By Michael Castleman
Michael@mcastleman.com
For 40 years now, social Liberals and
Conservatives have waged a culture war over sexual politics. Conservatives have
fought bitterly against abortion, sex in the media, and sex education in public
schools, castigating them as clear signs of moral decay. They have promoted
abstinence until marriage as The Answer to everything from teen pregnancy to
AIDS. With equal passion, Liberals have championed women's right to abortion,
and teachers' right to discuss contraception and prevention of sexually
transmitted infections (STIs), insisting that this information is The Answer to
everything from teen pregnancy to AIDS.
The views of the Liberals and
Conservatives appear diametrically opposed. But based on my five years of
experience in family planning and teen sex education, and subsequent 25 years
as a sex counselor and journalist specializing in sexuality, I have come to
believe that the two sides are not the Hatfields and McCoys. They're actually
Romeo and Juliet, hailing from feuding clans, but in bed with each other.
When it comes to teen sex, the Liberals
and Conservatives have very similar core values. Neither of their approaches to
sex education makes sense (though the Liberal view is a tad more realistic).
And neither of their programs has ever been shown to accomplish anything significant.
Meanwhile, the real answer to teen sex
education has been hiding in plain sight for a good 25 years. It's the power of
parents. Parents are by far teens' most effective sex educators. Parents are
certainly not perfect sex educators. But they're doing a better job than they
did two decades ago, and a modest program of adult education could improve
their abilities even more. Helping parents become better sex educators might
even transcend the supposed Liberal-Conservative divide, and promote sexual responsibility
to adolescents based on a concept completely foreign to both sides, the simple,
elegant fact that sexual responsibility, contraception, and STI prevention lead
to better, more pleasurable, more satisfying sex.
Compared with adults, teens spend more
of their lives focused on the media. My 15-year-old daughter does her homework
on the computer, while watching TV, with music blaring, while IMing her
friends, Television, movies, popular music, and advertising are soaked in sex:
* Network programs directed at teens
are filled with sex and sexual allusions.
In a recent episode of “Desperate Housewives,” three of the four main
characters engaged in sexual banter with their husbands, a mother breast-fed
her five-year-old, and a gay teen kissed his boyfriend.
* Cable TV is more explicit, notably
HBO's recently concluded "Sex and the City," whose career-women
characters wouldn't be caught dead without a vibrator in their purses. Many
scenes on "The Sopranos" take place at a topless bar, where the
dancers have been shown orally gratifying the mobsters.
* Teen-oriented music is equally
sex-obsessed. Five years ago, when my daughter was 10, she loved the song,
"Bad Touch" by the Bloodhound Gang:
Put your hands down my pants and I bet
you feel nuts.
Yes, I'm Siskel, yes I'm Ebert, and
you're getting two thumbs up.
You and me baby ain't nothing but
mammals,
So let's do it like they do on the
Discovery Channel.
You show me yours, and I'll show you
mine.
Then we'll do it doggie style, so we
both can watch "X-Files."
* Pornography is more mainstream than
ever. Every video store stocks it. You may have to be 21 to rent or buy it, but
any kid can wander into the Adult section and view the almost-X-rated box
covers.
* Finally, using the Internet, every
imaginable type of pornography, and then some, is just a click away. Before my
Web-surfing son left for college, he downloaded photos and video clips that
would make Hugh Hefner's hair curl.
Does media exposure to sex spur teens
to become sexual? It’s debatable, but some research says yes. RAND Corp.
researchers interviewed 1,792 teens, age 12 to 17 at the start of the 2004 TV
season. Then the researchers analyzed the sexual content of the 2004 television
season. Two-thirds of shows contained clear sexual content. At the end of that
season, they interviewed the teens again. As the sexual content of the shows
they watched increased, so did their likelihood of first intercourse and other
sexual activities.[1]
In addition to unprecedented access to
sex-promoting media, today's teens also have more opportunity than previous
generations did to "do it." When today's parents were growing up,
many of their mothers stayed home, making access to sofas and bedrooms
logistically difficult. Today, however, most mothers work outside the home, and
many teens spend their after-school hours with no adult in sight. Recently, I
attended a party for a friend's 18-year-old daughter who was going off to college.
