News & Research Reports

OT Best Practice Relative to The Sexual Expression of Adolescents or Mentally Handicapped Persons
Approved for publication by the Board of International Occupational Therapists For Christ. By Scott Worley, MA, OTR/L

Have you ever wondered if you should be encouraging sexual abstinence more strongly as you work with adolescent, young adult or mentally handicapped clients?

The desirability for all individuals to choose and be able to fully participate in activities that are of interest to them, and that are available to and participated in by normal healthy individuals, has long formed a foundational principal of occupational therapy. In recent years, emphasis on client centered approaches, and increasing consideration of sexual expression as a legitimate occupation of concern has led more occupational therapists to be involved in programs that include the human sexuality of our clients. This can be particularly true in programs and facilities for adolescents, young adults and community or institutional programs for persons with mental illness or mentally handicapping issues.

These pressures lead therapists to the necessity to investigate the requirements of evidence based best practice with regard to the services, education, philosophies and recommendations we present for clients and others. What does recent scientific evidence demonstrate that best practice to be?

Research continues to indicate that reserving sexual activity until, and exclusively within marriage markedly enhances the health of individuals.

Adolescent Mental Health

Adolescents, both boys and girls, who had been sexually active, were found to have markedly higher rates of depression and suicide than abstinent teens in a study reported by the Heritage Foundation that was made available on their web site. E-mail Family Policy Facts (June 6, 2003) of the North Carolina Family Policy Council presented results.

Sexually Active Teens More Depressed Unwanted pregnancy and sexually transmitted diseases are not the only consequences of premarital sexual activity, according to a new study released by the Heritage Foundation, which found there are significant emotional consequences as well. Analysis of data from the National Longitudinal Survey of Adolescent Health found that sexually active girls are more than three times more likely to be depressed and three times more likely to attempt suicide than abstinent girls. It also found that sexually active boys are more than twice as likely to be depressed and eight times more likely to attempt suicide than abstinent boys. The study also found that most sexually active teenagers (63 percent) wish they had waited longer before beginning sexual activity (55 percent of boys and 72 percent of girls). This study confirms what abstinence education proponents have advocated for years—that teens must receive a clear message that abstinence from sexual activity is the only way to avoid all of the negative consequences of premarital sex. Unlike the comprehensive sex education message, which promotes contraceptive use and alternative sexual activity as the way to prevent unwanted pregnancy and sexually transmitted diseases, the abstinence message also takes into account the emotional costs of sex outside of marriage—an element of the sex education debate that this study confirms is taking a toll on many young people.

Link to the Heritage Foundation Study: http://www.heritage.org/Research/Family/cda0304.cfm

New Cervical Screening Guidelines Show Abstinence Until Marriage To Be Best Preventative

New cervical cancer screening guidelines were released by the American Cancer Society in December, 2002. Without stating the obvious conclusion, the guidelines present data indicating that nearly all (if not all) cervical cancer is caused by human papaloma virus infection (which is a sexually transmitted disease). Excerpts from the article on the web site of the American Cancer Society clearly support abstinence from sexual activity until marriage (again, without stating the obvious conclusion) as the principal preventive measure and imply its cost savings to the health care system. The following excerpts from the American Cancer Society web site, cervical cancer screening guidelines, affirm that human papaloma virus (which is sexually transmitted) is so strongly accepted as the cancer’s cause that its (HPV) presence and a history of sexual activity outside of marriage are the most useful elements of screening for the potential presence of the cancer.

“Between 93 and 100 percent of squamous cell carcinomas of the cervix contain DNA from high-risk types of human papillomavirus (HPV), which are transmitted during sexual activity.”

“HPV DNA testing has greater sensitivity than cytology for detecting clinically relevant lesions.”

After presenting the convincing data and information about abstinence above, the authors fail to express its preventive influence and make the following statement.

“Because no study will be able to demonstrate reduction in the incidence of cervical cancer, the next best alternative is the ability to improve detection of high-grade precursors.” (Saslo, 2002).

At last, the Center for Disease Control supports the rather obvious conclusion that abstinence is the most effective preventive strategy (reported here from the Feb. 6 issue of Family Policy Facts, published by the North Carolina Family Policy Council {NCFPC, 2004}). From: NC Family Policy Facts, 2/6/03

