Teen Health in the News

source: Kaiser Network

June 27, 2002

Senate Finance Committee Passes Amendment to Welfare Reform Bill Supporting 'Abstinence-First' Sex Ed Programs

The Senate Finance Committee yesterday passed a welfare reform bill, known as the Work, Opportunity and Responsibility for Kids Act of 2002, that includes funding for both abstinence-only and "abstinence-first" sex education programs, the Washington Times reports. The bill, which is a revision of the 1996 Welfare Reform Act that is set to expire in September, would continue to provide $50 million each year in funding for abstinence-only education programs, a provision that is also included in the House version of the bill (HR 4737) that was passed last month (Wetzstein, Washington Times, 6/27). However, the committee also approved an amendment by Chair Max Baucus (D-Mont.) that would allocate $50 million each year for "abstinence-first" sex education programs, which would encourage abstinence but could also teach children about contraception (Peterson, National Journal News Service, 6/26). Currently, every state except for California receives federal abstinence-only education funding provided through the 1996 welfare reform legislation (Kaiser Daily Reproductive Health Report, 5/17).


Several groups and newspapers commented on yesterday's Senate action on the welfare bill. A summary of some of these statements follows:

*HHS: The Finance committee-passed bill "falls far short of President Bush's welfare reform reauthorization principles," HHS Secretary Tommy Thompson stated, adding that the full Senate should consider legislation that is "more in line with Bush's principles" (HHS release, 6/26).

*New York Times: A Times editorial expresses support for Baucus' abstinence-first amendment, in part because it "modif[ies] the government's blinkered approach" to sex education funding. Abstinence-only programs are a "recipe for disaster," and American teenagers must be provided with "information that could avert pregnancies or protect them from a fatal [HIV] infection should they become sexually active," the editorial concludes (New York Times, 6/26).

*Planned Parenthood Federation of America: Although PPFA "appreciates" the committee's effort to address sex education, Congress "needs to do more to ensure that all our children get medically accurate information necessary to protect their health," Planned Parenthood President Gloria Feldt said, adding that "[c]omprehensive [sex education] programs work best" (Planned Parenthood release, 6/26).

*Sexuality Information and Education Council of the United States: Young Americans want "medically accurate information and education" about sex, not abstinence-only programs that are "fear-based, biased and misrepresent the effectiveness of contraception and condoms," SIECUS President Tamara Kreinin said. She added that the final bill passed by the Senate should allow states "greater flexibility to craft an appropriate approach to intervention programs most suitable for their citizens" (SIECUS release, 6/25).

June 17, 2002

Sex Education, Abstinence Efforts Not Effectively Reaching Teens, BMJ Study Says

Sex education and abstinence programs directed at teens are not having the intended effect of lowering teen pregnancy rates, according to study in this week's BMJ, the Toronto Globe and Mail reports (Honey, Toronto Globe and Mail, 6/14). The study says that such programs are ineffective at causing teens either to delay sexual activity or to use contraception once they do begin having sex. A research team led by Dr. Alba DiCenso of McMaster University in Canada conducted a meta-analysis of 26 studies of sex education programs targeted at 11- to 18-year-olds in the United States, Canada, Australia, New Zealand and Europe. They found that pregnancy prevention programs overall are not working, "and in some cases, simply make things worse" (Canadian Press, 6/14). DiCenso's team identified four abstinence programs in which the pregnancy rate among participants was 50% higher than the rate among teens who did not take part in the programs. Although pregnancy prevention programs overall did not appear to be effective among teens, the authors cautioned that the results may be slightly skewed because most of the studies were conducted among teens who were African-American or Hispanic, populations that often have high pregnancy rates overall. These same pregnancy prevention programs "may be more successful in other populations," the authors noted (Agence France-Presse, 6/14).


Some of the authors' recommendations for improving pregnancy prevention strategies aimed at teens are outlined below:

*Researchers should take a closer look at teenagers who "do, and don't, get pregnant" to better determine which groups are at higher risk for teen pregnancy.

*Researchers should also more closely examine programs in countries such as the Netherlands, which have low teen pregnancy rates.

*Researchers may wish to review programs that have been effective among teens at preventing other high-risk behaviors, such as drug and alcohol use, to identify health behavior modification strategies that are effective with that age group.

*Programs should seek to involve parents on a wider scale, the authors said, noting that teens have indicated that they would prefer to get sex education messages from their parents rather than their peers (Canadian Press, 6/14).

*Programs should focus more on communication skills and sexual negotiation skills than on anatomy and "scare tactics," according to the authors, who noted that none of the interventions reviewed in the study "focused on strategies for improving the quality of sexual relationships" among teens (Agence France-Presse, 6/14).