The subject of teen sex came up. I waxed nostalgic about the big back seat of
my old '54 Plymouth. She looked at me askance: "A car? Why didn't you just
go to someone’s house?"
Today we have teens exposed to more
media sex than ever, and with more opportunity than ever to let their hormones
get the better of them. No wonder the
adult world is so nervous about teen sexuality. And no wonder both Liberal and
Conservative groups (who want funding for their programs) scream in unison that
among all industrialized nations, the U.S. has the highest teen birth rate.[2]
Oddly, however, despite raging
hormones, a sex-soaked culture, and empty homes after school, over the past 15
years, American teens have become significantly more sexually conservative. In
addition, when they have sex, they are more likely than ever to use
contraception:
* In 1991, 54.1 percent of teens
reported having had intercourse. In 2003, it was down significantly to 46.7
percent.[3]
* In 1991, 37.5 percent of teens said
they were sexually active, meaning they’d had intercourse during the previous
three months. In 2003, that figure was down to 34.3 percent.[4]
* In 1991, 46.2 percent of teens said
the last time they had intercourse, they’d used a condom. In 2003, condom use
jumped to 63.0 percent.[5]
* From 1991 to 2003, the teen birth
rate has fallen a whopping 33 percent.[6]
* From 1988 through 2004, the Chlamydia
rate among teens has fallen 40 percent.[7]
(Chlamydia is the most prevalent STI.)
Now, Conservatives—and many
Liberals—feel uncomfortable with any
teen sexual activity. But the trend lines for the past 15 years clearly argue
against any developing "crisis." If there ever was a crisis, it has
subsided considerably. Today’s teens are more sexually conservative than most
adults believe, more conservative than many of their parents were at their age.
Conservatives have been quick to claim
credit for the steady, 15-year decline in teen sex. They say their program—abstinence
until marriage—is paying off.
There is no doubt that during the past
decade, the nation's sex education programs have been reshaped by the
Conservatives. During the 1990s, U.S. school sex ed programs turned decisively
away from "comprehensive" instruction, which includes contraceptives
and STD prevention, and toward just one approach, abstinence until marriage.
One survey of 3,754 sex education teachers in grades 7 to 12 showed that in
1988 just 2 percent of school sex education programs taught abstinence-only. By
1999, the figure had increased almost twelve-fold to 23 percent. Moreover, sex
education programs that do not insist on abstinence increasingly promote it: In
1988, 25 percent of teachers said abstinence was their "most important"
message. By 1999, the figure had risen to 41 percent.[8]
The rise of abstinence-only sex
education has certainly been associated
with the decline in teen sex. But Conservatives say that it was the cause.
In fact, there is no evidence to show a cause-and-effect relationship.
Abstinence promotion began in earnest
in 1998 with $50 million a year authorized in the 1996 Federal Welfare Reform
Act.[9] But teen
STI rates have declined steadily since 1988, ten years before the
start of the abstinence push. The teen birth rate began falling in 1991, seven years before federal funding for
abstinence education began, back when only a tiny fraction of sex ed programs
preached the Conservative message.
In addition, considerable evidence
shows that abstinence-only programs don't work. Abstinence-only sex ed is most
deeply entrenched in the South, and notably less popular in the rest of the
country. Guess where teens are most likely to become pregnant—in the South.
