Safe sex ads: where everyone is above average

New safe sex ad from Candies Foundation with Bristol Palin and Mike Sorrentino from Jersey Shore. First, Bristol looks a bit nervous, fidgeting as she's talking about sex and safe sex, which is odd since I would think they could try refilming until she didn't look nervous. Second, Mr. Sorentino whips out condoms, and brags that they're large-sized, and then offers one to Ms. Palin, just in case. A condom that's too large is only marginally better than no condom at all. What good does it do for a safe sex ad to raise the size issue when, by definition, only a small proportion of their viewers need large-sized condoms? While googling around for information about what proportion of males "need" large condoms, I found an article which said that the market share for a single large-sized brand went up from 5% to 20%, but that the condoms are not actually larger than other condoms.

Balanced arguments are more persuasive

According to this summary of a meta-analysis, arguments are more persuasive when both sides are presented, even when preaching to the choir. This research explains why abstinence-only sex education --- which is still funded at $50 million per year and requires that only disadvantages of birth control and condoms be presented, not advantages --- does not encourage abstinence as well as comprehensive sex education does, even among those inclined to believe it, and why the only abstinence-only program found effective (the Jemmotts' program) was not one-sided enough to be funded under federal abstinence-only funds.

Vows, oaths, and pledges

Rabbi Marc Angel explains why virginity pledges don't work, although he's talking about loyalty oaths in Israel, and why they are a bad idea: "To those who are loyal to Israel, oaths are not necessary. To those who are not loyal, oaths won't help."

My Baltimore Sun op-ed defending O'Donnell on abstinence, but not on poverty

My op-ed in today's Baltimore Sun says that O'Donnell's personal religious beliefs about abstinence and masturbation are reasonably mainstream evangelical beliefs, but that her mainstream Republican beliefs ignore that the Bible says that fortunate, wealthy societies have an obligation to provide for the poor.

Originally I framed the article as we should be sensitive to her because the Bible says to be sensitive to those who are alone through no fault of their own like widows, orphans, and converts, but the Bible also says societies have the obligation to be generous to the poor. This obligation to sensitivity for widows, orphans, and converts seems to extend to be sensitive also to people who are involuntarily single, as virtually all religious single adults are, and abstinence must be a particularly difficult subject for her since abstinence means that she has an idealized view of marriage and her eventual husband she hoped would love her for her beliefs and admire her for having stuck to them since her conversion to become more religious. I liked the parallelism, but it involved too much speculation about her personal life.

More importantly, I'm not a religious authority, so it's not my place to say what we should and shouldn't do.

Two good comments so far on Baltimore Sun. One said how to you judge which beliefs you criticize candidates for. That's a really terrific topic --- many politicians have personal religious beliefs, but they maintain a line between those beliefs and the policies that they support. One example is Joe Lieberman where it's my understanding that his personal religious beliefs should in theory make him more supportive of social programs to help the poor, but lately he has been voting against these programs for what may be political reasons. A case where religious beliefs do influence policy for Christine O'Donnell is that she is clearly extremely anti-abortion and anti-choice --- she would ban abortion even for rape survivors --- and there's every reason to expect she would vote that way, and that's a great reason to vote against her, but that's from her policy statements, not from her religious beliefs. On the other hand, there are some distinguished politicians who have personal beliefs against abortion, and they themselves would not have abortions except under limited circumstances, who have strongly pro-choice voting records. It would be a great study to look at when what we know of candidates' personal religious beliefs agree with their voting records, and when their personal religious beliefs contrast with them. And perhaps this study has already been done. Any political scientists to comment?

Second comment calls for holding politicians accountable for making "rational evidence-based decisions," and oh my, I am so in agreement with that. Not making evidence-based decisions, and instead making decisions for reasons of politics, is extremely common in our government. Paul Krugman is a Nobel Prize winning economist and an expert in the Great Depression, and he's been writing op-eds for the past 2 years saying that we need to give more stimulus or unemployment is going to stay high for years and years, and we are going to lose a generation. And he's been saying the same theme over and over, and he's an extremely distinguished economist, a Nobel Prize winner, and not enough politicians listened to him to affect policy. And the failure to provide fiscal policy that can be adequate stimulus is the worst way that the government can fail people. We're talking about hurting young adults who happen to be coming of age now and during the next several years, and the effects of a worse job market when they come of age will affect them for their ENTIRE LIVES, and they will have not just lower earnings, but (judging by studies of past generations born in high unemployment eras) worse social problems. That's huge, and in my opinion way more important than abstinence education. But, yes, abstinence education is a shame, especially how $50 million abstinence-only funding came back in the health care reform bill in order to get it through Congress. And both of those issues are because of the 60 vote filibuster, and the fact that Senators no longer have to actually filibuster, they can just claim that they are. Some have said that if they actually had to speak for 24 hours straight, they would do it less. Again, the political scientists can speak.

New sex ed game

This sex ed game Privates is supposed to be fun. I don't use a PC, so I will never know, but it definitely looks better than the web game that they gave as an example of a terrible sex ed game: parts were funny and parts just strange, like their character names: Captain Condom, Power Pap, Willy the Kid (phallic-shaped but short), and Wonder Vag. Really, Wonder Vag. I played for 30 seconds before I had 4th grade flashbacks. Looking forward to hearing how Privates works out.

