Deciding not to have sex..." I like the statement with deciding best because it emphasizes the choice aspect.

I am not sure that framing would change efficacy of a curriculum, but the qualitative research from a couple months ago about adolescents' sexual decisions does indicate that the first two phrasings are probably ineffective, so it wouldn't hurt to try.

And there is no reason the abstinence movement couldn't adopt this wording. Everyone knows that adolescents have agency over their sexuality --- at the end of the abstinence program, they will be making decisions, not passively following rules. Adolescents who intend to be abstinent need to make decisions about intimacy, and in fact their decisions are more difficult if they want to be effective. Decisions have to include complete and accurate information which requires teaching birth control accurately.

There are certainly some sex-positive books written for young evangelical adults that emphasize their agency; one even says that sexuality is part of every social interaction ("Soul Virgins" written by two evangelical sex therapists, reviewed here earlier). I haven't seen any sex-positive literature for teenagers, but that doesn't mean it doesn't exist. Many of the adolescent curricula that I have seen do talk about sexuality as a contaminating external force, and that's just not productive.

The abstinence movement has other models for sexuality, such as sexuality as altering relationship development, that while negative don't mark sexuality as bad, but just as out of place in an adolescent relationship, and do concur with the mainstream adolescent research. So many of my colleagues begin papers by citing the statistic that most adolescents who have had sex wish they'd waited and that younger people are more vulnerable to STDs. (This American Life even has a segment about how couples use sweet talk to avoid being in the moment and developing their relationship. And last night the Big Bang Theory featured a girlfriend using sex to avoid uncomfortable conversation.)

These models of sexuality require discussions about how to develop healthy and meaningful romantic relationships. That's more difficult to teach than moralism and threats, but has some chance of being effective.

Sunday, November 30, 2008

Chicago papers are shocked: first kiss post-marriage

The Chicago papers seem surprised that a couple waits until marriage to kiss. The couple are abstinence educators, and the story seems completely unremarkable to me: while adherence among Orthodox Jews to modesty laws is far from 100% especially post-engagement, many do wait until marriage even to touch or hold hands. Personally I find the weirdest part of the situation that the couple would kiss for the first time in public.

On a related note, a Huffington Post columnist recommends that people avoid situations that require self-control because self-control is finite. She's not talking about sex in this situation, though.

The sex columnist in the Swarthmore College paper (my almost alma mater) has some good questions including some related to abstinence:

You know the old joke about the cobbler’s children having no shoes, the priest’s kids getting knocked up, and the sex columnist’s partners not getting off?
I’m a Swattie and this week all I’ve got for you is questions, a lot of which get to the heart of everything I’ve been writing about this semester, but none of which I have answers to.

Why is asking for what you really want so damn hard sometimes? Why is it that nearly every time I do ask for what I want, I get a good response, and I’m still scared of it? Why do I have a hard time, sometimes, even when I’m asked point-blank what I want? Where did I learn that it’s a bad thing to express desire?

Why do we think of sexual assault as only something that evil people do in evil moments, rather than as something that belongs on a behavioral continuum? Similarly, why do I still sometimes find myself on the brink of sexual activity which I don’t really want, and having a hard time saying no?

Why do I have an easier time talking about safe sex in a “fluids” sense than in an emotional sense? Why do so many of us have an easier time being vulnerable physically than emotionally, for that matter?

Why do people get surprised when I say that you should probably only engage in activities that could get you pregnant with somebody who agrees with you about what to do if your birth control fails?

Why do the people who get so upset about being judged for not being abstinent sometimes get so upset when somebody else chooses abstinence freely? How the hell does anyone still think abstinence-only education is a good idea in view of the piles of evidence that says it’s not?

Why do we focus on giving and getting sex rather than sharing sex? Is it that hard to carry over certain lessons from kindergarten? Wouldn’t this sort of model really help the whole sexual assault thing?..
And my whole sexual ethic has grown up around the idea of self-care. So recently I’ve found myself, when asked what makes for a good partner, talking about the three Cs a lot—careful, caring, and communicative.

I've never seen this column before, but any sex columnist that regularly mentions a sexual ethic must be great. I'm not a regular reader of the genre (other than Dan Savage), but I've never seen the phrase "sex ethic" in any sex column.

Tuesday, November 25, 2008

New abstinence ring design

Abstinence rings have a new design: the Hebrew verse from Song of Songs "I am my beloved's and my beloved is mine" (אֲנִי לְדוֹדִי וְדוֹדִי לִי, הָרֹעֶה בַּשּׁוֹשַׁנִּים.) a common art and jewelry theme sold to Israeli tourists and in Jewish bookstores, especially common on wedding parephenalia. I can see how it's appropriate, but it's jarring.

Others they could consider. . .

אֲנִי לְדוֹדִי, וְעָלַי תְּשׁוּקָתוֹ. "I am my beloved's, and his desire is for me [but we're going to get married first]." (7:11)

For a longer verse, they could consider
עַל-מִשְׁכָּבִי, בַּלֵּילוֹת, בִּקַּשְׁתִּי, אֵת שֶׁאָהֲבָה נַפְשִׁי; בִּקַּשְׁתִּיו, וְלֹא מְצָאתִיו.
"On my bed in the nights I sought the one my soul loves; I sought him, but I didn't find him." (3:1)
as a threat about the results of inappropriately intimate dating.

There is no בבתי קפה בלילות בקשתי
"In cafes at night I sought..."

Monday, November 24, 2008

My favorite safer sex pamphlet

I pick up safer sex pamphlets wherever I find them, and so far my favorite is the Fenway Health Center's pamphlet. It gives a much broader range of sexual activities than any I've seen, and lists exactly which STDs are transmissible by them, and which STDs are transmitted by skin-to-skin contact so cannot be protected against by condoms.

A real problem in sex ed is how to talk about the skin-to-skin contact STDs. Sometimes they don't get mentioned except in an oblique way such as "The safest sex is no sex at all. Condoms cannot make you 100% safe." which can be read by the optimistic as implying 90% protection against all diseases. (In the abstinence-only literature, it's phrased as "Condoms can leave you vulnerable to many horrible diseases." which sounds like condoms are no good at all.) I like that this pamphlet treats STDs as individual entities each with their own transmission risks, rather than over-simplifying them.

They do not mention which STDs are commonly tested for in different clinical settings and which tests may need to be specially requested, which is an unfortunate gap because testing practices vary and many people speak of STDs as something tested for as if there were just one test for all known STDs when some STDs aren't tested for at all (e.g., as far as I know, no one screens men for HPV.)

Tuesday, November 18, 2008

Test your teen pregnancy knowledge

Dr. Joyce Brothers's column today is test your knowledge about teen pregnancy: 7 true/false questions.

Her wording on whether abstinence education prevents teen pregnancy is circuitous:

While there is a role for abstinence education in reducing pregnancies, studies have shown that often it is not enough. Many children who have been told to just say no end up having sex, anyway, but aren't equipped to prevent pregnancy because they often don't plan to have sexual intercourse. A combination of abstinence programs with comprehensive sex education focusing on safe sex and pregnancy prevention is thought to be a more effective way to deal with preteens and teenagers.

As written, the first sentence sounds like abstinence education works sometimes, rather than not at all (as far as we know). The second sentence is pure speculation. And her description of sex education makes the abstinence portion stand out, perhaps in an effort not to alienate readers.

