Sex Ed

Ross Douthat reflects on the recent news that teenage birthrates inched upward during the Bush era, after more than a decade of decline:

The new numbers, declared the president of Planned Parenthood, make it "crystal clear that abstinence-only sex education for teenagers does not work."

In reality, the numbers show no such thing. Abstinence financing increased under Bush, but the federal government has been funneling money to pro-chastity initiatives since early in Bill Clinton's presidency. If you blame abstinence programs for a year's worth of bad news, you'd also have to give them credit for more than a decade's worth of progress.

More likely, neither blame nor credit is appropriate. The evidence suggests that many abstinence-only programs have little impact on teenage sexual behavior, just as their critics long insisted. But most sex education programs of any kind have an ambiguous effect, at best, on whether and how teens have sex. The abstinence-based courses that social conservatives champion produce unimpressive results -- but so do the contraceptive-oriented programs that liberals tend to favor.

I think Douthat overstates the equivalence: there's much more evidence that abstinence-based sex education is a failure (such as this 2007 Congressional study) than there is for contraceptive sex ed, which has been linked to mild reductions in teen pregnancy. But I think his larger point is accurate: it's really difficult to change the sexual habits of adolescents.

That's because we've been trying to change behavior with facts and information. We've assumed that the way to get kids to wear condoms is give them statistics about sexually transmitted disease, or that the way to get students to abstain from sex is to lecture them on morality, or the difficulty of caring for a child while in high school. The problem with such facts is that they don't help teens deal with their moment of sexual decision, which most likely occurs when they're half naked and deranged with desire. In other words, we've assumed that sexual choices are rational choices, influenced by classroom exhortations and dry information. But that's wrong.

Look, for example, at this R-rated experiment, by the behavioral economist Dan Ariely and neuroeconomist George Loewenstein. They began by asking twenty-five male undergraduates at UC-Berkeley a series of provocative sexual questions. The first set of questions concerned their sexual preferences. Could they imagine having sex with a 60 year old woman? What about getting sexually excited by contact with an animal? Did they like getting tied up during sex? The next set of questions dealt with sexual morality. Would the male students slip a woman a drug to increase the chance that she would have sex with them? Would they keep trying to have sex after their date said "no"? The final set of questions was about safe sex. Would the men insist on using a condom? Is it safe to have unprotected sex if you "pull out" before ejaculation?

Each male student answered these naughty hypotheticals in two different states of mind. In the first condition, the subjects were told to answer the questions without being aroused. They were supposed to contemplate sex in an un-sexual state of mind. In the second condition, the subjects were shown pornography while answering the questions. (They were alone in their dorm room for this part of the experiment.) When asked in advance, the men didn't think that being aroused would significantly alter their answers. They assumed that their sexual preferences were relatively immune to such temporary emotional biases.

The men were completely wrong. Their desire to engage in peculiar sexual acts - like being tied up, or getting spanked while having sex - nearly doubled when they were aroused. Their morality was even more malleable: they were three times more likely to commit a sex crimeâ¯such as using a date-rape drugâ¯when staring at pornographic images. And, of course, being aroused also made them much less likely to use condoms. Although the undergraduates could all recite the benefits of sexual protection, this rational knowledge was irrelevant. The charge of arousal was simply too powerful: they could no longer resist doing the wrong thing, even though they knew it was wrong. As Ariely and Loewenstein drolly concluded: "Efforts at self-control that involve raw willpower are likely to be ineffective in the face of the dramatic cognitive and motivational changes caused by arousal."