June 12, 2002

Report Ranks Country's 'Kid-Friendly' Cities Based on Infant Mortality, Teen Pregnancy, Low Birthweight Data

Atlanta, Ga., is making the greatest improvements among large U.S. cities on three child health indicators -- infant mortality rate, teen birth rate and the number of low-birthweight babies -- according to a report released yesterday by Population Connection, formerly known as Zero Population Growth, the Atlanta Journal-Constitution reports (McKenna, Atlanta Journal-Constitution, 6/10). The "Kid-Friendly Cities Health Improvement Report Card," part of a series of Population Connection reports, used CDC statistics from 1990 and 1998 to grade cities on the three criteria. Of the 25 cities with populations of more than two million, Atlanta received the highest grade, an A-plus, while St. Louis, Mo., received the lowest grade of C-minus. The report also analyzed data from 140 cities with populations between 100,000 and two million, of which Cedar Rapids, Iowa, received the highest grade, while Eugene, Ore., received the lowest (Population Connection release, 6/5). The data for all three indicators were collected "in exactly the same way for the same populations" in 1990 and 1998. Report findings for the three indicators are summarized below:

*Infant mortality -- Defined as the death of an infant who is less than one year old, infant mortality "reflects the well-being of both mother and child" and is affected by a variety of factors, including the health of the woman, environmental conditions and socioeconomic status, the report states. Nationally, the infant mortality rate fell from 9.2 deaths per 1,000 live births in 1990 to 7.2 deaths per 1,000 live births in 1998, an improvement of 28%. However, disparities between cities remained, with 12 of the 25 largest cities studied reporting infant mortality rates above the national average in 1998. Racial disparities also remained, with 13.9 deaths per 1,000 live births recorded for African-American infants, compared to 6.0 deaths for non-Hispanic whites, 5.8 deaths for Hispanics and 5.5 deaths for Asian/Pacific Islanders in 1998.

*Births to teens -- The national rate of births to teenage mothers also declined slightly over the study period, falling from 12.8% in 1990 to 12.5% in 1998. Nineteen of the 25 largest cities studied showed improvements, but 17 cities still had teen birth rates higher than the national average in 1998. The report notes that reducing the rate of births to teenagers is particularly important because infants born to teens are more likely to have low birthweight and are at a higher risk of infant mortality than infants born to older women. Children born to teen mothers are also more likely to live in poverty and less likely to graduate from high school than other children.

*Low birthweight -- Defined as less than 2500 grams, or about 5.5 pounds, low birthweight infants are at increased risk of infant mortality and long-term illness than infants with normal birthweight. The percentage of low birthweight infants born between 1990 and 1998 rose from 7.0% to 7.6%, a 9% increase, with 13 of the 25 study cities showing no improvement in the proportion of low-birthweight infants, according to the report. Poverty, poor maternal health and a lack of prenatal care are all factors that may contribute to low birthweight. However, data from the National Center for Health Statistics show that the rise in the rate of low birthweight over the study period was largely due to increases in the number of multiple births caused by the increased use of fertility treatments. The percentage of low-birthweight infants fell slightly among African Americans -- from 13.3% in 1990 to 13.2% in 1998 -- but it remained "extremely high" compared to the proportion of low-birthweight infants among other ethnic groups, which in 1998 were 6.4% among Hispanics, 6.6% among non-Hispanic whites, 7.1% among American Indians and Alaska Natives and 7.4% among Asian/Pacific Islanders ("Kid-Friendly Cities Health Improvement Report Card," June 2002).

Lowering Teen Pregnancy Rates

Population Connection President Peter Kostmayer said that "[a]ll the cities, regardless of their grade, have two things in common -- they all have kid-friendly success stories and they all could do better." He added, "Clearly one thing that we have to do is find ways to provide more teen pregnancy prevention programs that give young people access to comprehensive reproductive health care and education" (Population Connection release, 6/5). Lowering teen pregnancy rates "is key to a higher" ranking, the Detroit News reports. "Cities that didn't do well with teen pregnancies didn't do well in the other areas either," Brian Dixon, director of government relations for Population Connection, said (Morris, Detroit News, 6/11).

