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    Our children need a real SEX education

    In a recent survey, almost HALF OF LOCAL HIGH SCHOOL students said they had engaged in SEXUAL INTERCOURSE. One in 10 of those had their first experience by age 11. While advocates may debate whether to teach these children ABSTINENCE or CONTRACEPTION, one point is clear:

    By DEBORAH HARDIN WAGNER
    © St. Petersburg Times
    published June 2, 2002


    The bell rings, and the rumble in the hall intensifies. Within seconds, the students in Ms. Hamilton's class come bounding in, full of energy, full of themselves. Many are in mid-sentence, as if carrying on a conversation that has flowed endlessly for months, save for pesky interruptions for class time.

    The kids are extra revved up, and not just because it's the sixth period of the day. Holiday vacation is right around the corner, and the break is beckoning their minds and allegiance elsewhere.

    As they jockey for seats and clear their desks, they finally notice the visitor, smiling down from the front of the room.

    "Hello, students," she says. "I'm Debra Armstrong, your prevention specialist. My job is to prevent anything from coming between you and graduation -- and that includes sexual involvement."

    The once-busy room grows still. The word sexual has gotten their attention, all except for the round-faced boy in the back, who hasn't lifted his head from his desk since he came in.

    * * *

    They don't know it yet, but these sixth-graders at Hillsborough County's Monroe Middle School are about to participate in one of the most controversial social experiments of our day: abstinence education. That word alone is enough to send parents, educators and politicians to their respective corners -- and have them come out swinging. The liberals among them are quick to decry abstinence education as naive, without acknowledging that it is a critical counterweight to the "Just Do It" cultural message bombarding today's youth. The conservatives usually cling to it as the Holy Grail, without conceding its irrelevance to a huge segment of the teen population: those who have already become sexually active.

    Few, from either camp, know much about the specific programs they extol or condemn.

    Critics often talk about abstinence education as if it were a pre-packaged monolith, but abstinence programs -- like the students in Jo Anne Hamilton's class -- come in many varieties. In Hillsborough, the program is a creative hybrid that combines four one-hour abstinence-only classroom lessons with individual or group counseling for students who are sexually active or at high risk of becoming so. Parents are notified and can opt their children out. Few do, for good reason.

    Funded by the county Workforce (formerly WAGES) Board -- and brought to Hillsborough through community teamwork -- the program is offered to sixth-graders in only 11 of Hillsborough's 37 middle schools, those located in neighborhoods with the highest crime, poverty and teen-pregnancy rates. The program is taught by five specially trained prevention specialists, who have offices on campus and use the "Postponing Sexual Involvement" curriculum first piloted in Atlanta in the mid-1980s.

    PSI carries none of the harsh moral overtones or shame-based messages characterizing the more extreme "abstinence-until-marriage" programs now the darlings of the federal government. Indeed, the word "marriage" appears nowhere in the PSI curriculum. While advocates in the abstinence debate argue over whether to stress personal health or personal morality, Armstrong and the other prevention specialists emphasize another reason altogether: social irresponsibility. Hillsborough's program teaches that while sexual thoughts and feelings are natural, teens need to learn how to postpone expressing them through sexual involvement until they can handle the responsibilities that come with birth and parenting.

    "We absolutely come through on the social ramifications of teen sex," explains Sheila Bateau, a prevention specialist now teaching at Sligh and Franklin Middle schools. "We tell them they're not ready to have sex -- not at the level where they can take care of a baby if one comes."

    In the classroom, contraceptives are mentioned only to emphasize that they are not 100 percent effective and in response to students' questions (and then, only briefly). But the follow-up counseling is a different story. There, with the parents' consent, specialists can and often do discuss contraceptives in more detail. While they delve into the mechanics of condom usage only when asked, they offer students key information about the different types of contraceptives, the risks associated with each and the need to read and follow product instructions carefully.

    It is precisely this opportunity for one-on-one counseling, and the diverse cadre of dedicated professionals who provide it, that sets Hillsborough's program apart and gives it needed depth.

