Defining Abstinence: Views of Directors, Instructors, and Participants in Abstinence-Only-until-Marriage Programs in Texas. (Articles)
Goodson, Patricia, Suther, Sandy, Pruitt, B. E., Wilson, Kelly, Journal of School Health
Shared meanings and common understanding of sexuality-related terminology are vital for the success of health education efforts in schools and communities. Meanings of sex-related terms, however, are not necessarily or automatically agreed upon by individuals. Alongside anecdotal data, scientific research has accumulated evidence that misconceptions and ambiguities pervade the field of human sexuality. In a survey of undergraduates, (1) researchers found that 59% of sampled students did not define oral-genital contact as "having sex" though the behavior placed them at risk for sexually transmitted infections (STIs). Another study (2) revealed that students' labeling of specific acts as "sex" depended on several factors such as type of behavior (vaginal, anal, or oral sex) and whether participants in the behavior reached orgasm.
Sexuality education--a key component for disease prevention and promotion of responsible sexual behavior (3,4)--also is plagued with problems related to terminology, definitions and shared meanings. Nuances surrounding the terms "sex" and "gender," for instance, still require clarification in some college-level sexuality textbooks, as do the subtleties contained in the many legal and cultural definitions of the term "rape." (5,6) The taxonomy currently employed for various approaches to school-based sexuality education ("comprehensive," "abstinence-only," "abstinence-based or abstinence-plus," and "abstinence-only-until-marriage") represents another instance of contention. Educators debate whether the existing language used to describe adolescent pregnancy and STI prevention programs might be outdated, inadequately descriptive, and/or biased. (7)
Ambiguities and debate surround both the definitions of certain sexuality terms as well as the terminology employed in sexuality education. Thus, it seems reasonable to assume that the semantic difficulties surrounding terms and phrases related to "sex" may equally affect the construct of sexual "abstinence." This study examined how program directors, program instructors, and participant youth from a sample of federally funded abstinence-only-until-marriage education programs in Texas define the term "abstinence" and its object (from what one abstains). Due to a paucity of systematic examinations of "abstinence" definitions, this study contributes to the promotion of clarified, shared meanings in the arena of sexual health promotion for adolescents.
Background and Rationale
In recent years, increasingly larger amounts of funding have been allocated to promote abstinence-only-until-marriage education. This type of education presents marriage as the only morally acceptable context for sexual activity, emphasizes abstinence from all sexual behavior until marriage and does not teach contraceptive use or disease-prevention methods. (8) Allocation of federal funds for these programs was mandated by the Personal Responsibility and Work Reconciliation Act (PL 104-193), signed into law in 1996. The provision contained in this act (Section 510[b], Title V of the Social Security Act) allocated $50 million per year to states, for fiscal years 1998 through 2002, specifically for abstinence-only-until-marriage education. Based on a funding formula and state matching required by Title V, Texas currently has the largest amount of federal monies invested in abstinence-only-until-marriage programs. (9) In 2000, the Texas Department of Health (responsible for disbursing funds from the Welfare Reform Bill in Texas) contracted with the authors to conduct an independent evaluation of 32 programs funded by Title V in the state. This paper presents a portion of the data collected through this evaluation effort.
Abstinence-only-until-marriage programs presently enjoy substantial economic and political support, but evidence of effectiveness of this approach is scarce. (10,11) Systematic and rigorous evaluations of these programs are, therefore, paramount both for accountability purposes and for evidence-based prevention practice. Evaluations of sexuality education efforts pose strategic and methodological difficulties, including programs' resistance to evaluation due to fear of losing funding and/or political support; design of valid and reliable evaluations with noncontaminated control groups; school districts' hesitancy in allowing surveying of youth regarding sexual attitudes and behavior; appropriateness of instruments for generating valid and reliable data; inadequate funding allotted to evaluation; and premature evaluations. (12)
Among these problems, absence of clear and operational definitions of evaluation variables such as the constructs of "sex" and "abstinence" may represent the most pivotal obstacle. (13,14) It is difficult to conduct valid, equitable, and useful evaluations of sexuality education programs or abstinence-only-until-marriage programs if evaluators define key program variables in one manner, while program personnel and program participants define them differently. (15-17)
The rationale for this study lies--ultimately--in the need for rigorous evaluations of abstinence-only-until-marriage programs. A necessary preliminary step, however, involves understanding program personnels' and participants' articulation and perception of the concept of "abstinence" which, in turn, will inform the development of appropriate and valid measures of these programs' effectiveness.