June 12, 2002

Detroit Free Press Profiles Growing Trend of Oral Sex Among Young People

Recent reports that more teenagers and preteens are engaging in oral sex are causing concern among health officials and educators, some of whom would like the CDC to begin tracking the oral sex habits of young people, the Detroit Free Press reports. Teachers in Oakland County, Mich., report that some students are beginning to "experiment" sexually as young as age 10, and several fifth- and sixth-grade students have already said that they have "tried" oral sex. Young people are "embracing an increasingly casual attitude toward oral sex," and many teens say that the act "is not sex at all," the Free Press reports. Sex education teachers say that teens are "hearing the message to choose abstinence or to protect themselves against pregnancy." However, teens' definitions of concepts such as virginity, oral sex and intercourse can complicate efforts to communicate abstinence messages, as young people may engage in oral sex rather than vaginal intercourse to maintain their virginity and practice safe sex. Lisa Remez, associate editor of a sexual and reproductive health journal for the Alan Guttmacher Institute, noted that many girls perform oral sex in order to "remain virgins" while experimenting sexually. Diane Waggoner, health education consultant for Oakland Schools, stated, "When I talk to kids about oral intercourse, they look at me funny because they don't consider it intercourse. A lot of kids think that since they can't get pregnant with oral sex, they are practicing abstinence and are safe." Dr. Lloyd Kolbe, director of the CDC's Adolescent and School Health program, stated, "What young people must understand is that it is possible through oral intercourse to be infected with HIV and other serious STDs" (Low, Detroit Free Press, 6/11).

June 11, 2002

Kentucky School District Examines Ways to Educate Middle School Students About Oral Sex, Disease Transmission

School administrators and parents in Fayette County, Ky., are planning meetings to address the increasing rates of oral sex and sexually transmitted diseases among middle school students, the Lexington Herald-Leader reports. Dr. Hatim Omar, a University of Kentucky specialist in adolescent medicine, said that since January he has treated at least 10 middle school-aged students for STDs contracted through oral sex, compared to six such cases in 2001, two in 2000 and two in 1999. Four students who developed tonsillitis after contracting gonorrhea said that they had acquired the disease at off-campus parties where oral sex between students was prevalent. Doctors and school officials say that adolescents often do not equate oral sex with sexual intercourse, and many young teens believe that oral sex is "safer than vaginal intercourse." Mike Kennedy, acting health education coordinator for the school district, said that the district had a coordinated sex education curriculum until 1990, but now each school determines its own content for the courses. Kennedy stated that he does not know of any middle school sex ed classes that currently address the topic of oral sex. Beaumont Middle School PTA President Debbie Boian said that she wants middle school PTA leaders to discuss creating programs at each school to talk to students about the risks of disease transmission from oral sex and other sexual behavior. Pediatrician Tom Pauly stated that parents and physicians need to "[deal] with incidents directly and speak bluntly" with middle school students to help them understand both the emotional and physical consequences of sexual activity. "We advise them to abstain," Pauly said, adding that he discusses with middle school-aged patients both the "medical complications and the psychosocial complications of engaging in oral sex at such a young age" (Spears, Lexington Herald-Leader, 6/9).

Better Education is Key, Editorial Says

One "unexpected outcome" of the emphasis on abstinence in sex education is that young people "aren't clear on exactly what they should abstain from," leading many to "mistakenly conclude that any sexual behavior that won't result in pregnancy is safe," a Lexington Herald-Leader editorial states. The increased incidence of oral sex among middle school students suggests that children view this form of sexual activity as both "less intimate" and "less risky" than sexual intercourse, the editorial says, even though STDs including herpes, syphilis, chlamydia, gonorrhea, human papillomavirus and HIV can be spread through oral contact. According to the Herald-Leader, a belief among young teens that oral sex does not constitute sex is especially problematic because "youngsters who don't yet consider themselves sexually active are not likely to be routinely checked for STDs as part of medical care." While it is "encouraging to see Lexington school officials and parents deal openly with this sensitive topic," the editorial concludes that school sex education programs need to do more to "[arm] kids with the facts about sex," as well as with "the expectation that they'll become partners in intimate relationships built on trust and respect" (Lexington Herald-Leader, 6/11).

June 11, 2002

Pittsburgh Post-Gazette Profiles Debate Over Abstinence-Only Sex Education

The Pittsburgh Post-Gazette on Sunday profiled the debate over public school-based abstinence-only sex education, which promotes postponing sex until after marriage and does not include information on contraception. The House of Representatives has voted to renew funding for abstinence-only education as part of the reauthorization of the 1996 Welfare Reform Act, which originally allocated $50 million over five years for states to provide abstinence-only programs. The Senate has not yet considered the reauthorization bill, but President Bush is "strongly push[ing]" the bill as a way to combat the country's "sex-saturated culture," despite conflicting evidence about such programs' efficacy, the Post-Gazette reports. Rep. Joseph Pitts (R-Pa.) said that lawmakers have a "duty not to send mixed messages to our youth" by including discussions about birth control in schools. But Rep. Jim Greenwood (R-Pa.), who personally supports abstinence, believes that "mixed messages may be best," the Post-Gazette reports. According to Greenwood, lawmakers are doing a "disservice to teens" by not including more comprehensive sex education. "Why can't we tell kids the whole truth and trust them? If all you say is 'just say no,' you'll be laughed out of the 6th and 7th grades," he said (McFeatters, Pittsburgh Post-Gazette, 6/9).

