The Failure of Choosing the Best, an Abstinence Program Educating Adolescent Students –Kathleen Grueter
Introduction –Current Speculation
Over Abstinence Education
Sexual activity amongst uneducated adolescents has
remained a highly publicized issue in the United States for decades. According
to the Centers for Disease Control and Prevention in 2011, 47% of all U.S.
teenagers have had sexual intercourse and 16% of all U.S. teenagers were never
taught in school about HIV or AIDS infection (1). In 2012, the U.S. Department
of Health and Human Services (HHS) stated that one-third of new HIV infections
come from people ages 13-29, the larges of any age group (2). Federally funded
sex education is utilized in the United States as a primary prevention tool to
address numerous public health concerns. Sex education seeks to decrease
unplanned adolescent pregnancy and the development of sexually transmitted
infections, as well as to promote safe and healthy relationships (3).
The United States has
funded more than $1.5 billion abstinence-only education programs since 1997 and
until 2010 it was the only form federally funded (4, 7). As the U.S. Department of HHS states, “Abstinence education is an important
preventive component of an overarching federal strategy designed to protect
youth from the physical, psychological and economic consequences associated
with teenage sexual activity and non-marital childbearing” (3). However, the Obama Administration made the
politically controversial decision in 2010 to defund abstinence-only
educational program and began funneling money towards “proven effective”
comprehensive sex education programs (4). While comprehensive programs
promote safe sex and the use of contraceptives, abstinence programs value the moral
importance of saying “no” to the temptation of sexual intercourse prior to
marriage.
One abstinence program still federally funded is Choosing the Best. This program was
established in 1993 and reaches over four million students across the nation.
This program believes “abstinence is the only way to eliminate physical and
emotional risk associated with premarital sex” (5). Choosing the Best has adapted courses for students ranging from
middle school through high school to touch upon the various challenges and
pressures adolescents face at each stage of life. This program believes it is
effective due to the following five keys: Choosing
the Best provides current information on health consequences of sex,
instills confidence against peer pressure, involves parents, creates a
motivational classroom environment, and builds strong moral character in
teenagers (5).
Choosing the Best has the potential to
have a deeper impact and reach a wider range of adolescences, however drastic
changes must be made towards their intervention technique. This paper critiques
three aspects of Choosing the Best as a public health approach to
educate adolescent students on sexual education, in particular its use of the
individual level theory, the Health Belief Model. Furthermore, this paper
provides an alternative intervention that addresses the three crucial flaws of Choosing the Best.
Critique #1: Choosing the Best: Influenced by the
Health Belief Model
One of the five keys to
effectiveness of Choosing the Best is
that provides current information on the health consequences of sex. Choosing the Best, like all abstinence
education programs, is based around the idea that public health officials will
positively influence adolescent students if they intervene early and inform
students of the risks of premarital sex as well as the benefits of abstinence.
For example, Choosing the Best Path,
which is aimed grade seven students, teaches that “one in five Americans aged
twelve and up contract genital herpes. Assertiveness training in these eight
lessons engage students in learning how to say “NO” to premarital sex and “YES”
to health relationships” (5). Choosing
the Best assumes that once students understand the perceived risks of
having sex, such as out-of-wedlock pregnancy and the contraction of a sexually
transmitted infection (STI) like genital herpes, the adolescents will choose
abstinence; these students value their health and will rationally deter from
the psychological, physical, and financial repercussions that can extent from
premarital sex. This assumption that we, as human beings, rationally follow a
value expectancy model when making decisions is based on the oldest and most
popular individual behavior theory, the Health Belief Model (HBM) (10).
The HBM was created in the 1950s due to the research of the
U.S. Public Health Service (USPHS) social psychologists, Godfrey Hochbaum,
Irwin Rosenstock, and Stephen Kegels (8).
USPHS offered free tuberculosis screenings to citizens through mobile
clinics; the social psychologists sought to understand the reasoning behind the
decision of the majority of the citizens to not take advantage of the mobile
clinics (8,9). Through their research, they determined that all of the citizens
performed a cost-benefit analysis and only a few actually believed the perceived
benefits outweighed the perceived costs and took action. This analysis was based upon their perceived
susceptibility of becoming diseased, the perceived severity of this disease,
the perceived benefits of taking action, and the perceived barriers of taking
action. After weighing their costs against the benefits, those intent on
preventing and screening for tuberculosis waited for the “cue to action”. Their
attendance at the screening was determined by their “self-efficacy” and ability
to successfully follow through with action (9).