Virgin dating site

Virgin dating site "use[s] virginity as a significant compatibility tool to bring people together. Some people may overlook the bonding power of virginity. Virginity as an important common aspect between people can lead to close friendships, or can even serve as a mutual precious gift of marriage."

I wonder how many users they will have and whether any will not also be on eharmony or a big evangelical dating site (presuming that there is an equivalent to jdate for evangelicals.) It is interesting that they would segment the evangelical dating market like this.

Could quantitative students bypass premed requirements?

Mt Sinai medical school has a program that admits non-science majors who have not taken the traditional premed curriculum, but instead have majored in the humanities and social sciences. These students do just as well, are more likely to spend time doing research, and are twice as likely to become psychiatrists than regular track students.

It's interesting that they limit the exceptions to humanities and social science majors. What about quantitative majors? Is there a med school who will take math, physics, and computer science majors who have not taken all the premed courses? Many science-smart students like learning hard material and are turned off from the grade-conscious nature of premed courses. If you are required to be grade conscious, you don't take risks by taking hard classes: the course that I learned the most from during my freshman year was a full-year math class where I got one of the bottom 2 grades in the 55 person class during the first semester and my advisor urged me to drop the class, but the second semester I was in the top third of the course. It was a trial by fire that helped me in theoretical graduate school statistics courses, and I wouldn't have taken it if I had been afraid of that first semester B-. And if I'd moved up from the 2nd percentile to "only" the 40th percentile, that would have also been a victory. The happy ending is that I learned how to write proofs, or in a pinch fake them reasonably well.

By contrast, I took a premed biology course during my first semester of college, and I loved the material. It was totally fascinating, as were the dissections (though the calves heart smelled), and I think my A- was good enough that I could have been premed if I'd wanted to. The difficult part was keeping my lunch down when my classmates continually asked what was going to be on the test. After half a dozen memory-based quizzes, I was so pleased when a quiz actually asked us to figure something out for ourselves. Finally: thinking! Some of my classmates protested this question because "it wasn't in the textbook!" Someone who spoke that way in a math or physics course would be ridiculed, and an instructor wouldn't even see the need to defend the question. Of course students are required to use critical thinking. In this premed class, memorizing the textbook seemed to be an accepted part of the culture.

From the other side of the lectern, at least in a biostatistics course, premed students were a complete joy to teach. In graduate school, I was the only TF for a 53 student biostatistics class that was 90% premed, and they were some of the nicest and most interested students that I taught. Perhaps they were fun students to teach because only the most intellectually curious premed students self-selected into biostatistics, or because all of the material was highly related to actual medicine rather than abstract science, so they saw the immediate relevance, or because of the way we taught the class with lots of handouts and everything in the textbook and being very clear about expectations.

So I don't mean to stereotype premed students. But as a math and physics undergraduate, the prospect of taking orgo and p-chem was not appealing just because of the culture that I perceived there.

A bigger argument for a quantitative track to med school is that the quantitative fields of study absorb just as much time as the intensive humanities majors: it takes (at least) as much time and coursework to learn to do proofs, derivations, program computer operating systems, and analyze complex datasets, as it does to read, write, and speak foreign languages and write a 200 page senior thesis.

Research idea: alcohol and handedness

Left-handed respondents over 50 years old drink more often than right-handed respondents in a recent study. If any teen risk data includes handedness, that would be an interesting research project.

Sexually transmitted infection postdoc

As my time on the CDC's STD postdoctoral fellowship draws to a close, Cake Wrecks featured an appropriate cake (above).

New study on the determination of different suicide attempters

People with guns in the house are more likely to commit homicide or suicide, according to hundreds of studies in the injury prevention literature. This difference exists even for households that have owned a gun for years, which means that in most cases, the gun was not bought for the purpose of a homicide or suicide that happened years after purchase. The common interpretation of the data is that many people have impulses that might lead them to homicide or suicide, but those who have a gun available can carry out their impulse quickly and easily, so are more likely to do so. By contrast, the suicidal/homicidal impulse does not last long enough for people to actually go and specially buy a gun for the purposes of carrying out their impulse.

Now a study finds that people who attempt suicide by gun are only moderately more likely to attempt again and successfully kill themselves. It may be the case that in many of the gun attempted suicides, the suicidal attempt was just the fulfillment of an impulse facilitated by gun access. If a gun were not available, certainly some people could be determined enough to actually go out and apply for a gun permit and then get a gun, but for many people the impulse would dissipate, and they would not have carried out the impulse.

Other suicide attempt methods associated with only moderate likelihood of a later successful suicide are gassing, jumping from a height, or drowning, and those with low likelihood of successful suicide are cutting and poisoning. Those with high likelihood of successful suicide are hanging, strangulation, or suffocation.

Likely gender is also involved. Cutting and poisoning are more common among women, and women are less likely to be successful at suicide.

The hypothesis about impulse being the cause of gun attempted suicides implies that most of the methods with low or moderate chance of successful later suicide are easily accessible and implemented, and indeed many involve materials easily available and could conceivably be carried out impulsively. The methods with high likelihood of later suicide also involve easily accessible materials, but may involve psychic costs that make them difficult to implement.

In short, I think the Supreme Court may have just increased the suicide and homicide rates by allowing more people easier access to guns that can be available quickly and easily enough to fulfill an impulse that would otherwise dissipate.