June 10, 2002

Antiabortion Activists Protest Opening of Rhode Island Teen Reproductive Health Center

A group of antiabortion activists on Wednesday protested the opening of a health center in Pawtucket, R.I., that will provide reproductive health services -- but not abortions -- to teens, the Providence Journal reports. The center is operated by Planned Parenthood of Rhode Island and is located in the Women's Care Inc. clinic every Wednesday from 4:30 p.m. to 7:30 p.m. The teen center will offer a variety of reproductive health services, including contraceptive education, emergency contraception, routine gynecological care and testing for pregnancy and sexually transmitted diseases, to teens ages 13 to 19. Teen peer educators will provide the majority of the information dispensed at the clinic, and a health educator, a physician and a nurse practitioner will also staff the center. The teen center will not offer abortions, but opponents of the clinic say that the center will "encourage teenagers to have sex, engage in contraception and, ultimately, seek abortions." But clinic operators say that there is an obvious need for teen reproductive health services because Rhode Island has the highest teen pregnancy rate in the Northeast. "Young people need to be informed. We can encourage abstinence. We can encourage delay (of sexual activity). But we can't pretend it's not happening," Miriam Inocencio, president of Planned Parenthood of Rhode Island, said (Castellucci, Providence Journal, 6/6).

June 7, 2002

CDC Releases 2001 Birth Statistics; Teen Birth Rate Continues to Decline and Number of Caesarean Births Rises

The overall U.S. teen birth rate fell 5% last year to mark a new "record low," according to preliminary birth statistics released yesterday by the CDC. The report found that the overall birth rate dropped among females ages 15 to 19 from 48.5 births per 1,000 girls in 2000 to 45.9 births per 1,000 girls in 2001, with the largest gains made among teens between the ages of 15 and 17, who experienced an 8% decline in births last year. The birth rate declined among all racial and ethnic groups, with black teenagers experiencing the greatest decline (8%). The reduction in the number of births to teens is especially important for the health of both mothers and infants because teens are the least likely to receive "timely" prenatal care and are more likely to smoke and give birth to low-birthweight infants. "The research shows us that when teens postpone parenthood, they improve their lives and the lives of their children," HHS Secretary Tommy Thompson said, calling the record low an "important milestone in our fight against teen pregnancy" (HHS release, 6/6). Researchers are not sure what factors led to the decline in teen births, but they say that higher levels of sexual abstinence and better use of contraceptives probably contributed to the decrease (Wetzstein, Washington Times, 6/7). Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy, said that the "credit for these impressive declines goes primarily to teens themselves who are increasingly making wise decisions about sex and their future." NCPTP President Isabel Sawhill added that despite the "good news," U.S. teen pregnancy rates remained "unacceptably high" and called on Congress, which is currently considering welfare reauthorization legislation, to "mak[e] sure that resources are available to support effective national, state and community efforts to prevent teen pregnancy" (NCPTP release, 6/6). James Wagoner, president of Advocates for Youth, said, "We cannot put the progress we are making in jeopardy. Congress has the opportunity in the coming months to reverse course and fund pregnancy prevention programs that the research shows really work. ... We can and must do a better job at prevention" (Advocates for Youth release, 6/6).

June 4, 2002

Teens 'Redefining' Sex, Engaging in 'Riskier' Sexual Practices

Teenagers are having sex at younger ages and are engaging in "riskier" sexual practices, but many "mask their promiscuity by redefining what sex is: only intercourse counts," the Detroit News reports in an examination of the "conflicting trends" in teenage sexuality. According to the CDC Youth Risk Survey, the number of Michigan high school students who reported ever having engaged in sexual intercourse fell from 54% in 1991 to 45% in 1999 -- a decline many observers have attributed to an increased emphasis on abstinence. However, the survey did not address teens' behavior with regard to anal sex and oral sex, two activities that teens commonly do not categorize as "having sex," the Detroit News reports. "A fair number [of teens] don't think of oral sex or anal sex as sex, which is frightening because (the result is) more interplay with different types of sexual activity between younger and older teens," Lynn Ponton, a professor of psychiatry at the University of California-San Francisco and author of "The Sex Lives of Teenagers," said. She added that most teens do not know that they can acquire sexually transmitted diseases through such contact. The Michigan Department of Community Health in 2000 reported 8,591 cases of chlamydia among youth under age 20, with 599 of those cases occurring in teens ages 14 and younger. Dr. Anju Sawni, an adolescent health specialist at Children's Hospital of Michigan, added that health professionals are seeing a growing trend in STD cases among teens aged 13 and 14.

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