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.
Sunday, May 16, 2010
Friday, May 14, 2010
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.
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.
Sunday, May 2, 2010
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).
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.
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.
Monday, April 12, 2010
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."
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."
Sunday, April 11, 2010
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.
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.
Friday, April 9, 2010
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:
On the other hand, condom education isn't necessarily safe either:
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.
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.
Tuesday, April 6, 2010
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.
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.
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