Sarah Palin has a new ad featuring women who, the ad implies, are traditional, sensible moms who know best. The ad makes vague statements like "We don't like the direction this country's going," as the camera lingers over blonde, brunette, grey, and white-haired daughters, mothers, grandmothers, of all shades of white, and even one in a wheelchair with "Don't Tread On Me" on the wheelchair's back. That sure sends a message, but I darn well hope that was completely unintentional. Right?

13 year old girl performs abortion with a pencil

So many things wrong in this news story: in Pennsylvania, a state requiring parental consent for abortions, a 13 year old girl pregnant by her 30 year old "boyfriend" attempts to perform an abortion with a pencil, goes into labor, boyfriend buries the stillbirth or baby in a plastic shopping bag in the woods, and girl goes into hospital.

Things wrong:
1. Sexual coercion of minors often happens in families where parents just aren't paying attention. Parents are so out of the picture here that this 30 year old "boyfriend" has been with this girl for 1 year.
2. Even in the best of cases, adolescents have undeveloped judgement. Where teens will not involve their parents, doctors are the next best alternative. Not allowing doctors as an alternative, teens turn to their own judgement. Adolescents' brains aren't fully developed, so they may not see consequences of their actions.
3. Shady characters like pedophiles have poor judgement. This fellow may even be a murderer if baby was born alive, and yet the boyfriend is the only adult acting in this story. A legal abortion would involve doctors and nurses.
4. Finally and most importantly, illegal abortions are dangerous. On top of the trauma of pregnancy which is usually unsafe for a 13 year old, she had to be hospitalized.

Laws have to work at the borderlines. Most pregnant minors are 17 or so, many parents are supportive, and most teens tell their parents about their pregnancies, but 12 year olds do have sex and get pregnant, and often it's in crazy cases like this where the parents are just not paying attention. In my 8th grade class of 70 children in the best-funded school district in Illinois (at the time), we had 1 pregnant girl, and same in the year before us class of 60 children, a pregnancy rate of about 3% for those two years.

In Utah, a similar case of a woman asking to be attacked in order to induce abortion created a new anti-abortion law.

Could this case possibly cause Pennsylvania to alter its abortion laws so that parental consent was no longer required? I wish, but somehow it seems unlikely.

Parent sex education

A recent XKCD notes that parents may need to teach their parents a lot more about sex now that there are internet popup ads. While it's a funny exaggeration of the situation and it seems to be a new situation, it does illustrate the age-old truth that kids always know more than adults think, making it clear that all the time discussing whether to teach contraception in schools is a waste. A study that I did found that most Southern Baptists surveyed in church Sunday School learn about birth control and STD prevention from their schools and from their peers. Take away the schools, and you are left with peers. And internet pop-up ads.

Quantitative work is not mysterious

Some are impressed by quantitative skills. Those of us who were math and physics majors (or in my case, both) are more realistic. Monday's xkcd gives a secret trick in the mouse-over box that pops up that all math and physics majors learn. For those who haven't figured it out, I'm glad that there's a comic strip to reveal the secret.

Also, a few weeks ago, there was a good xkcd about the attitude of some science types towards about interdisciplinary work.

Another area of broad agreement: adults aren't sexualized enough

Camile Paglia says that upper middle class adult culture isn't sexualized enough, which is the same point that many conservative religious movements do. Femininity has been devalued, different roles for men and women has taken out the mystery and magic of relationships, we oversexualize young people and undersexualize adults. Young people are having sex before marriage, and older people are not marrying or not having sex in marriage. These points appear in many evangelical Christian, Catholic, and Orthodox Jewish assessments of culture, and in dating books from across the spectrum. (An example of the latter: Rachel Greenwald, a secular Jew who did a qualitative study of 1000 men about their dating histories, found in her study that one reason that men cite for not continuing a relationship past early dates is that the women dress and behave on dates in the same way as they do in the office.)

We can keep in mind that every model is wrong, but some models are useful: these statements are of course oversimplifications and generalizations. But it's really interesting to see a point where some from the left and some from the right can agree, when they would agree on so little else.

Something we can all agree on: not sexualizing little girls

USC researchers have released a report on the role of women and girls on children's TV. The research finds that females are underrepresented, portrayed as primarily interested in appearance and romance, and that characters are sexualized. I was shocked to see how two children's TV characters were made over as sexualized. Both characters were originally little girls. Now they look older, thinner, show more skin, and Rainbow Brite especially looks like jail bait.

The right and left wings of the sex education debate don't agree on much, but they do agree that reducing women and girls to sexual and romantic roles is distasteful and inappropriate. I hope that all can find some constructive action to counter these disturbing trends.

Anecdote vs. data: soda taxes

I'm constantly amazed how many people doubt that tobacco taxes and soda taxes work, even people who are educated and listen to empirical research in other parts of their lives. The reasoning seems to be that because they don't feel particularly price sensitive --- making purchase/quantity decisions based on goods' prices --- they aren't price sensitive. Likewise, because they have seen people continue to smoke and buy cigarettes at high prices, they believe few people are smoking less or quitting smoking due to tobacco taxes.

Campaign for Tobacco Free Kids put out a new report on this subject, documenting simultaneous decrease in smoking and increase in revenues from tobacco taxes. The economic research on the subject indicates that soda taxes could be similarly effective.

