DOMESTIC ABSTINENCE–ONLY PROGRAMS:

ASSESSING THE EVIDENCE

HEARING

BEFORE THE

COMMITTEE ON OVERSIGHT

AND GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

SECOND SESSION

APRIL 23, 2008

Serial No. 110–115

Printed for the use of the Committee on Oversight and Government Reform

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DOMESTIC ABSTINENCE–ONLY PROGRAMS: ASSESSING THE EVIDENCE

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DOMESTIC ABSTINENCE–ONLY PROGRAMS:

ASSESSING THE EVIDENCE

HEARING

BEFORE THE

COMMITTEE ON OVERSIGHT

AND GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

SECOND SESSION

APRIL 23, 2008

Serial No. 110–115

Printed for the use of the Committee on Oversight and Government Reform

(

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html

http://www.house.gov/reform

(II)

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

HENRY A. WAXMAN, California, Chairman

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

BRIAN HIGGINS, New York

JOHN A. YARMUTH, Kentucky

BRUCE L. BRALEY, Iowa

ELEANOR HOLMES NORTON, District of

Columbia

BETTY MCCOLLUM, Minnesota

JIM COOPER, Tennessee

CHRIS VAN HOLLEN, Maryland

PAUL W. HODES, New Hampshire

CHRISTOPHER S. MURPHY, Connecticut

JOHN P. SARBANES, Maryland

PETER WELCH, Vermont

——— ———

TOM DAVIS, Virginia

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

VIRGINIA FOXX, North Carolina

BRIAN P. BILBRAY, California

BILL SALI, Idaho

JIM JORDAN, Ohio

PHIL SCHILIRO, Chief of Staff

PHIL BARNETT, Staff Director

EARLEY GREEN, Chief Clerk

DAVID MARIN, Minority Staff Director

(III)

C O N T E N T S

Page

Hearing held on April 23, 2008 .............................................................................. 1

Statement of:

Capps, Hon. Lois, a Representative in Congress from the State of California; and Hon. Sam Brownback, a U.S. Senator from the State of Kansas .................................................................................................................. 15

Brownback, Hon. Sam ............................................................................... 25

Capps, Hon. Lois ....................................................................................... 15

Keckler, Charles, Acting Deputy Assistant Secretary for Policy, Administration for Children and Families, U.S. Department of Health and

Human Services; and Marcia Crosse, Ph.D., Director, Healthcare, U.S.

Government Accountability Office ............................................................... 296

Crosse, Marcia ........................................................................................... 312

Keckler, Charles ........................................................................................ 296

Santelli, John, Department Chair, professor of clinical population and

family health, Mailman School of Public Health, and professor of clinical pediatrics, College of Physicians and Surgeons, Columbia University; Georges Benjamin, executive director, American Public Health

Association; Margaret J. Blythe, M.D., Chair of American Academy

of Pediatrics’ Committee on Adolescence; Stanley Weed, Ph.D., director,

Institute for Research and Evaluation; Harvey Fineberg, M.D., Ph.D.,

president, Institute of Medicine of the National Academies; Max Siegel,

policy associate, AIDS Alliance for Children, Youth and Families; and

Shelby Knox, youth speaker ......................................................................... 84

Benjamin, Georges .................................................................................... 153

Blythe, Margaret J. ................................................................................... 162

Fineberg, Harvey ....................................................................................... 191

Knox, Shelby .............................................................................................. 217

Santelli, John ............................................................................................. 84

Siegel, Max ................................................................................................. 202

Weed, Stanley ............................................................................................ 171

Letters, statements, etc., submitted for the record by:

Benjamin, Georges, executive director, American Public Health Association, prepared statement of .......................................................................... 155

Blythe, Margaret J., M.D., Chair of American Academy of Pediatrics’

Committee on Adolescence, prepared statement of .................................... 164

Brownback, Hon. Sam, a U.S. Senator from the State of Kansas, prepared

statement of ................................................................................................... 27

Capps, Hon. Lois, a Representative in Congress from the State of California, prepared statement of ........................................................................... 19

Crosse, Marcia, Ph.D., Director, Healthcare, U.S. Government Accountability Office, prepared statement of ........................................................... 314