According to the CDC, teen birth rates in Alabama, Georgia, and South Carolina
are two to three times those in Vermont, New York, and Michigan.[10]
Controlled trials also fail to show any
benefit from abstinence-only sex education. In one study in New York City, 312
middle schoolers were surveyed about their attitudes toward teen sex. Then for
four months, 125 of them participated in a daily, small-group, 45-minute class
that promoted abstinence. At the start of the study, there were no differences
among the students in sexual attitudes or experience. But by the end of the
course, significant differences emerged: Compared with students who did not
take the class, those who did were more likely to disapprove of teen
sex—apparent support for Conservative claims. However, one year later, those
who took the class were just as likely
to have become sexually active, and just as likely to have become involved in a
pregnancy.[11]
Conservatives don’t like to discuss
this study, or several others that have come to the same conclusion.[12] They
prefer to focus on a 2001 survey of 6,800 teens at 141 high schools by the
National Institute of Child Health and Human Development (NICHHD).
Researchers from the Heritage Foundation, a Conservative think tank, analyzed
the data and found that compared with teens who did not take virginity pledges—vows
to remain virgin until marriage—those who did delayed first intercourse an
average of 18 months.[13]
Not so fast. The Heritage researchers
never attempted to publish their findings, so they were never subjected to peer
review. In 2005, researchers at Columbia and Yale independently re-analyzed the
NICHHD data and discovered serious statistical flaws in the Heritage analysis
that invalidated their findings.[14]
Meanwhile, in 2004, the CDC’s National
Longitudinal Study of Adolescent Health, a survey of 12,000 teens, showed that
among teens who signed virginity pledges, only 12% lived up to them. More than
three-quarters—88%—did not. And compared with those who did not sign the
pledges, those who did developed sexually transmitted infections at the same
rate.[15]
Finally, in 2002 researchers at
McMaster University in Hamilton, Ontario, analyzed 26 studies of various
approaches to reducing unintended teen pregnancies, both abstinence-only and
more Liberal programs. The abstinence-only programs did not delay first intercourse in either boys or girls. Compared with
the number of teen pregnancies before the programs were presented, after four
abstinence-only programs, the number of pregnancies increased.[16]
Politically, Conservatives have been
very successful turning the nation’s school sex education programs toward
abstinence-only. But as a formula for minimizing teen sex, pregnancy, and STIs,
the Conservative program is a bust. It just doesn't work.
What about the Liberal approach, comprehensive
sex education that includes birth control methods and STI prevention? As it
happens, San Francisco, where I live, has one of the nation's most
comprehensive sex education programs. It runs from grades 5 through 8, and
includes puberty issues, all the contraceptive methods, and STI prevention—with
a major emphasis on prevention of AIDS, which, since 1981, has killed 18,000
San Franciscans.
In addition, at my kids’ public middle
school, the sex ed program culminated in the 8th grade with a visit from two
19-year-old women who'd had babies at 17. As part of a local program called the
TeenAge Parenting Project (TAPP), these moms earn money by visiting schools,
and discussing contraception and how parenthood has changed their lives. My
kids had different opinions of the TAPP women. They made a big impression on my
son, now 19. Six months after their visit, he still vividly recalled their
regret over having become parents so young, their inability to afford cars or
apartments of their own, and their need to work to support their children,
which has meant going to college at night, and taking only one course per term.
"They won't graduate for 12 years," he explained at age 12.
"That's as long as I've been alive." Four years later, my daughter
took a dimmer view of the TAPP women: “The teen moms were stupid. If you get
pregnant in high school, you’re stupid.” My daughter’s evaluation was harsh,
but she got the point. This is about as hard-hitting as Liberal comprehensive
sex education ever gets.
Personally, I’m all for school sex ed
that includes contraception and STI prevention. During my years in family
planning, I was a guest speaker at many schools. But do these programs
accomplish anything? They do not. The McMaster University analysis of 26 outcome
studies included many Liberal programs. Like the abstinence-only initiatives,
Liberal sex education did not delay first intercourse in either boys or girls.
It did not improve use of contraceptives. And it did not reduce unintended
pregnancies.[17]
Recently Susan Dominus, an editor at
Nerve.com, an Internet sex-and-relationship site aimed at young adults, wrote
an essay in the New York Times about
sex education: “It must amaze teenagers that sex education can generate such
political firestorms, given how dull it usually is. At my public high school,
we did not take it seriously. Despite the relative candor of the curriculum, I
can’t remember anything useful, much less sexually inspiring.”[18]
San Francisco’s sex ed program is among
the nation's most comprehensive. Yet my kids’ teachers—and the teen moms—talked
themselves hoarse promoting abstinence.