To be honest, very few program evaluations measure teen pregnancy because it's usually rare in the general population (her readers). Sex ed is much more effective in getting kids to delay sex and use condoms more (or at least claim to). Pregnancy is hard to affect using just a curriculum. Perhaps unsurprisingly: there are always kids who don't pay attention to any curriculum in any class, and they may be the same ones who get pregnant.

Wednesday, November 12, 2008

Traffic safety: speeding

Traffic safety is a big problem for adolescents. Injury is the leading cause of adolescent death, and traffic accidents where an adolescent is the driver is probably a large portion of that. Most studies of the question that I've heard of have concluded that everyone would be much better off if driving licenses weren't given until 18, and some places have instituted graduated licenses for 16 and 17 year olds.

With that background, here is a study of adults about the perceptions of whether speeding is safe: the vast majority of adults perceive speeding is safe, and safety is proportion to their perception of their likelihood get caught. I've observed this myself: everyone knows the slogan "speed kills", many know that kinetic energy is proportional to the square of velocity (i.e., so each incremental speed increase raises the risk even more). Some may even know that the majority of children survive being hit by a car going 25 mph, but the majority die being hit by a car going 40 mph. And everyone speeds. It may be an issue of overconfidence in driving abilities since nearly all drivers believe they are above average drivers; availability, since all drivers have either gotten a ticket or know someone who has, but few know those who have been in accidents; and all kinds of other psychological fallacies.

With this attitude prevalent among adults, it is almost unimaginable that adolescents would get a safe message about driving. It may even be futile to try to change adolescents' attitudes and behavior in the face of such widespread adult opposition. It seems that any campaign to prevent adolescent traffic injury would have to start with adults' attitudes, but how? How much increased enforcement of speed limits would it take? Is that even possible in crowded urban highways where the average speed is 10+ mph faster than the posted speed limit?

Here's the paper's abstract:

In recent decades, it has become more common for speed limits to be set for political reasons rather than for safety reasons. As a consequence, the motoring public seems to have increasingly begun questioning the rationality of speed limits. This is evident in observed speed data that show that the majority of drivers routinely exceed posted speed limits. A key motivating factor in drivers’ tendency to exceed the speed limit is that they believe that the excess speed does not threaten safety. This paper, specifically studies this matter by using a survey that asked drivers how fast above the speed limit they feel they can drive before safety is threatened. A probabilistic model is estimated using data gathered from 988 drivers in Indiana. Estimation findings show that drivers’ perception of the speed above the speed limit at which they will receive a speeding ticket is a critical determinant of what they believe is a safe speed – suggesting that enforcement plays an important role in safety perceptions. Other variables found to be significant factors in determining the speed above the speed limit at which safety is first threatened include age, gender, being previously stopped for speeding, and drivers’ ethnicity.

Monday, November 10, 2008

Whoa, this is me!

Catching up on my Google emails of all mentions of the word abstinence to me, I ran across a virginity pledge study that I'd not heard of. When I read the article, I realized it was about my work.

Two local TV stations covered my APHA presentation, and broadcast stories the next day Springfield, Missouri and Bakersfield, CA. And thankfully, that's it.

I wonder how that happened. Both are ABC news, so I guess ABC news wrote the story and sent it to affiliate stations and these were the only ones who chose to publish/broadcast it.

Nuance; catching up

1. Book review of Sex in Crisis in the Times Online. Gives historical perspective on the Christian sexual revolution. Need to think more about it, but what sticks out:

Even the Right’s arguments about abortion are often now less about whether it is an act of murder than about whether social science finds it harmful. Despite there being "no reliable data to measure the phenomenon," Justice Kennedy supported his vote to weaken Roe vs Wade with the observation that "severe depression and loss of esteem can follow" from ending a pregnancy.

That's incredibly disheartening, and it makes explicit that social science that finds A to be marginally bad or B to be marginally good might influence policy to completely ban A or subsidize B, instead of a more nuanced perspective.

2. Bill Smith of SIECUS writes that abstinence-only funding should be directed to comprehensive sex education, keeping the federal government funding sex ed, uniquely across all areas of curriculum. Arguably it is a health issue, but even if it makes sense for the federal government to be funding sex ed, politically it seems to me way too dangerous and too easily taken out of context. The anti-comprehensive sex ed folks find a single quote to prove that sex ed is morally degenerate: e.g., they are forever talking about how sex ed teaches kids to use grape jelly in sex.

3. The UK also has abstinence research centers. I did not know this. One is going to publish a book "Just sex: Is it ever just sex?" It is a good question, but not if all nuance is abolished (see point #1).

4. Did I already post the New Yorker article Red Sex, Blue Sex about how "red America" (how the nomenclature has changed!) sees teen pregnancy relatively casually.

5. I was going to write about another virginity pledge study and realized it was my own research.
See the next post.

6. More than $200 million: a GAO study found that apparently some healthy fatherhood HHS funds are being misused for abstinence education. No quantification on how many organizations and how much money.

HHS commented on our finding that some grantees were operating
programs focused on abstinence education. HHS stated that it is
impermissible to use Deficit Reduction Act (DRA) funding for abstinence
education, however, grantees may use funding from other sources to
provide abstinence education through programs separate from the Healthy
Marriage and Fatherhood programs. We visited one such program whose
staff told us that they used DRA funding to support their abstinence
education program and that abstinence education was not provided as a
single lesson, but was the focus of the entire curriculum.

7. RAND study on TV and teen pregnancy by my colleagues. Abstinence sites are reporting the story as well.

Valerie Huber of the National Abstinence Education Association commented on the need to combat an over-sexualized society with abstinence education.

"We have a highly sexualized culture that glamorizes sex," said Huber. "We really need to encourage schools to make abstinence-centered programs a priority."

8. In-depth feature on Silver Ring Thing, one of the most detailed descriptions I've seen.

Tuesday, November 4, 2008

The dream is alive

I grew up just north of Chicago in Evanston hearing about Dr. King --- my elementary school was named for him, the principal and some of the older teachers had marched in the civil rights demonstrations, and everything was 50-50 white-black. We listened to his speeches for a few days every January, sung the civil rights songs, and learned about Africa. At the same time, it was so clear that the inequalities he spoke about persisted: only a few white students came from families with single moms, while almost all the black students did; some were raised by their grandmothers, in retrospect because some of their moms were really young; the black students came from one set of neighborhoods and the white students from others; I remember in 6th through 8th grade one of the 35 girls in the 8th grade was pregnant by middle school graduation, which in retrospect is even more shocking than I thought it was at the time; I also remember an African-American friend in 8th grade talking about her older boyfriend who could drive --- at the time, I was impressed, but now I realize how creepy that was. My best friend in middle school was black and was constantly called an Oreo: she lived in the same neighborhoods as the other African-Americans and went every Saturday to get her hair straightened and every Sunday to church on the south side, but she had gone to private school K-5 and spoke more like her white classmates than the blacks from her neighborhood.