The point is that we've been arming our kids with the wrong mental tools. Instead of giving them statistics, we need to provide them with the cognitive tools to deal with temptation. Instead of urging them to abstain, we need to show them how to abstain. There is no secret recipe for overcoming our "hottest" urges, like sexual desire. But you could do worse than giving kids a short lesson in metacognition. I think Walter Mischel's work with four-year olds and marshmallows is relevant here:

At the time, psychologists assumed that children's ability to wait [to delay gratification for a second marshmallow] depended on how badly they wanted the marshmallow. But it soon became obvious that every child craved the extra treat. What, then, determined self-control? Mischel's conclusion, based on hundreds of hours of observation, was that the crucial skill was the "strategic allocation of attention." Instead of getting obsessed with the marshmallow--the "hot stimulus"--the patient children distracted themselves by covering their eyes, pretending to play hide-and-seek underneath the desk, or singing songs from "Sesame Street." Their desire wasn't defeated--it was merely forgotten. "If you're thinking about the marshmallow and how delicious it is, then you're going to eat it," Mischel says. "The key is to avoid thinking about it in the first place."

In adults, this skill is often referred to as metacognition, or thinking about thinking, and it's what allows people to outsmart their shortcomings. (When Odysseus had himself tied to the ship's mast, he was using some of the skills of metacognition: knowing he wouldn't be able to resist the Sirens' song, he made it impossible to give in.) Mischel's large data set from various studies allowed him to see that children with a more accurate understanding of the workings of self-control were better able to delay gratification. "What's interesting about four-year-olds is that they're just figuring out the rules of thinking," Mischel says. "The kids who couldn't delay would often have the rules backwards. They would think that the best way to resist the marshmallow is to stare right at it, to keep a close eye on the goal. But that's a terrible idea. If you do that, you're going to ring the bell before I leave the room."

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In other words, the nuns were right all along: to stop yourself from thinking about sex, go wash the kitchen floor, or go take a cold shower.

I have read about Mischel's work in your book and I found the explanation difficult to accept there as well. You say that the "prefrontal cortex was forced to exercise its cortical authority and inhibit the impulses that got in the way of the goal". I have not seen clear evidence for such an "inhibition" in the data. Could there be some other mechanism by which immediate gratification is postponed for greater gratification in the future? The claim of "cortical control" seems like a justification for the "rational thinking animal" meme. But, is there really any evidence for this "inhibiting the animal instincts" mechanism? To be clear, I am not questioning the result, just the explanation.

By Ray in Seattle (not verified) on 02 Feb 2010 #permalink

But marshmallows and sex are two different things. It seems like Mischel-style metacognition only makes sense when there's an eventual payoff for in-the-moment abstinence. If I skip the candy bar, I'll enjoy my dinner more in 2 hours; If I save instead of spend, I can afford a nice summer vacation. But what's the equivalent for sex? Sexual abstinence (unfortunately) doesn't guarantee better or more frequent sex in the future. The choice we offer teens is totally asymmetric: forgo this very extremely pleasurable activity, and you'll avoid these low probability (seemingly) negative outcomes... there's no sense of a net gain in the long run.

Do we know that filling out questions on the form relates to what actually happens in the situation? Do people reliably behave as they think they would behave in a given situation, regardless of the influence of a stimulus? I find it hard to believe that people know themselves that well.

And now I want a marshmallow.

When I was in High School I was constantly aroused in class.

I agree with #5: answering a hypothetical question while aroused does not mean you're more likely to do the actual thing in real-life. It's easy to SAY "I'd like to be tied down and spanked" or "I'd definitely slip her a rufi." But that's not the same as actually carrying out a strategy to drug a girl, or actually letting yourself be tied down by people you may not know well or trust completely. (For one thing, there's no guarantee the degree of sexual arousal would be the same in real life. It's easy to get aroused in the safety of a dorm room, porn and hypothetical questions; a bit less likely in a real situation when actual consequences suddenly rear their head.)

As for "metacognition," one way to keep teens from thinking the kind of thoughts that would get them in trouble, would be to ensure they get exposed to as many other thoughts, ideas and activities as possible. That won't keep them from getting horny, of course, but it could give teens the idea that a "relationship" can be built on more common intrests than sex.

By Raging Bee (not verified) on 02 Feb 2010 #permalink

If you want to solve the teen pregnancy problem, there are two things you need to do that would go extremely far in reducing it:

(1) have comprehensive sex education - keep abstinence for the families that wish to have their child educated that way, but push for comprehensive education, and

(2) give condoms away in the schools.