    "The most spectacular thing about the program is it provided something we knew was lacking," says Mary Ellen Gillette, the school district's director of student services. "With other prevention programs, the teachers go in, present the curriculum, and they're gone. This model is based on the reality that teens need someone to talk to on an ongoing basis."

    Hillsborough's program is not nearly enough. In an ideal world, the program would be offered in all of the county's middle schools, not just a selected few. It would span four months, not merely four weeks. It would be reinforced again in the district's high schools, where nearly one of every two students, statistics say, have had sex. And, yes, it would be supplemented by what both the research and students themselves say kids need: more information about where to get free condoms and how to use them properly.

    But this is not the ideal world. This is Hillsborough County, where money is tight, sensitive issues are unnecessarily politicized, and high school seniors get barred from speaking at graduation just for distributing condoms in their senior prom gift bags.

    Still, Hillsborough's program is a vast improvement over the pregnant void it stepped in to fill. And despite the furor swirling around programs of its general ilk, it is quietly offering these kids something of real value: a frank, if limited, talk about the pressures and consequences of having sex too young.

    For many, it may be the only thing standing between them and a teen pregnancy.

    * * *

    "Who can give me a reason why teens should wait before having sex?" Armstrong asks, after laying down some ground rules and piquing the students' interest with snippets of what lies ahead.

    Three hands shoot up, and she calls on them in turn.

    "They might have a baby," the first student answers.

    "They might have to drop out of school," replies the next.

    "They could get in trouble with their parents," says the third, to a round of hearty nods from her classmates.

    By this time a fourth hand has drifted up. The boy with his head on his desk is now sitting up, ready to participate. Pleased, Armstrong calls on him to answer.

    "They could get traumatized. . . ." he starts slowly, as his classmates turn to look. A faint hint of concern washes over Armstrong's face, as if she fears that the question has touched a raw nerve. She gently signals for the boy to continue. ". . . By seeing big 'ole body parts they've never had to see before," he blurts out, punctuating his words for greater comedic effect.

    Laughter ripples across the class. Even Armstrong seems amused, if not more than a tad relieved.

    It would not be the last moment of levity in a subject lesson whose consequences are anything but humorous.

    The Trends: No Room for Complacency

    This is a time of unparalleled hope on the teen-pregnancy front. The birth rate among teens -- in Florida, as elsewhere -- is at an historic low. Why? Fewer teens are engaging in sex, experts say, and more who do use contraception, at least at their first sexual excounter.

    But it is far too early to declare victory. While overall teen birth rates have fallen since 1996 in two of every three Florida counties, success has proved uneven -- and precarious -- across the various age, race and ethnic groups. Hillsborough and Pinellas are prime examples. In both counties, teen birth rates were generally down again last year, according to still-preliminary data from the state Department of Health. Yet, births were up, on both sides of Tampa Bay, among 13-year-old African-American girls and older white teens. Bucking the norm altogether, births among Hispanic teens have climbed since 1990, according to DOH.

    Of all the trends, this one is as consistent across the race and ethnic groups as it is troublesome: kids are having sex at an increasingly early age. Indeed, while sexual activity has declined for all other ages, it has risen 15 percent since 1997 for teens under the age of 13, according to data from the 1999 National Youth Risk Behavior Survey. The consequences are on full and alarming display in Hillsborough, which has the highest birth rate for 10- to 14-year-olds of Florida's large metropolitan areas.

    Dianne Reeger is concerned by what she sees -- and she's seen plenty, including the case of a Hillsborough pre-teen who, by age 12, already had two kids.

    "I have lots of babies in here having babies," says Reeger, a social worker at Genesis, Tampa General Hospital's community program for women and children. "There's no one reason. Part of it is that children are maturing faster physically, while sex is becoming so commonplace."

    What's more, experts say, those adolescent girls are more likely than ever to be having sex with males substantially older than they.

    "The saying is, the younger the girl, the older the guy," explains a frustrated Suzanne Sullivan, a registered nurse who helps run Teen West, the district's program for teen mothers. "The gap is growing wider."