We were all told that we could all be president if we wanted to --- black or white, male or female --- but it was clear that some had a heavy disadvantage and fewer role models. We learned about the same figures every black history month: George Washington Carver and all the uses of peanuts, Frederick Douglas --- and while these were impressive men that anyone could look up to, I think it felt a little stale to list a small number of black male role models, some from the 19th century, when over 10% of young black men were in prison at any given time and a black male had more than a 20% chance of ever being incarcerated. So it was a huge deal when Harold Washington was elected as the first black mayor of Chicago. And, a decade later, Carol Mosley Braun as senator.

Living around college-educated upper-middle-class people, it's easy to forget how viscerally important the election of an African-American as president is for young people. Yes, it's a first in the sense that we can mark it off in the history books as done in the same way that it would have been if a woman were elected. But it is much more than that, and we will only begin to understand it during President Obama's term. For one thing, every child called an Oreo has the best response ever. "Is the president an oreo?"

Monday, October 27, 2008

Palin consistent on sex ed

I voted for my senator Barack Obama for president and find the McCain campaign increasingly creepy. I do feel compelled to point out that Sarah Palin has been unfairly attacked as wavering on sex education because that is not true. I see at least a few of these stories every day.

Sarah Palin in 2006 took the position that sex ed should teach both abstinence and contraception, but should not be overly explicit. See my post from early September on this point which gives documentation. What overly explicit means varies by person: some mean that sex education shouldn't teach about fisting, sex with food, or BDSM, while others are squeamish about teaching that masturbation is normal (viz. Jocelyn Elders). Regardless, it's a consistent position, and it's actually the position of most parents: very few actual parents in the real world are opposed to teaching birth control. It's only the political lobbies which have staked out this position.

As I said in early September, Palin's position in 2006 shows what an outsider she was to the political scene that she took the position of most parents instead of that of the religious right.

Thursday, October 23, 2008

Abstinence as the Israeli peace process

A certainly flawed analogy occurred to me about the abstinence debate. Adolescent and young adult sexuality is like the Israeli peace process.

In Israel, no one is truly against the peace process. If the hawks believed there existed some action that they could take that would bring enduring and true peace to Israel, they would agree to it in an instant. The disagreement between the right and the left in Israeli politics is not for or against peace: it's for or against the likelihood that any given action by the state of Israel could result in peace. The hawks say that the prospects for peace lie in the hands of others, and Israel has done what it can and possibly more, i.e., many actions that were useless or dangerous.

As in Israeli politics, I don't think the disagreement over sex education is about the desirability of adolescents and young adults abstaining from sex until they have lower risk of STDs and are in a loving lasting relationships. The disagreement is about the likelihood of any action by adults inducing this ideal state. The abstinence camp is idealistic like the peace groups in Israel. The comprehensive sex ed camp say that adults have very limited actions they can take, and the best they can do is containment, and that attempts to induce this ideal state are useless or possibly dangerous.

It's not impossible for either ideal state to emerge. If nothing else, when the Messiah comes there will be lasting peace in Israel and around the world and everyone will make wise sexual decisions all the time. Until then, it's not clear.

(Of course, the optimists on abstinence are usually hawkish on Israeli politics, and vice-versa. Who said people had to be consistent.)

Review of Unprotected

This book is unfortunately one that can be accurately judged by its cover. A girl in an uncomfortably-short skirt and high-heeled strappy sandals, slumps dejectedly at a table, her Burberry purse slung over the other shoulder, shadows and limbs strategically placed. And by its title, Unprotected: A campus psychiatrist reveals how political correctness in her profession endangers every student, by Anonymous, M.D. This evident alarmism --- PC is so insidious that the author must remain anonymous or risk Birkenstocks being thrown through her front windows --- that pervades the book may cause parents and aggrieved social conservatives to pick up the book, but it does no good for Dr. Anonymous's arguments and alienates people who might otherwise agree with her.

A friend of mine, an observant Jew who every week attends prayer services where the sexes are separated by a curtain, is a prime candidate for a reader who might agree with this book's argument. Her conclusion after skimming the book, however, was, "Books like this make me mad." She objected to its overly dramatic language and attempt to scare the reader into agreement.

Dr. Grossman's arguments (Dr. Anonymous turned out to be psychiatrist Dr. Miriam Grossman from UCLA) are themselves very worth consideration and further research. Here they are. I think any of these could spawn half a dozen good studies. I do not think that they are generally repressed by political correctness at the level of academic research. Research is usually not sufficiently disseminated, though, and maybe that is the problem: this certainly wouldn't be the first area where quality of health care suffered because practitioners followed their intuitions instead of evidence-based guidelines or the evidence was never disseminated in the first place.

At any rate, here they are:

1. Casual premarital sex may be emotionally dangerous for at least some adolescents and young adults, especially for women due to their hormonal response to orgasm and stimulation of erogenous zones. Many young women have strong emotions that accompany what they had wanted to consider casual relationships, which surprise them.

2. People know very little about STDs and underestimate the risks:
a. Condoms don't protect completely against some STDs, especially since adolescents and even young adults don't use them consistently.
b. Younger people are more vulnerable to STDs than older people.
c. Some STDs are incurable and some have a small chance of causing fertility problems over a relatively short period.
d. STDs are given short shrift in the larger health care picture. She concludes college should require universal testing for common STDs such as chlamydia, just as they require universal testing for TB.

3. Abstinence is not considered to be a virtue to the extent that other disciplined behaviors are. (I made this argument a few weeks ago.)

4. Counselors are required to be culturally competent to deal with all potential clients, but while they are taught sensitivity to rare minorities such as transgender and Muslims, this cultural sensitivity does not extend to larger traditional minorities such as evangelical Christians, conservative Catholics, and Orthodox Jews.

5. A spiritual discipline, whether meditation, yoga, or traditional religious prayer, appears to be beneficial for mental health in both the short and long term.

6. HIV is more difficult for healthy people to contract from vaginal intercourse than people commonly believe, and this disproportionate fear of HIV may cause anxiety and panic attacks in some people, as well as discounting larger actual risks from more contagious STDs.

7. Abortion has different meanings to different women, and different meanings before and after an abortion. Some women regard abortion as simply a medical procedure, and other women see more profound meaning in abortions, and some women change their beliefs about abortion after their experiences with them.

8. Women underestimate the risks to their fertility of waiting to have children past age 35, most do not know that fertility declines dramatically after age 35, and that fertility technology is very limited in its ability to help women and also very expensive.

These topics can be addressed in both research and in practice.

In research, these topics are neglected, but only to the extent that many women's health and sexual health issues are. When raised in the right way, my experience is that almost everyone considers these to be legitimate arguments and subjects of study.

In practice, it may be another story. It is true that some of these issues are not well-disseminated, but lots of research isn't. People are woefully ignorant about their own health, and the surprise isn't that some issues are neglected, it is that some concerns manage to rise to the top. The concerns she mentions that young adults are highly aware of are weight control, cholesterol, and osteoporosis. The motivation for the the first is immediate self-interest, knowledge about cholesterol comes via middle-aged men, and I'm not sure the third is a concern college students are aware of, but to the extent that they are, their knowledge comes via middle-aged women and grandparents with brittle bones. STDs are hidden and stigmatized and can't be as salient to young adults.