Most teens don't want to purchase condoms or birth control. Whether they come from a poor family and would rather spend their hard-earned dollars on food rather than protection, or if they are too embarrassed to go into a store to buy them. If they had the things with them, they'd use them. It's pretty much that simple. They don't want their parents finding out (especially true for girls who want birth control, asking the parent is a tremendous barrier-to-entry).

I wonder how many 60 year-old women reading here are smiling ruefully at the company they kept in that experiment...
So, how should teenagers be taught to strengthen impulse control?
It would be interesting to see the curriculum of well-thought out program which taught metacognition. I'd sign up for it also.

Much fuss has been kicked up over the report in the Washington Post that, in contradiction to years of previous research and data, there has finally been an abstinence-only study that shows that it can work under some circumstances if itâs taught properly.

The major problem: What the study describes isnât abstinence-only sex ed. In fact, it is so very much NOT abstinence-only sex ed that it could never qualify for Federal funding as such:

Why do people act like one single negative finding reverses a standing body of information? One positive abstinence-only finding isn't nearly as good as you know, every other finding put together.

That doesn't mean abstinence only education can't work, but you can't reach that conclusion without repeated, independently confirmed findings.

Interesting thoughts, even though #5 and #7 make a good point as well. It would also be interesting to see how girls would do in this experiment. After all, it takes two to tango (and to get pregnant) ...

Teenage pregancy rates are highest in areas that are poor, where life expectations are low, and where married-with-children is the exception rather than the norm. Middle-class teenagers with college plans and married parents do get pregnant, but at a much lower rate (and they are more likely to abort if they do). So, having the motivation to avoid pregnancy is at least as important as having the means to avoid it.

I liked this post very much - I am tired of people making excuses for behavior rather than deciding to apply some self control when faced with a strong emotion. As sentient beings I find it rather offensive that the majority of us seem to readily accept that some passions are just too difficult not to give in to. If we were talking about a bad temper rather than sex and the end result was bodily harm to another human being, I don't know that the excuse, "I was so angry I couldn't stop myself" would get quite the same acceptance. Besides, Abstinence achieves a lot more than lowered un-planned pregnancy rates and STI's; think about the emotional and psychological consequences of sex before being fully committed to someone (i.e. marriage). It can be just as damaging, but since it is socially acceptable, it's okay? Come on, I believe we're better than that.

I'm really interested to read the study on how differently people look at the world when aroused. I'm particularly curious about the guys whose sexual morality goes down. Do you think it's a function of something wired in them, or is it some kind of metacognition training they got along the way? Even in situations that don't involve questionable morality, some guys seem to be wildly opportunistic, others more restrained, and others perfectly happy to wait until marriage and then stick with one woman their whole life. It's difficult to believe the difference all has to do with how they were raised, or any kind of sex ed class they took.

I can't speak for anyone else, but I can at attest to being super obsessed by sex as a teenager but also super influenced by religious teachings and fear of pregnancy, which meant that 1) I postponed intercourse about two years longer than I would have otherwise and 2) When I did start having intercourse (as opposed to everything but), I was VERY compulsive about using birth control.

My boyfriends generally weren't as scrupulous about avoiding intercourse -- I was always the one to put the breaks on, and it was difficult.

But the majority of guys I eventually slept with -- not all -- were pretty responsible about birth control (meaning they were willing to support me in using it and/or use a condom themselves). There were a couple of anti-condom whiners.

Could it be partly a gender thing? As a woman I resent very old fashioned idea that it's our responsibility to put a break on male sexuality (because that aspect of my experience was really a drag) but maybe there's some wisdom in it.

I note that the study Jonah mentions above was done on males.

Jonah's analysis rings true for me. I have enough lust issues in my 50s; in my teens I felt like a sputtering live wire every day. While I agree that the best course for sex-ed is to give kids the facts and talk realistically about the consequences, I can say that in retrospect that the classes I had were as bureaucratic as Jonah describes -- a rote parade of bland statistics, dry biology and an edu-film or two designed to make you think about sex as if it were like driving drunk. Never in that time did a trusted educator talk to us sympathetically about the intensity of hormone-charged delirium. I suspect no sex-ed class, whether just-the-facts or all-abstinence-all-the-time, can really get through to kids without making such a connection.