Two premises guide the conceptual framework for the study. First, the language and meaning program personnel and youth clients assign to the term "abstinence" are important elements in the design, implementation, and evaluation of programs. Second, understanding how program staff and participants perceive sexual abstinence is only possible through an analysis of the concepts, words, and language patterns they use to reveal the meanings and norms being attached to the notion of abstinence. (18)
The 32 programs funded by Title V in Texas during 2000-2001 embodied a variety of approaches and educational strategies. Most programs targeted youth and were delivered in schools, after-school, or in the community. A case study evaluation design (19) was used to examine a sample of eight of these programs, chosen purposefully to represent each of the types of programs (in-school, after-school, community-based), from both rural and urban settings. Within the sample of eight programs examined more closely, three were headquartered inside schools or school districts; seven focused on delivering in-school programs, after-school programs or combinations of both; three targeted communities alongside the school population; seven targeted youth clients; and one program targeted adult clients exclusively (training community leaders to deliver the abstinence message).
Program directors and instructors from the purposive sample were interviewed during spring 2001. A total of 25 interview sessions was conducted with 29 participants (24 female, five male). Of the 29 interviewees, 10 were program directors and 19 were instructors. Two programs had more than one director, each administering different aspects of the program. During interviews, participants answered the questions, "How is your program defining `abstinence'?" and "What should kids `abstain from,' specifically?" Interviews were conducted at the sites and followed standardized, open-ended questions. Questions used in the interviews were developed by the authors, based on preliminary assessment of each program's proposal to the funding agency. An average of three interviews per site were conducted. Interviews lasted from 30 to 90 minutes and were audiotaped with participants' permission.
Focus groups were conducted during the same time period, with youth actively participating in the abstinence-only programs in six of the eight sampled sites. Youth were selected for focus groups by their program's staff. A total of 37 youth participated in the focus groups (mean number of participants was six). Youth ages ranged from eight to 17 years. Twenty were female and 17 were male. Participants were asked "When you hear the word `abstinence,' what comes to mind?" The evaluation's protocol and instruments were reviewed and approved by the Institutional Review Boards of Texas A&M University and the Texas Department of Health.
Interview and focus group data were transcribed verbatim into a word processor and subsequently transferred into the NUD*IST software package for qualitative data analysis. (20) Data segmentation and coding were carried out by two independent readers. Inter-rater reliability was established through comparisons of coding schemes. Inconsistencies were resolved through discussions between readers and, when applicable, with the entire evaluation team.
The data were searched for dominant themes and examined for patterns of similarity and contrast in their content. Themes were coded and the number of respondents citing each of the themes was counted. For the youth client focus groups, coded themes were counted per focus group session, not per youth respondent. If the theme was present in the transcript of the focus group session, that theme was counted as being cited in the focus group, regardless of how many participants mentioned that specific theme/code. This numerical reporting of qualitative data was chosen because these numbers provide an important measure of prevalence of the various definitions in this sample.
Definitions of abstinence provided by interviewees clustered under two main patterns labeled "positive" and "negative," despite the limitations inherent in such terminology. Unlike colloquial use, where "positive" and "negative" connote the values of "good" and "bad," use of the terms in this study did not presuppose any such values. Instead, definitions categorized under the umbrella term "negative" defined abstinence in terms of avoidance and of negation: "not performing" certain behaviors, "avoiding," "not engaging,'' and "not participating," were some of the most commonly used phrases characterizing these definitions. Conversely, definitions that clustered under the "positive" pattern emphasized a more proactive stance, highlighting specific attitudes and behaviors that must be internalized, incorporated, and practiced by youth to be characterized as an abstinent lifestyle: "being positive about oneself;" "making the right choices;" "being responsible."