Another problem is that so frequently these discussions are politicized. Many have a suspicion of anything that might turn out to be the socially conservative version of political correctness. It seems to me that in the current administration, this suspicion is more than justified. I've heard from a few different people that the administration has made appointments even at low levels to enforce their socially conservative PC (SCPC). One example went down to the same semantic pickiness that liberal PC is mocked for: the appointee ensured that the term "prostitution" was used instead "commercial sex work," and even those who found the former term offensively pejorative were pressured into using the term. Since the liberals were underdogs in this and many other situations, it seems highly sensible that they would resist what they perceive as SCPC infiltration.

Reasons besides politics why each concern is not disseminated adequately are worth exploring, and I may do that.

I hope that in the future administration, we can move past these political divisions and actually work constructively together to solve these real problems, first by disseminating the existing evidence and then by doing new work. It may be simply an issue of framing issues the right way, and unfortunately this book does nothing to help its own cause.

Free wedding for abstinence

Contest for a free $10,000 wedding to a couple in the Atlanta area if they agree not to have premarital sex, or at least that they shouldn't have premarital sex, serve alcohol at the wedding, and open the wedding to up to 100 members of the public, but they haven't had any entries. I wonder how much the no alcohol at the wedding rule is what is holding people back from entering, or allowing random guests, or if 10,000 isn't enough to have a good wedding anymore especially with 100 extra guests.

Thursday, October 16, 2008

Size, metric and English

Finally, a condom that is also a ruler. Condometric come in both metric and English units.

Teen sex by teens

How to talk to kids about sex on a 2007 This American Life's episode called "How to Talk to Kids". The teens interviewed for the episode give just two tips --- give facts and attempt to talk to your kids --- and also acknowledge that it's an inherently awkward situation. A mother narrates her experience reacting to her teenager's revelation that she has had sex.

They feature this website by teens teaching each other about sex which was started because adults gave unhelpful information.

Friday, October 3, 2008

"If I was willing to settle for sex without commitment, I'd get a hotter guy!"

I wonder if anyone has actually used that line. I ran across it on, an abstinence site sponsored by the Orthodox Union that started in spring 2007.

Friday, September 26, 2008

Do virginity pledgers feel hip?

Somehow the financial markets are stealing attention from sex education, so the only article on abstinence today is from the Marietta College newspaper. The editorialist begins by combatting some stereotypes about pledgers:

[P]eople who choose to remain abstinent aren't always considered the most fun. Sure, they're great to take home to meet Mom and Dad, but they're probably not the people you'd want to go out with on Saturday night... But maybe, just maybe, the people choosing to wait for sex are actually smarter than they're given credit for.

"Virginity pledgers: they're smarter than you think"? (Never mind smart is not the opposite of fun. The stupid and boring are so unfortunate, but they do exist.) She also mentions the Silver Ring Thing as if it is new, when it's had hundreds of thousands of participants over several years. And a (successful) ACLU lawsuit against its receipt of federal funds.

The virginity pledge movement was designed to give a hip new face to virginity. The new chic for virginity has had fantastic mainstream media exposure, including a front page article in the NY Times's Sunday Style section in 1994, a year after the first virginity pledges. Evangelical music is now taken seriously by music journalists, and there are evangelical Christian rock music festivals and hipster magazines. A secular journalist who explored evangelical youth culture found it reasonably compelling, as she wrote in her book, which is an evangelical version of the chassidic Boychiks in the Hood. There are even reasonably sex-positive, non-sexist dating books for evangelical young adults that make the realistic assumption that many of them are having sex, reviewed in this blog a few months ago. And parody rap songs, like my personal favorite Baby Got Book.

Evangelical youth culture seems vibrant and fun even to skeptical on-lookers, so it is surprising to me that would someone who (I'm guessing) favors virginity pledges feel the need to defend pledgers, and defend them so faintly. This editorial may be exceptional, but I wonder if it's an indication that evangelical youth culture isn't well-disseminated, or if it doesn't reach its goal of instilling confidence in evangelicals that their culture is fun and viable. As large as the evangelical youth population is, the creative class which creates the culture is obviously much smaller than the mainstream media and I'm sure many have day jobs, so they just can't be even close to as prolific in producing quality films, music, and TV shows. (Are there any hip evangelical TV shows?) Baby Got Book is 4 years old (according to the copyright on the official youtube version), and as one commenter says, their camp plays it constantly, so they almost have it memorized.

Evangelical youth culture won't lure adolescents simply on hipness and some adolescents will be religious even if they do feel stodgy, but those on the border may need to be convinced that they aren't missing out on fun. The editorial indicates that --- questions of adolescent libido aside --- virginity pledgers have a stodgy (but smart) image in the view of the editorialist.

Is this view more widespread?

Friday, September 19, 2008

Why faith-based marathon training might delay teen sex

I was half-joking in my previous post when I said that marathon training might delay teen sex more than abstinence programs. Of course, that would not hard to do because the definitive study of abstinence programs finds they don't delay teen sex at all.

Marathons fit in with the question of how people who don't intend to run marathons admire those who do, and I wasn't thinking about it as a potential intervention. The reason marathon training might delay teen sex is that the studies by the National Campaign to Reduce Teen Pregnancy show that comprehensive lifestyle programs are the most effective programs of all: these are the programs which involve the adolescents in some kind of activity, improve support systems, and take a lot of time.

The half-joking reasons why marathon training might delay teen sex are that they will be too tired and scheduled to find a partner and find time alone with the partner. But in the ideal case, first, it could create a close-knit and supportive group that meets regularly for long periods of time, so the group will reinforce its norms more strongly than a more loose group. Second, setting a high goal and working towards it may raise participants' self-efficacy, the confidence that they can accomplish their goals in general. Self-efficacy may be particularly important in the case of religious teens that have sex even though they think they shouldn't. Third, working towards a big goal may make that goal more salient in their minds, and may make sex slightly less salient. The endorphins wouldn't hurt. Plus, as one commenter said, maybe it would delay puberty, though I'm not sure if marathon training is safe so young.

This is assuming the maximal best case where all of the participants are super into the idea. Obviously in the real world, most would drop out, and only the most risk-seeking kids would stay in the program so it would be hard to find the right control group to test whether it works.

Casual team sports take up some time, but might not have enough intensity to raise participants' self-efficacy.

Friday, September 12, 2008

Abstinence at MTV music awards

This article came through my Google keywords, originally from a pro-life website:

Jordin Sparks, last year's American Idol winner, has high standards and at this year's MTV video music awards (VMA), she fearlessly made them public...

The host of the VMAs, Russell Brand, a British comedian ... took shots at the Jonas Brothers, a group of three brothers who are well known in the entertainment industry for wearing chastity rings and for being vocal advocates of premarital chastity.

"I'd take it a little more seriously if they'd wear it on their genitals," said Brand about the boys' promise rings. Brand then joked that the brothers' decision not to have sex before marriage was "a little bit ungrateful because they could have sex with any woman they want. That is like Superman deciding not to fly and go everywhere on a bus."

A few minutes later, however, Sparks shot back from the podium: "I just have one thing to say about promise rings. It's not bad to wear a promise ring, because not everybody - guy or girl - wants to be a slut."


Sparks comment at the VMA's was met with an audible cheer from the crowd and elicited a sheepish apology from the show's host.

"I didn't mean to take it lightly," Brand said about purity rings. "I don't want to piss off teenage fans."

However, Brand could not resist a parting shot, observing that, while he supported chastity rings, "a bit of sex, it never hurt anybody."

