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.)

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.

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.

hr



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!

Health.com: 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?.

Bloomberg

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.

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
- health.com and maybe cnn.com
- Health News
- Maybe New Scientist of London
- British Medical Journal
- Baltimore Sun
- Chicago Tribune

Yay!

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

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.

"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.