Tuesday, June 30, 2009

Sweden's mandatory sex ed: a social conservative's nightmare

This is what the Evangelicals are afraid of US sex education becoming: mandatory with strawberry-flavored condoms handed out by teachers. The article also notes that tax money subsidizes sex toys sold in state-owned pharmacies.

According to the article, before the legal change "Twenty-seven percent of immigrants’ daughters are kept from participating in some school subjects." That's a large number. Does that mean boys were allowed to go?

Needless to say, the US isn't even close to being like Sweden and would never remove the option for students to opt out. Given the high rates of chlamydia and other STDs among high school students, it would be great to hand out condoms in sex ed classes, but that would never happen and if it did they would be the most boring condoms possible.

Evangelical Christianity and self-selection

Evangelical Christians have the goal that everyone within their fold adhere to norms such as abstinence from premarital sex. Clergy and active congregants adhere to the norms most of the time, but many evangelical teens have sex lives only slightly more conservative than the average American or European teenager. I've long wondered whether the reason for this discrepancy is that evangelical Christianity includes many people who, for whatever reason, are unlikely to adhere to all the norms.

Comparing religions can only be done in the spirit of "All models are wrong, but some are useful", so with that in mind I thought about religious self-selection in the context of some youtube videos making their way around some progressive Jewish blogs with enthusiasm and modern Orthodox blogs with hesitant, tepid approval, apparently spurred by an article in the Forward, a US Jewish newspaper.

This is a fantastic video of a secular Israeli girl band called "Woman of Valor" (Prov. 31) singing "Open our eyes to your Torah, cause us to cleave to your commandments, and unite our hearts in love and awe of your name" a line from the liturgy repeated over and over*. They also sing "On the rivers of Babylon" (Psalm 137) and "The angel who saved me" (Genesis 48). In the US, I would guess that this would be fairly standard evangelical Christian popular music, but in Israel it is Tel Aviv secular, performed at the Gay Pride parade, and so extremely exciting and outrageous**.

If the evangelicals are including the equivalent of the Tel Aviv secular who obviously connect to some aspect of the Bible and yet for whatever reason are not interested in some of the religious norms, programs like virginity pledges may reach only the Jerusalem religious who would abstain anyhow.


(*) It begins "That we shouldn't ever be bashful or ashamed or stumble." There's also a rap segment in the middle that isn't a text also about connecting with the divine.

(**) Comments on the video are outraged. My translation of some of them:
- If they really believed what they sung, they would dress differently and they wouldn't dance like that and they would seem even slightly like daughters of Israel. G-d should have mercy on us, what a desecration of G-d's name.

- When someone sings to open our eyes to your Torah and be caused to cleave to your commandments when she is, pardon me, half naked is really not respectful. It's like going to the synagogue to pray in a bathing suit. Does that seem right? It's like the Maimonides's example of going into a ritual bath holding an impure reptile, doing something good but in an improper manner.

- I don't understand the connection between the meaning of the text and the clothing. They say they want to be open to G-d's commandments and they are not fully dressed.

Monday, June 29, 2009

Funding transformative research

NY Times article on conservatism in science funding. To add to the chorus: it's not curing cancer or anything, but my virginity pledge research would have probably not gotten funded by NIH. I didn't expect to find that virginity pledgers would lie about having had sex, so I wouldn't have known to look for that and I wouldn't have been able to write a proper research proposal to do that.

Friday, June 26, 2009

Congratulations to North Carolina

North Carolina passed a bill mandating that 7-9th graders be taught both abstinence methods of contraception and STD prevention, and the governor is expected to sign it. This bill is different than the original proposed, which had required that all schools offer two sex ed classes that parents would choose between. This bill just allows parents to pull their children from the STD/pregnancy prevention portion of the class.

The current policy for the past 15 years has been that school districts that wish to teach birth control in school must go through a separate approval process to be able to teach birth control.

It is sad that no Republicans voted for the bill. I wonder whether there is any compromise legislation or any research that would convince Republicans to allow teaching birth control in schools.