The editorializing makes it not a strict news story, so it has to be taken with a grain of salt. Assuming that the facts about who said what are correct, though, I think it's interesting that the host made the second remark about abstinence. If the article is accurate, it comes off as a little defensive.

Before I comment, I want to be clear that taxpayer-funded public policy and individuals' personal choices are separate issues. Public policy has to be evidence-based and so far the evidence for abstinence education and virginity pledges is simply not there. Even if there were evidence, it is unprecedented and contrary to conservative political thought for the federal government to promote a specific curriculum.

Individual choices to deny themselves are often applauded, even by people making different choices: so many times I've heard people sincerely say to a vegan or marathoner, "Wow, I could never do that." Even if they don't personally see the value of veganism or marathoning, per se, many people want to eat less meat or get more exercise. And just as an interpersonal issue, it's nice to tell someone that you value their choices.

Sexual abstinence seems like it should be similar. Even people who don't believe in premarital abstinence have been in situations requiring sexual restraint --- being in any committed relationship or avoiding a relationship with an inappropriate partner --- so disparaging remarks like this really puzzle me.

You can admire marathoners while opposing federal grants to marathon-training programs. Though, completely seriously, marathon-training programs could be more effective in delaying adolescent sexual initiation than abstinence, or perhaps any classroom curriculum.

Where are all the church-sponsored adolescent running groups?

Monday, September 8, 2008

Palin supports abstinence-plus, but doesn't call it that

The LA Times reports that Sarah Palin supports teaching condoms in sex ed. Although she declared herself to be a supporter of abstinence-only sex education, Palin said during a debate in 2006, "I'm pro-contraception, and I think kids who may not hear about it at home should hear about it in other avenues."

The political orthodoxy is that teaching any contraception cancels out any message of abstinence (e.g., the Abstinence Clearinghouse's statement in the article), but Palin seems not to believe that. It's possible for a conservative Evangelical Christian to agree that it's important to make sure all kids have accurate information about contraception.

Much has been made of the "small town values" and "common sense values" discussed during the Republican convention (see the third segment of Friday's Daily Show for an attempt to define them).

Is it possible that one of the "common sense values" is a pragmatism about the limits of values in affecting behavior?

Thursday, August 21, 2008

Short abstinence updates

Catching up on some of the abstinence news while I was away:

1. A WSJ article tells of a teen vampire series with a large and burgeoning readership enraptured with the characters' intense restrained abstinent romance. The WSJ review of the actual book, however, is skeptical: "The most devoted readers will no doubt try to make excuses for this botched novel, but [author Stephanie] Meyer has put a stake through the heart of her own beloved creation."

2. Abstinence is not merely not-having-sex, but is apparently seen by some teensas a step towards having sex. Before sex is salient, not having sex is the default, and there's no thought of doing otherwise. Abstinence doesn't become a conscious choice until sex is an actual possibility. How this should change abstinence-focussed sex ed is a good question.

A new online sex ed campaign

The Portland Oregon Planned Parenthood created a new campaign for teens which manages to be both informative and dripping with irony. Or perhaps I am overinterpeting the irony.

It amplifies the weird stilted moments of any sex ed video where a creepily earnest adult pops up, uses overly slangy and very dated slang, and creates what any normal teen would find an uncomfortable moment. In the usual sex ed videos in my experience, the teens seem unfazed and take in the information. In this one, they just look uncomfortable, and in some cases walk away. These are more over the top than the usual ones, but also might feel more genuine because of that especially because the kids are responding as real kids would if a sex ed video inserted itself into their lives. An example of an overly stilted moment: in the abstinence episode, a girl (who in a past episode was afraid she had an STD) tells her friends that she can't go to a party because she plans to spend the night masturbating.

Tuesday, August 5, 2008

Dating as casual sex

An interesting piece in Salon purports to be ``In defense of casual sex.'' In fact, it is a defense of dating widely, the old-fashioned form of dating. For instance, this book advocates that its evangelical audience should date as many people as possible, even people they would never picture themselves marrying such as the secular, in order to learn about themselves and their relationships.

The only difference between the Salon author's dating and the old-fashioned version is how the date ends.

The Salon author acknowledges both versions of dating as valid, but thinks that people should be able to choose which path they take. She says that the abstinence movement "prescribes a particular path, rather than encouraging young women to blaze their own trail." which is a weird criticism of a conservative religious movement, which by its nature prescribes and proscribes. That's its job. Congregants can choose whether to listen --- as in the case of Catholics and birth control --- but a conservative religious movement by its very nature would never endorse fully open choice about anything.

Her premise that the abstinence movement is a unitary entity with a single path is also wrong, just as conservative religious movements' sweeping criticisms of "secular culture" as if it were a single entity. Our culture is just so divided that the two sides aren't aware of each other.

A sociologist studying dating among evangelical Christian young adults could probably find half a dozen legitimized paths towards marriage, ranging from courtship to wide dating with some sexual involvement. More importantly, they would also find another half a dozen of actual paths that people take, and I'm sure some are similar to the Salon author's path. Sexually active conservative Christians have had a handful of sexual partners by the time they finish college, and the handful of conservative Christian dating books that I've read all acknowledge that. I've seen none that speak of using sex as a carrot, though I don't deny they exist; they do speak of setting sexual boundaries as an exercise that will help in maintaining a marriage.

There's very little new to be said about dating and relationships, and much shared ground, as people would know if they would talk to each other. After acknowledging the shared ground, they can talk about the differences. The conservative authors already acknowledge that they are putting young adults in a difficult position, and that many young adults don't hold to the ideal. In this theoretical conversation, the parties could talk about whether more partners or more intimate relationships are better for developing one's sexuality, whether sex takes up time that might be better spent on more varied activities that would reveal more about the relationship, and whether making sex transgressive even though most conservative Christians have premarital sex causes problems.

Ironically, the author's ending is quite conservative, as she ends the article telling how she met her significant other. First-date-sex aside, she lives happily ever after in a monogamous mutually respectful relationship, just as the evangelical dating books want their readers to.

Thursday, July 31, 2008

Abstinence thongs

Finally. More abstinence-themed thongs

Australian abstinence-only controversy: separation of church and state

The abstinence-only sex education (AOSE) movement was started under the early Reagan administration after prompting by the newly-energized Christian right, and expanded as different churches created curricula, most notably the Southern Baptist Conference's True Love Waits program in the early 1990s. AOSE has never, as far as I'm aware, been promoted in a purely secular context, but secular curricula have been written by organizations which are either religious or run by evangelical Christians. The curriculum I'm most aware of is the Catholic church's Pure Love program, which has both secular and religious versions of their virginity pledge.

Apparently, the same is true in Australia --- a pro-abstinence (though not abstinence-only, it sounds like) curriculum originally written by Presbyterian and Baptist churches is taught in some schools, and a member of Parliament is protesting that because the curriculum is more conservative than the beliefs of most Australians (80% of whom approve of abortion choice) and violates requirements that school instruction be secular.

I'm sympathetic to that position, but to play devil's advocate for a moment: is there any such thing as a secular sex ed curriculum? For every sex ed curriculum, there's some religion which would agree with it as their own view. Even a curriculum which says, "Some people believe abstinence before marriage and others believe in saving sex for a relationship with someone you love, but you should make your own decision." is the position of some religion, I would guess UCC and UU have a statement like that in their curricula, for instance.

