Abstinence-only sex education

Laura Bush with an AIDS orphan at a center in Zambia that promotes abstinence and faith for youth.

Abstinence-only sex education is a form of sex education that teaches not having sex outside of marriage. It often excludes other types of sexual and reproductive health education, such as birth control and safe sex. Comprehensive sex education, by contrast, covers the use of birth control and sexual abstinence.

Evidence does not support the effectiveness of abstinence-only sex education.[1][2] It has been found to be ineffective in decreasing HIV risk in the developed world.[3] It does not decrease rates of sexual activity or unplanned pregnancy when compared to comprehensive sex education.[1]

The topic of abstinence-only education is controversial in the United States, with proponents claiming that comprehensive sex education encourages premarital sexual activity, and critics arguing that abstinence-only education is religiously motivated and that the approach has been proven ineffective and even detrimental to its own aims.

Description

Abstinence education teaches children and adolescents to abstain from sexual activity, and that this is the only certain method of avoiding pregnancy and sexually transmitted infections (STIs). With a heavy focus on the importance of "family values," programs also teach that abstinence until marriage is a standard by which to live.[4][5]

Effectiveness

Systematic reviews of research evaluating abstinence-only sex education have concluded that it is ineffective at preventing unwanted pregnancy or the spread of STIs, among other shortfalls.[1][6]

STI transmission

A 2015 meta-analysis found that abstinence-focused programs had no effect on the likelihood of contracting STDs.[7]

A Cochrane systematic review suggests that abstinence-only education neither increases nor decreases HIV risk in high-income countries.[3] In the developing world there is a lack of evidence of effect.[8] In 2008, Douglas Kirby reviewed the evidence for the effectiveness of abstinence-only education programs and found little evidence to justify the use of such programs.[9] A 2011 meta-analysis found that it was ineffective at reducing the risk of HIV infection among adolescents.[10] Abstinence education has also been found to include misleading medical information and exclude potentially life-saving information about sexual risk reduction.[11] A 2016 study found "that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states."[12]

Pregnancy

Research conducted on 48 states of United States showed that "The level of abstinence education (no provision, covered, promoted, stressed) was positively correlated with both teen pregnancy and teen birth rates.[13] Also, in John S. Santelli's research, the decline of teenage pregnancy rates during 1995–2002 were largely due to improved contraception, and the reduction in pregnancy risk among teenagers at age of 18 or 19 is entirely ascribed to more contraception.[14]

According to SIECUS, the Sexuality Information and Education Council of the United States, "[s]cientific evidence simply does not support an abstinence-only-until-marriage approach."[15] A 2010 report by the Guttmacher Institute pointed out that pregnancy rates for teens 15–19 reversed their decline in 2006, near the peak of the Abstinence Only campaign in the United States.[16]

While sex education has been linked to a delay in the first time having sex,[17][18] abstinence-only programs specifically haven't shown this link, and do not seem to have an impact on if or when young people begin having sex.[19]

Society and culture

Support

Proponents of abstinence-only sex education argue that this approach is superior to comprehensive sex education because it emphasizes the teaching of morality that limits sex to that within the bounds of marriage, and that sex before marriage and at a young age has heavy physical and emotional costs.[20] In addition, abstinence programs often teach young people that pleasure in sex is most likely to be found within marriage, and therefore, that they should wait to engage in sexual activity until they are married.[21] Abstinence generally places a great emphasis on the importance of the institution of marriage, which some proponents believe allows young people to grow and develop as individuals.[22]

Proponents suggest that comprehensive sex education encourages premarital sexual activity among teenagers, which should be discouraged in an era when HIV and other incurable STIs are widespread and when teen pregnancy is an ongoing concern. Many supporters of abstinence-only education do so out of the belief that comprehensive guides to sex or information about contraceptives will ultimately result in teens actively pursuing and engaging in sexual activities,[23] while others oppose the endorsement of contraception for religious reasons.[24] Teenagers are framed as less intelligent and less responsible than adults. They are seen as unable to control themselves due to 'raging hormones'. As a result, a teenager's sexual desire is something that needs to be controlled.[25] Thus, dividing the teens into two separate categories in the minds of adults: "the innocent and the guilty, the vulnerable and the predatory, the pure and the corrupting."[26]