Davis, Hon. Tom, a Representative in Congress from the State of Virginia, prepared statement of ........................................................................ 13

Fineberg, Harvey, M.D., Ph.D., president, Institute of Medicine of the

National Academies, prepared statement of ............................................... 193

Jordan, Hon. Jim, a Representative in Congress from the State of Ohio,

prepared statement of ................................................................................... 257

Keckler, Charles, Acting Deputy Assistant Secretary for Policy, Administration for Children and Families, U.S. Department of Health and

Human Services, prepared statement of ..................................................... 298

Knox, Shelby, youth speaker, prepared statement of .................................... 219

Sali, Hon. Bill, a Representative in Congress from the State of Idaho:

Heritage Foundation study ....................................................................... 229

Prepared statement of ............................................................................... 226

Page

IV

Letters, statements, etc., submitted for the record by—Continued

Santelli, John, Department Chair, professor of clinical population and

family health, Mailman School of Public Health, and professor of clinical pediatrics, College of Physicians and Surgeons, Columbia University, prepared statement of .......................................................................... 87

Siegel, Max, policy associate, AIDS Alliance for Children, Youth and

Families, prepared statement of .................................................................. 204

Souder, Hon. Mark E., a Representative in Congress from the State

of Indiana, staff report ................................................................................. 37

Waxman, Chairman Henry A., a Representative in Congress from the

State of California, prepared statement of ................................................. 5

Weed, Stanley, Ph.D., director, Institute for Research and Evaluation,

prepared statement of ................................................................................... 173

(1)

DOMESTIC ABSTINENCE–ONLY PROGRAMS:

ASSESSING THE EVIDENCE

WEDNESDAY, APRIL 23, 2008

HOUSE OF REPRESENTATIVES, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, Washington, DC.

The committee met, pursuant to notice, at 10 a.m. in room 2154,

Rayburn House Office Building, Hon. Henry A. Waxman (chairman

of the committee) presiding.

Present: Representatives Waxman, Cummings, Kucinich, Watson, Yarmuth, Norton, McCollum, Hodes, Sarbanes, Welch, Davis

of Virginia, Burton, Shays, Souder, Duncan, Issa, Foxx, Sali, and

Jordan.

Staff present: Phil Barnett, staff director and chief counsel; Kristin Amerling, general counsel; Karen Nelson, health policy director;

Karen Lightfoot, communications director and senior policy advisor;

Naomi Seiler, counsel; Earley Green, chief clerk; Teresa Coufal,

deputy clerk; Jesseca Boyer, investigator; Caren Auchman and Ella

Hoffman, press assistants; Zhongrui ‘‘JR’’ Deng, chief information

officer; Leneal Scott, information systems manager; Kerry Gutknecht, William Ragland, and Miriam Edelman, staff assistants;

Larry Halloran, minority staff director; Jennifer Safavian, minority

chief counsel for oversight and investigations; Keith Ausbrook, minority general counsel; Ashley Callen, minority counsel; Jill

Schmaltz and Benjamin Chance, minority professional staff members; Brian McNicoll, minority communications director; and Ali

Ahmad, minority deputy press secretary.

Chairman WAXMAN. The meeting of the committee will come to

order.

We are all here today because we are concerned about the wellbeing of America’s youth. We may not see eye-to-eye about policy,

but we share the common goal of improving adolescents’ health.

The statistics are shocking. A few weeks ago the Centers for Disease Control released data showing that one in four teenage girls

in the United States has a sexually transmitted infection. Of all

American girls, 30 percent become pregnant before the age of 20.

For African American and Latino girls, the rate is 50 percent. And

thousands of teenagers and young adults in the United States become infected with HIV each year.

If we are serious about responding to these challenges, we must

base our policy on the best available science and evidence, not ideology.

We are here today to discuss evidence on the effectiveness of abstinence-only programs. There is a broad consensus that the beneVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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fits of abstinence should be taught as part of any sex education effort. But abstinence-only programs teach only abstinence. In federally funded abstinence-only programs, teenagers cannot receive information on other methods of disease prevention and contraception, other than failure rates.