My son came home very clear that abstinence is the only 100 percent effective birth control method.
Nonsense. There's another method that's
also 100 percent effective, not to mention very popular, always available for
free—and quite enjoyable. It's non-intercourse lovemaking, namely, genital hand
massage and oral sex. But even the most Liberal, most comprehensive sex
education classes never mention them.
To mention them would violate the fundamental axiom of American sex education,
the core value that unites the Liberals and Conservatives far more than
anything divides them, namely, that for teens, sex is dangerous. We don’t have “sex education” in this country. We have
“dangers-of-sex” education.
To discuss hand jobs, fellatio, and
cunnilingus, sex educators would have to discuss sexual pleasure, which is absolutely verboten. During the Clinton Administration, Surgeon
General Jocelyn Elders found out just how forbidden it is. She casually
mentioned that because everyone masturbates, perhaps it should be taught to
children. Faster than you could say “do it yourself,” she was fired.
Both Liberals and Conservatives agree
on the dangers of sex: coercion, teen pregnancy, and STIs. They also agree that
abstinence is the best defense against all of them. Then the Liberals concede
that, gee, abstinence is just maybe a little unrealistic, so, kids, if you
can't keep it zipped, please use contraception, particularly condoms, which
prevent both pregnancy and STIs.
Both Conservatives and Liberals insist
that they deserve the credit for the decrease in teen sex over the past 15
years. But as we have seen, there is no compelling evidence that either
approach deserves any credit. Nonetheless, there is no denying that since 1991,
the teen pregnancy rate has declined 33 percent. The teen Chlamydia rate has
dropped 40 percent. And teen condom use is up 17 percent. These are substantial
changes. If neither the Liberal nor Conservative approaches has caused them,
what has?
No one knows for certain. But I have a
theory. I think parents deserve the
credit. They have been talking more about sex with their children—and getting
through to them.
Now, as the father of two teenagers,
believe me, I have a great deal of difficulty believing that when parents talk,
teens listen. As far as I can tell, the only time my kids listen to me is when
I say: “Here’s your allowance.”
Nonetheless, studies going back 25
years show that when parents discuss sex and their own sexual values openly and
frankly, teens listen and take what they hear to heart. They delay becoming
sexual active, and, when they do, they are much more likely to use condoms.
Here is a sampling of recent reports:
* University of Pennsylvania
researchers surveyed 219 inner-city girls, aged 12 to 19. Those who reported
the most conversations with their mothers about sex were the least likely to
have intercourse, particularly unprotected intercourse.[19]
* As part of the National Longitudinal
Study of Adolescent Health, University of Minnesota researchers interviewed
2,006 boys and girls, aged 14 and 15, who said they were virgins. In subsequent
interviews, the teens least likely to have intercourse were the ones who said
they had “frequent communication” with their mothers about sex.[20]
* At Northridge State University in
California, researchers videotaped many interactions among 55 Latino mothers
and their teenaged children, then coded the conversations for content that
involved sex and sexual values. As mothers’ discussion of sex increased—notably
disclosures about their own dating and sexual experiences—their children were
less likely to become sexually active.[21]
* Researchers at the State University
of New York, at Albany, interviewed 10,000 students in grades 7 to 11 twice,
one year apart, about sex discussions with their mothers. Students expressing
the greatest satisfaction with these discussions were less likely to have
intercourse. If they did, they were more likely to use contraception, and less
likely to become involved in a pregnancy.[22]
* Finally, the most compelling evidence
of the power of parents comes from a 1998 CDC survey of 372 sexually active teens
around the country. Compared with those whose mothers did not discuss the
necessity of using condoms, the teens whose moms did were three times more likely to use them during their first sexual
experiences and 20 times more likely
to use condoms subsequently.[23] These
differences are large enough to account for the substantial drop in teen
pregnancy and STIs, and the significant increase in teen condom use.