Opposition

Opponents and critics, which include prominent professional associations in the fields of medicine, public health, adolescent health, and psychology, argue that such programs fail to provide adequate information to protect the health of adolescents. Not only is information inadequate, but opponents believe that young people have the right to receive comprehensive information about how to protect themselves and their sexual health.[27] Accurate information is especially important since, although some supporters may claim that abstinence is an effective method, it has been found that a small percentage of people actually practice it.[27]

Some critics also argue that such programs verge on religious interference in secular education. Opponents of abstinence-only education dispute the claim that comprehensive sex education encourages teens to have premarital sex.[28] The idea that sexual intercourse should only occur within marriage also has serious implications for people for whom marriage is not valued or desired, or is unavailable as an option, particularly LGBT people living in places where same-sex marriage is not legal or socially acceptable.[29][30][31][32][33] Abstinence-only education is often criticized for being overly heteronormative, idealizing the institution of heterosexual marriage to the denigration of queer relationships.[34] In addition, the heteronormativity of abstinence-only education, as well as the focus on marriage, means that members of the LGBT community will never receive formal information about how to practice safe sex, which is problematic, since they are already at an increased risk for STIs.[35]

According to Advocates for Youth, abstinence-only sex education distorts information about contraceptives, including only revealing failure rates associated with their use, and ignoring discussion of their benefits.[36] The language surrounding medicine and health is construed as being both objective and value free.[34] This objectivity is then adopted by conservative politicians and campaigners to assert authority which historically holds its basis in religion.

Definition

Another problem for abstinence education is the definition of abstinence. Santelli (2006) states that there is no strict definition of abstinence within the US federal government guidelines for teaching abstinence-only sex education, using a mixture of non-specific phrases, like "postponing sex" or "never had vaginal sex," while also using moralistic terms or phrases like virgin, chaste, and "making a commitment".[37] This has resulted in sexual activities that are not penile-vaginal, including mutual masturbation, oral sex and anal sex, being considered outside of the scope of abstention from sex, which is termed technical virginity.[38]

Global impact

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S government's initiative to combat HIV/AIDS globally.[39] PEPFAR works with the governments of 22 countries worldwide to create sustainable programs to prevent HIV and improve the lives of those suffering.[40] PEPFAR provides funding to other countries to help combat HIV/AIDS. It does so with certain guidelines and restrictions on the recipients. PEPFAR promotes an "ABC" approach – Abstain, Be faithful, and use Condoms. Funding recipients may give information about condoms to youth over 15 years old, but cannot use the funding to provide condoms or promote usage. In countries receiving funds from PEPFAR, teens under the age of 15 are not allowed to receive information about condoms.[41] The rationale behind this is to not encourage sexual activity despite evidence that condom use does not cause promiscuity.[42] PEPFAR was founded in 2003 with the mandate that 33% of its funds provided for prevention be used for abstinence-only education. Since the reauthorization in 2008, this mandate was removed, with a shift toward directives to spend at least 50% on abstinence-only education.[43] The role of parters has been an area of debate surrounding PEPFAR. In 2006, 23% of all the community partners were faith-based and debate exists over whether the U.S. should be allowing grants specifically written for faith-based organizations and prevention.[44] A few countries that have received PEPFAR funding – specifically Mozambique and Rwanda – have expressed distaste for the U.S.' push for faith-based education and abstinence-only funding.[44] Human rights groups have expressed concern that condom availability has decreased since PEPFAR's involvement in the global AIDS crisis.[45]

The $1.3 billion that the U.S. government spent on programs to promote abstinence in sub-Saharan Africa had no meaningful impact.[46][47][48]

Funding

In the U.S., states may apply for federal funding of abstinence-only sex education programs from either Title V, the Adolescent Family Life Act (AFLA), and/or Community-Based Abstinence Education (CBAE).[23] To be eligible for funding, programs must satisfy requirements given under the Social Security Act, which is reproduced here verbatim:[49]

(2) For purposes of this section, the term "abstinence education" means an educational or motivational program which—

(A) has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
(B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
(C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
(D) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;
(E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
(F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society;
(G) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and
(H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.