To date these programs have gotten over $1.3 billion of Federal

taxpayer money, along with hundreds of millions of dollars in State

funds, to conduct programs in schools and communities throughout

the country. Meanwhile, we have no dedicated source of Federal

funding specifically for comprehensive classroom sex education.

The purpose of this hearing is to examine whether the evidence

on abstinence-only programs justifies this expenditure of $1.3 billion in taxpayer funds.

I respect the commitment and intentions of people who run abstinence-only programs. They are doing it because they care about

young people and want to counter the sexual messages that are all

too pervasive. Young people who work in these programs demonstrate to their peers that not all teens are having sex, which is

an important message. But we will hear today from multiple experts that, after more than a decade of huge Government spending,

the weight of the evidence doesn’t demonstrate abstinence-only programs to be effective. In fact, the Government’s own study showed

no effect for abstinence-only programs.

In 2007, the Bush administration released the result of a longitudinal, randomized, controlled study of four federally funded programs. The investigators found that, compared to the control group,

the abstinence-only programs had no impact on whether or not participants abstained from sex. They had no impact on the age when

teens started having sex. They had no impact on the number of

partners. And they had no impact on rates of pregnancy or sexually

transmitted diseases.

There is a lot of talk about the failure rates of condoms. It is

time we face the facts about the failure rate of abstinence-only programs.

There are also serious concerns about the content of some of

these programs. A report I released in 2004 found false or misleading medical information in the majority of the abstinence-only curricula most frequently used by Federal grantees.

While some of these errors have been corrected, recent reviews

have continued to find misinformation. Some programs are still

teaching stereotypes about gender, like the idea that men judge

themselves based on their accomplishments and women judge

themselves based on their relationships. And the exclusive focus on

abstinence until marriage ignores the needs, and sometimes even

the existence, of gay and lesbian youth.

Meanwhile, more and more research shows that many well-designed, comprehensive programs that teach about abstinence and

contraception are effective. Comprehensive, age-appropriate programs have yielded results including increasing contraceptive use,

delaying sex, and reducing the number of sexual partners. In other

words, the evidence demonstrates that, not only do good comprehensive programs not encourage teen sexual activity, they actually decrease it.

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This shouldn’t be too surprising, because in effective comprehensive programs, young people are taught that abstinence is the

safest choice, the healthiest choice, the choice that they should

never feel pressured to abandon.

Americans want taxpayers’ dollars to be watched for carefully by

the Congress. They want us to fund programs that produce results.

Yet we are showering funds on abstinence-only programs that don’t

appear to work, while ignoring proven, comprehensive sex education programs that can delay sex, protect teens from disease, and

result in fewer teen pregnancies.

This triumph of ideology over science is bad economics and even

worse health policy.

Today we are going to hear from experts at the American Public

Health Association and the American Academy of Pediatrics. They

will tell us that, based on their professional assessments, the

weight of the evidence does not support the continuation of current

abstinence-only policy. Instead, both organizations support comprehensive education that includes both abstinence and information on contraception.

The Society for Adolescent Medicine has submitted a statement

that says, ‘‘Efforts to promote abstinence should be provided within

health education programs that provide adolescents with complete

and accurate information about sexual health.’’

The American College of Obstetricians and Gynecologists have a

similar view. They submitted a statement that states, ‘‘Careful and

objective scholarly research during the last two decades has shown

that sexuality education does not increase rates of sexual activity

among teenagers; rather, sexuality education increases knowledge

about sexual behavior and its consequences and increases prevention behaviors among those who are sexually active.’’

The American Psychological Association submitted a statement

recommending that, ‘‘[p]ublic funding for the implementation of

comprehensive sexuality education programs be given priority over

public funding for the implementation of abstinence-only and abstinence-until-marriage programs until such programs are proven to

be effective.’’

And the American Medical Association has an official policy stating that it ‘‘supports Federal funding of comprehensive sex education programs that stress the importance of abstinence in preventing unwanted teenage pregnancy and sexually transmitted infections and also teach about contraceptive choices and safer sex.’’