Over the years, there has been speculation over the HBM and
if all human being decision-making can be based upon this value expectancy
model. Studies have questioned whether we, as human beings, choose to engage in
healthy behavior simply because we value the outcome and understand that a
certain behavior will lead to this outcome (8, 11). As Day, Dort, and Tay-Teo
suggest, one of the flaws of utilizing the HBM is that model “does not have the
power to predict behaviors consistently”. The HBM is often times successful at
predicting certain linear human behaviors, such as choosing to take part in a
tuberculosis screening. However, the HBM cannot always predict more complex
behaviors that involve external pressures, such as adolescents engaging in sex
(11).
Dan Ariely furthers this thought that human behavior is not
always simple to determine in his book, Predictably
Irrational. In Chapter 5: The Influence of Arousal, a study is performed on
decision-making and sexual arousal “to understand the degree to which rational,
intelligent people can predict how their attitudes will change when they are in
an impassioned state” (12, pg. 89). The study compared participants’ answers on
the topics of prevention, protection, conservatism and morality first when they
were in a hot aroused state, then in a cold state (12, pg. 97). The results
demonstrated that we as human beings are completely irrational at times and a
model, such as the HBM, cannot predict this irrationality. For example, on the
five questions on immoral activity the participants were 136% more likely to
engage in immoral activity when in a hot state compared to a cold state (12,
pg. 136). This study castes doubt that informed adolescent children enrolled in
Choosing the Best will always weigh
the costs and benefits and choose abstinence. Although in a cold state a
teenager may understand the repercussions associated with premarital sex, they
will not always make the rational choice depending on their emotional state.
Furthermore, this study suggests that Choosing
the Best and other abstinence education programs are not the most suitable
form of sexual education for adolescent children; teenagers need to be informed
about contraceptives due to the fact their behavior is not always rational.
Critique #2: Choosing the Best: A Trigger for Psychological Reactants
The second key to
effectiveness of Choosing the Best is
that this program instills confidence against peer pressure. According to the
Psychological Reactants Theory, this aforementioned ability to combat against
peer pressure is highly unlikely. Adolescent children enrolled in this program
are taught that abstinence is the only way to truly remove the risk of the
physical, psychological, and financial risks associated with premarital sex. As
Jack W. Brehm suggests, “Freedom of behavior is a pervasive and important
aspect of human” (13). This abstinence or nothing attitude leads to freedom
feeling threatened. A sense of control has been taken away from these teenagers.
As Paul J. Silvia state, “One way to bolster a threatened freedom is to
exercise the freedom—people thus seek censored activities, show “boomerang
effects” in response to threatening messages” (14). Rather than adhere to the
guidelines of abstinence, adolescences are likely to respond to peer pressure
and engage in sexual promiscuity because it is a freedom that they have not
been provided.
Studies have yet to
prove the long-term effectiveness of abstinence programs, such as Choosing the Best, which suggest that
adolescences are indeed experiencing reactants and the “boomerang effect” is
occurring. Title V of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 was established and began funneling $50 million into
abstinence education annually. In one
study, Congress authorized
a multi-year evaluation of effectiveness of four abstinence-only programs
funded by Title V. The study demonstrated that the abstinence education
programs had no impact on the rate of sexual activity or rate of unprotected
sex of the adolescences (15). As Advocates for Youth states, “No abstinence-only program has
yet been proven through rigorous evaluation to help youth delay sex for a
significant period of time, help youth decrease their number of sex partners,
or reduce STI or pregnancy rates among teens” (4). Rather than threatening the adolescents’
freedom and triggering psychological reactants, Choosing the Best ought to establish autonomy by informing them of
all of their options, including contraceptives.