    Chris Holt Brown, one of the program's prevention specialists who teaches at Madison Middle School, knows that family circumstances often play a role. Teen girls may have early sex as a way, conscious or otherwise, to copy behavior in the home -- or to escape from it.

    "You just can't even begin to imagine the home life some of these girls have," Brown says. "One of my middle-schoolers, who has no father and five siblings in the home, often has to share a bed with her older brother and his girlfriend, while her mom sleeps outside in the family van with her boyfriend.

    "It's a whole different world for many of these girls," she concludes. "To them, having sex is the easy part."

    Sixth Grade: Growing at different speeds

    Like other sixth-graders, Ms. Hamilton's kids come in all different shapes and sizes -- and, no doubt, levels of sexual experience. For every girl showing signs of a maturing body, there are two with petite forms and auras of innocence, who look like they still belong in the third grade. Some of the girls have legs, when seated, that barely reach the floor.

    Others have legs that won't quit.

    Like their peers elsewhere, Ms. Hamilton's kids came to sixth grade with vastly differing ideas about their own bodies and sex itself. Some of the girls don't understand their own menstruation or even the fact that they have ovaries, say the prevention specialists. Some of the boys believe that drinking Mountain Dew or other yellow drinks will decrease their sperm count.

    "One of my girls actually thought she could get pregnant just by sleeping next to someone," says Brown.

    "Many of these girls appear grown on the outside," explains prevention specialist Bateau, "but on the inside, they're still little girls."

    One thing's for sure, though: these are not the sixth-graders of old, the ones today's politicians remember from their own childhoods. Most of these kids have been drenched in sexual imagery, in the media if not their own homes, and that worldliness shows itself in their talk and their strut. The reality is that most sixth-graders are not yet having sex. But the trends suggest that a few already are.

    Judging by the kids in Ms. Hamilton's class, it is not always possible to know which students are which.

    * * *

    "So why do some teens have sex?" Armstrong asks the students.

    It's the second class, and the kids already have covered impressive ground. They've seen, and snickered at, a video about puberty. They've broken into small work groups and made lists of TV shows and songs that try to sell sex. (The assignment was a piece of cake, judging from the quips heard wafting from the groups: "He came up and did her right there." "Looked like a sausage." "Oysters? Yuk!")

    And they've heard, more than once, the closest thing the program has to a mantra: It's okay to think about sex, talk about sex, and develop feelings about sex, but it's not okay to have sex!"

    While Armstrong's question lingers in the air, a student comes sauntering in, with obvious attitude. She takes her seat and immediately slumps down, showing little interest in what's happening around her. She's wearing an oversized purple football jersey and, in a class that spans the spectrum of size, is more physically developed than most.

    Her classmates take note of her arrival, then turn back to the pending question.

    "For gratitude," the round-faced boy answers, his inviting green eyes lighting his face. "So they can get pleased."

    "You mean gratification, yes," Armstrong responds smoothly, gently correcting the boy's choice of word in the process. "What else?"

    "Because they think it's relaxing," a girl replies, rolling her eyes at the playful "ooo's" and "ahhh's" coming from her classmates.

    "To be cool, fit in."

    "To get away from their parents."

    "To prove something."

    By now, the girl in the jersey has perked up, and her face, with its pretty, chiseled features, is quizzical. She raises her hand.

    "I heard that when you have sex you can smell it in the air afterwards," she says, with a look both curious and coy. "Is that true?"

    Armstrong is unfazed.

    "You are more than welcome to come talk with me about that -- or anything else -- after class," she tells the girl, with an inviting tone that says she means it.

    "Anytime."

    Abstinence 'Plus': The Chance for Counseling

    It is precisely this opportunity for counseling that is the Hillsborough program's most promising feature. Prevention specialists get to know the students as middle school wears on -- and come to be seen by them as well-intended, if not trusted, adults. With that rapport, the specialists can discuss sex and contraceptives with at-risk students more fully than in the classroom, while still tailoring the information they provide to the specific needs and sexual maturity of each teen who comes for help. And the teens do come, by referral from teachers or on their own. The program this year counseled over 600 students who were sexually active or on the verge of becoming so. The specialists not only discuss sex and contraception, as appropriate, but also urge at-risk teens to become more involved in school and community activities -- a key factor in reducing sexual activity.