Going the other way, many people don't perceive expensive produce as a barrier to produce consumption. If they choose to buy more expensive produce (e.g., shopping at a more expensive store, only organic/local), they don't see that their decision to buy more expensive produce could decrease their fruit and vegetable consumption. At most levels of income, probably they will buy less if the produce costs more. Certainly they would buy more if it were cheaper: I've noticed that yelp reviews of lower cost produce shops and supermarkets commonly remark that they can get several huge bags of produce for the cost of one bag of produce at their regular store, and that they do get more when they shop at these stores (e.g., this one in Chicago).

People who otherwise listen to economic research and use it to guide decisions and opinions in the rest of their lives, and who believe in things that they can't see like germs, atoms, and molecules, somehow don't believe in price elasticity because they can't see it. I wonder if anyone's researched the impact of belief in price elasticity on economic behavior.

Limits of randomized experiments

I just got back from the Mid-Atlantic Causal Inference Conference, the leading meeting for statisticians who look not just for associations, but for causality. Randomized experiments are the gold standard for causality because randomization ensures that on average, the treatment and comparison groups are similar. Experiments do have limitations, however, that come primarily from their great expense: experiments may need to be small and short duration, weakening the chance that experimenters can see an effect. The study described in this article is a perfect example: 22 autistic children were randomized to a gluten-free, casein-free (GFCF) diet for 18 weeks and then given a "challenge" of these foods about 4 weeks into the trial; by the end of the trial 8 of the subjects had dropped out.

Seemingly, there are hundreds of parents on internet mailing lists and websites putting their children on a GFCF diet. GFCF diet is hard to implement, and it takes weeks or months or practice to get right, and even then an errant crumb can disrupt the progress, and it's unclear how long kids need to be on the diet to see an improvement because determining the starting point is so inexact. A parent can probably remove >90% of gluten and casein from their child's diet starting on day 1, but hunting down the remaining 10% to reach 100% adherence takes a long time. And 99.9998% adherence may be exactly what's required: the FDA definition of gluten-free is 20 ppm. Once the GFCF diet is in place, many parents say that it improves their children. Now a randomized trial that started out with 22 participants and lost 8 of them comes into the news with the headline, "Eliminating Wheat, Milk From Diet Doesn't Help Autistic Kids."

An experiment doesn't have the luxury of trying to refine the diet to make sure that it's being done correctly, or to figure out the length of time the diet needs to continue until there's improvement. An experiment generally determines the treatment in advance rather than trial and error, since trying to get the best result is, to a certain extent, cheating (i.e., risking a spuriously significant result that occurred simply by chance).

A good experiment is an invaluable tool for understanding reality, but a so-so experiment is no better than a qualitative study of people on internet websites.

Chemicals and comparison groups

Current legislation is trying to ban a plastic that has been used for 50 years to line cans, so I decided to look into how much evidence there is that this plastic is dangerous, and whether the potential substitutes for this plastic are safe. The American Council on Science and Health finds little evidence that this plastic is dangerous; they find no proposals for what plastics might substitute, much less any evidence on the alternatives' safety profiles. Their analysis raises very good points and is worth reading.

Just as in statistics, the important question for any risk analysis is "compared to what?" Nothing is dangerous on an absolute level: risks always have to be weighed against their alternatives. When we banned DDT decades ago, it may or may not have had beneficial effects for the eagle population, but malaria has rebounded: going from millions of cases in Sri Lanka to a couple dozen, and then back up to a million cases after the DDT ban. Malaria still affects hundreds of millions of people around the world, many cases that might be prevented if DDT spraying were allowed. The developed world has not had malaria since the 1940s --- perhaps if malaria had rebounded, perhaps we would see pesticides as the life-saving tools that they are --- but we do have the resurgence of bed bugs, even on the Upper East Side, after they had been almost completely eliminated 50 years ago. Maybe the good effects of the DDT ban are worth hundreds of millions of cases of malaria in the developing world and bedbugs in the developed world, but alternatives always need to be considered. The WHO has backed bringing back DDT because it was so useful.

With the current talk of banning BPA, the comparison group is completely missing. By banning a plastic without discussing alternatives and their risks, we risk having worse alternatives or no alternatives.

Ambivalence or Planned Parenthood

A lot of evidence finds that a sizable number of young adults are ambivalent about pregnancy: they don't want to get pregnant, but they wouldn't mind if they did. Bill Albert of the National Campaign to Prevent Teen and Unplanned Pregnancy asks whether ambivalence is the right mindset in which to start a family, which reminded me of last week's A Prairie Home Companion.

In honor of Mother's Day, a skit on last week's Prairie Home Companion contrasted today's view of motherhood with the earlier generation. In today's motherhood, the woman says to her husband that they may need to work on their relationship and openness before they are really completely ready for having children, although they've already been married over a dozen years, and the childbirth is assisted by a midwife, a chanting Tibetan monk, and a dolphin named Sparky. The earlier generation, the woman says, "Gee John, I just got back from the doctor, and guess what?" John says, "Guess we ought to get married then." Her childbirth is attended by a doctor who is also a veterinarian, and she runs back to the potato field to finish harvesting right afterwards.

Certainly planning is best, but there is certainly such a thing as too much planning and waiting. Earlier not-quite-planned parenthood is difficult but so are fertility treatments. Parenthood is difficult no matter when it's done; while parenthood is gratifying, according to the research that I'm aware of, people with children are less happy than people without children. May everyone find a middle ground that they can be happy with, and be able to have as many children as they would like.