All of these professional societies have reached the conclusion

that abstinence-only programs are not supported by the weight of

the evidence and that the Government should support more comprehensive programs for youth.

States are also reaching that conclusion. Today 17 States, including California and Virginia, decline to accept these abstinence-only

funds. Many of these States cite the lack of evidence supporting abstinence-only programs and the restrictive program guidelines as a

basis for their decisions.

We will hear testimony from witnesses who believe that abstinence-only education does have positive effects. I respect the depth

of their commitment, but ultimately we need to focus on the full

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body of evidence on what works to achieve our shared goals of

keeping teenagers safe and reducing teen pregnancies. We have already spent over $1.3 billion on abstinence-only programs. The question we must ask today is whether we can justify

pouring millions more into these programs when the weight of the

evidence points elsewhere.

I look forward to our witnesses’ testimony today.

[The prepared statement of Chairman Henry A. Waxman follows:]

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Chairman WAXMAN. I want to recognize our ranking member,

Mr. Davis, for his opening statement.

Mr. DAVIS OF VIRGINIA. Thank you, Mr. Chairman.

I know I have to go to the floor to manage our side of some of

the committee’s bills, so I will not be here for the full hearing, but

I want to thank you for convening this hearing to review the performance of federally funded education programs on sexual abstinence.

Not surprisingly, we can expect strong feelings and views to be

expressed on all sides today, because we are talking about an issue

of fundamental importance to public health and to the healthy development and well-being of our children. But disagreements need

not turn disagreeable. To be constructive, mutual respect and understand of divergent perspectives should drive our discussion.

We proceed from the premise that everyone here today speaks

and acts only out of a sincere and well-informed interest in a

healthy future for young people throughout our Nation. Despite differences over how to best reach it, the goal of delaying sexual activity among teenagers is widely—almost universally—shared. The

benefits of abstinence are as absolute and obvious as they are difficult to convey through the inconsistent surge of teenage hormones, cultural stereotypes, and peer pressure.

In the public health realm, scientific certainties are rare, but we

know without question not having sex absolutely protects young

people from the physical and emotional perils that can and do befall those who engage in high-risk and age-inappropriate behaviors.

High school is a difficult enough time without the added pressures

of complex sexual relationships that too often result in pregnancy,

sexually transmitted diseases, and emotional trauma.

Young people should be spending that time of their lives focusing

on school, extra-curricular activities, friends, and their futures, not

succumbing to the risks of early age sex. And those risks are substantial. A third of American young people will become pregnant

before the age of 20. A third of those between the ages of 15 and

17 reportedly already feel pressure to have sex. One in four teenage girls is infected with STDs. And, tragically, STDs are found at

almost twice that rate in African American young women. And half

of all new HIV infections occur in people under the age of 25.

As dire as these numbers may seem, progress has been made

since the early 1990’s. Between 1990 and 2004, the teen pregnancy

rate fell 38 percent. The percentage of high school students who

have had sexual intercourse also declined over the same decade.

Today it is estimated less than half of American high school students have ever had sex.

Despite these important gains, the United States compares unfavorably in these measures with other developed nations. Particularly among racial minorities, troubling disparities persist.

So we appropriately ask today how well Federal programs support abstinence education. It is a fair question, but it is not the

only question that bears on how to protect public health and the

welfare of precious young lives.

In this discussion we should abstain from an urge to take an allor-nothing approach or make false choices between abstinence-only

programs and more clinical—some might say permissive—sex eduVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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cation. Particularly today, against cultural trends that glamorize

the immediate gratification of physical and material wants while

minimizing personal responsibility, we need to use every means

available to reach young people to help them make responsible decisions.

Focusing only on the performance of abstinence-only programs

also risks leaving the impression the Federal Government funds

only those courses, or that just those efforts need oversight. In fact,

the Federal Government funds the full spectrum of sex education,

as it must under our Constitutional system. Decisions about the

nature and content of sex education in schools are made at the

State and local district levels, with strong input from parents. Different communities have different mores and traditions. What

works in Utah may not be what is needed or wanted in rural Mississippi or inner city Los Angeles.

