Evaluating the Effectiveness of Personal Responsibility Education Programs

Teen sexual activity carries substantial costs, not only for the adolescents involved but also for society as a whole. These costs include the risks of sexually transmitted diseases (STDs), emotional and psychological distress, and unintended pregnancies. Abstinence education is crucial for the physical and psycho-emotional well-being of young people. Besides advocating abstinence from sexual activity until marriage, these programs emphasize the development of character traits that prepare youths for future goals.

The Scope of Teen Sexual Activity and Its Risks

Teen sexual activity remains a pervasive issue in the United States, posing significant health risks and carrying long-term implications. Early sexual activity is linked to an elevated risk of STDs, diminished psychological and emotional well-being, poorer academic performance, teen pregnancy, and out-of-wedlock childbearing. However, many of these risks can be avoided if teens choose to abstain from sexual activity.

Defining Abstinence Education

Abstinence education promotes "abstinence from sexual activity outside marriage as the expected standard for all school-age children" and underscores the social, psychological, and health benefits of abstinence. These programs equip youths with essential life and decision-making skills, fostering personal responsibility and laying the groundwork for healthy relationships and marriages in the future. Studies suggest that abstinent teens, on average, report better psychological well-being and achieve higher educational attainment compared to their sexually active peers. Delaying or reducing early sexual activity among teens can significantly lower their exposure to the risks of unintended pregnancies, STDs, and psycho-emotional harm.

Overview of Research on Abstinence Education

This article examines 22 studies focusing on abstinence education. Sixteen of these studies evaluated abstinence programs designed primarily to teach abstinence, with 12 reporting positive findings. The remaining six studies analyzed virginity pledges, with five indicating positive outcomes. Overall, 17 of the 22 studies reported statistically significant positive results, such as delayed sexual initiation and reduced levels of early sexual activity among youths who received abstinence education.

Specific Programs and Their Evaluations

Abstinence-only Intervention: A 2010 study published in the Archives of Pediatrics and Adolescent Medicine concluded that an "abstinence-only intervention reduced sexual initiation" and recent sexual activity among African-American adolescents. Two years after participating in an eight-hour abstinence program, approximately one-third of the participants had initiated sexual activity, compared to nearly one-half of the non-participants who were enrolled in a general health program. This randomized controlled experiment, considered the gold standard for evaluations, involved 662 sixth- and seventh-grade African-American students.

Reasons of the Heart (ROH): A 2008 study assessed the impact of the ROH curriculum on adolescent sexual activity among seventh-grade students in three suburban northern Virginia public schools. Researchers also collected data from a comparison group of seventh-grade students in two nearby middle schools that did not participate in the program. The evaluators surveyed students in all five schools before and after the program. One year later, 32 (9.2 percent) of the 347 ROH students who were virgins at the initial survey had initiated sexual activity, compared with 31 (or 16.4 percent) of the 189 comparison group students.

Sex Can Wait: This three-series abstinence education program includes one series for upper-elementary students, a second for middle school students, and a third for high school students. A 2006 study evaluated the program's long-term (18-month) impact on adolescent sexual behavior. The researchers compared students who participated in Sex Can Wait to those who received their school districts' standard sex education curricula on two behavioral outcomes: overall abstinence and abstinence during the last 30 days. Eighteen months after the program, upper-elementary students who participated in Sex Can Wait were less likely than non-participants to report engaging in recent sexual activity. Among middle school students, participants were also less likely than non-participants to report engaging in sexual activity ever and in the preceding month before the 18-month follow-up.

Heritage Keepers: This is a primary prevention abstinence program for middle school and high school students.

For Keeps: Taught by outside facilitators, For Keeps was a five-day curriculum with 40-minute sessions that focused on character development and the benefits of abstinence. The program aimed to help students understand how pregnancy and STDs can impede their long-term goals and emphasized the psycho-emotional and economic consequences of early sexual activity.