Fantastic WW2 sex ed film for soldiers

This film shown to World War II soldiers is already better than any official abstinence-only (a-h criteria compliant) education curriculum. The message is do not have sex, but if you do, use a condom, and it shows a condom and then tells how to put it on, and do not drink so much that you are careless. And then it closes with the typewritten message on the screen, "Do not be so weak as to let some ignorant individual persuade you that you must seek sex relations to be a good sport. If you follow his advice, you are only being a fool."

Short and to the point, and an easy substitute for weeks-long curricula. And this was before there was even effective treatment for either syphilis or gonorrhea. (And before we were aware of chlamydia, herpes, and HPV.) Interestingly, the film was made in 1941, or either in the 24 days after the US declared WW2 or prior to entering WW2. Either way, it's clear that the army clearly anticipated that STIs can be a major problem, and it knew that it had to prevent STIs as much as possible, rather than waiting for them to come up. Unfortunately, there is no such common unifying impetus to prevent STIs today.

Policy proposal: given that some idealize the times before the sexual revolution, states that are reluctant about giving modern comprehensive sex education should limit themselves to material produced by state and federal government bodies prior to the sexual revolution. The vintage government films that I've seen are more practical and factual than the abstinence-only curricula that I've seen.

Why doctors need to know Bayes theorem

In graduate school, I was the head TF for several general audience statistics courses, and my favorite subject was Bayes theorem because it implies that many "common sense" policies are, in fact, dangerous. Given a dreaded disease, drug use among ship captains or pilots, or anything else, it's so easy to say, "Just test everyone." But in fact, that's not good policy.

Social psychologist Gird Gigerenzer's new book covers some instances of asking doctors to give probabilities to their patients, and they do a horrible job. The question presents the information exactly as doctors are taught: prevalence, sensitivity, and specificity (false positives).

The probability that one of these women has breast cancer is 0.8 percent. If a woman has breast cancer, the probability is 90 percent that she will have a positive mammogram. If a woman does not have breast cancer, the probability is 7 percent that she will still have a positive mammogram. Imagine a woman who has a positive mammogram. What is the probability that she actually has breast cancer?

A prestigious doctor, department chief with 30 years of experience "was visibly nervous while trying to figure out what he would tell the woman. After mulling the numbers over, he finally estimated the woman’s probability of having breast cancer, given that she has a positive mammogram, to be 90 percent. Nervously, he added, ‘Oh, what nonsense. I can’t do this. You should test my daughter; she is studying medicine.’ He knew that his estimate was wrong, but he did not know how to reason better. Despite the fact that he had spent 10 minutes wringing his mind for an answer, he could not figure out how to draw a sound inference from the probabilities."

And he was typical: more than 90% of the doctors were wrong, mostly very wrong.

When the question was posed in terms that are easier for people to understand, nearly all of the doctors got the question right.

Sweden has had sex education since 1918

While doing a literature review for a paper about syphilis, I learned that Sweden has had what we would now call comprehensive sex education since 1918 ("Venereal Diseases and Sex Education", Report by a Swedish Government Committee, British Medical Journal, vol 1, no. 3204, May 27, 1922, p.842), as part of their "venereal disease" prevention law.

A 1943 discussion of sex education shows that current discussions are almost identical to past dicussions. The Archbishop of Canterbury noted that "if men and women would abstain from fornication the problem would be reduced greatly and become a purely medical matter. The bulk of the evil is primarily a moral problem." and he suggested that by distributing condoms to the troops "the implication is that many are expected to practice fornication" and thus it increases. One person cited one example in which moral suasion worked to prevent sex among soldiers --- the Black Sea Army in World War I --- and that the forces would respond if chastity were portrayed "in the right way".

On the other side, a medical officer from St. Pancras argued that the Church's teaching was unhelpful and that creating a taboo against premarital sex causes those who break the taboo to become rebels and outcasts. An alderman calls for sex education for those age 13 and up since otherwise they will learn about sex from "street talk", while a doctor calls for sex ed starting at age 11. Meanwhile, a minister in the Church said that he has discussed venereal diseases openly for years, and in a separate report, a psychiatrist noted that "The clergy were more broad-minded than schoolmasters."

Three months without federal abstinence-only funding

The US had 3 months without abstinence-only funding on the books before the health reform law reinstated it: $50 million a year for 5 years for the states, the exact same level of state-level abstinence funding as in the previous administration, even though fewer states are applying for the funds. Even Alaska under Sarah Palin "missed the deadline" for abstinence grants in the last round. (No Sarah Palin jokes. Missing the deadline just seems to be the politically expedient method of not participating in abstinence funding.)

The difference between current funding and the previous administration seems to be $154 million: community organizations are no longer given abstinence grants ($141 million in 2009) and the Adolescent Family Life abstinence program is no longer listed in the budget ($13 million in 2009). Not funding AFL is surprising, and I wonder if I've missed something since that program has been funded consistently since the early 1980s, but I don't see in the 2011 HHS budget; this program generally flies under the radar and is usually not mentioned in media reports about abstinence education, even though organizations like Advocates for Youth track it.

