General Articles

New Abstinence Program Shows Some Results, Shortcomings


Source: John B. Jemmott III, PhD; Loretta S. Jemmott, PhD, RN; Geoffrey T. Fong, PhD, Efficacy of a Theory-Based Abstinence-Only Intervention Over 24 Months: A Randomized Controlled Trial With Young Adolescents,” Archives of Pediatric and Adolescent Medicine (February 2010): 152-159.
This study sought to evaluate the effectiveness of an abstinence-only intervention in delaying sex among young adolescents. In the study, 662 African-American students in grades six and seven were recruited from four public middle schools serving low-income communities in Philadelphia; a population at high risk for unintended pregnancy and sexually transmitted diseases (STDs), including HIV. The participating students, who were an average of 12 years old, were randomly assigned to five theory-based programs. The programs consisted of two or three four-hour sessions, and were taught in groups of six to eight students. The sessions were implemented on Saturdays in classrooms at the participating schools.
The programs included an eight-hour abstinence-only intervention, an eight-hour safer sex-only intervention, an eight-hour comprehensive (abstinence and safer sex) intervention, a 12-hour comprehensive intervention, or an eight-hour general health-promotion intervention. The general health-promotion intervention served as the control group for the study. The effectiveness of each program was measured over a period of 24 months with follow-up questions to the participants.
The abstinence-only program presented in this study was not designed to meet the restrictive criteria (known as the A-H definition) that was required in order for programs to qualify for federal abstinence-only-until-marriage funding. For example, Federal Requirement ‘B’ instructed programs to teach “that abstinence from sexual activity outside marriage is the expected standard for all school age children.”[1] In contrast, the abstinence-only intervention presented in this study recommends that students abstain from intercourse “until a time later in life when the adolescent is more prepared to handle the consequences of sex.” In addition, program facilitators were explicitly instructed not to criticize the benefits of condom use or allow the view that condoms are ineffective to go uncorrected.
Key Findings:
  • 23.4% of the sixth and seventh grade student participants reported having had sex prior to the interventions.
  • Of students who reported not having had sex before the programs started, the following percentages reported sex during the 24 month follow-up period:
                o   32.6% of the abstinence-only program participants
                o   41.2% of the eight-hour comprehensive program participants
                o   42.4% of the 12-hour comprehensive program participants
                o   46.6% of the health-promotion control group participants
                o   51.8% of the safer sex-only program participants
  • The abstinence-only program showed significant delay of sexual initiation among participants in the program.
  • The abstinence-only program showed no effect on condom use among participants.
  • Both the eight-hour and 12-hour comprehensive programs examined in the study reduced the likelihood of participants having multiple partners in the previous three months.
SIECUS Analysis:
This study adds some important new data to the conversation about what type of sexuality education delays sex among young teens, however, it in no way validates previously discredited abstinence-only-until-marriage programs. The abstinence-only program developed by the Jemmotts for this study did not require abstinence-until-marriage, did not use fear- and shame-based messages about sex, and refused to let suggestions that condoms are ineffective go unchallenged. These criteria alone would make this program ineligible for the federal funding for abstinence-only programs that has existed for the past 14 years. Therefore, this study leaves intact the significant body of evidence showing that abstinence-only-until-marriage programming is ineffective.
The abstinence intervention provided as part of this study clearly represented an exceptional approach to education for adolescents. The level of engagement and involvement with participants, small facilitator-to-student ratio, consistent follow up, and one-on-one sessions were undoubtedly hugely beneficial to participants. SIECUS believes we should certainly strive toward this dedication to the sexual health of our youth, but recognizes that such programs and large investments of resources remain rare and are certainly not the norm in abstinence-only programming. Moreover, we do not feel that this study alone merits a new investment in abstinence-only programming. 
While SIECUS and other leading organizations have always stressed an abstinence-focused approach for young teens and pre-teens, the early age that participants in this study began to have sex underscores the need to introduce protective methods to young people early; before their sexual debut.To implement abstinence-only programming with 12 year old students, of which nearly 25% have already engaged in sexual intercourse, is highly problematic. As the Society for Adolescent Medicine has pointed out, it is unethical for healthcare providers or health educators to withhold information that young people need to protect themselves and it seems obvious that this group of young people needed information about contraception and condoms.[2]
Instead of abstinence-only interventions, we would rather see the sort of exceptional resources invested in this program devoted to sex education that is ethically sound and strives to create sexually healthy adults, not just temporarily abstinent ones.  To do that we need a vast range of programs for different cultures, communities, and age groups that provide young people with the skills to make safe and healthy decisions not only about sexual intercourse and contraceptive use, but about communication, relationships, diversity, and countless other issues that are related to sexuality.

[1] For more information about the A-H definition, see the SIECUS Community Action Kit at the following link: <>.

[2] John Santelli, “Abstinence-only policies and programs: A position paper of the Society for Adolescent Medicine,” Journal of Adolescent Health (January 2006): 83-87.