Sex educators of all political stripes
moan that many parents have trouble discussing sex with their children or
refuse to do so, and that if they do discuss sex, they’re often misinformed.
Hence the major push for sex education in schools. Clearly, some parents can't
or won't discuss sex, and many who do are not particularly well-informed or
articulate. But I contend that to be effective sex educators, parents don't
have to be eloquent. They just have to try—even
if it involves admitting their own discomfort with the subject.
Parents of teens are trying. They are
discussing sex more than their own parents did—even if they don't want to. Events have forced the subject on them.
During the 1960s, when I was a teenager, the news media were virtually devoid
of sex news. Today, it's difficult to avoid sex news: abortion, Viagra, AIDS,
other STIs, breast implants, gay marriage, sex toys, sex offenders,
pornography, sex-change surgery, and on and on. Even if parents don’t want to
discuss these things, sex subjects keep coming up, and they wind up discussing
them with their kids.
While the Conservatives and Liberals
continue to clash over the content of sex education—mostly how much to
emphasize abstinence—a survey by the Kaiser Family Foundation found that most
American parents want their children to receive more sex education than even the most comprehensive Liberal
programs provide. The Kaiser survey of 4,000 parents and students found that in
addition to information about STIs (supported by fully 98 percent of parents)
and contraceptives (90 percent), 97 percent of parents wanted instruction on
how to talk with teens about sex, 88 percent wanted teens to learn to negotiate
safe sex with partners, 79 percent wanted more information on abortion, and 76
percent wanted discussion of homosexuality.[24]
The Kaiser survey strongly suggests
that American parents are much less conservative than the Conservatives say
they are, and much less conservative than Liberals and sexuality professionals
fear.
Currently, chances are slim to none
that sex education will ever provide what the parents in the Kaiser survey
requested. If that's what parents want their kids to learn, they have to teach
it themselves.
School sex education programs have
focused on the wrong group. Schools should offer classes to parents to help them discuss sex with their children.
Conservatives have long argued that sex education belongs in the home. They’re
right, not just because parents control the message, but because unlike lame
school-sponsored programs, home-based sex education actually gets through to
teens.
Could such an idea work? The research
is scant, but one recent study offers hope. Penn State researchers divided 50
mothers of 11- to 15-year-olds into two groups. One attended two brief classes
on talking with teens about sex. Afterwards, the kids of the women who received
the instruction said they felt more comfortable talking with their mothers
about sex, and engaged them in more discussions of birth control.[25]
But if Liberal and Conservative parents
attended the same talk-to-your-teens-about-sex classes, wouldn’t all hell break
loose? I doubt it. In my experience as a sex educator, relatively few parents
are sexually dogmatic. They often seem that way, not because they are truly
doctrinaire, but because they feel confused about parenting teenagers (who
doesn’t?), and afraid of what “they”— peers, teachers, Conservatives, Liberals,
the media, and others—might tell their kids when they’re not around.
Talk-to-your-teens-classes for parents eliminate the fear factor. They give
parents of all political persuasions the space to wrestle with sexual issues
and decide for themselves how they want to approach their teens, who might soon
become sexually active—or might already be.
If I taught such a class, first I would
work to reassure parents that the sky isn’t falling. I would present the
statistics. Today’s teens are more sexually conservative than many of their parents were. Next, I would invite participants
to reminisce about some of their sexual experiences as teens. The fact is, many
parents who embrace the Conservative line in public were anything but as
teens.
Finally, I would invite parents to
articulate their values and practice discussing them, whatever they might be.
If Conservative parents want to insist on abstinence when they talk to their
kids, that's their prerogative. But personally, I would present a much
different perspective—and my wife and I have in discussions with our kids.