The decrease in abstinence-only education funding from $204 million to $50 million represents additional good news: the $50 million is going to states who are scrutinized more heavily. For instance, some states have laws requiring that all sex education be medically accurate. On the other hand, increasing numbers of states require contraception to be taught in sex education, which may mean that even if the states wanted to apply for the abstinence funds, their state law mandates a curriculum that is incompatible with the abstinence education requirements. The a-h definition of abstinence education in the Title V is so restrictive that the only abstinence-only program that has ever been shown effective (Jemmott and Jemmott's research) could not be funded under Title V.

Another difference between the pre-2009 and current HHS budgets is that abstinence was featured prominently in the budget in 2009 and before. Many pages of the pre-2009 budgets mentioned abstinence, and there was a whole subsection describing all the sources of abstinence funding and their histories. The 2011 budget doesn't have any text about abstinence and only includes abstinence in the itemized totals, mostly for past years, and has "--" where future years of abstinence funding are supposed to be listed. (The new 50 million a year isn't yet listed in the 2011 budget.)

While the country had only the 3 month period between the zero-ing out of abstinence education at the end of December 2009 and the passage of the health reform bill at the end of March 2010, there's certainly a big shift.

The really interesting question is how many states will apply for abstinence funds, since more states now have comprehensive sex education laws that are incompatible with applying for the funds, and whether it would be possible for the a-h definition to be changed. Or if the $50 million will go only to the states with strong abstinence-only constituencies such as Louisiana and Texas.

Sex Education of the Weird

A recent News of the Weird had two pieces of news related to sex education, but the weirdest was in this Thursday's New York Times.

First, abstinence-only sex education was the explanation for a teen's harassment of women:

Sheriff's deputies in Austin, Texas, arrested Anthony Gigliotti, 17, after complaints that the teen was annoying women by following them around in public and snapping photographs of their clothed body parts. Gigliotti told one deputy that he needed the photos because the sex education at his Lake Travis High School was inadequate. [KXAN-TV (Austin), 2-2-10]

On the other hand, condom education isn't necessarily safe either:

Clumsy: Teacher Karen Hollander filed a lawsuit in November against the New York City Department of Education after taking a fall on "slippery foreign substances," including condoms, on the floor at the High School of Art & Design. Since schools distribute condoms on campus, she said, the department is responsible when students open them and discard them during the lunch period, littering the floor. [New York Daily News, 11-21-09]

The weirdest of all, however, was in the New York Times. In response to a new comprehensive sex education law that requires contraception education to be included in any sex education course, the district attorney of a county in Wisconsin "warned that teachers face 'possible criminal liability' for teaching youths how to use contraceptives."

As the GAO found, some fraction of abstinence-only education just isn't true. While well-intentioned, this prosecutor's warning is no exception.

Do teens consider oral sex to be sex?

A recent study finds that only 20% of a convenience sample of teens consider oral sex to be sex. This finding has been documented anecdotally, such as in the classic scene from the 1994 movie _Clerks_, where the main character is described to hear the discrepancy in his girlfriend's number of sexual partners and number of oral sex partners. (3 vs. 37.) He had only been told about the former.

Of course there's the caveat that this convenience sample has no implications about US teens' norms in general since the sample wasn't random.

Public vs. private virginity pledges

The abstinence movement has been marked by grand gestures, and yet Melanie Bersamin found that teens who promise themselves to abstain until marriage are more likely to delay sex, while teens who take virginity pledges are not likely to delay sex. I gave a presentation about virginity pledges recently, so when I read the following, I thought of it:

The first tablets of the Ten Commandments, given with so much drama, were
destroyed. The second tablets, given privately and quietly, survived and became
the spiritual foundation of the people of Israel.

The Me'am Lo'ez points to the moral of this story: the really important and
lasting things in life are often done by individuals in privacy, through their
own exertions. Things done with much publicity may not be as permanent. (Marc Angel)

Perhaps the virginity pledge movement was a victim of its own success: the public nature of the pledges, the 1.5 billion in abstinence funding, and the attempts to seem trendy may have been the sound and fury signifying nothing of the first ten commandments.

Positive predictive values and gun control

The US has a number of workplace and school shootings, and each incident goes the same way. Media dig up events from the perpetrator's past (putting the perpetrator's name everywhere when the perpetrator's name really should forgotten, and the victims the ones who are remembered), including criminal record, complaints from co-workers, qualitative assessments of the shooter's mental health, and random anecdotes, and all of these events are assembled to answer the question of whether someone could have known that the perpetrator was so crazy.

While some of these incidents from a perpetrator's past are indeed crazy, they have poor positive predictive value: the most recent shooter apparently punched a woman over a booster seat at an IHOP. But such ironic and strange incidents happen all the time, which I know as an avid reader of News of the Weird. Attempting to predict who will go bezerk is like looking for a needle in a haystack: many people do minor strange, crazy things, and even do so multiple times, but most people who do minor strange things will not commit homicide. Even looking at more severe incidents, such as shooting a brother at age 20, may not necessarily predict future violence. Though allegedly sending a bomb to a dissertation committee member seems more likely to predict future violence, she was cleared of that charge.

Attempting to predict who will snap begs the question. We can't. Even if we had Big Brother comprehensive databases of every person's past, and were willing to disregard rules of evidence and dropped charges, we couldn't predict severe violence. The real issue is not which people are likely to snap, but rather why our gun control policy allows people such easy access to firearms that when they do snap they can do so much damage. Human psychology is fallible, but in countries without easy access to firearms, the damage comes in the form of broken objects, bruises and broken bones, and perhaps even a stabbing. Firearms create more damage, and damage that is most likely to be deadly.

