Abstinence-only education modestly delays initiation of sexual activity

Article Outline

• Question
• Design
• Setting
• Participants
• Interventions
• Outcomes
• Main Results
• Conclusions
• Commentary
• Copyright

Jemmott JB, III, Jemmott LS, Fong GT. Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Arch Pediatr Adolesc Med 2010;164:152-9.

Back to Article Outline

Question 

In young adolescents, how efficacious is an abstinence-only intervention in preventing sexual involvement?

Back to Article Outline

Design 

Randomized controlled trial.

Back to Article Outline

Setting 

Four urban public middle schools in the northeastern US.

Back to Article Outline

Participants 

Six hundred sixty-two African American students in grades 6 and 7.

Back to Article Outline

Interventions 

An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex–only intervention targeted increased condom use; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.

Back to Article Outline

Outcomes 

The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.

Back to Article Outline

Main Results 

The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48- 0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99, Number Needed to Treat = 12). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

Back to Article Outline

Conclusions 

Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.

Back to Article Outline

Commentary 

This is a well-designed study targeting high-risk middle school youth with excellent long-term follow-up. Very few studies have compared abstinence-only education to other forms of education in a randomized control study. This study had multiple intervention groups (abstinence-only education, two different groups of comprehensive sex education, safer sex education, and the control was health-only education) and very little difference in age of sexual initiation was found amongst all of the groups studied. It should also be noted that statistically significant results in this study were very close to not being significant, sometimes within a tenth of a point. This may have been secondary to the intervention not being effective or the sample size not being large enough to show significance. Interestingly, this study was done with theory-based abstinence-only curriculum, which is not the typical curriculum that is taught in schools or churches. In one secondary outcome measure, half of the youth were also randomized to an interim maintenance group with several re-enforcement sessions; this group did not demonstrate difference in sexual initiation. Given that sexual initiation is an age-graded activity, results other than sexual initiation, such as knowledge, intentions, or interim sexual behaviors addressed in comprehensive classes may still be beneficial to the youth as they get older and become sexually active.