The evidence from RAND's intervention to teach parents how to teach sex education to their adolescents finds that even with an 8 week program for these parents who volunteered to participate, the majority of parents STILL didn't teach their kids how to use condoms. And this is a group of parents cherry-picked for their motivation. Other parents would likely do worse. No matter what your ideals are about parents' duties towards their adolescents, the reality seems to be that if you want condom use to be taught, you have to put it in the schools. Or let them learn on youtube or in an STD clinic waiting room. Watching instructional videos in the waiting room of an STD clinic reduces the risk of repeat visits, after all.

Tuesday, June 23, 2009

Reformulating or rebranding abstinence

There's a vivid and interesting piece in the Nation about the abstinence movement's attempt to rebrand/reformulate itself. At times, I laughed: Jessica Valenti writes dynamically and compellingly. She raises some important points, though I don't agree with everything she says. (E.g., I think that the trend of traditional religions using feminism to promote traditionalism is complex and subtle. Her take is that "the virginity movement is ... a targeted and well-funded backlash hellbent on rolling back women's rights using modernized notions of purity, morality and sexuality.")

The central point of her article is crucial: the abstinence movement recognizes that it needs to give accurate information about contraception, which I see as a terrific coup for the cause of scientific accuracy. Perhaps the reformulation is being done with good will: they see problems with current version and honestly they want to make it better for the sake of teens' health. Or perhaps Valenti is right and this recognition is just lip service and won't change what they are actually doing, though even lip service is good.

Whether reformulation or rebranding, this change calls for vigilance. The abstinence-only movement is taking the "only" out of their label: now it's "abstinence centered" which is confusingly similar to "abstinence-plus" or "abstinence-based" which mean comprehensive sex education, so it will take an extra moment to even determine whether a curriculum intends to be comprehensive or not.

If there are inaccuracies in the new curricula, they may be more subtle. The most productive thing reproductive health community can do is make sure that what is taught in schools is accurate. Some states mandate that all sex education gets reviewed by clinicians for accuracy, but others don't. If all states established such requirements of review by medical experts, that would make it a moot point whether the abstinence movement is doing a cynical rebranding or a good will reformulation of its movement.

Utah's sex education

Utah is considering new sex education approaches. They recently changed their sex education laws to allow teaching of contraception in school sex education classes, but teachers are still apparently afraid of saying the wrong thing and getting fired, so the new sex education law is aimed at mandating teaching contraception. The Salt Lake Tribune editorial board endorsed the bill.

I spoke with a group that is helping out the legislature about ways to bridge the ever-present gap between conservative and liberal views of sex education: conservatives are afraid that teaching contraception encourages kids to have sex, and they were confused that some programs that teach birth control actually cause kids to DELAY sex. The most obvious explanation, of course, is that teens are terrific detectors of propaganda. They want to make their own decision, but they need to be given the autonomy to do so, not just told what to do. As everyone knows, to order a teen to do something without giving them alternatives risks losing the chance to influence them at all.

I also suggested that they include parents in the sex education curriculum somehow, such as through take-home assignments that adolescents complete with their parents. It's a good idea to get parents and adolescents talking about sex, and it may reassure conservatives that the role of schools and parents in sex education is complementary.

I'm excited to see what happens. Utah!

Meanwhile, Oregon just passed a new sex education bill that requires that all abstinence sex education must also include "other material and instruction on contraceptive and disease reduction measures."

Decreased contraceptive use among teens

I was pleased that the NYT editorial board highlighted the recent study by John Santelli, Mark Orr, Laura Lindberg, and Daniela Diaz about decreased use of contraception in an analysis of the Youth Risk Behavior Survey. As the media reports it, Santelli and collaborators found that fewer teens are using contraception than previous highs a few years ago, and the speculation is that the decrease is from abstinence-only sex education.

Other research certainly indicates that abstinence is one plausible explanation for the decrease in contraceptive use. The trouble is that there are many other possible explanations, but the trend data on teen sexual decisions is so poor that we'll never know which explanation is responsible for this particular decrease in contraception use. The survey used by Santelli has at most a dozen relevant questions, and any information beyond that gets lost to the mists of time.