Something that I would like to see is a source reader with excerpts of essays from a range of religious perspectives: mainline, evangelical, Catholicism, Islam, Judaism. It's a bit meta, but that's what public education is: you learn the positions of religions X, Y and Z on sex, without much discussion about how it applies to life. To prevent it from being too meta, there could be an assignment where adolescents discuss the material with their parents and find out what their parents believe. That's the closest thing you can get to a truly secular curriculum, in my opinion.

It's also much more sophisticated than the standard sex ed books which are written at a middle school grade level even for what's taught in high school. I'm sure that a college level reader like this must exist, though cursory look I haven't found one.

If there were one, what should be in it?

- The theology of the body essays
- Rabbi Eliezer Berkovits's 1976 essay on sexual ethics (in _Essential Essays on Judaism_)
- If it will go into abortion: selections from the Talmud and Maimonides on when abortion is justified. If I recall correctly there are similar in the (Muslim) hadiths, and they reach similar conclusions.

What is the most prominent evangelical writings on sexual decision making? I'm only aware of the popular ones (Lauren Winner, Josh Harris, John Townsend, Doug Rosenau and Michael Wilson).

Other recommendations? Anything good in First Things published lately? What are the leading Muslim essays on the subject? Anything by Eastern Orthodox figures?

What are the more left-wing intellectual essays on sexual ethics? Most of the ones I'm aware of, even by e.g., R Eugene Borowitz the preeminent philosopher in Reform Judaism, are relatively conservative, which makes sense because what leads someone to write on a topic is disagreeing with the prevalent practice in the culture.

To be continued . . .

Abstinence and LBGT students

Critics of abstinence-only sex education note that it doesn't teach any material to help LGBT students understand and feel comfortable with their sexual orientations. One school which teaches AOSE has used this to justify a ban against allowing a student Gay-Straight Alliance to meet in the school, saying "The defendant's club policy is not discriminatory because it legitimately removes an entire subject matter category from its limited public forum, a category the defendant determined poses a risk to student well-being because school students are adolescents who lack the maturity to properly handle the sensitive subject of sexuality."

The school's justification is a funny statement in itself, but particularly so because the issues of a student LGBT club are primarily for psychosocial and even mental health support given the high rates of mental health issues among LBGT adolescents. If they wanted to be smart-asses about pointing out that the club has very little to do with sex, they could properly call the club, "The Gay Suicide- and Runaway- Prevention Club."

At any rate, such a renaming is unnecessary because a federal judge rejected the school's justification, so the one student who wants to revive the club may now do so.

Monday, July 28, 2008

A Catholic Church contraception counterfactual

An op ed from a former Catholic priest on Pope Paul VI's anti-birth control encyclical 40 years ago, and how it might have been different:

In traditional Catholic morality, the nature of a human act, the intention and the circumstances must be all considered in weighing its rightness or wrongness.

But as Pope Paul presented his case, intention and circumstances are irrelevant. The nature of contraception is so heinous, so intrinsically evil that alleviating circumstance and good intention don't count.

We can all acknowledge that contraception is on a different level from, say, killing a human being. Yet killing is an act that may not be determined good or bad until we know intention and circumstances. The placing of absolute judgment on contraception itself—by pill, condom or whatever—raises the bar to a level that seems to many responsible and thoughtful people to be irresponsible.

Killing is not always wrong. But contraception always is?
The problem with Humanae Vitae is rigidity. The pontiff was correct in seeing what strange fruits the revolution would produce, but his cure was as bad or worse than the disease.

He could have acted differently. He could have said that the world is facing an unprecedented challenge in human history that requires careful study and expert inquiry. He could have said that selfish, non-generative lifestyles are not acceptable, that thoughtless contraception cheapens sex, that circumstances count very much and that people have an obligation to weigh carefully what they do.

He could even have praised the values of natural family planning. He could have become a respected conversant among national and world bodies seeking credible answers. But because of the absolute ban, popes, bishops and theologians have had little to offer except a repeated no, no, never!

Church leadership left the table 40 years ago, painting itself into this corner.

Within the church itself the saddest byproduct is what has been happening to its membership. Many parents of the 1960s retained an overall confidence in the church while dissenting on the contraception issue. Their children widened the sense of separation, and the grandchildren may not even realize there ever was a religious institution that had wisdom and a sense of real community to share.

I've never known very much about Catholicism, so I've never thought that the pope's decision on contraception could have been any different from how it was. Many religions have confronted issues of modernity, especially sexual, with barriers rather than moderation. The possibility that the Catholic response could have been more moderate raises the question of whether the American political landscape and even other religions' stances might have also been more nuanced.

On the other hand, an issue that the author does not consider is that as a religious policy issue, people are generally not very good at moderation. Moderation can be interpreted as outright acceptance.

So on one hand, the religious authorities can decide to maintain credibility by proclaiming a moderate position, but risking that the public would be too liberal with the position. Or the religious authorities can risk losing credibility with the public by proclaiming a clear-cut ban. If the religion's major objective is to ensure that people follow the law, is it possible that there might be more compliance in the first scenario? As much as I would like to say that there would be more compliance under a liberal stance, I don't have any information that would lead me to conclude one way or the other. Obviously the solution is that in cases where the religious authorities just want a specific outcome, they should conduct randomized policy experiments before they decide on religious law. It's a pipedream, I know, but I'm mostly serious. Many religious decisions turn on predicting outcomes that are unknowable without formal study.

Wednesday, July 16, 2008

Shutting down dialog happens in both directions

The cases where people suggesting condoms as STD prevention are shouted down and find themselves in a hostile environment are well known. It also happens the other way, apparently: a story from Uganda about a 16 year old mocked for being pro-abstinence.

DURING a high school classroom discussion on HIV/AIDS prevention, the teacher asked the students: “What can be done to stop the spread of this fatal disease?” Some students talked about condoms and received the knowing affirmation of the teacher.

However when James, 16, raised his hand and answered: “We must promote and support young people to abstain until marriage,” he was attacked and stigmatised!

The teacher laughed derisively and mockingly told him, “Abstinence does not work for young people. It is just a dream.” James, who had chosen to abstain from sex after an abstinence presentation in Grade Eight, felt ashamed but he knew better. Other students began to mock and sneer at him. Again, James raised his hand and tried to explain how he had made the choice to abstain till marriage. “For some of us,” he said, “abstinence is not a dream, it is a present reality.”

The comments of the teacher had already created a hostile environment for James, and now he became the butt of the class jokes. Subsequently, James was mockingly labelled stereotype names ranging from “little mamas boy,” “ignorant kid”, “holy pope”, “virgin Mary” to “you are so ugly, that’s why you can't get any.” As if bent on breaking his will, two girls approached him and sarcastically told him they wanted to cure him of this dreaded disease called virginity. They recited stories of people who abstained and their genitals withered and fell off and that he was a good for nothing boy. They then walked away laughing.

Their use of gay pride terminology is perhaps unintentionally ironic:

Children who abstain are forced to survive shame and psychological violence by hiding in the “closet.” They are treated as lepers, social outcasts whose virginity is not a badge of pride, but rather a mark of disgrace. This is what I call “abstinence stigma.” While many parents teach their children the value of abstinence and saving sex for marriage, they are un-aware that the social contexts where young people make informed decisions about sex are contaminated with hostile and judgmental attitudes towards abstinence. It is a form of phobia.