Funding, which began in the 1980s, has continued to increase since its inception, though support for the programs and legislation surrounding them has become dependent upon the current administration.[50] For example, George W. Bush administration was supportive of abstinence-only programs, while the Obama administration has worked to decrease funding in order to provide more federal dollars for comprehensive sex education.[50]

Politics

The Christian Right, who initially stood against having school-based sex education programs, began supporting abstinence-only programs due to the focus on marriage.[51] As a driving force behind the abstinence movement, they have focused on getting more funding for these programs and have also been successful in creating more awareness surrounding abstinence through their use of activism.[52] To the New Right, the abstinence-only sex education movement was an opportunity and an avenue to change the current view and status of sexuality in America, aligning it more with their own values, and as a result, creating individuals who remained abstinent until marriage, and thus, citizens who embodied values of self-discipline and morality.[53] In addition, abstinence-only programs utilize ideas of individualism and personal responsibility when educating young people about sex, seeking to create individuals who take responsibility for sexuality and morality.[54] These ideas underlie the basis of conservative ideology, a focus on the individual having a strong place in the beliefs of this group.[55] Thus, it makes sense that support for abstinence-only programs as an effective form of sex education has been linked to conservative individuals.[56]

Religion

Religious doctrines take varying stances on contraception and pre-marital sex, some of which are covered by:

See also

References

  1. 1 2 3 Ott, MA; Santelli, JS (Oct 2007). "Abstinence and abstinence-only education". Current Opinion in Obstetrics and Gynecology. 19 (5): 446–52. PMID 17885460. doi:10.1097/GCO.0b013e3282efdc0b. Abstinence-only curricula have been found to contain scientifically inaccurate information, distorting data on topics such as condom efficacy, and promote gender stereotypes. An independent evaluation of the federal program, several systematic reviews, and cohort data from population-based surveys find little evidence of efficacy and evidence of possible harm.
  2. ↑ Chin, HB; Sipe, TA; Elder, R; Mercer, SL; Chattopadhyay, SK; Jacob, V; Wethington, HR; Kirby, D; Elliston, DB; Griffith, M; Chuke, SO; Briss, SC; Ericksen, I; Galbraith, JS; Herbst, JH; Johnson, RL; Kraft, JM; Noar, SM; Romero, LM; Santelli, J; Community Preventive Services Task, Force (March 2012). "The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services.". American journal of preventive medicine. 42 (3): 272–94. PMID 22341164. doi:10.1016/j.amepre.2011.11.006.
  3. 1 2 Underhill, K; Operario, D; Montgomery, P (Oct 17, 2007). Operario, Don, ed. "Abstinence-only programs for HIV infection prevention in high-income countries". Cochrane database of systematic reviews (Online) (4): CD005421. PMID 17943855. doi:10.1002/14651858.CD005421.pub2.
  4. ↑ Lamb, Sharon (2013-10-01). "Just the Facts? The Separation of Sex Education from Moral Education". Educational Theory. 63 (5): 443–460. ISSN 1741-5446. doi:10.1111/edth.12034.
  5. ↑ Lindberg, Laura Duberstein; Santelli, John S.; Singh, Susheela (2006-12-01). "Changes in Formal Sex Education: 1995–2002". Perspectives on Sexual and Reproductive Health. 38 (4): 182–189. ISSN 1931-2393. doi:10.1111/j.1931-2393.2006.tb00277.x.
  6. ↑ Kirby, D. (2007). "Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases". National Campaign to Prevent Teen Pregnancy.
  7. ↑ Petrova, D; Garcia-Retamero, R (2015). "Effective Evidence-Based Programs For Preventing Sexually-Transmitted Infections: A Meta-Analysis.". Current HIV Research. 13 (5): 432–8. PMID 26149164. doi:10.2174/1570162x13666150511143943.
  8. ↑ Fonner, VA; Armstrong, KS; Kennedy, CE; O'Reilly, KR; Sweat, MD (2014). "School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis.". PLOS ONE. 9 (3): e89692. PMC 3942389 Freely accessible. PMID 24594648. doi:10.1371/journal.pone.0089692.
  9. ↑ Kirby, Douglas B. (September 2008). "The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior". Sexuality Research and Social Policy. 5 (3): 18–27. doi:10.1525/srsp.2008.5.3.18.
  10. ↑ Johnson, Blair T.; Scott-Sheldon, Lori A. J.; Huedo-Medina, Tania B.; Carey, Michael P. (1 January 2011). "Interventions to Reduce Sexual Risk for Human Immunodeficiency Virus in Adolescents". Archives of Pediatrics & Adolescent Medicine. 165 (1): 77–84. PMID 21199984. doi:10.1001/archpediatrics.2010.251.
  11. ↑ Santelli, John S.; Speizer, Ilene S.; Edelstein, Zoe R. (January 2013). "Abstinence promotion under PEPFAR: The shifting focus of HIV prevention for youth". Global Public Health. 8 (1): 1–12. doi:10.1080/17441692.2012.759609.
  12. ↑ Carr, Jillian B.; Packham, Analisa (2017-04-01). "The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes". Health Economics. 26 (4): 403–420. ISSN 1099-1050. doi:10.1002/hec.3315.
  13. ↑ Stanger-Hall, Kathrin (October 14, 2011). "Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.". PLoS ONE. 6: e24658. PMC 3194801 Freely accessible. PMID 22022362. doi:10.1371/journal.pone.0024658.
  14. ↑ Santelli, John; Lindberg, Laura; Finer, Lawrence; Singh, Susheela (2007). "Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use". American Journal of Public Health. 97 (1): 150–156. PMC 1716232 Freely accessible. PMID 17138906. doi:10.2105/AJPH.2006.089169.
  15. ↑ SIECUS Fact Sheet (includes research citations).
  16. ↑ Table 1.0,"U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity." http://www.guttmacher.org/media/nr/2010/01/26/index.html, downloaded 20100127.