Some teens get pregnant because they want to. It's not a question of not knowing how to use birth control; they want someone to love them or to establish themselves as adults. Other teens get pregnant because they are in coercive relationships with older men who support them financially --- perhaps especially relevant in insecure economic times --- and the men want babies. I heard a story from a Maryland public school teacher about a 14 year old girl in her class who recently got pregnant because her 20+ year old boyfriend and his mother wanted her to; the boyfriend's mother wants to take care of the baby and the girl's mother is indifferent to the situation.

These stories represent more fundamental social problems than simply inconsistent or incorrect condom use, but the current data is so poor that if one reason for the lower contraceptive use was that more girls are being coerced by older partners to get pregnant, we would have no way of knowing. Such issues of teen pregnancy are not liberal or conservative, but some conservatives are opposed to funding surveys that would collect data to better understand the issues because they are uneasy about asking questions about sex to teenagers. If they could better understand the implications of their opposition, and what a good investment it would be to understand teen pregnancy better by funding an annual survey that monitors issues exclusively relevant to teen pregnancy and STD prevention, perhaps we could start to decrease the rate of teen pregnancy.

MBAs and evangelical teens both take pledges

I was waiting for someone to make this comparison between virginity pledges and the pledges some business schools are offering to help their students not grow up to become Bernie Madoff and the subprime mortgage industry.

Truth be told, we don't know whether pledges and other one-time events affect behavior in general, but the common sense view that character is built slowly and reinforced over time would seem to prevail. We don't have as much knowledge about hidden areas of life such as sex and white collar crime, but we all know that New Year's resolutions can be helpful but not decisive.

The next stage in this comparison I'm still waiting for: a good stand-up routine comparing MBAs and evangelical teens, speculating on how you could do joint events to encourage both not having premarital sex and not becoming white collar criminals.

Friday, June 19, 2009

Forever relevant

A retrospective look at Judy Blume's Forever, a book about a couple's first love and decision to have sex. (The article was published 4 years ago, but is making the rounds again through reproductive health blogs.)

What the article does not mention is the issue of sex outside of romantic relationships which has become more normative in the past decade or two. What I like the most about this book is that having such a healthy relationship of communication portrayed in the book creates an ideal that might discourage teens from pre-relationship and non-monogamous sex. Adolescents have famously short time horizons, and will wait for marriage only extremely particular conditions and maybe not even then, but waiting for a devoted and loving girlfriend or boyfriend rather than just a sex partner may be attainable.

Obesity and "light" food

Some people have speculated that the idea of light or reduced calorie food is partially responsible for the obesity epidemic, but usually with regard to processed food with the famous ``Snackwells effect'': people eat a whole box of low fat cookies instead of 2 Oreos.

I started thinking about that after baking a cheesecake. I used this recipe from Rose Levy Birnbaum with full fat cream cheese and sour cream but no crust because I grew up without pie crusts. I never have foods like full-fat cream cheese and sour cream in the house and I felt so decadent buying them and putting them all in a bowl together, so it was with a morbid curiosity that I decided to compute the calories: 12 slices = 240 calories each, 8 servings = 350 each. If I'd used Neufchatel cheese which is an almost invisible substitution, 8 servings = 300 each.

That didn't seem like many calories, so I decided to compare a light cheesecake I'd recently heard about from the Best Light Recipe. The light recipe uses cottage cheese, yogurt, and Neufchatel cheese, so clearly they must save some calories, yet according to their calculations the cheesecake serves 12 and has 340 calories in each slice, 100 calories more than Birnbaum's recipe. Both recipes get made in a 9 inch dish. Maybe slices of the Best Recipe are marginally taller, but like glass width I'm guessing that's the type of size difference that people don't perceive readily.

So it's not just the Snackwells effect: the low-fat version doesn't even have less calories, and could have more. I've made my decision: when it comes to dessert, full fat only. The rest of the time I can scrimp and use 1 T oil when the recipe calls for 1/4 c.

Here's my calculation of the Birnbaum cheesecake calories for those who want to check my math:

  • 1 lb cream cheese, 1600 (1120 if Neufchatel cheese)
  • 1 c brown sugar, 829 (774 if white sugar)
  • 1 T cornstarch,
  • 3 eggs, 225
  • 1/2 T vanilla
  • 1/4 t salt
  • 1 lb sour cream, 900

Total calories: 2855 (2375 if Neufchatel cheese).

