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Sex-ed sells

The press trumpets a "safe sex" education study, despite a researcher's apparent conflict of interest and data that suggest less than meets the eye

Consider this scenario: A nationally known researcher publishes a scientific study touting programs that the government pays his employer to market. Wouldn't this constitute a conflict-of-interest story worthy of national media attention? Not if the researcher works for the safe-sex cartel.

This summer the National Campaign to Prevent Teenage Pregnancy-an advocacy group endorsed by former President Bill Clinton-published a report claiming that abstinence education showed no proof of effectiveness. But "comprehensive" sex education (i.e., programs that pay lip service to abstinence while advocating condoms) reduces both teen pregnancy and sexual activity, said the report. The Campaign based its assertion on a four-year study called "Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy."

Written by Douglas Kirby, a Campaign board member and a senior researcher for the California-based ETR Associates, the study lauded eight "comprehensive" sex-education programs, including three community-outreach projects and five sex-education curricula, as showing "strong evidence of success." Depending on the definition of "success," that means delayed teenage sexual activity, increased condom use, or reduced pregnancy rates.

Although Mr. Kirby's report reviewed only three abstinence programs and acknowledged that "the jury is still out" on abstinence education, national media were quick to convict. The New York Times confidently asserted that "abstinence-only" education has "no impact on young people's behavior," while USA Today called for more federally funded safe-sex education. But neither newspaper mentioned Mr. Kirby's conflicts.

As the nation's largest nonprofit, health-education clearing house, ETR (an acronym for Education, Training, Research) conducts scientific studies and produces brochures and manuals on health topics ranging from pelvic exams to Internet dating. In addition to annually distributing some 8 million publications to schools, corporations, and medical clinics, ETR also serves as a powerful marketing tool for the U.S. government.

Each year, the U.S. Centers for Disease Control and Prevention (CDC) publishes a list of health-education programs that it calls "Programs That Work." The CDC offers incentives to public schools to use the programs, including a free teacher-training session. WORLD discovered that ETR not only receives money to package the CDC-endorsed programs and provide training sessions; it also has been paid to provide research to weigh their "effectiveness."

That suggests a direct conflict of interest since the sex-education curricula that Mr. Kirby's study advocates are "Programs That Work." ETR sells three of them-"Reducing the Risk," "Safer Choices," and "Becoming a Responsible Teen." So not only does Mr. Kirby tout his own company's products as the best in the country; he also promotes curricula that

his employer develops for the federal government. It's Big Brother turned

mass marketer.

Here's how the marketing works: Through "corporate agreement grants," the CDC pays ETR to transform "Programs That Work" into curricula and train public schools how to use them. According to ETR training director Linda Fawcett, ETR has also received funding from the CDC to evaluate some "Programs That Work," including "Reducing the Risk" and "Safer Choices." Mr. Kirby denied his co-worker's assertion that ETR received government funding to evaluate any programs other than "Safer Choices," arguing that "I have very openly stated both in the presentations and in 'Emerging Answers' that some of the materials are published by ETR. I have certainly not covered up anything." Evaluators are selected by "competitive procurement," explained Lloyd Kolbe, director of the CDC's adolescent and school health division. "We wouldn't disallow an organization to compete … based on their being successful in developing … 'Programs That Work.'"

But conflict-of-interest issues aren't the only thing the national media missed. They also ignored data that cast doubt on the "safe-sex" message. They failed to report that out of 250 programs examined in Mr. Kirby's study, only 3 percent-eight programs-showed significant success. So instead of dismissing abstinence education on the basis of three programs, the media could have reported that the majority of safe-sex curricula studied produced insignificant results.

"Programs find success in reducing teenage pregnancy," announced The New York Times headline. But the Times neglected to mention that none of the sex-education curricula advocated by Mr. Kirby's study decreased teenage pregnancy rates or sexually transmitted diseases (STDs). The curricula "reduced sexual risk-taking; but they did not provide evidence they reduced teen pregnancy," said the report. This from a report published by a campaign "to Prevent Teen Pregnancy."