. . .

Speaking of News of the Weird, here's one from last year about a Yale PhD and professor:

Love Can Mess You Up: Before Arthur David Horn met his future bride Lynette (a "metaphysical healer") in 1988, he was a tenured professor at Colorado State, with a Ph.D. in anthropology from Yale, teaching a mainstream course in human evolution. With Lynette's guidance (after a revelatory week with her in California's Trinity Mountains, searching for Bigfoot), Horn evolved, himself, resigning from Colorado State and seeking to remedy his inadequate Ivy League education. At a conference in Denver in September, Horn said he now realizes that humans come from an alien race of shape-shifting reptilians that continue to control civilization through the secretive leaders known as the Illuminati. Other panelists in Denver included enthusiasts describing their own experiences with various alien races. [Rocky Mountain Collegian, 9-28-09]

NY Times on the undergraduate sexual economy

Just as Katherine Bogle found: The NY Times reports that women are outnumbering men on campus, and turning to hookups in hopes of hooking a man. Based on both what I've learned anecdotally and also read in Rachel Greenwald's qualitative study of dating among adults, that's counterproductive. As someone told me when explaining why he thought early sex was intrinsically casual sex, "Everyone knows that if you have sex on the first date, you'll never see each other again."

If their concerns are long term, as many of these women and those in Bogle's study said, the women's decision to eliminate half the men to start with is also counterproductive. The article describes a campus that is 60% female where half the men are undesirable, and half of the desirable are coupled. Take a campus of 1000 students (all straight): 500 available women, 200 "undesirable" men, 100 available "desirable" men, and 100 each coupled "desirable" men and women. Effectively, the women have created a situation where the gender ratio is 5:1 female to desirable male, when it would otherwise be 5:3. Of course all the women expect that they are going to be the lucky 10% in a couple, so it would seem that this situation doesn't hurt them. In fact, since it seems likely that even couples are more unstable in a 5:1 gender ratio than a 5:3 gender ratio, labeling half the men as undesirable hurts even coupled women.

As one woman quoted in the article said, "As for a man’s cheating, “that’s a thing that girls let slide, because you have to. If you don’t let it slide, you don’t have a boyfriend.”" (Obviously counterproductive, no matter what the gender ratio is.)

Webster's dictionary is too sexually explicit

This article reads like it's from the Onion, but in fact parents really do seem to have asked their school district to ban the dictionary from the school library because of its definition of "oral sex," and the district complied.

Not only that, but the school district is looking for more objectionable words in the dictionary. ' "It's hard to sit and read the dictionary, but we'll be looking to find other things of a graphic nature," district spokeswoman Betti Cadmus told the paper [the Guardian].' Just ask any 8 year old. Those "graphic" words are the first words a curious 8 year old turns to when they open any dictionary.

What do school officials think the dictionary is for? Kids don't need to look up terms that they have ample information about such as "flower" and "toe". They need to look up ideas that they do not have ready access to, such as sexual behavior, substance use, and intelligence, as a quote from a board member illustrates well:

Board member Randy Freeman, an elementary school teacher and parent to four daughters in Menifee schools... said it's "a prestigious dictionary that's used in the Riverside County spelling bee, but I also imagine there are words in there of concern."

In other words, it sounds like he's never opened a dictionary.

"Hooking up" in the medical literature

Searching pubmed for the term "hooking up" reveals the following (sex-related) articles:

First mention was in 2003 in the Journal of Sex Research, and the most interesting paper by far: "both women and men rated their peers as being more comfortable engaging in these behaviors than they rated themselves. Men expressed more comfort than did women in engaging in these behaviors, and both sexes overestimated the other gender s comfort with hooking up behaviors."

Second mention: 2007, in J Interpersonal Violence about unwanted sexual experiences while hooking up.

2008: 3 mentions.
1. Hookups more likely among extraversion and less likely among low conscientious. [Note: this puts some context behind qualitative study of Bogle that women perceived all "dateable" men as interested only in hooking up: these women may view only high extraversion and low conscientious as dateable, while the low extraversion and high conscientious may have been considered less dateable.]
2. Oral sex seems not to be regretted, just vaginal sex, and especially with a one-time-only encounter or with someone met in last 24 hours.
3. More likely among higher income, white, alcohol users; women less positive reactions.

2009: 3 mentions.
1. The first longitudinal study looking for predictors of hookups (measured in the second wave), but nothing surprising: alcohol, high school hook-ups predict college hookups. Any sex in hookups associated with psychological distress for women but not men.
2. Qualitative study: men also have feelings about casual sex, not all positive, and not all no-strings-attached.
3. Hookups may have higher than normal STI risk, and may undermine sexual self-efficacy.

Interesting to find that there are only 8 articles that turn up. Obviously casual sex is more common in the literature, but the phenomenon of "hooking up" may be more widespread or normative than past casual sex. Certainly the first paper, about students' own attitudes towards casual sex being more ambivalent than their perceptions of their peers' beliefs, may not have been true a few decades ago.

An elderly psychiatrist's theories of casual sex

A recent paper in Dec 2009 found no greater mental health problems among students who "hook up" than students who don't.