    Fifteen-year-old Angela (not her real name) referred herself when she was a middle-schooler at Monroe. Now a successful student at Tampa Bay Technical High School, with aspirations to start up her own teen-counseling program over the Internet, she knows how critical that one-on-one help can be.

    "Some teens are very hard-headed," Angela explained. "They think, "Until it happens to me, let me do it my way.' If adults want to make a difference, they have to be very understanding and have their heart and soul into it -- like Ms. Armstrong did when she counseled me. I would be out having sex now if she had not shown me that she was into what I was saying. Not a lot of people do that."

    The prevention specialists routinely encourage the kids they counsel to talk to their parents. But they know that such discussions are not always possible or constructive.

    "They will tell me things they won't tell their parents," says Brown. "It's just natural at this age. Mom's gonna be more emotional, while I can level with them. If they tell me a condom doesn't feel natural, I remind them that a nine-month pregnancy won't feel real natural, either!"

    Shantavia Watson, a sixth-grader at Franklin Middle School, agrees.

    "Half the time, kids don't want to talk with their parents because they know they'll get mad and go off on 'em. Having the counselor there is really important," says the 12-year-old.

    More than mere anecdote suggests that the counseling is making a difference. Last year, University of South Florida researchers compared 87 students who had received the classroom lessons and counseling with 73 similar students who had not. While the program did not appear to reduce sexual activity, it did increase the likelihood that sexually active girls would use birth control.

    That result is more encouraging than the national data on similar programs without a counseling component. Though abstinence-only lessons have been shown capable of influencing student attitudes in the short-term, no reliable study has, as of yet, demonstrated that they can change sexual behavior over the longer haul.

    The program's success does not surprise Bateau.

    "I can see first-hand how we're impacting the students," she says. "We're seeing pregnancy rates drop in our middle schools. The nurses are begging us to come into the high schools, where more of the pregnancies are. That's where we need to reinforce this curriculum."

    Abstinence minus: Not enough students covered

    For every hundred students the program reaches, thousands more -- middle-schoolers as well as high-schoolers -- have the benefit neither of its classroom lessons on abstinence nor of the extra contraceptives information its counseling can provide. The program's leaders are not to blame. They had the foresight to grab what limited money was available and spend it on those schools that arguably needed the program the most. But that begs the question:

    Shouldn't some school-based prevention effort target the rest of Hillsborough's teens?

    School nurses cannot be expected to pick up the slack. They are already overwhelmed with the many physical and mental-health needs of today's students. Nor can guidance counselors, whose load has only grown with Florida's increased emphasis on state testing, school safety and discipline. Without a broader strategic outreach, too many sexually active teens are going unprotected -- by contraceptives and by Hillsborough's educational establishment.

    While those sexually active teens are using contraceptives more often on their first sexual encounter, fewer are doing so on subsequent episodes, experts warn. On a recent community-planning survey, only seven percent of sexually active Pinellas high-schoolers reported that they use condoms every time. The rate is bound to be similar, if not worse, for Hillsborough. Some experts speculate that the abstinence-only message -- by stressing condoms' failure rates, not success rates -- may inadvertently dissuade teens from using them at all.

    Shawna, an eighth-grader at Monroe, knows all about starting sex -- then stopping contraceptives. With an estranged mother, a father in prison, and two sisters pregnant by 16, Shawna (not her real name) was having sex by age 12, with a physically abusive high-school dropout four years her senior.

    "He was older, always one step ahead of me," she says. "He came on me real strong and talked me into it, though I know it was my fault, too."

    Shawna and her boyfriend used condoms at first, but stopped soon thereafter.