Positive and negative definitions were further analyzed in terms of their constituent elements. Four elements of positive definitions were identified and labeled Internal Management, Values/Attitudes Incorporation, Abstinence as an Option, and Investment in the Future. Direct quotes from participants, illustrating each element, are presented in Figure 1.
The Internal Management element characterized references to various aspects of youth's self-monitoring, such as self-control, responsibility, self-management and decisionmaking. Values/Attitudes Incorporation consisted of references made to beliefs and values that youth must internalize to live an abstinent lifestyle. Examples of these include self-esteem, empowerment, and respect for others. The Abstinence as an Option element defined abstinent behavior as an alternative for youth who believe early engagement in sexual activity is the norm. These statements emphasized the fact that, especially for such youth, abstinence represents the gateway to a range of unexplored and potentially gratifying choices. Investment in the Future characterized definitions of abstinence that referred to "saving sex for marriage," "waiting for the right person," "postponing," or that called attention to abstinence as a means of preventing future problems and promoting wellness. Far from depicting an absolute avoidance of sexual pleasure, these terms conveyed the perspective of delayed gratification.
Each of these four elements was mentioned by at least 26% of program staff and in at least 17% of the youth focus groups (Table 1). The most frequently cited positive element for program directors was Abstinence as an Option (60% of directors cited this element), followed by Internal Management (50%), Values/Attitudes Incorporation (50%), and Investment in the Future (40%). Internal Management was the most frequently cited element for program instructors (63%), followed by Values/Attitudes Incorporation (52%), and Investment in the Future (52%). In the youth focus groups, Internal Management and Values/Attitudes Incorporation were the most frequently cited positive elements (half of the groups cited both elements). Similar distributions of responses were found across the three groups of interviewees for all positive elements, with only one exception. While 60% of program directors mentioned Abstinence as an Option, only 26% of program instructors referred to this concept, and only one youth focus group cited that element (Table 1).
Definitions that clustered under the "negative" pattern emphasized "restraint," "refrain," "distance from," "avoidance," "no engagement," and "no involvement." Further analysis of the constituent elements of negative definitions revealed these elements to be the same as the objects of abstinence: those behaviors one should avoid in order to be abstinent. Almost all respondents said the object of abstinence in this negative sense was "sexual activity." When respondents defined abstinence as "not engaging in sexual activity" they were asked, "And how do you define sexual activity?" Negative-patterned responses were categorized, then, according to six elements: Sexual/Vaginal Intercourse; Oral Sex; Anal Sex; Pre-Coital Behaviors; Behaviors with the Purpose of Sexual Arousal; and Non-Sexual Behaviors. Direct quotes illustrating these elements are in Figure 2.
The element Sexual/Vaginal Intercourse characterized responses referring to heterosexual coitus or copulation. Oral Sex and Anal Sex categorized specific references to these types of sexual behavior. Answers coded as Pre-Coital Behaviors comprised petting, kissing, and touching, behaviors that could lead to sexual intercourse. Although Behaviors with the Purpose of Sexual Arousal could, conceptually, have been combined with Pre-Coital Behaviors, the distinction was maintained because "intention of sexual arousal' is the wording contained in a widely accepted definition of abstinence, originally articulated and disseminated by one of the Texas-funded programs. Only definitions that contained the specific phrase "intention/purpose of sexual arousal" were coded as such. A measure of how frequently this specific terminology was mentioned can be construed as a proxy measure of the extent to which the definition has "spread" and been adopted by various programs in the state. Non-Sexual Behaviors was the code attached to answers that focused on behavior such as alcohol consumption, drug use, and smoking, as well as consumption of pornography and other materials (music, videos, films) deemed incongruent with an abstinent lifestyle.