The third key to effectiveness of Choosing the Best is that the program
promotes parent involvement and participation at home. According to an
experiment performed in Deflecting
Reactance: The Role of Similarity in Increasing Compliance and Reducing Resistance,
when participants lack similarities with a communicator, threats to freedom
decrease the likelihood that the participants will agreement with the
communicator (14). Moreover, when the
communicator was similar to the participants in characteristics, such as age or
year in school, these similarities had a great effect on agreement. As Silvia
states, “it was predicted that interpersonal similarity can reduce reactance by
increasing compliance and by reducing resistance” (14). Therefore, according to
the Psychological Reactants Theory, it would be best to not use parents as a
communicator on a topic as sensitive as sexual activity. The adolescents could
feel threats to freedom due their dissimilarities with the communicator and the
“boomerang effect” could occur (14). According to this experiment, it would be
most effective to use a communicator that is both likable and similar to the
adolescent students (14).
Critique
#3: Choosing the Best: Limiting
Health as the Core Argument
Choosing the Best’s fourth keys to
effectiveness is creating a motivational classroom environment. As their
website states, “The philosophy of Choosing the Best is that abstinence education is about health for our
teens” (5). This program is centered on the core value of health; it could gain
more enthusiastic support in the classroom if it honed in on a more compelling
core value, like opportunity or freedom (18). As stated in The Power of a Frame: Analysis of Newspaper Coverage of Tobacco
Issue—United States, 1985-1996, “the concept and symbolic importance of
individual freedoms are deeply ingrained in American myth, culture, and law”
(18). Americans are intrinsically drawn to the idea of freedom. Therefore Choosing
the Best does not utilize the most effective means of attracting teenagers
or creating a motivational classroom environment. Rather than emphasizing
health, Choosing the Best ought to
focus on this educational program providing adolescence the opportunity and
freedom to a better future. If Choosing the Best reframes their core values it
will emotionally appeal to a greater audience.
The final key to effectiveness is building strong moral
character in teenagers. To better achieve this goal, they need to better
connect with their audience by promoting their brand as a desirable service
that teenagers strive to be apart of. According to Leonard L. Berry,
“Strong-brand service companies consciously pursue distinctiveness in
performing and communication the service, use branding to define their reason
for being, connect emotionally with customers, and internalize the brand for
service providers” (16). Choosing the
Best strives to build strong character in adolescents so it needs to better
communicate its goal to attract and emotionally connect to the masses of youth.
Rather than simply branding itself as an education resource for healthy, moral
teens, Choosing the Best could brand
itself as company that develops confident, knowledgeable young adults with the
world at their fingertips.
New Intervention: Comprehensive Sex Education with
the Use of Mass Communication
In spite of its flaws, Choosing the Best has the right intentions of educating the
American youth on the risks associated with premarital sex. Moreover, this
program has an enormous platform and reaches four million students. If Choosing the Best utilizes the following
radical intervention, it will be able to reach an even greater number of
adolescents and have a deeper impact.
First, Choosing
the Best must begin providing comprehensive sex education. Adolescence must understand the types of
contraception and correct precautions to take if and when they decide to engage
in sexual activity. With more and more evidence available on the ineffectiveness
of abstinence education, it is time for the restructuring and redirection of
this form of education program. The Obama Administration decided in 2010 to
begin funneling money into comprehensive sex education because unlike
abstinence education, there is evidence to demonstrate that comprehensive education
delays the onset of sexual activity in youth and increases condom and
contraceptive use (17).
Second, each school that is enrolled in Choosing the Best, must begin a
peer-mentoring program. Previously, Choosing
the Best provided video vignettes of teens, classroom discussions with
teachers, and conversations with
parents, however these methods were insufficient as a means of communication
with vulnerable adolescents. One study in particular demonstrated that students
enjoyed peer-led education compared to teacher-led education (21). Through the
peer-mentoring, adolescent students can communicate with each other on topics
that are difficult to discuss with adults and receive advice. This program
would allow upperclassmen students to act as mentors to their younger peers and
provide valuable guidance due to the fact they recently experienced similar
circumstance. The mentors not only relate to the mentees in age, but the
mentors are also can relate in terms socially and economically as they are from
the same region (14).
Third, the brand of Choosing the Best must be transformed. Previously, Choosing the Best was branded as a program that focused on the core
values of teen health and morality. Now that Choosing the Best provides comprehensive sex education, it will be
branded as a program that provides youth the freedom to make their own
autonomous decisions (18). The American youth are now choosing the best
decision for themselves. The slogan will be “Knowledge is Power”.