Best Friends (BF): The Best Friends program, which began in 1987, operates in approximately 90 schools across the United States. The Best Friends curriculum is an abstinence-based character-building program for girls starting in the sixth grade and offers various services such as group discussions, mentoring, and community activities. Discussion topics include friendship, love and dating, self-respect, decision-making, alcohol and drug abuse, physical fitness and nutrition, and AIDS/STDs. A 2005 study evaluated the District of Columbia's Best Friends program, which operated in six of the District's 20 middle schools. Adjusting for the survey year, students' age, grade, and race and ethnicity, the study reported that Best Friends girls were nearly 6.5 times more likely to abstain from sexual activity than YRBS respondents.

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Not Me, Not Now: This community-wide abstinence intervention program targeted children ages nine through 14 in Monroe County, New York, including the city of Rochester. The Not Me, Not Now program used a mass communications strategy to promote the abstinence message through paid television and radio advertising, billboards, posters distributed in schools, educational materials for parents, an interactive website, and educational sessions in school and community settings. The program was effective in reaching early teens, with approximately 95 percent of the target audience in the county reporting exposure to a Not Me, Not Now ad. During this period, the sexual activity rate of 15-year-olds across the county dropped from 46.6 percent to 31.6 percent, a statistically significant decrease. Additionally, the pregnancy rate for girls ages 15 through 17 in Monroe County fell from 63.4 pregnancies per 1,000 girls to 49.5 pregnancies per 1,000, also a statistically significant reduction.

Abstinence by Choice: This program operated in 20 schools in the Little Rock area of Arkansas, targeting seventh, eighth, and ninth-grade students and reaching approximately 4,000 youths each year. A 2001 evaluation of a sample of 329 students found that only 5.9 percent of eighth-grade girls who had participated in Abstinence by Choice a year earlier had initiated sexual activity, compared with 10.2 percent of non-participants.

HIV Risk-Reduction Intervention: A 1998 study evaluated a two-day abstinence-based HIV risk-reduction intervention.

Stay SMART: Delivered to Boys and Girls Clubs of America participants, Stay SMART integrated abstinence education with substance-use prevention and included instructions on general life skills. The 12-session curriculum, led by Boys and Girls Club staff, used a postponement approach to early sexual activity and targeted both sexually experienced and sexually inexperienced adolescents. A 1995 study evaluated Stay SMART's impact on adolescent sexual behavior.

Project Taking Charge: This six-week abstinence curriculum was delivered in home economics classes during the school year and designed for use in low-income communities with high rates of teen pregnancy. The program was evaluated in Wilmington, Delaware, and West Point, Mississippi, based on a small sample of 91 adolescents. The program may also have delayed the onset of sexual activity among some of the participants.

Teen Aid and Sex Respect: An evaluation of the Teen Aid and Sex Respect abstinence programs in three Utah school districts reported that certain groups of youths who received these programs delayed the initiation of sexual activity.

Virginity Pledges and Their Outcomes

Several studies using the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of American youth, have found that adolescent virginity pledging was associated with delayed or reduced levels of teen sexual activity, other risky behaviors, teen pregnancy, and STDs.

Delayed Sexual Activity: A 1997 study published in the Journal of the American Medical Association examined a large national sample of teenagers in the seventh through 12th grades. The authors found that the level of sexual activity among students who had taken a formal pledge of virginity was one-fourth the level of their counterparts who had not taken a pledge but were otherwise identical in race, income, school performance, degree of religiousness, and other social and demographic factors. Another study of the virginity pledge movement, published in 2001, found a similar association between pledging and delayed sexual activity. The study reported that taking a virginity pledge was associated with a reduction of approximately one-third in the likelihood of early sexual activity, adjusted for a host of other factors linked to sexual activity rates including gender, age, physical maturity, parental disapproval of sexual activity, school achievement, and race. When taking a virginity pledge was combined with strong parental disapproval of sexual activity, the probability of initiating sexual activity was reduced by 75 percent or more.