The most frequently cited object of abstinence in the negative sense was Sexual/Vaginal Intercourse, across all three groups of interviewees (60% of directors, 68% of instructors, 50% of focus groups). For program directors, the other most frequently mentioned negative elements were Oral Sex (50%) and Behaviors with Purpose of Sexual Arousal (40%). Program instructors' definitions exhibited a different pattern. For them, Non-Sexual Behaviors was the second most frequently cited element (52%), followed by the element of Oral Sex (42%). While one-half of the focus groups mentioned Sexual/Vaginal Intercourse as the object of abstinence in the negative sense, one-half of them also referred to Non-Sexual Behaviors. None of the focus groups, however, cited the element of Pre-Coital Behaviors, and only one focus group mentioned Oral Sex and Anal Sex (Table 1).
The majority of definitions--80% of program directors, 89% of program instructors, and 83% of focus groups--cited both positive and negative elements concurrently. Patterns of co-occurrence of elements varied widely among directors and youth focus groups. Among instructors, however, patterns of combinations of positive elements were observed: Internal Management and Values/Attitudes Incorporation were cited concurrently by 30% of instructors; Internal Management and Investment in Future, by 30%; and Values/Attitudes Incorporation and Investment in Future also were cited by 30% of instructors. Additionally, simultaneous mention of Sexual/Vaginal Intercourse and Non-Sexual Behaviors was present in 21% of definitions given by instructors.
Variations in frequency and patterns of citations of definitional elements depict an interesting profile of participants in the study. Program directors, for instance, appeared to value the idea of abstinence as a viable option for youth more highly than program instructors or youth themselves. Such preference may be due to program directors' need to articulate a theoretical perspective for the programs and their outcomes, because many of them are responsible for writing and managing the grants submitted to funding agencies. Program instructors, conversely, appeared to place more importance on youth's mastering of self-monitoring skills such as decision-making. The salience of this theme for instructors may reflect their immersion in the daily contact with the children and their need to more concretely (and less theoretically) operationalize applications of the construct of "abstinence."
Not surprisingly, positive themes most frequently cited in the focus groups reflected the same distribution encountered among instructors. That youth responses followed instructors' response patterns and not those of directors suggests a certain (and potentially problematic) degree of "distance" between those who coordinate programs and those who participate in them. Yet, instructors' and youth's matching patterns suggest youth appear to be assimilating their instructors' messages regarding abstinence. Lack of alignment between instructors' and directors' positive definitions also may indicate distance between these two groups, the meaning of which remains open to reflection and further study.
Among the negative elements of the definitions of abstinence, patterns similar to those described above were found: youth and instructors have comparable distributions of responses, while directors' salient themes differed. While youth and instructors indicate that abstinence is avoidance of sexual intercourse and other, non-sexual behaviors such as drinking, smoking, and using drugs, program directors portray abstinence primarily as the avoidance of both sexual intercourse and oral sex. Since one of the concerns related to abstinence-only programs is that these programs delay sexual intercourse while increasing the prevalence of oral sex, the emphasis on abstinence from oral sex may represent directors' concern with avoiding such stigma for their programs. (14)
These findings are limited, however, by methodological difficulties characteristic of field-based evaluations. First, the purposive, nonrandom selection of programs (according to type and geographical location) may preclude extrapolation of results. Second, results from the youth focus groups are limited due to the selection bias introduced by the manner in which youth were recruited. Program staff selected and invited youth to participate, so the authors did not have access to nonparticipant youth nor to those who might have been dissatisfied with their programs.
This evaluation of the Texas programs had no intent of producing representative or generalizeable results. While the reliability of this study's findings is limited, the authors are confident that three lessons learned in this effort can be extrapolated to similar programs and their evaluations. The first lesson learned confirmed that the Texas abstinence-only-until-marriage programs' staff have, in fact, clear definitions for "abstinence." From a program evaluation perspective, the presence of clearly articulated variables facilitates the evaluators' role of defining outcome measures and of detecting expected and unexpected program effects. Moreover, clear definitions prevent conflicting meanings among program stakeholders and evaluators and the subsequent influence of definitions articulated by politically powerful groups. (21)
The second, and perhaps more surprising lesson learned in the evaluation concerns existence of positive-patterned definitions of abstinence and the widespread consensus surrounding them. Prior to this assessment, the authors believed abstinence was defined only by avoidance or self-denial. Program staff and youth, however, articulated the concept of abstinence in a manner that did not delve exclusively into the disciplined refrain from sexual pleasures and its consequences, but emphasized incorporation of positive attitudes and behavior that contribute to both the sexual and overall well-being of individuals. Uncovering this "positive side" of abstinence was important for shaping evaluation measures. Had the authors proceeded on the assumption that abstinence has, as one program director stated, "only one definition: when you abstain from something, you stay away from it, you do not take part in it," the evaluation would not have adequately captured the philosophical framework, the implicit theories, the proposed outcomes nor the methodological choices for program delivery observed in the sample.