  17. ↑ Wind, Rebecca (March 8, 2012). "Sex Education Linked to Delay in First Sex". Guttmacher Institute Media Center.
  18. ↑ Lindberg, Laura; Maddow-Zimet, Isaac (October 2012). "Consequences of Sex Education on Teen and Young Adult Sexual Behaviors and Outcomes" (PDF). The Guttmacher Institute. 51 (4): 332–338. doi:10.1016/j.jadohealth.2011.12.028.
  19. ↑ Kohler, Pamela K.; Manhart, Lisa E.; Lafferty, William E. (Apr 2008). "Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy". Journal of Adolescent Health. 42 (4): 344–351. PMID 18346659. doi:10.1016/j.jadohealth.2007.08.026.
  20. ↑ PBS, February 4, 2005 Religion & Ethics Newsweekly, Episode 823 Retrieved on 2007-14-03
  21. ↑ Lamb, Sharon; Lustig, Kara; Graling, Kelly (2013-05-01). "The use and misuse of pleasure in sex education curricula". Sex Education. 13 (3): 305–318. ISSN 1468-1811. doi:10.1080/14681811.2012.738604.
  22. ↑ Luker, Kristin (2007). When Sex Goes To School: Warring Views On Sex - And Sex Education - Since The Sixties. New York, NY: W. W. Norton & Company. pp. 102–105. ISBN 978-0-393-06089-8.
  23. 1 2 Stanger-Hall, Kathrin F.; Hall, David W. (2011-10-14). "Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S". PLOS ONE. 6 (10): e24658. ISSN 1932-6203. PMC 3194801 Freely accessible. PMID 22022362. doi:10.1371/journal.pone.0024658.
  24. ↑ Shorto, Russel (May 7, 2006). "Contra-Contraception". New York Times Magazine.
  25. ↑ Fields, J (2012). "Sexuality Education in the United States: Shared Cultural Ideas across a Political Divide". Sociology Compass: 1–14
  26. ↑ Fields, p. 6
  27. 1 2 Santelli, John; Ott, Mary A.; Lyon, Maureen; Rogers, Jennifer; Summers, Daniel; Schleifer, Rebecca. "Abstinence and abstinence-only education: A review of U.S. policies and programs". Journal of Adolescent Health. 38 (1): 72–81. doi:10.1016/j.jadohealth.2005.10.006.
  28. ↑ Douglas Kirby, Ph. D.: Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. National Campaign to Prevent Teen Pregnancy, 2001. Homepage of the study. Archived May 17, 2007, at the Wayback Machine.
  29. ↑ K Van Wormer, R McKinney: What Schools Can Do to Help Gay/lesbian/bisexual Youth: A Harm Reduction Approach. http://www.questia.com/PM.qst?a=o&se=gglsc&d=5002082003
  30. ↑ Journal of Adolescent Health: Volume 38, Issue 1, Pages 83–87 (January 2006): Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine: John Santelli, M.D., M.P.H.a, Mary A. Ott, M.D.b, Maureen Lyon, Ph.D.c, Jennifer Rogers, M.P.H.d, Daniel Summers, M.D.e http://www.jahonline.org/article/PIIS1054139X05002764/fulltext - "abstinence-until-marriage programs discriminate against gay, lesbian, bisexual, transgender and questioning youth, as federal law limits the definition of marriage to heterosexual couples."
  31. ↑ United States Ignorance Only Hiv/aids, Human Rights and Federally Funded Abstinence-only Programs in the United States Texas: a Case Study; Human Rights Watch, September 2002, Vol. 14, No. 5(G)., Page 39.
  32. ↑ Nancy D. Polikoff, Beyond straight and gay marriage: valuing all families under the law; Politics, Culture and Society Series, Beacon Press, 2008 ISBN 0-8070-4432-6, ISBN 978-0-8070-4432-2
  33. ↑ Debran Rowland, The boundaries of her body: the troubling history of women's rights in America, SphinxLegal, 2004, ISBN 1-57248-368-7, ISBN 978-1-57248-368-2
  34. 1 2 Wilkerson, A (2013). "I Want to Hold Your Hand: Abstinence Curricula, Bioethics, and the Silencing of Desire". Journal of Medical Humanities. 34: 101–108. PMID 23468394. doi:10.1007/s10912-013-9213-0.
  35. ↑ Pingel, Emily Sweetnam; Thomas, Laura; Harmell, Chelsea; Bauermeister, José A. (2013-08-15). "Creating Comprehensive, Youth Centered, Culturally Appropriate Sex Education: What Do Young Gay, Bisexual, and Questioning Men Want?". Sexuality Research and Social Policy. 10 (4): 293–301. ISSN 1868-9884. PMC 3862289 Freely accessible. PMID 24348222. doi:10.1007/s13178-013-0134-5.