The Federal Government’s role is to empower States and localities to make those choices, not supplant the judgment of parents,

teachers, and school boards. So we permit States, school districts,

and community organizations to seek Federal funds for the types

of sex education they judge best to meet the needs of their students. We should not deny them the option of abstinence education

programs because some perform better than others. Each life saved

is of immeasurable value.

Data on the impact of abstinence education programs may be difficult to capture or slow to be recognized, but problems with how

abstinence is taught cannot be allowed to undermine its indispensability as a core element of what is taught. It is inaccurate and

unfair to claim all abstinence education programs are the same or

that all such programs fail, therefore none should be funded.

To bring a more nuanced view to the evaluation, we asked that

Dr. Stan Weed be invited to testify. His work in this field should

shed a needed light on the elements of an effective abstinence education program. I thank Chairman Waxman to agreeing to our request for this witness. Identifying what works and what doesn’t

can help focus Federal funding on the best practices and the most

efficient programs.

We welcome all of our witnesses this morning and look forward

to a constructive conversation on how to fund the very best abstinence education programs.

[The prepared statement of Hon. Tom Davis follows:]

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Chairman WAXMAN. Thank you very much, Mr. Davis.

First of all, by unanimous consent, without objection, all Members will be permitted to enter opening statements in the record.

We are pleased to have two of our colleagues with us today to

present their position on this issue. We have Congresswoman Lois

Capps, representing the 23rd District of California, where she

serves on the Energy and Commerce Committee. She is the founder

and co-chair of the House Nursing Caucus and is the Democratic

Chair of the Congressional Caucus for Women’s Issues.

We are pleased to have you with us.

Senator Sam Brownback is the senior Senator for Kansas. He

serves on the Appropriations, Judiciary, and Joint Economic Committees and is the ranking member on the Joint Economic Committee.

We are pleased to have you here, as well.

I guess before we do that, I should inform you and all the witnesses that it is the practice of this committee that everyone who

testifies before us testifies under oath, so even though you are

Members of Congress I think we ought to apply the same rules to

you, as well.

[Witnesses sworn.]

Chairman WAXMAN. The record will indicate that the witnesses

answered in the affirmative.

Ms. Capps, why don’t we start with you. Your prepared statements will be in the record in full. We would like to ask, if you

would, to keep your oral presentation to around 5 minutes.

STATEMENTS OF HON. LOIS CAPPS, A REPRESENTATIVE IN

CONGRESS FROM THE STATE OF CALIFORNIA; AND HON.

SAM BROWNBACK, A U.S. SENATOR FROM THE STATE OF

KANSAS

STATEMENT OF HON. LOIS CAPPS

Ms. CAPPS. Thank you, Chairman Waxman, for inviting me to

participate today. It is an honor for me to appear with my esteemed colleague from the Senate.

I sit before you today both as a colleague in the House and as

a registered nurse. Long before I entered the halls of Congress I

worked as a school nurse and health educator for the Santa Barbara Public School Districts. My responsibilities then were to make

decisions that best meet the needs of my students and school district, much as they are now to make decisions that best represent

the needs of my constituents and the American people.

As a public health nurse, it was natural for me to reinforce that

prevention is a most important component of health education.

Teaching young people about healthy behaviors, including the risks

associated with unprotected sex and teen pregnancy, are important

messages that need to be conveyed, always in alliance with the parents involved.

I know from my first-hand experience what does and doesn’t

work with youth. That is why I promoted comprehensive health

education for all students, including age-appropriate information

about reproduction and decisionmaking associated with sex, always

with the parents’ permission.

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Knowing about mitigating the risk of sexually transmitted disease and ways to prevent pregnancy are important life skills needed in today’s world. Withholding this information from teens does

a great and perhaps dangerous disservice to them, and one that

runs contrary to my training and education as a public health

nurse.

In my work as a school nurse I have been part of many curriculum review panels regarding sex education at both the school site

and the local school district level. These panels are always centered

around parents and include teachers, administrators, board members, and often community health professionals such as pediatricians.