A third lesson revealed that the presence of both positive and negative dimensions in the majority of definitions of abstinence appears to serve at least two important programmatic and political functions within the "world" of abstinence-only sexuality education. The first function allows representation of approaches of a broader scope than the traditional pregnancy and STI prevention-focused efforts. Despite its controversial value, many of the programs awarded federal funding for abstinence education are not sex education programs. Many are youth development efforts that had already been teaching about abstinence from nonsexual behaviors such as drug and alcohol use. Incorporating the abstinence-from-sex message was a natural way to secure funding, and espousing a "broad" definition of abstinence is, therefore, consistent with these programs' history and goals.
The second function of variable definitions of abstinence is meeting-program participants' needs. Some program staff members interviewed for this study admitted that their target population would have difficulty making sense of exclusively negative definitions of abstinence, especially if program participants were already engaging in sexual intercourse. Defining abstinence in positive ways allows program instructors to focus on delivery of constructive, character-based messages and youth-development skills that would, otherwise, not be possible within an exclusively "negative" paradigm. A negative approach focuses, mainly, on teaching about negative consequences of sexual activity with the development of coping and refusal skills. Program personnel seem to expect that a "positive" approach in programs that include sexually active teens, will influence youth outcome variables other than sexuality-related ones which, in turn, may lead teens to practice abstinence.
Inherent complexity in the definitions encountered in this study is evidence that abstinence-only-until-marriage programs pose important challenges for evaluators of sexuality education. These challenges include listening to program stakeholders for their concepts, experiences, and values as reflected in the language used to talk about the programs; the challenge of making sense of these experiences and language and translating them into valid evaluation goals and tools; the challenge of not merely listening and attributing meaning, but of meaningfully incorporating stakeholders' "voices" into the evaluation; and the challenge of fairly representing programs in all of their idiosyncrasies. If these issues are not addressed, evaluations run the risk of being unfair, meaningless and useless, despite the urgent need for such assessments.
Table 1 Percentage of Respondents Citing Elements of Positive and Negative Definitions of "Abstinence" Directors Instructors Main Elements (N = 10) (N = 19) % (n) % (n) Positive Definitions Internal management 50 (5) 63 (12) Values / attitudes incorporation 50 (5) 52 (10) Option 60 (6) 26 (5) Investment in future 40 (4) 52 (10) Negative Definitions Sexual / vaginal intercourse 60 (6) 68 (13) Oral sex 50 (5) 42 (8) Anal sex 10 (1) 16 (3) Pre-coital behaviors 30 (3) 26 (5) Behaviors with purpose of sexual arousal 40 (4) 26 (5) Non-sexual behaviors 30 (3) 52 (10) Youth (Focus Groups) * (N = 6 focus groups) % (n) Positive Definitions Internal management 50 (3) Values / attitudes incorporation 50 (3) Option 17 (1) Investment in future 33 (2) Negative Definitions Sexual / vaginal intercourse 50 (3) Oral sex 17 (1) Anal sex 17 (1) Pre-coital behaviors 0 (0) Behaviors with purpose of sexual arousal 33 (2) Non-sexual behaviors 50 (3) * Responses were counted per focus group session, not per respondent in focus groups. Figure 1 Illustrations of Elements Contained in the Positive Definitions of Abstinence (direct quotes from interviewees) Internal Management "I think abstinence means that if you choose not to do something you keep to that decision and you keep your commitment." (Participant Youth) "Making choices and being responsible and not being influenced by peer pressure ..." (Program Director) Values/Attitudes Incorporation "... we are seeking to help children understand abstinence and accept it attitudinally as a lifestyle." (Program Director) "... to live an abstinent lifestyle you got to be positive about yourself, you've