Those who promote the fear of abstinence and virginity should be referred to as “abstino-phobes.” The word abstinophobia can aptly convey the irrational fear and discrimination meted out on the children who choose to abstain.

Paradoxically, while popular culture seeks to celebrate diversity, the only children who must go into the closet of shame are the “virgin and the abstainers.” Who will break the doors of this closet and tell these children to “break the shame” and walk in the abstinence pride?

We need to break the chains of “abstino-phobia” with campaigns of breaking the silence. We need school-based safe spaces of small groups where young people can meet for support without fear and stigma.

We need large school rallies where those who are in the abstinence closet of shame can come out loud and proud.

I've heard other anecdotes from young adults and even adults who received negative reactions or simple bafflement after their lack of sexual experience was revealed. Bias and stigma does go in both directions.

Tuesday, July 15, 2008

How to communicate weight loss messages to patients

A college friend of mine wrote in her live journal about her reaction to a doctor's initiation of the topic of weight at an appointment she had to address a recent injury. The doctor's approach seemed to be attempting to be non-intrusive: she gave a neutral factual statement that my friend looked from a picture like she used to be lighter. What happened next was interpreted as my friend as "asking if I knew I was going to DIE OF THE FAT."

Clearly something went wrong here in the immediate clinical encounter. Probably the doctor should have sensed from the conversation that my friend wasn't terribly open to discussing the subject and found it intrusive, especially since weight was completely irrelevant to the purpose of the appointment. If the doctor didn't want to just let the subject drop, she could have at most asked neutrally how she felt about that difference, and let it drop when my friend said that she felt fine.

But there's a larger question: how do physicians manage to acknowledge fat acceptance, but also send a message of obesity prevention?

Contrary to the blog comments, research is clear that on average mortality increases monotonically with BMI. Walt Willett's book has some nice plots of this. Fertility decreases monotonically with BMI. Even if recent research showing mortality improvements for some diseases in the BMI range 25 to 29 is completely free of confounding, so it's the weight which is associated with the decreased mortality rather than another factor that wasn't adequately adjusted for, it's only for a few of the evaluated diseases and mortality is much higher for BMI over 30.

Not to belabor the obvious, but these studies can only be refuted by studies of similar validity. They're not a massive conspiracy against anyone. They're just what the data revealed. Anyone who wants to reexamine the data to find a better explanation or find deemphasized null findings within the reports is free to do so, but so far no one has. And it's not impossible. See this reexamination of Framingham Heart Data on diet and cholesterol.

Anecdotes about outliers are just that. The studies hold on average, and while no one likes to think of themselves as average, all of us are average in most domains of life.

How can the overriding medical evidence be communicated in this sensitive way? I don't know, but here are some stabs at some of the issues:

- Many people feel powerless to change their weight, or feel that only heroic efforts can be successful. There does seem to be such a thing as a weight setpoint which is clearly resistant to change, see e.g. Gina Kolata's book.

- If it's not possible to change weight and live one's life in what one feels as a reasonable way, it makes a great deal of sense to accept weight as a given, and to see messages about overweight as taunting from people who just don't understand. Especially since sometimes they are.

- A never-overweight person sees their entire relationship with food, hunger, meals, clothes, and society completely differently and may therefore say stupid things like "Just lose weight," when it's anything but "just." Even the statements like "even 10 pounds makes a difference" while well-intentioned don't entirely help. One of the nicest but perennially thin people I know once said, "you're not that fat."

- It's not that easy, but it's usually not impossible either. In the spirit of self-discovery and self-experimentation while attaching no emotional weight to the results, people can design tests of the many approaches to food and diet, a few weeks long for each, to see whether anything changes their relationship to food or their weight.

And there are so many: beyond the obvious popular ones, the support-group types, there's the most kooky-seeming and yet potentially most profound by Berkeley psychology professor Seth Roberts.

-Logically, of course, it's not possible to prove a negative; it's not possible for people to prove what they perceive as reality that "weight loss is impossible for me" or "weight loss is only possible for me at an unacceptably high physical or emotional cost." But honestly these questions of obesity prevention and fat acceptance have such high emotional content on both sides that it's hard to say that there's much logic left.

No answers here, but maybe useful questions come out of it.

Tuesday, July 8, 2008

The ultimate in the because-I-think-you-need-it present

The CDC has created unintentionally funny health-themed greeting cards, such as:

- What have you been up to since your last HIV test? --- Let's go get tested again!

- Feel better from your surgery --- and walk around soon afterwards, so you don't get Deep Vein Thrombosis

- Don't just "Wait and See"! --- Just because a sore is painless and disappears doesn't mean that the disease is gone. Get tested for Syphilis today.

Is there any way to make a health-themed greeting card which does not seem preachy?

At least they had the good sense not to make "obesity awareness" greeting cards.

Monday, July 7, 2008

Wrong number

Last night I went on a second date with someone.

The next morning at 6:45, I was sitting down to breakfast and had just finished a reprint of the NYT article about need for Orthodox Jews to be more open about sex, and the phone rings. I run to get it.

Guy, sounding a bit muffled for the entire conversation and at times inaudible: "Hi. How are you doing?"

Me, assuming it was my date: "Pretty good. You're up early."

We exchange the usual generic preliminaries. I had been in the kitchen preparing to put breakfast together, but went into my room and sat on my bed to avoid waking up my roommate.

Guy: "It sounds like you're still in bed."

Me: "I've been up for awhile. I was just preparing breakfast, but went back to my room to talk to you."

Guy: "I really wish I could be there with you and hold you. Are you dressed? What are you wearing?"

Me, thinking that this seemed pretty premature: "I'm not dressed yet. I'm thinking about going jogging, so dressed for that."

Guy, wistfully: "Do you want to run together? I'll come over."

Me, thinking doesn't he have to get to work?: "Well, I don't run very fast. I think you'd be disappointed."

Guy: "But we could run together holding hands... Say something sweet."

Me: "Chocolate. Popsicles."

Guy: "Something sweeter."

Me: "Um, .... I can't perform on cue. Aren't the sweetest things the things that come up spontaneously? Anyhow, I didn't peg you for being such an early riser."

Guy: "I just missed you."

Me, thinking it's been less than 8 hours and wondering whether I would hear from this guy every 8 hours from now on: "Um, I missed you too. So, shall we get together later this week?"

Guy: "Wait, is this Shira [not the name he used]?"

Me: "Shira?" My first thought was that my second date was seeing other people, which is totally reasonable, but how tacky after the conversation.

He gets embarrassed as we figure out it's a wrong number. He tells me his name, say Yonatan. I give my full name, first and last. I explain that I thought he was last night date, and somehow he asks me if I'm religious, and how religious. We establish that we're both observant Jews. In spite of the confusion somehow it was a comfortable conversation and this being a huge coincidence, it is the kind of thing which is always billed as fate (I've heard at least one wrong number story where they ended up getting married), so he feels the need to add, "But I have a girlfriend." Obviously. We exchange sociological affiliations, high school, synagogue, grew up where, which yeshiva in Israel, etc., and establish how this mistake happened. I'd never heard of his synagogue, high school, or Israel yeshiva, so I assume that they are black hat (yeshivish).