As I interpret the research, it seems
to me that whether or not teens are sexually active, they want their parents to
acknowledge them as sexual beings. I believe that desire is a big reason why so
many studies show that teens delay sexual initiation when their parents discuss
sex with them. By talking about it, the parents acknowledge that their kids are
sexual beings. Once recognized as sexual, teens don’t have to prove it to
themselves by becoming sexually active before they feel ready.
One of the hardest things about
parenting teens is realizing that you’re no longer in control, that your
adolescents are beginning to live their own lives their own way. Conservatives
lay down the law and expect to be obeyed. In my view, that’s unrealistic. All a
parent of teens can hope to do is provide some guideposts. Here are my wife’s
and mine: consent, condoms, lubrication, and pleasure.
* Consent. We never want our kids
sexually coerced. We’ve told them, especially our daughter, that if they ever
feel coerced, they should extricate themselves from the situation by any means
necessary, and if they need help, we’ll do everything in our power to help
them.
* Condoms. Pregnancy, AIDS and other
STIs are real possibilities. When used properly, condoms virtually eliminate
them. Condoms aren’t perfect, but Conservatives have seriously over-estimated
failure rates. For pregnancy prevention, depending on how carefully they are
used, condoms are anywhere from 85 to 98 percent effective.[26] This
does not mean that couples can expect
two to 15 pregnancies per 100 acts of condom-covered intercourse. It means that
if 100 couples use condoms exclusively for one full year, somewhere between two
and 15 of them can expect an accidental pregnancy. Sexual frequency varies
greatly, but the landmark “Sex In America” study, a survey of a representative
sample of 3,432 Americans, found that the most typical frequency was three
times a month,[27]
or 36 times a year. So 100 couples would make love around 3600 times a year and
two to 15 would experience an accidental pregnancy, a risk of somewhere between
1 in 1800 to 1 in 240. One in 240 is
about the risk of being incarcerated.[28] One in
1800 is about the chance that a high school football player will grow up to
play in the Superbowl.[29] Condoms
are not perfect, but they substantially reduce risk of pregnancy and STIs. To
reduce pregnancy risk further, teens can add another contraceptive method, for
example, the Pill.
* Lubrication. Comfortable sex is
well-lubricated sex. In addition, condoms are much less likely to fail when the
vagina is well lubricated. Many women do not produce much natural vaginal
lubrication, especially teenagers who are anxious about having sex. Commercial
lubricants are inexpensive, and in just a few seconds, they can mean the
difference between discomfort and comfort. When our son became sexually active,
we gave him some lubricant. We also allowed him and his girlfriend to make
love in his room, a safe place. (They also made love in the girl’s bedroom,
with her parents’ knowledge and permission.) The relationship lasted a year.
Several times, she thanked us for the lube.
* Pleasure. Erotic pleasure is one of
life’s greatest gifts. Every parent who has ever enjoyed deeply fulfilling
lovemaking knows that the most pleasurable sex involves mutual trust and deep
relaxation. Who can trust a lover who is coercive? Who can trust a lover who
doesn't care about contraception? Who can relax with a lover who isn't willing
to take the minimal precautions necessary to prevent STIs? Consent and safe sex
are much more than just public health initiatives. Along with adequate
lubrication and leisurely, playful, whole-body sensuality, they are the very
basis of fulfilling sex. This country sells everything with sex. Why not use
sex to sell sexual responsibility? It’s one the few places where a "sex
sell" is truly appropriate.
Liberals and Conservatives both tell
teens the same thing: Sex is dangerous. Don't do it. But the research clearly
shows that neither the Liberal nor Conservative approaches have any impact on
teen sex, pregnancy, or STI rates.
My wife and I have tried to present a
different message to our kids: When you feel ready to become sexually active,
embrace responsible sex because it enhances pleasure.
If our message were widely promoted, I
believe we would see even greater decreases in teen pregnancy and STIs. In
addition, we would help our children grow up to be something they all truly
want to be—good lovers.
San Francisco-based writer Michael
Castleman is the author of 13 consumer health books, among them, Great Sex.
[1] Collins, RL et al. “Watching Sex on Television Predicts Adolescent Initiation of Sexual Behavior,” Pediatrics (2004) 114:280.