got to make very difficult decisions in life, you know, you're always gonna have that boyfriend or girlfriend that's not gonna agree to wait until marriage." (Program Instructor) "In our abstinence programming, abstinence has a more social connotation. It talks about who you are, the relationship with your family, and how you treat others." (Program Director) Abstinence as an Option "A lot of them [children] don't know how to have a relationship, friendship relationship. To them, love means romantic love. Because to them, that's all they know and that's all they see on TV. And I explain to them you can have love, friendship, you know, love for a friend ..." (Program Instructor) "In the abstinence class, students really get to explore and say, `Well, maybe I don't really want to do this [have a sexual relationship]." (Program Instructor) Investment in the Future "I'm not saying abstinence is the end-all-be-all and the only answer. But it's part of the answer, I think. And it has its little function in trying to achieve a better world for all of our kids. A better country, you know, stop these senseless killings, and helping kids make better choices, see a future for themselves. Give them some hope, there's so much apathy. And give them some goals, and something to strive for, something to set their mind on." (Program Director) Figure 2 Illustrations of Elements Contained in the Negative Definitions of Abstinence (direct quotes from interviewees) Sexual / Vaginal Intercourse "Refraining from sex. Actually, the act of sex, intercourse. Be it orally, be it vaginal, it is all sex." (Program Instructor) Oral Sex "We're defining abstinence as withholding and not engaging in sexual relations until marriage. We include in sexual relations all kinds of sexual activities, intercourse, and of course, oral intercourse." (Program Director) "To not engage in sexual activity. I mean sexual intercourse, oral sex, the whole spectrum, because a lot of young people are looking at oral sex as not being sex." (Program Director) Anal Sex "I define abstinence as refraining from sexual engagement [...] intercourse, oral sex, anal sex." (Program Instructor) Pre-Coital Behaviors "The term `abstinence' means that a person is choosing not to have sex. They're abstaining from any sexual activity. I would say that any sexual activity would mean that they do not participate in any forms of petting." (Program Instructor) "No mutual masturbation." (Program Instructor) Behaviors with Purpose "A deliberate and calculated decision of Sexual Arousal to refrain from sexual activity. Sexual activity is the intentional sexual contact for the purpose of sexual arousal." (Program Instructor) Non-Sexual Behaviors "Abstinence from drugs, abstinence from alcohol ... Of course I encourage them to, if they are ever in a room where pornography is present, or someone is, you know, looking at something like that, that they remove themselves. So I, you know, that could be included, abstaining from engaging in and looking at pornography." (Program Director) "Different things not to do ... Like drugs, alcohol. Don't drink beer. Don't eat (laughing)." (Participant Youth)
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Patricia Goodson, PhD , Assistant Professor, (firstname.lastname@example.org) ; Sandy Suther, MA, Doctoral Student, (email@example.com); B.E. (Buzz) Pruitt, EdD, Professor, (firstname.lastname@example.org); and Kelly Wilson, MEd, Doctoral Student; (email@example.com); Dept. of Health & Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX 77843-4243. This study was supported by a grant from the Texas Department of Health to the first and third authors. This article was submitted June 7, 2002, and accepted for publication July 29, 2002.…
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Publication information: Article title: Defining Abstinence: Views of Directors, Instructors, and Participants in Abstinence-Only-until-Marriage Programs in Texas. (Articles). Contributors: Goodson, Patricia - Author, Suther, Sandy - Author, Pruitt, B. E. - Author, Wilson, Kelly - Author. Journal title: Journal of School Health. Volume: 73. Issue: 3 Publication date: March 2003. Page number: 91+. © 1999 American School Health Association. COPYRIGHT 2003 Gale Group.
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