Tuesday, June 16, 2009

Worm therapy

The hygiene hypothesis is that public health has eliminated many of the pathogens our bodies evolved to fight against, yielding autoimmune diseases (e.g., lupus, diabetes type 1, celiac, Crohn's diseases), allergies and asthma, and other diseases of inflammation because our bodies are used to fighting something so instead attacks itself or benign agents. Someone claims to have cured their asthma by deliberately getting himself infected with hookworms. It's an absorbing and completely ironic travelogue: needing to find disease in the developing world to feel healthy. Others have recovered from Crohn's disease after hookworm infection, and two companies sell hookworm infection. One operates in Mexico just across the US border and gives a bandaid with a hookworm larva on it.


Wednesday, June 10, 2009

Life Values and Intimacy Education

I just finished reading
a paper
about the new sex education curriculum sponsored by the Jewish Orthodox rabbinical seminary at Yeshiva University and was really impressed.

It's truly comprehensive: it goes from elementary school through 12th grade, follows the sex education guidelines of SIECUS (an advocacy group that is unfortunately dismissed by the evangelicals as a fringe liberal group), and teaches the students about masturbation, condoms, and that they're not allowed to touch or be alone with the opposite sex: really abstinence-plus. And they teach 11th graders about sexual ethics based on the Talmudic story of the yeshiva student who visits a prostitute.

I haven't seen the curriculum beyond this paper, but what I've seen is fantastic. (As when I look at evangelical books, I overlook the wording issues that seem overly normative.) I'm sure once I see the whole thing I will have a more mixed opinion.

My favorite part is the list of questions to ask about people you're dating:

1. Do I treat the other person as a person or a thing? If you go out
with him/her because he/she is good looking (a “prize” to be
with) or a way out (a ticket to the movies), that isn’t love.
2. Would you choose to spend the evening alone with him/her if
there were no kissing, no touching, and no sex? If not, it isn’t
3. Are the two of you at ease and as happy alone as you are with
friends? If you need other friends around to have a good time,
it isn’t love.
4. Do you get along? If you fight and make up a lot, get hurt and
jealous, tease and criticize one another, better be careful, it may
not be love.
5. Are you still interested in dating or secretly “messing around”
with others? If so, you aren’t in love.
6. Can you be totally honest and open? If either or both of you are
selfish, insincere, feel confined, or unable to express feelings,
be cautious.
7. Are you realistic? You should be able to admit possible future
problems. If others (besides a parent) offend you by saying
they are surprised you are still together, that you two seem so
different, that they have doubts about your choice, better take
a good look at this relationship.
8. Is either of you much more of a taker than a giver? If so, no
matter how well you like that situation now, it may not last.
9. Do you think of the partner as being a part of your whole life? If
so, and these dreams seem good, that is an indication of love.

HIV prevalence in Chicago

A new Chicago Dept of Public Health (CDPH) study finds sobering results about HIV prevalence among men who have sex with men (MSM): of those sampled, 30% of black men, 12% Latino, and 11% of white tested positive.

There's a statistical twist: the reports of the study only give the sample size 570 which is almost irrelevant compared with how they chose these men. Since the detail wasn't given I would guess that they went to stereotypical places, so results would be more accurately reported as being in terms of MSM who go to the stereotypical hangouts where CDPH knew where to find them. I would expect these men to have more sexual partners, more high risk behavior, and so more likelihood of HIV and other STDs. Such high prevalence among any group is of course shocking, but if some omniscient being did a random sample of all MSM, they could pull the partnered, boring, reclusive, etc., and find lower prevalence.

Further, I wonder if their sampling method is differentially selective for higher risk in some groups than others. Gay black men don't have a neighborhood in Chicago comparable to Lakeview, the predominantly white gay neighborhood in Chicago (my former neighborhood), so the more easily sampled may be the very highest risk. In Lakeview they could have found ice cream shops, laundromats, dog supply stores, and yoga classes where upwards of 30% of the clientele are gay; I doubt there's anywhere else in the city with such a high concentration in non-gay-themed gathering spaces. Even if they limited themselves to bars, it might still be that gay bars in Lakeview attract a much broader cross-section of the Lakeview community than African-American gay bars on the South/West side of the city.