CDC Concludes Abstinence Surest Way to Prevent HPV

A new report from the Centers for Disease Control and Prevention (CDC) concludes that abstinence is the “surest way to eliminate the risk” of the widespread and potentially deadly sexually transmitted disease known as the Human Papillomavirus (HPV). CDC Director Dr. Julie Gerberding submitted the long-awaited report, entitled “Prevention of Genital Human Papillomavirus Infection,” to Congress in late January. In the report, the CDC describes the transmission and health consequences of genital HPV infection, and suggests prevention strategies. HPV is one of the most common sexually transmitted diseases in the United States and often has no visible symptoms. Because the virus can be spread through skin-to-skin contact, condoms do little if anything to protect against its transmission. In fact, the CDC states: “The available scientific evidence is not sufficient to recommend condoms as a primary prevention strategy for the prevention of genital HPV infection.” Even more disturbing, HPV is the leading cause of cervical cancer worldwide, which kills 4,100 women each year in the United States alone. In the report, the CDC concludes that abstinence is the best way to protect against HPV, stating: “Because genital HPV infection is most common in men and women who have had multiple sex partners, abstaining from sexual activity (i.e. refraining from any genital contact with another individual) is the surest way to prevent infection.” For sexually active individuals, the CDC recommends “a long-term, mutually monogamous relationship with an uninfected partner,” but also points out that “it is difficult to determine whether a partner who has been sexually active in the past is currently infected.” To help prevent cervical cancer, the CDC recommends that all sexually active women receive regular cervical cancer screenings, as well as treatment for any precancerous legions”

Is Effective Abstinence Education the Healthy Answer?
Research is demonstrating that effective abstinence based education is a principal element of improving mental and physical health.

Increasingly, scientific evidence indicates that the popular comprehensive sex education programs (that present a buffet of choices including protected sex, alternative sex practices without abstinence or with abstinence as one of many choices) are ineffective. They have been found to result in increased teen sexual activity, teen pregnancies, increased abortions, increased rates of sexually transmitted diseases and higher HIV and AIDS infection rates among program participants. In contrast, effective abstinence education programs (those presenting abstinence as the only safe and healthful method) demonstrate sound healthful results in nearly every area of concern.

Several reports demonstrating the effectiveness of abstinence-based programs at influencing health, behaviors and attitudes in a positive direction are presented here, with permission and as reported by the North Carolina Family Policy Council in its weekly Family Policy Facts. Readers are invited to visit the NCFPC web site at www.ncfamily.org and the links below for additional information.

Study Finds Abstinence Program Successful

A study published in a recent issue of the American Journal of Health Behavior reports that high school students who participated in the "Sex Can Wait" abstinence curriculum were more likely to be committed to abstinence than students who did not participate in the Program. The curriculum was developed at the University of Arkansas and consists of an 8-week course for upper elementary, middle school and high school students. The lead-researcher on the study, Professor George Denny, called the findings "encouraging and a bit surprising," pointing out that researchers did not expect to see changes in behavior because of the short time span of the program. [LifeSite Daily News]

The Success of Abstinence Education on This Week’s
Family Policy Matters

The first major study to examine the impact of abstinence education on teen behavior has been released and shows that, contrary to the claims of those who advocate comprehensive sex education, abstinence is responsible for the drop in pregnancy and birth rates. On this week’s show, Dr. Joanna Mohn, a physician from New Jersey and the primary researcher for this study, talks about the study’s finding and about the impact this research could have on the current debate about the effectiveness of abstinence education.” (NCFPC, 2003a)

Destructive Social, Marital & Economic Effects of Teen Sex

The negative and harmful effects of teen sex go beyond its devastating effects on sexual and physical health. One depressive emotional effect was already described above. A young woman’s marriage, social and economic states are also negatively influenced as described in a study by the Heritage Foundation.

How Teen Sex Hurts Women
Family Policy Matters

Few people dispute that early sexual activity among women increases the chance of contracting a sexually transmitted disease and of having an unwanted pregnancy. But there are other risks involved as well. According to a new study released by the Heritage Foundation, early sexual activity can also affect the future stability of marriage, personal happiness and financial situation. This week’s guest, Melissa Pardue, a Fellow in Social Welfare Policy at the Heritage Foundation, further explains these findings and why it is important to discourage early sexual activity among women. Go to www.ncfamily.org, (NCFPC, 2003b).

The Harms of Teen Sex
Family Policy Matters

This week’s, Family Policy Matters" is the first of a two-part series of interviews by Bill Brooks with Dr. Meg Meeker, a pediatrician specializing in adolescent medicine. Dr. Meeker is the author of Epidemic: How Teen Sex is Killing Our Kids, a book that describes the dramatic rates of teenage sexually transmitted diseases and what parents and teachers can do about it. Dr. Meeker will be discussing some of the issues that she raises in her book including her own conversion to the abstinence message and what teenagers are really facing in today's pro-sex,culture. "Family Policy Matters" can be heard weekly. (NCFPC, 2002a)

Failure of Comprehensive Sex Education &
“The Safe Sex Message”

While the studies are demonstrating the abstinence message is effective, comprehensive sex education and its safe sex message has been demonstrated to have disastrous effects on the health, emotional and social functioning of participants that create related social problems in society.