As a school nurse I also had the privilege of directing a program

for pregnant and parenting teens, which allowed them to stay in

regular high school with their peers. Part of this program was, of

course, to provide care for their children while they were studying

and in class, but, more importantly, this teen parenting program

provided education on life skills with an emphasis on parenting, as

well as an education on how to prevent or delay further teen pregnancies. After all, teen parents are all too likely to have a second

birth relatively soon. About one-fourth of teenage mothers have a

second child within 24 months of that first early birth.

Mr. Chairman, according to a 2005 CDC study, 46.8 percent of

all high school students reported having had sexual intercourse.

For high school seniors, this figure reaches 63.1 percent. The bottom line is, as much as parents and teachers and all of us alike

stress abstinence among teens, sexual activity is a reality for many

young people. So what can we do to confront that reality?

Some say that abstinence-only education is the answer, but

claiming that the only proper information with teens, even teens

who are already parents, is abstinence only and nothing else means

withholding scientifically based medical information. This is completely unrealistic, in my view.

Of course, abstinence is at the core of any comprehensive sexual

education curriculum. Practicing 100 percent complete abstinence

is 100 percent effective in preventing pregnancy, and that is a primary message. For many young people, this message reinforces

positive behaviors, but it is not realistic to expect such behavior

from all teens, so the best thing we can do to protect young people

from the negative consequences of unsafe sex is to give them the

information they need. We know this works.

A national campaign to prevent teen pregnancy study revealed

that over 40 percent of the comprehensive education programs that

were evaluated delayed the initiation of sex, and more than 60 percent reduced unprotected sex. Furthermore, no comprehensive program hastened the initiation of sex, according to the study, or increased the frequency of sex.

Conversely, just last year a federally funded evaluation of the

Title V abstinence-only programs conducted by Mathmatica Policy

Research, Inc. found no evidence that these programs—that is abstinence-only—increased rates of sexual abstinence. Scientific study

after scientific study has shown that these programs are ineffective

and often contain false information, something that bears out in

my own anecdotal survey of them.

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I urge us not to add to the $1.3 billion in Federal dollars that

have been invested over the past decade in programs that are ineffective and many of them downright false.

I am proud that my own State of California has rejected these

dollars from day one. In fact, California is the only State that has

never applied for and never received Title V abstinence-only untilmarriage funding. California would have been eligible for over $7

million in Title V abstinence-only until-marriage funding in fiscal

year 2007, but the State chose not to apply for these funds due to

the extraordinary restrictions upon how the money must be spent.

This was based on the State’s previous experience in the 1990’s

with a State-funded abstinence-only education program that proved

to be ineffective. Evaluation of the program proved that youth who

were given abstinence-only education were not less likely than

youth in the control groups to report a pregnancy or a sexually

transmitted infection.

California isn’t the only State to draw these conclusions. The

Kansas Department of Health and Environment conducted a 2004

evaluation of abstinence-only until-marriage programs, and this

evaluation found that there were no changes noted for participants’

actual or intended behavior, such as whether they planned to wait

until marriage the have sexual.

The evaluation also revealed negative changes in attitudes. After

participating in abstinence-only until-marriage programs, students

surveyed were less likely to respond that the teachers and staff

cared about them, and significantly fewer students felt that they

had a right to refuse to have sex with someone. Researchers therefore concluded that, rather than focusing on abstinence-only untilmarriage, data suggests that including information on contraceptive use may be more effective at decreasing teen pregnancy. This

evaluation is, unfortunately, all too typical of the result of the abstinence-only education programs.

Mr. Chairman, as of 2008, January, 17 States have rejected Title

V abstinence-only funding based on sound public health concerns

and because Governors have deemed the program to be inconsistent with their State’s values or public health mandates.

I commend these States for making smart decisions regarding

the health of their young people and listening to parents who want

more comprehensive education for their children. Recent polling reveals that a vast majority of adults support a comprehensive approach to sexuality education. According to a study conducted by

the National Campaign to Prevent Teen and Unplanned Pregnancy, 78 percent of California residents support programs that

teach about abstinence as well as how to obtain and use contraceptives.