Arne and Melissa raise my question: how would females differ in that test?

Historically, it has been the female's role to guide the course of sexual courtship, and interestingly, they/we have employed something like the delayed marshmallow as our best tool. "Oh, yes, darling, I know, I'm so excited too, but just think of the splendor if we wait, just think of how blissful we'll be in bed 24/7 when we're older/married, and just think of the hell we'll likely suffer if we don't." Etc., words to that effect. Distract the poor guy with consequences and rewards, anything to put it off.

There is also the disturbing mitigating circumstances in our culture that teases and titillates at every commercial, and most often in between, while preaching hellfire and brimstone from the pulpit. Peer pressure is way too strong at that age, especially in the face of temptations, and parents fight daily with applying the old standards of controlling their kids' environments and supervising their activities; it's pretty much a losing battle.

Those rural situations that show the highest failure rates are also looking at parents who are forced to work two jobs, are often single and without support for a unified adult front, and a very broad-based hopelessness that actually uses sex as the distraction from miserable lives and futures rather than looking for distractions from the sexual temptations.

Once again, it appears the inequalities so many suffer can be blamed at least in part for these sad statistics.

Dear lllphd

I'am curius as to why federal funding of a health issue creates
such controversy. I agree - females control this ritual based on pre selection and timing. But if STD's or pregency can be avoided why create fear in something that is as natural as verbal communication. In the end sex is communication no matter the age - nature always finds away so whats wrong with information that leads to making it safe

Why are some Countries so much better at containing teen pregnancy than America is?

By Michael C (not verified) on 04 Feb 2010 #permalink

Michael C: I wonder if it's an attitude thing like the high incidence of binge drinking in the US (where drinking age is high) versus countries where drinking age is low.

The high religious aspect of abstinence only education - and a "just wait until you're married. we dont have to have a sex talk" attitude prevalent in the USA makes teenagers ultimately unprepared for when they do have unplanned and thus unprotected sex.

I've become convinced that we have this argument over and over because there is now an entrenched industry pushing both sides of the issue.

Here we are, yet again, debating a survey result without putting on our thinking caps. The survey everyone is hot and bothered about involves various eight to twelve HOUR programs.

It's absurd.

If you can rely upon these numbers, and I presume you can, why would the numbers in America be eight times higher than free and easy Sweden and Denmark. Both are fixed in our minds eye as dens of sexual iniquity, overrun by socialists and atheists, and yet they have a tiny fraction of the US problem.….

There has to be something at work here that we are not looking at, that makes the USA the WORST of the developed countries.

By Michael C (not verified) on 04 Feb 2010 #permalink

@MichaelC:"There has to be something at work here that we are not looking at, that makes the USA the WORST of the developed countries."

Teenage pregnancy rates track child poverty rates with striking precision. Prosperous Marin county has similar teenage birth rates as the Netherlands. Poor Tulare county has teenage birth rates close to that of Guatemala. It's not that the rich adolescents are aborting away the problem; poorer teenagers are overrepresented in abortion clinics.


I think the most helpful solution for teenagers is having someone approachable to talk to about their concerns about sex. Someone who won't judge or lecture them, and give them enough respect to make their own (informed) decision about it. This is where Planned Parenthood comes in. The information, support, and contraception is there. I think most teenagers would use it if they weren't afraid of their parents finding out. We can only benefit by increasing the availability of such facilities.

By Elizabeth (not verified) on 06 Feb 2010 #permalink

from a teenagers point of view, sex ed does inform us on statistics and decision making, but i think the research is spot on with the aroused vs. non aroused experiment, the state of mind is just not the same

my school doesn't teach abstinence, but it teaches safe sex, AND NO ONE HAS GOTTEN PREGNANT

i think safe sex is what people should teach teens because then they won't be overrun by arousal and make stupid choices
(by the way...a guy going to cvs and buying condoms is basically a right of passage)