    "I wanted to try sex without it, to see if it felt any different. At the time, I didn't think about all the risks I was taking. I was just plain stupid. Now I know better."

    Shawna says she's no longer taking those risks, thanks in large measure to the one-on-one talks she had with Armstrong. She wants to be a forensic scientist and recently won a college scholarship through a program for at-risk students. But she worries about her friends that are still having unprotected sex.

    Those friends are at even greater risk now that Hillsborough's HIV-education program is no longer in force. Offered to students in the 8th, 11th and 12th grades, the abstinence-based program was taught by gifted AIDS resource teachers, who gave students sobering lessons about sexually transmitted diseases, including HIV. At least at the high-school level, the lessons included candid instructions about how to use condoms properly. But the program, a casualty of the recent budget wars, was suspended late last year. Its loss has only served to accentuate the gap in prevention education for the district's sexually active teens.

    Abstinence-only advocates often argue that talking to young teens about condoms contradicts the abstinence message and encourages sexual experimentation. It incites and entices, they say. Seeing the wide range of sexual maturity in Ms. Hamilton's class, one can better understand the advocates' reticence.

    But the research on comprehensive sexuality programs, unlike that on abstinence-only programs, is extensive and on this point is nearly conclusive: age-appropriate contraceptive education does not hasten the onset of sex, increase its frequency or increase the number of sexual partners. Such a conclusion might indeed seem counter-intuitive. But it has been confirmed, as recently as last summer, by Douglas Kirby, a renowned research scientist with ETR Associates, who reviewed more than 250 programs.

    How much detail on condoms would be "age-appropriate" for sixth-graders? Reasonable people can differ. Guidelines from the Sexuality Information and Education Council of the United States (SIECUS) suggest that middle-school students be given, along with the abstinence message, brief instructions on the different methods of contraception, where contraceptives can be bought and how they are to be used. On this, however, there is less room to differ: contraceptives education is most effective when it comes prior to first intercourse.

    Under that criteria, school leaders have little time to waste. Surveys of sexually active high-schoolers show that nearly 30 percent had their first intercourse when they were 13 years old or younger. Before its recent suspension, Hillsborough's HIV/AIDS program routinely asked middle-school students to list the topics they wanted to know more about. Their No. 1 answer? "How to use condoms properly."

    Across the bay, Pinellas' students have less reason to ask. In 1995, the Pinellas School Board approved a one-day "barrier protection" class for eighth-graders, as a small part of the district's human-sexuality curricula. Once trained, teachers explain how to use, unwrap and discard condoms properly and the dangers of not doing so.

    "Eighty percent of my schools have almost 100 percent participation," explained Peggy Johns, Pinellas' supervisor for health education. "The parents understand its importance."

    Opponents of condom-education make a good point. Even adults often fail to use condoms as they should. Can we really teach young teens, with their immaturity of judgment and control, to remember to use protection properly every time? Some kids in Ms. Hamilton's class, no doubt like other typical sixth-graders, looked like they could barely remember to tie their shoes.

    But the alternative to condom education -- leaving sexually active teens with no guidance about the dangers and consequences of unprotected sex -- is no option at all.

    "It is more important that we focus on teaching sexually active teens to use contraception consistently than ignore the pink elephant in the room," says Reeger. "We can't not educate them and then keep our fingers crossed that they will figure it out."

    William Melvin, a sixth-grader at Franklin, has a more personal reason for wanting more information, about both abstinence and contraception.

    "I would like to see and learn way more. The more you learn about sex, the longer you can hold it back."

    * * *

    The second session is drawing to a close, and Armstrong has asked the class to offer reasons why teens might become sexually involved. Most of the students are hanging onto her every word. A few, including the girl in the purple jersey, seem easily distracted.

    "To hold onto a boyfriend or girlfriend," one student answers, and most of the class agrees.

    That doesn't sit well with another student, a vibrant girl showing little signs of the self-consciousness so common at this age.

    "That's definitely not true," she interjects, trying to set her misguided classmates straight. "They'll just kiss and tell and use your body," she says, with a tone of authority.