Fourth, Choosing
the Best will utilize the media to extend their influence throughout the
nation and create a movement around the catch phrase “Knowledge is Power”. Choosing the Best will send a press
release to the media announcing the transformation of the program. The press
release will state that Choosing the Best
will be holding a rally in Times Square in New York City to announce the exact
changes to the curriculum, including the “Knowledge is Power” movement (20).
Speakers at the rally include young actors, singers, and athletes in support of
the movement (14, 19). After the rally, Choosing
the Best will broadcast commercials on typical youth television stations
and buy advertisements on social media websites and teen magazines. These
advertisements will include positive stories from teens as well as celebrities
(19). The American youth will be even more attracted to the “Knowledge is
Power” movement and more likely to seek Choosing
the Best educational programs at their schools when they see that popular
young celebrities in support the program.
The overall purpose of Choosing the Best’s “Knowledge is Power” movement is to empower the
youth of American to seek comprehensive sex education. We all deserve the right
to make an informed decision about our bodies and our future.
Defense of New Intervention 1:
Under the new intervention, Choosing the Best utilizes comprehensive sex education. This form
of education greatly reduces the flaws associated with abstinence-only
education. Abstinence education is based off of the Health Belief Model and makes
assumptions about human behavior. It assumes that we weigh the perceived
threats associated with an action against the perceived benefits and make an
informed decision. While these assumptions are true when evaluating certain
human behaviors, they do not predict accurately the complex and emotional
nature of sexual activity. Teaching comprehensive education and informing
adolescent students about all forms of contraception prepares these teenagers
for all circumstances. We, as human beings, are irrational and ought to be
informed and prepared to handle any circumstance.
Defense of New Intervention 2:
The new intervention greatly reduces the occurrence
of psychological reactants. These students do not feel their freedom has been
taken away because they are no longer threatened by ultimatum of abstinence or
nothing. There is very little likelihood of the “boomerang effect” occurring
under this intervention because the students are now informed and free to make
whatever decision they wish (14). Rather than feeling threatened, the students
feel autonomous.
Moreover, this intervention significantly decreases
the probability that students will experience reactants when in the presence of
a communicator. Previously, students were taught in a classroom setting with
discussion and video vignettes, as well as discussion with parents at home. By
establishing a peer-mentoring program, the students are now learning from
communicators that are similar to them and more susceptible to agree with their
message (14, 19). Secondly, the use of a young celebrity to deliver the message
of joining Choosing the Best will
likely increase the support and popularity of the program. As Silvia states,
“Liking another person increases the tendency to like objects that the other
person likes” (14). Not only is the celebrity similar in age, they are also
extremely likable.
Defense of New Intervention 3:
Rather than simply
addressing the public health concern of sex education through a traditional
individual level model, the new intervention utilizes multiple alternative
models to better persuade American adolescents on the group level. These models address the fact that we as
human beings do not always make rational decisions.
First, the new intervention brands Choosing the Best in a way that does not
immediately associate this sex education program with health. Now this program
is associated with the phrase “Knowledge is Power”. When people think of Choosing the Best, it evokes feelings of
confidence and autonomy because it provides students the freedom and power to
make decisions for themselves (18).
Second, the new intervention
utilizes agenda setting theory. This program uses numerous sources of media
including the press release, the rally, television commercials, and social media
to get the message of “Knowledge is power” on the public agenda. This program
hopes to change human behavior by changing what is discussed in the media (20).
Lastly, the new intervention
utilizes modeling theory. As stated in The
Effects of Mass Communication, “[The media] provide symbolic modeling of
almost every conceivable form of behavior. A rich literature has shown that
both children and adults acquire attitudes, emotional responses, and new styles
of conduct from all the media, and especially from films and television” (19.)
If Choosing the Best advertises their
new brand through media sources they will have the capability of changing
behavior on the group level. The youth of America will see celebrities and
teenagers spreading the message of “Knowledge is Power” and want to join the
movement.
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Labels: Adolescent Health, Health Communication, Platinum, Sexual and Reproductive Health, STDs
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