"Most of these programs did not even measure or accomplish the most important outcomes they were designed for, yet the media have suggested that we now have the answer, and that is that we must teach contraceptives with abstinence to be effective," said Dr. Joe McIlhaney, who serves on the National Campaign's research committee and directs the Austin-based Medical Institute for Sexual Health. "I don't believe the data support that conclusion."

Why would a study on teen pregnancy prevention endorse curricula that fail to measure or reduce teen pregnancy rates? For the answer, it helps to review Mr. Kirby's conclusion: "The overwhelming weight of evidence shows that sex education that discusses contraception does not increase sexual activity," he wrote. "The research indicates that encouraging abstinence and urging the better use of contraception are compatible goals." The conclusion emphasizes what safe-sex programs did not do rather than what they actually accomplished, making it look like the real objective was not to study pregnancy rates, but to promote federally funded safe-sex programs.

And increasingly safe-sex programs need such promotional assistance. The 1996 welfare reform bill allocated over $50 million to abstinence education, and President Bush has promised an additional $137 million. Meanwhile, at least seven states have passed laws requiring public schools to emphasize abstinence until marriage when teaching sex education. That trend has threatened safe-sex advocates who, undergirded by 20 years of federal funding, regarded public schools as their uncontested turf.

In the medical publication STD Advisor, safe-sex advocates vented their frustration: "We got condoms in the schools because we were aggressive," said CDC adviser Dorothy Mann, who oversees Philadelphia family-planning clinics. "Too often we are nice guys and we keep backing up and getting on the defensive." Another CDC adviser suggested using "researchers in your battles so that you aren't alone."

According to South Carolina Attorney General Charlie Condon, the CDC used carrot-stick grants to pressure school districts into using curricula, including ETR's "Reducing the Risk." "It is our understanding that in order for the State of South Carolina to receive grant monies … the state is required to use five curricula which CDC designates as 'programs that work,'" said a statement released by Mr. Condon last summer. Arguing that the curricula violated the state's abstinence law, he cited a "Reducing the Risk" worksheet called "The Steps to Protection":

"Suppose you are concerned about preventing a pregnancy or preventing STD and want to use a condom and foam. The steps to protection are described. You are to write how you would do it," says the worksheet. Another worksheet requires students to visit or call a family-planning clinic. "Simply putting the word 'AIDS' on the cover of a health education textbook does not permit educators to place a graphic sex manual or promotional advocacy for condoms inside," said Mr. Condon. He has threatened to prosecute 11 school districts using CDC-endorsed curricula.

The CDC's Dr. Kolbe denied that his organization requires states to use "Programs that Work" in order to receive grants: "There is absolutely no requirement, there never has been and there never would be.... We simply identify these curricula, and we provide support for there to be one training in the curricula that people can go to if they're interested."

But Ohio health teacher Carol Freas says it was school officials who didn't give her any choice. After they blocked her efforts to introduce an abstinence curriculum three years ago, she attended one of those government-funded, "Programs That Work" training sessions. At the three-day seminar, trainers taught Mrs. Freas and eight other attendees how to get "Programs That Work," including "Reducing the Risk," into their local school districts: "We were told to find people in the district who have control over the curriculum. They also told us that each school district has curriculum standards that the teacher has to cover during the year, and that we would be called upon to help rewrite those standards."

During one strategy session, trainers showed a film depicting a mother pleading with her local school board not to adopt safe-sex curricula. Trainees laughed and jeered at the woman as instructors discussed how to handle similar objections. "I felt so out of place," said Mrs. Freas. But as others jeered, she took notes and made audio tapes. At the end of the program, instructors asked graduates to sign a contract promising they would train 20 other people. Mrs. Freas fulfilled her commitment by training 20 Christian activists who launched a statewide campaign to defund CDC-endorsed curricula. She also took her seminar notes and tapes to local talk shows and legislators. As a result, Ohio sent roughly $1 million back to CDC in 1999. Other states, including Utah and Nebraska, have followed suit with similar proposals. But Mrs. Freas isn't celebrating: "Our one little victory did not stop their agenda; it's still proceeding like a freight train."

Candi Cushman

Candi Cushman