Thursday, July 30, 2009

So we're the majority, now what?

Now that it's official that there is no money allocated to abstinence-only sex education, reproductive health advocates are firmly in the majority. Two articles that came up on my news alert email show contrasting approaches.

The first criticizes the National Campaign to Prevent Teen and Unplanned Pregnancy, which is a moderate organization that summarizes research on which sex ed programs are effective. They don't rule out that there might exist abstinence-only programs that work, but they say simply that there's no evidence that they work, and that moderation is why almost everyone trusts them.
This article doesn't see that moderation as quite so benign, saying they are not much better than the abstinence-only camp, calling them sex negative and saying they engage in "slut shaming", and that relationships don't turn out better if you wait to have sex until the 50th date instead of the 1st. That last question is an interesting one; as far as I know, there's no academic research on it, but I'd love to see the grant entitled, "Maximizing romantic returns: An investigation of the optimal time in a dating relationship until young women should put out." (Naturally to avoid confounding, the project would need to use matched sampling.)

The second articletalks about how complicated young women's sexualities are now, perhaps summarized as too much information without enough knowledge and wisdom. Women who initiate sex early do so under coercion, even without actual coercion many adolescent women don't feel comfortable saying no, and that when they say yes it is hesitant; she puts this well, so I will quote her:

The "yes" to sex and sexuality I hear young women often express sounds like the way many of us who took other languages in high school and trying to speak them in the country of their origin in our later years. Like asking with a feigned confidence where the drivel is when we wanted to ask where the bathroom was.

BGLT culture is more available to BGLT teens, yet only in certain places; women's bisexuality is accepted only as men's entertainment; and transgendered teens feel pressure to transition young, before age 18. Uniquely, she also emphasizes that teens' relative lack of responsibility compared to past generations (e.g., delays in moving out and getting a job) does not prepare them to take responsibility for their sexualities when the stakes are higher. Overall a fantastic summary: lots of questions, few answers other than the suggestion of communicating to teens that we understand that things are complicated.

When reproductive health advocates are in the minority, we show the status quo's failures. Even if it were right, the first article is not constructive; engaging in such divisiveness is a waste of a valuable opportunity to improve the situation. By contrast, the second article is constructive by laying out current problems of teen sexality in all their complexity. Now to move on to address them.

Abstinent for a year

Another book in the genre of people chronicling a year in which they do something unusual. This book is about being abstinent for a year Chastened: No More Sex In The City by Hephzibah Anderson. According to the review:

Perhaps underpinning many of her own attitudes, Anderson writes authoritatively on 1990s ladette culture, that terrible, capricious period which spawned a sub-species of women for whom boozing, brawling and trawling for men was worn as a badge of honour (I can say that, I was one too). "We may have been sexually empowered, but we were also emotionally frustrated," she reflects. Her contemplation of the disempowerment of romantic courtship which has stemmed from technological advancement also rings disconcertingly true. "As if sitting by the phone weren't bad enough, now we had to take the phone with us and hear its silence in cafes and bars," she writes.

Its conclusion is "Chastity belongs back in the mainstream as a valid form of sexual expression."

Teen-written sex ed site: sexetc.

Teen-written sex ed site includes an article "Kissing: are you missing out on life's simple pleasures" imploring readers to slow down and smell the roses; another article covers what abstinent teens do. One quoted teen says, “Now that I’ve been in a relationship for over a year and we’re considering becoming sexually active, I realize that my sex ed experiences made me terrified of sex. My teachers made it seem like everyone had an STD, and that contraceptives are expected to fail. If it weren’t for my own reading, I wouldn’t know what kinds of contraceptives are available.”

It's neat to read a quote by a real teenager illustrating what the GAO talked about in how inaccurate and negatively slanted abstinence education is.

Monday, July 27, 2009

LA County implements STD tests by mail

Women up to age 25 anywhere in LA County are eligible to receive a free home testing kit so they can test themselves for chlamydia and gonorrhea. The Don't think, know project is modeled on the I want the kit project started by my colleague Charlotte Gaydos at Johns Hopkins.

The testing kit arrives in an unmarked envelope. They swab themselves, mail it back, and get their results back via an 800 number or the internet.

Hopefully the LA project will expand also to men, as the Hopkins project did.

"True Lunch Waits"

Study: Abstinence-Only Lunch Programs Ineffective At Combating Teen Obesity, a brilliant story in the Onion. The entire thing is fabulous but I love this part:

"I'm never ever going to eat, because eating is wrong, and I'm worth more than a chicken sandwich with asparagus and rice pilaf," Woodbridge seventh-grader Tracey Holmes said. "I heard Jennifer Hines eats all the time, like 50 times a day. I heard she eats all her ice cream upside-down, though, so she doesn't get fat. That's how it works."

"It's really hard, though," Holmes added. "I get so hungry sometimes. Especially after hours and hours of unprotected sex."

Thanks to Arthur for forwarding it.

Thursday, July 23, 2009

Increasing autoimmune diseases?

This blog is usually about teen sex, but I'm also interested in the speculation that allergies and autoimmune diseases have increased in recent years, so sometimes I write about those.

A study published this month found evidence of such an increased prevalence of one autoimmune disease in a sample of men. They took old blood sampled from men at an Air Force base just after World War 2 (1948-1954) and used as a comparison group men currently at similar ages and men with similar date of birth. They tested the blood for two indicators of celiac disease, an autoimmune disease: tTGA, followed with a second test (EMA) in only the tTGA positive and weakly positive subjects. I presume that they know that these tests have similar rates of false negatives and false positives in 60 year old blood as in fresher blood.