  36. ↑ Effective Sex Education, Brigid McKeon, 2006; http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=450&Itemid=336
  37. ↑ Santelli, John; Ott, Mary A; Lyon, Maureen; et al. (January 2006). "Abstinence and abstinence-only education: A review of U.S. policies and programs". Journal of Adolescent Health. 38 (1): 72–81. doi:10.1016/j.jadohealth.2005.10.006.
  38. ↑ Bryan Strong; Christine DeVault; Theodore F. Cohen (2010). The Marriage and Family Experience: Intimate Relationship in a Changing Society. Cengage Learning. p. 186. ISBN 0-534-62425-1. Retrieved October 8, 2011. Most people agree that we maintain virginity as long as we refrain from sexual (vaginal) intercourse. But occasionally we hear people speak of 'technical virginity' [...] Data indicate that 'a very significant proportion of teens ha[ve] had experience with oral sex, even if they haven't had sexual intercourse, and may think of themselves as virgins' [...] Other research, especially research looking into virginity loss, reports that 35% of virgins, defined as people who have never engaged in vaginal intercourse, have nonetheless engaged in one or more other forms of heterosexual sexual activity (e.g., oral sex, anal sex, or mutual masturbation).
  39. ↑ "About PEPFAR". PEPFAR.
  40. ↑ "Partnership Frameworks". PEPFAR.
  41. ↑ Boonstra, H.D. (2007). "Young People Need Help in Preventing Pregnancy and HIV; How Will the World Respond?". Guttmacher Policy Review. 10 (3). Archived from the original on 2014-11-05.
  42. ↑ "Abstinence & Fidelity". PEPFARWatch. Archived from the original on 2014-10-24.
  43. 1 2 Dietrich, John (2007). "The Politics of PEPFAR: The President's Emergency Plan for AIDS Relief". Ethics & International Affairs.
  44. ↑ "Access to Condoms and HIV/AIDS Information: A Global Health and Human Rights Concern". Human Rights Watch: 1–28. 2004.
  45. ↑ U.S. Push for Abstinence in Africa Is Seen as Failure Against H.I.V. By DONALD G. McNEIL Jr. New York Times. FEB. 26, 2015
  46. ↑ 19th Conference on Retroviruses and Opportunistic Infections in Seattle. US PEPFAR abstinence and faithfulness funding had no impact on sexual behaviour in Africa. Keith Alcorn. CROI News. 26 February 2015
  47. ↑ The impact of PEPFAR faithfulness and abstinence funding on HIV risk behaviours in sub-Saharan Africa. Conference on Retroviruses and Opportunistic Infections, Lo N, Lowe A, Bendavid E. Seattle, abstract 160, 2015.
  48. ↑ Social Security Act, Section 510
  49. 1 2 Weiser, Dana A.; Miller, Monica K. (2010-12-01). "Barack Obama vs Bristol Palin: why the President’s sex education policy wins". Contemporary Justice Review. 13 (4): 411–424. ISSN 1028-2580. doi:10.1080/10282580.2010.517970.
  50. ↑ Doan, Alesha E.; McFarlane, Deborah R. (2012-10-01). "Saying No to Abstinence-Only Education: An Analysis of State Decision-Making". Publius: The Journal of Federalism. 42 (4): 613–635. ISSN 0048-5950. doi:10.1093/publius/pjr052.
  51. ↑ Calterone Williams, J. (2011-08-15). "Battling a 'sex-saturated society': The abstinence movement and the politics of sex education". Sexualities. 14 (4): 416–443. doi:10.1177/1363460711406460.
  52. ↑ Kelly, Casey Ryan (2016-10-01). "Chastity for democracy: Surplus repression and the rhetoric of sex education". Quarterly Journal of Speech. 102 (4): 353–375. ISSN 0033-5630. doi:10.1080/00335630.2016.1209548.
  53. ↑ Boryczka, Jocelyn (2009-06-01). "Whose Responsibility? The Politics of Sex Education Policy in the United States". Politics & Gender. 5 (2): 185–210. ISSN 1743-9248. doi:10.1017/S1743923X09000154.
  54. ↑ Marietta, Morgan (2012). A Citizen's Guide to American Ideology: Conservatism and Liberalism in Contemporary Politics. New York, NY: Routledge. pp. 77–79. ISBN 978-0-415-89899-7.
  55. ↑ Hindman, Douglas Blanks; Yan, Changmin (2015-08-03). "The Knowledge Gap Versus the Belief Gap and Abstinence-Only Sex Education". Journal of Health Communication. 20 (8): 949–957. ISSN 1081-0730. PMID 25950234. doi:10.1080/10810730.2015.1018571.
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