Also there is the phenomenon of small numbers: the smaller the group you are drawing from, the more extreme the numbers get. Just two days ago I was estimating chlamydia prevalence among different subgroups of Evangelical Christians and I found a higher prevalence among a specific evangelical denomination of the more frequent church attenders than among evangelical frequent church attenders in general. Are people who have chlamydia attracted to this denomination? Does this denomination discourage condom use more than others? It's possible that was a real effect, and perhaps it will get its own paper, but it's also possible that the higher prevalence was because I was basing my estimate on only 73 individuals, versus 700 for the highly religiously involved.

Youth Pride Services, an agency that serves the African=American gay community in Chicago writes a letter to the editor of the Windy City Times (gay newspaper) saying that they have little visibility. Sadly, notification of this high prevalence may not bring them visibility either.

Parody of the day: STD E-cards

A parody of the CDC's STD ecards.

Kids holding a large piece of paper.
"Giving bad news is sometimes really hard.
So I'm saying I gave you crabs with the help of this card."

A couple holds hands in the sunset on a beach.
"Thanks for the blow job.
Sorry about the herpes!"

Man covering his genitals.
"I've been experiencing some genital burn.
So I got tested and now it's your turn."
Not a bad message since some STDs are more likely to be symptomatic in men than in women.

Monday, June 8, 2009

Abstinence on prime time

Abstinence has made prime time a few times lately:

1. ABC's the Goode Family. Pilot episode: Daughter of liberal vegans thinks of taking a purity pledge. Even though everyone in the family agrees with the sentiment, they are completely wigged out by the trappings, such as the purity ball, purity ring given by father, etc., the fact that it's held in a church and done by primarily religious people. The father is an academic administrator and says he can't be seen in a church or he risks credibility at work.

Perhaps the most insightful message I've seen on abstinence in entertainment: everyone agrees on abstinence, but disagrees on style and how to talk about it: abstinence-only or abstinence-plus. Ultimately I wouldn't be surprised if the inclination to favor "abstinence only" or "plus" were one of the hard-wired political issues that the neuro- political science folks are picking up on brain scans. Teaching birth control feels wrong. So you end up with political stances like Sarah Palin's as governor being in favor of "Abstinence only" that of course teaches birth control. Just can't say the words "comprehensive" or even "abstinence plus" because those evoke the extremes. (Not to pick on conservatives. The opposite also holds: some start to think about the Taliban and "she was asking for it" rape when the issue of modest dress comes up, even if it's minimal standards that everyone adheres to in professional settings without thinking about. As soon as it's called "modesty" instead of "professionalism," the hard-wired instinct kicks in.)

The show is terrific otherwise as well. My favorite non-abstinence part was a fictional animal rights group called "Animals or Else!"

2. Little Mosque on the Prairie had an episode where the fiance of a woman who wears a hijab (headscarf) asks to see his fiancee's hair, but they decide to wait until marriage for him to see her hair. Very little tension throughout this non-touching relationship, but it's a sitcom with only 22 minutes to an episode, and that's not their focus so they don't have to be realistic. Still neat to see the prism of abstinence from a slightly different perspective. I wonder how many viewers without a cultural background that involves hair-covering have an intuitive feeling about this issue. How many think that it's no big deal to show her hair, versus how many feel shocked at the thought.

3. The Jonas Brothers on South Park: "Purity rings are how we sell sex to little girls."

An outrageous thought, and yet the qualitative research finds that until adolescents can conceive of physical intimacy, they have no conception of abstinence, so both abstinence and sex are foreign thoughts to their mind. Telling pre-sexual teens about abstinence is as much of a foreign idea as telling them about sex. Presumably the same holds for telling them about abstaining from drugs or alcohol before they are in a social world in which people take drugs or alcohol.

My neighbor taped it for me , but I haven't gotten down to watch it with him and only saw the 2 minute clip on youtube, so I don't know what else it has.