Life Outcomes in Young Adulthood: Analyzing the most recent Add Health data, a 2004 study found that adolescent virginity pledging was linked to a number of positive life outcomes.

Programs with Uncertain or Questionable Results

A 2007 study evaluated a voluntary component of a three-part abstinence program focused on life skills education.
A study evaluated the Operation Keepsake program in Cleveland and reported positive results (i.e., reduced levels and delayed initiation of sexual activity), but the statistical significance of findings was less certain.
A study analyzed the Postponing Sexual Involvement program in Atlanta in the mid-1980s and reported positive findings (i.e., delayed onset of sexual activity), but the content of the program has been questioned.

Methodological Considerations in Evaluating Abstinence Programs

The research field of abstinence program evaluation is still developing, and only a limited number of programs have been evaluated thus far. Currently, several hundred abstinence programs are in operation nationwide, varying significantly in the youth populations they serve, their implementation, and their curricula. The few evaluated programs may not adequately represent the spectrum of abstinence programs.

Experimental vs. Quasi-Experimental Studies

Experimental studies offer the most rigorous evaluation design. A true experiment allows researchers to draw conclusions about a program's impact with a high degree of confidence. By randomly assigning youths to receive or not receive abstinence education, researchers aim to simulate how participants would have behaved without the intervention. In theory, random assignment eliminates any systematic differences between the intervention group and the control group. However, well-designed and well-implemented experiments are rare. Quasi-experimental studies adjust for observable factors other than abstinence education that might confound the results. The degree of confidence in the findings from non-experimental studies depends on the rigor of the evaluation design and the adequacy of the statistical analysis.

Longitudinal Surveys

The virginity pledge studies often used longitudinal surveys of self-reported data, following the same group of individuals from adolescence to young adulthood.

Reported Behavioral Outcomes

This article primarily focuses on significant positive behavioral outcomes reported in the studies, such as delayed onset of sexual activity, reduced levels of early sexual activity, and fewer sexual partners among adolescents. It also discusses studies that reported no significant impact.

Personal Responsibility Education Program (PREP)

PREP provides federal funding to educate youth on abstinence and contraception. Mathematica collaborated with the New York State Department of Health to rigorously evaluate the Teen Choice curriculum in alternative school settings in and around New York City. The curriculum covers abstinence, contraception, sexually transmitted infections, and healthy relationships. Six months post-program, Teen Choice had no effect on rates of unprotected sex.

Abstinence-Only vs. Comprehensive Sex Education

Abstinence-only programs are promoted as a solution to adolescent pregnancy and STDs, but their effectiveness remains questionable. The government has historically provided sexual health programming in two forms: comprehensive sexual education and abstinence-only education. However, the increase in abstinence-only programming has led to a decline in adolescents' sexual knowledge. Abstinence-only education excludes necessary sexual information regarding birth control, contraception, STDs, and HIV/AIDS and does not always contain medically accurate information. It also disregards the needs of LGBTQ youth.

Political Alignments and Sex Education

Political divides significantly influence sex education reform. While both Republicans and Democrats support including sex education in middle and high school, they differ on the topics covered. Democrats are more likely to support education including birth control, healthy relationships, consent, and sexual orientation, whereas Republicans are more likely to support education surrounding abstinence. Conservatives often view teen sex as the primary issue, while advocates for comprehensive sex education prioritize optimal health for teens and rely on scientific evidence.

Current State of Adolescent Sexual Activity and Education

The United States continues to have one of the highest teen pregnancy and STD rates in the developed world. Abstinence-only education has increased, leading to a decline in knowledge about safe sex and human sexuality. Many students engage in intercourse without information on condoms, infections, and consent. State laws severely restrict what health curricula can contain, with many states requiring abstinence to be taught or stressed.