I thought of this paper while reading the sex chapter in a book by psychiatrist Frederic Flach (1927-2006) who wrote much on resilience and depression. The thing I find so refreshing about his writing is how theory-based it is. I do not know whether the theories are right, but they allow him to tell a cohesive story in a way that data-driven writing would not.

1. Adolescence is a time for identity formation. Early sex interferes with that purpose of adolescence, and prevents sex from being integrated with their full identity. Sexual pressure may translate into substance use instead of the sex that they're not prepared for.

2. It's good that sexual guilt has been removed, but guilt also had a good effect of keeping people out of sexual affairs that may hurt people's self-worth or sense of personal integrity and lead to depression, such as marital infidelity, premature sex, or degrading situations.

3. The modern era has depersonalized many aspects of life, and people may be treated as statistical objects instead of people. Alienation is not rare. Sex has also been made impersonal in some contexts, but that may be because of the general social phenomenon of depersonalization, rather than something unique to devaluing sex (as some claim).

4. Sex may also be used to alleviate general loneliness and alienation, rather than for sexual purposes, and it's not successful at that. Low self-esteem in fact makes it hard to create a good relationship with trust and love, thus further reducing self-esteem.

5. Based on theories of Erikson and Buber, it's important for sex to occur within a framework of emotional intimacy, love, trust, and sharing everyday activities and life. If the primary sexual outlet is casual sex, "the inevitable enhancement of self-esteem that results from the complete experience does not occur and a slow, progressive waning in self-worth takes place, however it may be denied. Sexual harmony is not rooted in fine technique; rather, its foundation lies in both partners generously sharing with each other their bodies and their souls." (p. 97-98).

What I like the most about this analysis is that it posits distinct theories about what will happen in dynamic way that we can't capture easily with quantitative data. Data has to be extensive in order to capture a primary sexual outlet being casual sex, the absence of love, and a decline in self-worth. Not to mention being able to define and measure love and self-worth in meaningful ways. And the existing quantitative data on casual sex doesn't come close to being able to capture this.

This analysis does imply that given the choice of sex without love or no sex at all, the latter is preferable. Alternatively, it's optimistic, rejecting the idea of love as ever impossible.

Sexual fluidity in males

An extremely rare case of sexual fluidity in males: The Day I decided to Stop Being Gay.

This anecdote is similar to the qualitative study by Lisa Diamond, published in the book Sexual Fluidity, who documented 100 lesbian/bisexual/other women who spontaneously changed sexual orientation over the course of the 10 years after they graduated college.

The theory of sexual orientation that I'm familiar with are that female sexuality is more fluid, and male sexuality is more fixed --- though neither sexuality can be made to change, but rather may change spontaneously --- but this anecdote is an example counter to the view of male sexuality as being relatively more fixed.

He says he has another friend with a similar story. Will people start speaking of "gay until straight-marriage" as they do "lesbian until graduation"? GUS (GUM?) is a better acronym than LUG anyhow.

I wonder how it will turn out for him in 10 or 20 years. I do think that any woman would justifiably hesitate to marry him.

Next abortion restriction: must name the baby before abortion

Onion News Network: "New Law Requires Women To Name Baby, Paint Nursery Before Getting Abortion". The piece includes many other abortion law spoofs including 3 week post nursery-painting reflection period, a law that requires a woman who gets an abortion to donate a kidney, and pharmacists dispensing birth control in a blood red box with a skull on it while chanting "god have mercy on us" in Latin.

Non-useful graphical display of data: in the comics

Today's xkcd has a fantastic illustration of exactly what non-useful data display is.



Some displays of data are no more informative than the pie chart.

The 5 year pregnancy and other religious methods of dealing with deviance

One of the recurrent issues with religious restrictions on sexuality is how to deal with sexual transgressions. If a married woman's husband away has been away for 12 months, and she gives birth, how does a religion address this? The rabbis of the Talmud 1500 years ago declared that the length of pregnancy was 9 months, but birth can sometimes be delayed by 3 months, resulting in a 12 month pregnancy (Yevamot 80b). Apparently Muslim authorities made similar declarations, saying that a pregnancy can last 2, 4, or even 5 years. Likewise, I've heard of writings that a first pregnancy can be only 3 months long and yield a full-grown baby.

The source in the linked article is decrying this unscientific thinking, but it seems like the best alternative in a religious society that denies a high prevalance of transgression. Everyone knows that pregnancies are 9 months long (+/-), and much less than this will result in a small infant and much more than this is impossible, but declaring that reality fits the moral order rather than admitting the frequency of immorality is definitely more humane than calling people out on transgressions and treating them poorly. Which the editorialist seems interested in doing:

from a moral perspective, how can I provide a jurisprudential loophole for a woman who was probably promiscuous after the death of her husband and then presented her baby, conceived in sin, as a baby of her dead husband by relying on the [notion] of a hidden pregnancy or on a fatwa issued by some [cleric] or religious school? This is what happened on December 14, 1927 at a shari'a court in Mecca. The qadi... ruled that the baby was conceived by the woman's dead husband who had died five years previously.

Obviously the best option is to recognize that it's normal for healthy people to have sex, sometimes when it's against their religion's rules, and to provide a structure so that the best outcomes can prevail: sex ed, contraception, reasonable expectations. When that's not an option, a 5 year pregnancy seems like a great alternative.