I'm ready to hang up, but somehow it feels momentous that we had this phone call, and maybe we should keep in touch, though that would be ridiculous, so I settled for saying that I'm sure we would see each other around given how small the world evidently is.

But he asks my advice what to get as a gift for his girlfriend for her birthday. She's just-out-of-college age from a very religious background, and he's a few years older, and they've been together 2 years. He remarks on the irony that she's from a much more religious background, but rebelled a lot more than he did, and I ask if it's really an irony.

I ask why they don't get married already: 2 years is a long time, and honestly I'm a bit afraid for her that the relationship will drag on and break up and she'll lose the time. Her family wants her to marry someone more religious, and continues to set her up with more religious guys. It's unclear whether her family knows about him, but she apparently isn't willing to go against them at this point, or maybe she doesn't feel that it's necessary to think about marriage yet. Around her family, she adheres to the standard dress code, but in other circumstances she wears pants (normally not worn except among the most liberal Orthodox), and her roommates think she is with relatives when she is staying over at his place. He says dreamily, "It's so nice just to spend the night together, just kissing and holding each other, nothing else."

We have a generic conversation about gift ideas, almost anything he gets her she'll love etc etc, somewhere in the middle of which he says she wants to be shocked and he wants to get her something "shocking, sexy and fun."

"Sexy" seemed like a funny word to use --- obviously he and his girlfriend were somewhat intimate, but I had no idea how much. I was thinking of recommending one of the women-owned sex shops in NY, but didn't want to make any assumptions, so I asked what he meant by "sexy."

He tells me that they're going upstate for her birthday, and I exclaimed what a wonderful birthday present that was, but apparently he has to get her something in addition. He says he's also worried about spending shabbat in the hotel because of electricity is prohibited on shabbat, and that brings questions about the TV (don't turn it on?) and electric beds (?!). I suggested he bring a timer for the lights (he joked maybe they should just have the lights off the whole time), and added that if he's really concerned about the electric locks, in a pinch he has what to rely on to use electric locks on shabbat, but obviously other key options are better. After we talk a bit about the keys, he adds, "Will this rabbi say it's okay to make as much love as we want?"

I said that I didn't think that was likely, but some rabbis are accommodating about premarital sex using the mikvah, following usual procedure of married couples.

He says, "The thing is, we've done everything and anything. Everything! But not the act itself. And now we're planning to do the act while we're away."

I ask about protection, and he responds immediately, "Birth control or condom. We haven't decided yet. She doesn't want to use a condom because she wants to feel [incomprehensible]." I get worried, but apparently she started the pill awhile ago in anticipation, so they're safe.

I repeat the textbook line about condoms always being a good idea just in case and to get into the habit, although in this case, it seems unlikely that they're likely to have sex with other people --- it's already a big deal with each other after 2 years of dating. I think about mentioning UTI risk, but don't.

We talk about mikvah and premarital sex, and what different people do. He's been resigned that premarital sex was wrong, ans they decided they were going to break the law, and there was nothing to do about it. He knew that it was better for his girlfriend to go to the mikvah, but the force of the social stigma against premarital sex was so strong that he was willing to do a huge sin rather than violate the social norms. This is unusual, so I'm going to repeat it: he clearly cares about the religion, but he was willing to pick the worse option religiously rather than violate a social norm.

When we think about other religions that ban premarital sex, they can't mitigate it. In Judaism, everyone agrees sex without following the ritual laws involving mikvah is a huge sin, at least as bad as eating on Yom Kippur; premarital sex following the mikvah laws is more murky, but almost everyone will agree that using the mikvah for premarital sex is better than not using the mikvah for premarital sex, and there's a substantial opinion that it's negligibly wrong compared with the alternative.

He was amazed that people talk about religiously reasonable ways to have premarital sex, and I gave him some tips on ways to get around the social issues (i.e., not going to a formal mikvah, but instead using a body of natural water, even with a bathing suit (, but ultimately it's a matter of conscience how much to keep the laws.

He seemed happy to bring his actions a bit closer to Jewish law since that's the usual framework he's working in, but then he realizes that if they're going to have sex for the first time, and follow the Jewish law, they can't have sex again for 7 days, which uses up the time that they have upstate. He really wants the first time to be special. I break the news that of course the first time is special for being the first time, but it tends to last 30 or maybe 90 seconds, and it's only on the second time that couples start to figure everything out. That seems to sober him: if he's going to think about keeping the laws, having sex for the first time will last a very short time and then they won't be able to have sex again for the rest of the vacation, so the vacation can't be so momentous.

He tells me how much he loves her, and from his tone at the beginning of the conversation, it was clear, so again I asked about marriage. We talk some more about the possibilities, and the fact that sometimes people keep the laws and sometimes not. He says he'd like to be more religious; as excited at the prospect of having sex he sounded, he even sounds a little relieved about the idea of marriage, but he's not sure she would be for it. (He didn't say why: liberals would say it's because he doesn't want to sneak around anymore and this is the only way he saw not to sneak around; religious would say that he want to do the right thing; my guess is a bit of both.)

In the end, it sounds like he decided not to have sex and maybe to think more about marriage. It's not clear.

"I have one final question. But I'm too embarrassed."

"It's okay." We go back and forth a bit, with lots of silence on my end to give him space to ask the question before I add, "If you have any further questions, please feel free to call, or I can give you my email address. You can send a question by email if you prefer." It was probably a bit much for him to anchor the conversation more in the real world, so he asked me to hold on and the line went dead.

The conversation lasted half an hour. Presumably he has my number, but I'm sure that's the last I'll ever hear from him. So many times he said, "I can't believe we're having this conversation." Neither could I.

My reactions:

1. What a coincidence that out of all the phone numbers in my city, he reaches someone who speaks a religious language he recognizes, who had personal circumstances such that the first few minutes of the conversation were able to turn into a longer conversation, who at that very moment had just been reading the next page of the newspaper which was about premarital sex among Orthodox Jews, and who was open to having a balanced discussion about the big problem weighing on his mind.

2. Her family likely has no idea how little control they have anymore. They think that they can constrain her marriage choices, but in fact they're just delegitmizing marriage and making it more likely that their daughter is going to have substantial not-leading-to-marriage relationships.

Religious groups lament decline of marriage, and wonder why. In this case, it seems pretty clear. Here the family probably feels more religious pressure than they would have felt in the past to adhere strongly to ever-stricter social norms, so they pressure their daughter, probably about trivial issues. The daughter lives in a different city than her family and has enough autonomy to pursue this relationship, but it takes a real act of courage to stand up to them for a more public issue like marriage, especially given that she doesn't feel any real pressure to get married right then.

3. This guy so clearly wants to do the religiously acceptable thing, but he is also feeling constrained by social norms . He of course wants to have sex, and he was quite proud emphasizing the Everything! they had done prior to this, but he is not too impatient to wait for marriage. I was saying pretty radical things about how it's not unreasonable to have premarital sex with mikvah, so I probably did not prompt his self-presentation instinct to kick in. I think he really did seem to be reconsidering having sex with his girlfriend, and proposing instead.

4. I'm really not primed for early morning counseling. I was groggy and spoke way too much and told him things he already knows. Now that it's afterwards I have so many questions. Perhaps better under the circumstances that I didn't get to ask them.