They found more than 4-fold greater prevalence of celiac disease as judged by this test: 0.2% in the old blood and 0.9% and 0.8% in the new blood. Since the higher rates were found in the similar age comparison group, that finding provokes the question whether the subjects from the air base went on to develop celiac disease, but they don't have blood samples to answer that question.

I am curious whether this finding holds up in other large collections of old blood, (and also whether in 60 years their current samples of new blood test the same way.)

As a reader pointed out: the Air Force cohort was healthier than the contemporary young cohort due to having been pre-screened as part of their Air Force physicals. While this study's stated purpose is to be looking for asymptomatic celiac disease, there is of course a spectrum of non-specific symptoms, some of which may have caused the Air Force to screen people out and they would not have been screened out of the contemporary young cohort. It's too bad they don't have access to a contemporary Air Force cohort, though of course the Air Force standards might have changed over time. The only way to know whether this is a real effect is to repeat the study in different samples with different types of biases and vulnerabilities.

Since we don't know the reason for the higher prevalence of celiac today, the takeaway may be to live more like they did in the late 1940s including those swell hats and suits. If the increased prevalence is from the increased cleanliness we have now versus 60 years ago, use plain soap and toothpaste rather than the ones with antimicrobials and follow fewer food safety rules just as they did in the old days.

They also found that the 0.2% with presumably untreated celiac went on to die at 4 times the rate of the people without it; while they were dealing with small numbers, the mortality rate was at least twice the celiac negative (Hazard Ratio 3.9 with confidence interval (2.0, 7.5)), so this is important.

[Photo from Georgia Encyclopedia.]

Tuesday, July 21, 2009

Late night Congressional abstinence exchange

Congress abstinence debate had the following exchange:

Later in the debate, Rep. Diana DeGette (D-Colo.) said federal dollars should only fund sex education programs -- including abstinence-only ones -- in schools that have proof that they cut pregnancy rates. She noted that abstinence-only sex ed came along in 1981.

[Joe] Barton [R- Tex.] interjected that abstinence-only has been around much longer than that, at least since his dating days. "Every girl I dated practiced it," he said. "And it was very effective, because when I went to pick them up, their fathers reinforced it on me. So it does work and it has been around much longer than the 1980s."

"Maybe," DeGette suggested to Barton, "it was [practiced] on a case-by-case basis."

Friday, July 17, 2009

"Hey, Lloyd, let's run a sloppy study": FDA female condom advisory panel

The STD Center visited the FDA advisory panel on the new female condom in mid-December 2008, and a good time was had by all. The FDA makes the transcripts available, though they're somewhat difficult to find. Here is the main site for all the transcripts prior to the current year, and this site is for this year.

My favorite moment is at the very end of this transcript and at the very beginning of this one: Ralph D'Agostino expresses concern about approving devices supported by "sloppy" studies. He makes a very good argument earlier on (right before this quote) that people having difficulties with the female condom might drop out and that could affect the final results, and asks whether they usually impute for missing data and why they didn't do that here. His final conclusion is a policy conclusion:

DR. D'AGOSTINO: Yeah, but what I'm concerned about is that somebody reading this transcript may say, hey, Lloyd, let's run a sloppy study; we already have approval, already have, you know, precedent for it. I think that what we want is just, you know, give an impression that there are better ways of getting interview data. There are better ways of chasing down the dropouts and so forth, and I'm concerned that we're not emphasizing that. I may not differ from the bottom line where we're going. It's just that the signal may be that we have a better, more positive view of the study than we probably should have...I'm not arguing with the final vote, the way the final vote might go. I'm arguing with the sense that this study has more merit than it actually has, and getting that across is what I think we should need to do.

Thursday, July 16, 2009

Virtual virginity pledge

There's an ivirginity pledge application for the iphone catering towards the British virginity pledge audience. The bloggers have already had a field day speculating on what kind of activity this virtual purity ring will prevent. Interesting that it's a British group. Wonder if American groups will follow.

Thursday, July 9, 2009

White males are perceived as more competent

Teaching evaluations for statistics professors are almost always lower for women than for men. There's a similar finding by researchers at U Wisconsin Milwaukee that customers in general are more satisfied with the performance of white men than minorities or women.

The story shows the white male researcher's picture, giving them the opportunity to do a meta-study to find out whether including the picture makes the reader more convinced of the correctness of the findings.

Thursday, July 2, 2009

Virginity misconceptions

RH Reality Check has an interview with Jessica Valenti about the role of virginity in society. The cultural criticism part of the interview addresses a complex reality with many layers, but addressing some simple facts I think she may misunderstand the evidence to some degree:

1. The social science says that sexual initiation is important, both the age and circumstances. The age of sexual initiation is associated with concrete negative health outcomes, such as increased likelihood of STDs, pregnancy, less likelihood of using condom even in subsequent relationships. In many cases women, disproportionately African-American, have early sexual initiation within coercive relationships, often with men over 18.

2. Girls and women are more vulnerable than men in many sexual contexts: getting a woman pregnant can cause financial hardship to men, but women have more immediate consequences and educational/advancement consequences. Transmission rates of STDs to women are higher than to men for many diseases. While men are more likely to have symptoms of chlamydia and gonorrhea, these diseases are more likely to have lasting consequences for women than for men, the combination of which means that a woman might have lasting consequences without ever knowing. Intimate partner violence (IPV) is more common and more severe for women than for men.

As a female statistician who was a physics major in college, I know about sexism. On the other hand, there are some gender differences that are real. I also supported Larry Summers in that debacle.

3. My impression is that virginity is a concept that Evangelical Christianity applies to both men and women, and is concerned with both equally. That's not as much my area, but it's been my impression.