    The round-faced boy chimes in, seconding the notion.

    "My friend says he likes blondes, that they're "easy,' but I think he's dumb," he tells the class.

    Armstrong acknowledges the comments as she does them all -- without a slither of disrespect -- and closes the session with a hypothetical of Janice, a girl who lets boys come over after school while her parents are away.

    "What's the worst that might happen to Janice in that situation?" she asks.

    There's a pregnant pause as the students try to picture themselves inside Janice's house.

    "She could get raped," the round-faced boy says, then pauses to gather his thoughts.

    "Or worse," he concludes, "she could get killed in a drive-by shooting."

    Role-playing: More than 'Just Say No'

    If counseling is the program's most meaningful feature, its emphasis on role-playing is the first runner-up. By the time the students get to this final juncture, they have heard and discussed a slew of reasons why they should reject sex. But the prevention specialists do more than tell the kids to just say no. They give them rehearsals on making the word stick. Experts, including researchers for the United Nations, say that such role-playing is an essential element in any successful pregnancy-prevention model.

    Two years later, it's the classroom session that Shawna remembers best.

    "Older guys, they think they can get over on us because we're young," the eighth-grader explains. "But the role-playing gave us strategies on how to say no -- to look the person in the eye and mean it."

    * * *

    It's the last session. The kids are wired -- and not just because Christmas break is a week away. This is the session they've been waiting for: the one where they get to take center stage. The girl in the purple jersey runs in late. She slides low in her chair, resting her bended knee against the desk in front of her.

    Armstrong is busy whetting the students' appetites.

    "You guys are gonna get an assertiveness course -- for free! -- one that other people pay lots of money for," she tells them, having to backtrack to explain what the word means. "Before we start, though, how many of you went home last time, like I asked, and talked with your parents about appropriate sexual limits?"

    Only a few hands go up, and all of those slowly.

    "You need to talk to your parents. Try," she urges, for the umpteenth time. "But if you're too embarrassed, there are always others you can talk to, like your doctor, a relative, a counselor -- me."

    She emphasizes her availability with her gaze, then moves on.

    "Okay, now for the fun part. How many of you want to be actors or actresses when you grow up?"

    For once, the room has no shortage of raised arms.

    Armstrong first turns on a video, showing several vignettes of kids resisting peer pressure. Then she reinforces the main steps: say no; tell how the pressuring makes you feel; and refuse to discuss it anymore or simply walk away.

    The foundation laid, she asks for volunteers. Off the bat, she picks the round-faced boy and the girl in the purple jersey, who has spent much of the video talking with her neighbor.

    This time, there is no head on the desk, or sulky indifference. This time, there is no resistance. They both seem eager to be class guinea pigs.

    As their peers scream in a youthful mixture of disgust and delight, Armstrong sets up the scenario the two are to act out: the boy is putting pressure on the girl to kiss a friend of his, and the girl is to say no.

    Lights, camera, action.

    When her time comes, the girl in the jersey delivers her retort on cue but too meekly, betraying uncertainty in her voice. Armstrong encourages her to be more forceful, and the girl turns back to deliver her line. She breathes in as if summoning some inner strength, then belts out a determined "no." The boy reacts according to script: as one duly spurned.

    The classmates are impressed, and Armstrong is happy. She showers both students with compliments.

    The boy sits down, visibly pleased with himself and eager for another chance to perform.

    The girl takes her seat, too -- then lets out a laugh, one that sounds equal parts relief and derision.

    * * *

    It has been several months since Ms. Hamilton's kids participated in the program. No one from the class -- as of yet -- has come for counseling. But Armstrong will be there, ready to listen and talk, if and when they do.

    "The hardest part about this job is: How do I really know I've made a difference?" Armstrong, a working mother, said recently, in an unusually introspective moment. "If my students have refrained from sex, maybe they would have done that anyway. But what I do know is that they walk away from this experience with more respect -- because I give them a lot -- and the knowledge that someone has taken the time to try to give them all the information they need to know.

    "After that, it's up to them."

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