Furthermore, residents believe that the Federal Government

should pay for this instruction. That is why I am proud to be a cosponsor of legislation such as the Responsible Education About Life

[REAL] Act, and the Prevention First Act. It is in the best interest,

I believe, of public health of our entire society to ensure that all

students are receiving scientifically and medically accurate information that will enable them to make the healthiest lifestyle decisions for them.

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Furthermore, I believe that we must discontinue any funding

that is Federal for abstinence-only education programs. I believe

they have been a waste of taxpayer dollars and have produced no

positive results. As a Member of Congress, again, as a registered

nurse, this is a position I encourage my colleagues to adopt as we

have a responsibility, I believe, to protect the public health. We

should follow the recommendations of the Institutes of Medicine:

‘‘Congress, as well as other Federal, State, and local policymakers,

eliminate the requirements that public funds be used for abstinence-only education and that States and local school districts implement and continue to support age-appropriate, comprehensive

sex education and condom availability.’’

Thank you, again, for the opportunity to testify today.

[The prepared statement of Hon. Lois Capps follows:]

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Chairman WAXMAN. Thank you very much, Ms. Capps.

Mr. Brownback.

STATEMENT OF HON. SAM BROWNBACK

Senator BROWNBACK. Thank you very much, Mr. Chairman.

Thank you for allowing me to be here and to testify. I am glad to

join Ms. Capps. I have worked with her on a number of different

issues over the years, and it is always a pleasure to join her. I

think we have a bit of a different opinion on this one. I look forward to the discussion on it.

I come here because I am in the U.S. Senate, but I have five children and I have a fair amount of practical experience dealing with

this. Our oldest is 21, youngest two are 10. I think I identify with

most parents. I want the best for my kids and there is hardly anything I wouldn’t do for them to see that they do have the best.

I am like most parents in this country: I want them to abstain

from sexual activity until they are married. That doesn’t happen to

be just in the Brownback household. There is a Zogby poll in my

testimony; 8 in 10 parents want that for their children.

I think also I am like most parents in that I feel often that the

current culture pushes against what we try to teach in the

Brownback family, that you have respect for other people, that everybody is a dignified human, that we think this is something that

should be retained for marriage, and that is the best place.

It is something that we would hope our Government would back

us up on. That, I think, is at the crux of what the debate is here,

and it is about desire of parents and what is best for their kids,

high expectations, not low expectations, high expectations for our

children and a desire to lead them toward that.

We have a crisis in the country today. It is striking—I thought

stunning—when I read this number, that one in four teenager girls

in the United States has a sexually transmitted disease. One in

four, according to CDC. That is a truly shocking number.

Clearly, where we have put the bulk of our money in sex education, which is the comprehensive programs, have not worked. We

have a culture that pushes another way that rarely shows consequences of early sexual activity but really just says let’s just go

ahead and do it.

The end of this debate has been the push against abstinence education, which I think probably if we surveyed most Members here

toward their own children they would say no, that is what I would

hope my kids would do, and that is what I encourage them to do.

I would just say then why wouldn’t we have the Government do

similarly.

I have followed a number of the studies that have been coming

out looking at this. I don’t think all of them have been followed,

though. The Heritage Foundation just recently released a report

looking at 15 studies that have examined abstinence based programs only. They didn’t do the study on the programs, they just

pulled 15 programs out, and they found 11 of these programs on

abstinence reported positive findings, many of them quite extraordinary positive findings.

It seems to me that the route we should do, in listening to parents and listening to our own hearts here, would be to say, OK,

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what of these abstinence programs are not working, and let’s not

fund the areas that are not working rather than throwing the

whole idea out, which is supported by most parents.

I am most familiar with one here in Washington, DC, that I have

worked with over a number of years. I am the ranking member on

the Appropriations Committee for D.C., have been the authorizing

chairman for D.C. I have been very concerned about what is happening here in the District. The best one I am familiar with is Best

Friends program in Washington, DC. They had a 2005 study evaluation of the impact of the program. They found this about their

program: teenage girls in the six middle schools that participated

in the program were substantially less likely to engage in sexual

activity than similar teenager girls in the District who did not participate in Best Friends.

And they found collateral support, as well, or collateral positive

things. Best Friends girls were also significantly less likely to use

illegal drugs, smoke or drink, compared to their peers. And the program worked.