[2] CDC. “Teen Pregnancy” Fact Sheet. 10-2000.
[4] CDC. “Youth Risk Behavior Survey, 1991-2003.”
[5] CDC. “Youth Risk Behavior Survey, 1991-2003.”
[6] Martin, JA et al. “Annual Summary of Vital Statistics, 2003,” Pediatrics (2005) 11:619.
[7] CDC. “STD Surveillance, 2004.”
[8] Darroch, JE et al. “Changing Emphases in Sexuality Education in US Public Secondary Schools, 1988-1999,” Family Planning Perspectives (2000) 32:204. Landry, D et al. “Sexuality Education in Fifth and Sixth Grades in US Public Schools, 1999,” Family Planning Perspectives (2000) 32:212.
[9] Brody, J. “Abstinence-Only: Does It Work?” New York Times, 6-1-2004.
[10] CDC/National Center for Health Statistics. “Teen Births in the US: 1991-1996.”
[11] Liberman, LD et al. “Long-Term Outcomes of an Abstinence-Based, Small-Group Pregnancy Prevention Program in New York City Schools,” Family Planning Perspectives (2000) 32:237.
[12] DiCenso, A et al. “Interventions to Reduce Unintended Pregnancies Among Adolescents: Systematic Review of Randomized Controlled Trials,” BMJ (2002) 324(7351):1426.
[13] Schemo, DJ “Virginity Pledges by Teenagers Can Be Highly Effective, Federal Study Finds,” New York Times, 1-4-2001.
[14] Alttman, LK. “Studies Rebut Earlier Report on Pledges of Virginity,” New York Times, 6-15-2005.
[15] Altman, LK. “Study Finds That Teenage Virginity Pledges Are Rarely Kept,” New York Times, 3-10-2004.
[16] DiCenso, A et al. “Interventions ot Reduce Unintended Pregnancies Among Adolescents: Systematic Review of Randomized Controlled Trials,” BMJ [formerly British Medical Journal] (2002) 324(7351):1426.
[17] DiCenso, A et al. “Interventions ot Reduce Unintended Pregnancies Among Adolescents: Systematic Review of Randomized Controlled Trials,” BMJ [formerly British Medical Journal] (2002) 324(7351):1426.
[18] Dominus. S. “Abstinence Minded,” New York Times Magazine, 1-21-2001, p. 9.
[19] Hutchinson, MK et al. “The Role of Mother-Daughter Sexual Risk Communication in Reducing Sexual Risk Behaviors Among Urband Adolescent Females,” Journal of Adolescent Health (2003) 33:98.
[20] McNeely, C et al. “Mothers’ Influence on the Timing of First Sex Among 14- and 15-Year-Olds,” Journal of Adolescent Health (2002) 31:256.
[21] Romo, LF et al. “A Longitudinal Study of Maternal Messages About Dating and Sexuality and their Influence on Latino Adolescents,” Journal of Adolescent Health (2002) 31:59.
[22] Dittus, PJ and J Jaccard. “Adolescents’ P{erceptions of Maternal Disapproval of Sex: Relationship to Sexual Outcomes,” Journal of Adolescent Health (2000) 26:268.
[23] Miller, KS et al. “Patterns of Condom Use Among Adolescents: The Impact of Mother-Adolescent Communication,” American Journal of Public Health (1998) 88:1542.
[24] Schemo, DJ. “Survey Finds Parents Favor More Detailed Sex Education,” New York Times 10-4-2000.
[25] Lefkowitz, ES et al. “Helping Mothers Discuss Sexuality and AIDS with Adolescents,” Child Development (2000) 71:1383.
[26] Hatcher, RA et al. Contraceptive Technology.Ardent Media, NY. 2004. P. 334.
[27] Michael, RT et al. Sex in America. Little Brown, Boston, 1994. P. 116
[28] Krantz. L. What the Odds Are. HarperPerennial, NY, 1992. P. 292.