Analysis of Effectiveness of Abstinence-Only Education

Medical experts argue that abstinence-only education is not an effective public health strategy to reduce unintended pregnancies or STIs. Data shows at best, no change in teen pregnancy and STIs and have several studies which show an association between increasingly regulated abstinence policies and higher rates of teen births, pregnancies, and chlamydia infections . Systematic reviews have found no scientific evidence showing that abstinence-only programs delay sexual intercourse, facilitate abstinence, or reduce the number of sexual partners. Comprehensive risk reduction programs have a beneficial impact on sexual activity, use of contraception, and number of sex partners.

Rising Age of Marriage

The goal of abstinence education to delay sexual intercourse until marriage contradicts the trend of adolescents getting married later, leading to a wider gap between first sexual experience and marriage. Advocates for abstinence-only programs imply that sexual activity outside of marriage causes psychological and physical damage, but there is little evidence that consensual sex before marriage between adolescents causes any harm.

Exclusion of Marginalized Groups

Abstinence-only education often neglects adolescents who are part of a sexual minority, whether that be LGBTQ adolescents or sexually experienced adolescents potentially harming students.

Missouri Personal Responsibility Education Program (PREP)

Missouri PREP provides sexual health education programs to youth with the goal of reducing unintended teen pregnancies. Theories of change suggest that youth improve their sexual health knowledge, intentions, attitudes, and behaviors as a result of program implementation. A study examined youth sexual intentions to use a condom, engage in sexual behavior, and abstain from sex as a result of Missouri PREP program implementation. Youthâs scores on intentions, knowledge, and attitudes rise from pre- to post-survey. Knowledge gains are salient while attitudes remain relatively high and stable. Intentions to use condoms differ from those in intentions to have or abstain from sex. Missouri PREP saw improvements in knowledge, attitudes, and intentions as a result of program implementation. Three curricula were chosen in order to accommodate the demographic, geographic, and socioeconomic diversity within the Missorui communities targeted for program implementation. The three curricula primarily focus on comprehensive sexual education while stressing that abstinence is the safest way to prevent pregnancy. Standardized pre- and post-program surveys were used to assess PREP youthsâ intentions. Theories of change state that knowledge, attitudes, perceived behavior, and norms together shape intentions and behaviors.

GAO Report on Abstinence Education

In 2008, the US Government Accountability Office (GAO) released a report titled, âAbstinence Education: Assessing the Accuracy and Effectiveness of Federally Funded Programs,â which investigated the scientific accuracy and effectiveness of abstinence-only education programs. GAO found that factors such as inaccurate medical information contributed to overall conclusions that abstinence-until-marriage programs were unsuccessful at reducing the rates of adolescent pregnancy. GAO found that HHS and states did not properly substantiate the scientific accuracy of educational materials used in abstinence programs nor comprehensively assess the effectiveness of those programs. The report detailed the overall methods for the investigation and lists the three programs that GAO examined, which were the Abstinence Education State Program, Community-Based Abstinence Education Program, and Adolescent Family Life, or AFL, Program. GAO reported that the Administration for Children and Families, or ACF, neither reviewed nor required its grantees to screen program materials for scientific accuracy. Additionally, GAO found inaccuracies in ACF program materials in two of the five states it reviewed. For a study to be scientifically valid, it must have random control or well-matched comparison groups and it must measure biological outcomes or reported behaviors rather than attitudes and intentions. GAO found that some of the journal articles on abstinence education that it reviewed lacked at least one of the characteristics of a scientifically valid study of program effectiveness. GAO recommends to HHS that it reexamine its position regarding the provision.

Evaluation of SafeSpace

To determine the efficacy of a particular mobile sexual health education program, Child Trends, MyHealthEd, and Healthy Teen Network are conducting a five-year (2021-2026) randomized control trial evaluation of SafeSpace, an app-based sexual health intervention. The SafeSpace developers designed the program to provide youth a secure space to share personal stories and build health literacy.

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