Abstinence-only sex education can work - if it’s based on established strategies for helping young people change their attitudes about other types of risky behavior like smoking and drinking, new research shows.

African-American sixth- and seventh-graders who completed the eight-hour program, which involved a series of brief activities and games (and no lecturing), were one-third less likely to start having sex in the next two years compared to their peers who took part in a similar program that targeted health issues unrelated to sex.

“The evidence is solid, and it’s new, because this has never been done before,” says Dr. John B. Jemmott III of the University of Pennsylvania in Philadelphia, who helped conduct the new study and design the intervention, along with his wife Dr. Loretta S Jemmott and their colleague Dr. Geoffrey T. Fong of the University of Waterloo in Ontario.

Despite the massive amounts of money the United States has poured into promoting abstinence-until-marriage programs, there have been only a handful of flawed studies investigating the effectiveness of such programs, the investigators note.

These federally supported programs - initiated during the Clinton years at the behest of Congress - follow a series of guidelines focusing on the importance of abstaining from sex until marriage, and underscoring the allegedly harmful physical and psychological effects of premarital sex and out-of-wedlock childbirth. “They’re not based on an understanding of the motivation of children to have sex or to practice abstinence, and that’s what this intervention was based on,” John Jemmott said.

He and his colleagues designed their program using techniques proven to help adolescents avoid risky behaviors like cigarette smoking, drinking and drug use. Classes were conducted in groups of six to 12 children, with activities that included listing the pros and cons of abstinence versus the pros and cons of having sex. “This activity is in the context of a whole intervention that begins with a consideration of what are their goals and dreams for the future, where do they see themselves five years from now, where do they see themselves 10 years from now,” Jemmott explained.

These and similar activities, he said, help young people realize on their own that abstinence is likely to be the better choice. Other activities included role-playing and games designed to help participants understand and resist peer pressure.

Jemmott and his team assigned 662 children to this program; an eight-hour “safer sex only” program designed to promote condom use; an eight- or 12-hour intervention combining both approaches; or a control group in which children underwent an eight-hour educational program on health issues unrelated to sex.

Among the 132 boys and girls who completed the abstinence-only program, about a third said they started having sex within the following 24 months, compared to half of the 129 control group participants. Around 20 percent of the abstinence-only group reported having sex during the past three months, compared to around 30 percent of the control group.

One criticism leveled at abstinence-until-marriage programs is that they discourage condom use and put kids at greater risk of sexually transmitted disease if they do decide to have sex, Jemmott said. But the current study found no evidence that the abstinence-only program had any effect on condom use. Students who participated in the comprehensive programs were slightly less likely than control group participants to report having multiple partners.

Getting young people to hold off on having sex can have major beneficial consequences down the road, Jemmott noted; it reduces their risk of contracting sexually transmitted disease and getting pregnant, while the older someone is when they do have sex for the first time, the more likely they will be to use contraceptives.

SOURCE: Archives of Pediatrics and Adolescent Medicine, February 2010.