Two studies demonstrating that comprehensive sex education programs themselves tend to exacerbate the prevalence of the health and social problems they purport to improve are of note here. Of particular note are the sources of the studies. Both were reported by entities not known for constraint or conservatism in their approaches to sexual issues and neither was noted in the mainstream press in the United States. Both were illuminated and reported by Salem Radio Network News.

The first was in a report from Finland’s health ministry. It indicated that where comprehensive sex education programs were instituted, there were increases seen in sexually transmitted diseases, HIV and AIDS, pregnancies and abortions when compared with areas where those programs were not present (SRN News reporting results in 2001 of information that had at that time been available for about two years).

The second study (reported by SRN News in May of 2000) that appeared in the British medical journal Lancet, a liberal leaning publication, indicated that where safe sex education programs existed, STDs, HIV infections and AIDS increased in incidence.

Europe’s Failures With Liberal Sex

The failures of the European approach enabling wide expression of sexual activity outside of marriage and in the young are reviewed in The Rest of the Story, a short publication of Focus on the Family (Focus on the Family Dept. Legislative & Cultural Affairs, 2002) It reviews the rising incidence of HIV/AIDS, sexually transmitted diseases, a revival of the practice of marriage by a public fed up with government policies that promote safe sex and the unconscionable prescription of contraceptives to girls as young as 13 years old in the Netherlands without a suitable medical examination. Sadly, the proponents of comprehensive sex education and safe sex in the U. S. ignore the research demonstrating its ineffectiveness and health risks.

Conclusions and Implications for Best Practice

Summarizing research results we find that comprehensive sex education programs result in unhealthful outcomes that contrast markedly with the positive outcomes obtained using abstinence education. The comprehensive approach (promoting various safe sex methods) leads to increased sexual activity, increased incidence of sexually transmitted diseases (including HPV virtually the singular cause of cervical cancer), increased depression and suicide rates and other emotional problems and increased social problems among participants.

Abstinence education, unlike the comprehensive approach, has resulted in various positive results including reduced sexual activity, reduced teen pregnancy, positive mental health results, lowered STD incidence and others.

Abstinence only and abstinence until marriage programs are clearly emerging as best practice with regard to this important occupational participation area.

Research results require that occupational therapists rethink promotion or participation in comprehensive sex education programs. Substitution of effective abstinence based programs (i. E. long 2000) should be made a high priority. Therapists are encouraged to be alert to emerging scientific data regarding sex education and sexual activity. Recent studies and expected future data will likely result in the promotion of comprehensive sex education approaches being considered equivalent to malpractice (as medical bleeding as a cure for disease is now), and should be actively avoided by responsible occupational therapists.

References

Focus on the Family Legislative and Cultural Affairs. (2002). The Rest of the Story. 8605 EXPLORER DRIVE • COLORADO SPRINGS, C O 80920 • (719) 531 -3400

Long, Mike. (2000). Teenagers: Everyone is NOT Doing It. Ottawa, IL, Jameson Books Inc. (Information for parents, video programs for teachers and therapists can be obtained from M. L. Video Productions. PO Box 61863, Durham, NC 27715-1863. Phone:919 309-9818. Web site: www.Mikelong.com. E-mail: mikelong@mikelong.com.

North Carolina Family Policy Council (NCFPC). (2002a). The Harms of Teen Sex on This Week’s Family Policy Matters. Family Policy Facts (Nov. 7, 2002).

North Carolina Family Policy Council (NCFPC). (2002b). Study finds abstinence education successful. Family Policy News (December, 2002).

North Carolina Family Policy Council (NCFPC). (2003a). The Success of Abstinence Education on This Weeks Family Policy Matters. Family Policy Facts (July 18, 2003).

North Carolina Family Policy Council (NCFPC). (2003b). How Teen Sex Hurts Women on This Week’s “Family Policy Matters”. Family Policy Facts. (July 18, 2003).

North Carolina Family Policy Council (NCFPC). (2004). CDC Concludes Abstinence Surest Way to Prevent HPV. Family Policy Facts. (Feb. 6, 2004).

Saslow Debbie, Runowicz Carolyn D., Solomon Diane, Moscicki Anna-Barbara, Smith Robert A., Eyre Harmon J., and Cohen, Carmel. (2002).

American Cancer Society Guideline for the Early Detection of Cervical Neoplasia and Cancer. CA. 52, 6: 342-359.

Additional Resource

The Medical Institute, PO Box 162306, Austin, TX, 78716. Phone: 800 892-9484. Web Site: www.Medinstitute.org. (Most reliable and unbiased source of medical related information on issues of sexual health.)