You have Dr. Stan Weed that has done a more thorough investigation on the impact of the programs. I would hope that his testimony would be seriously considered.

I think there is a way forward on this, Mr. Chairman, and I

think it is to examine the abstinence programs, because not all of

them are created equal. Clearly we have a huge problem. Clearly

comprehensive sex education has not worked with the level of

STDs that we have in this country.

I would hope what we would do is look at what in these programs and which ones and what design of it has worked, and let’s

replicate and let’s support and let’s push that. And let’s be very

supportive of it rather than this constant public debate of attack

that I think reads out to most of the public, Well, we just don’t like

this approach. Then the public goes, Well, I guess you are going to

attack my parental ideas again. They get very frustrated. I know

I can speak as one.

I would hope we could work together on this. I don’t think this

needs to be a partisan divide on it. I think it is one that we can

work with parents and work with these programs and help design

them to work better. It would be my hope, my pledge to you and

to others to work to make them work better and to use the models

of the ones that do work.

Thank you for allowing me to be here, Mr. Chairman.

[The prepared statement of Senator Sam Brownback follows:]

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Chairman WAXMAN. Thank you very much, Senator Brownback.

I want to start off by telling you I agree with you. We ought to

see what works. I don’t think we ought to ignore the idea of trying

to emphasize abstinence. I think we ought to have that emphasis,

because the culture does push our young people to become much

more sexually active, and it is contrary to what many of us as parents and grandparents want for our children.

But the Federal Government only funds abstinence education

programs. We don’t fund comprehensive sex education programs for

teenagers. That is done at the State and local level. I don’t think

we ought to fund abstinence-only programs that won’t talk about

other alternatives, talk about a comprehensive approach, encouraging abstinence but also at the same time explaining some public

health realities to young people.

Some States, as Ms. Capps pointed out, Representative Capps

said some States have looked at the Federal requirement and it is

like the Federal Government telling them they had to do it only

one way, and the States didn’t like that.

I think we ought to let the States, if we are going to put Federal

dollars into it, make a decision. I would hope that all of them

would emphasize abstinence, and then I hope all of them would inform people about basic health information.

Ms. Capps, is that the point that you were making?

Ms. CAPPS. I appreciate the chance to respond. I want to also

agree with the Senator. There is so much that we have in common

in what we desire for our young people. We want them to grow up

to be healthy. I will confess my strong bias, which is on behalf of

health education, period. When you think about the diseases that

are so costly to us today—obesity, heart disease, and sexually

transmitted diseases and unwanted pregnancies—so much of it relates to healthy behaviors, which can be taught starting at a very

young age.

I have always been in favor of comprehensive health information

so that young people know about their bodies, know how their emotions work, and at age-appropriate times, with the permission of

parents, that this can be done, including sexuality and reproductive

matters.

Now, I am in favor of local decisionmaking about this. That is

how important I think it is. It is always the prerogative of parents

to have a say on sensitive issues of what their children learn and

don’t learn. That is why I believe that abstinence-only education

really directs something that should be decided at a more local

level.

We do have legislation that is in the process of being addressed

in the House that undergirds the importance of prevention, and

that is something I would champion.

Chairman WAXMAN. Senator Brownback, do you think we ought

to look at these programs in a cool, cold-hearted way to see whether they are working or not, and if they are not working say that

we ought to adjust them? And, second, do you think that we ought

to bar, at the Federal level, any funds for these sex education efforts to talk about anything other than abstinence? Do you think

it ought to be possible for the local areas to decide to use the funds,

as well, for a more comprehensive approach that talks about ways

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to stop the sexually transmitted diseases and unintended pregnancies assuming young people decide to be sexually active?

Senator BROWNBACK. Well, the answer to your first question, absolutely. But I think you have to also then look at the whole

gamut, and not just say, OK, we are going after abstinence education, which, Mr. Chairman, that is what this appears to be. And

if you say OK, let’s look at the whole gamut because we have a crisis here, and STDs, one in four girls, and I think in certain segmented communities it is one in two, and the current approach has

not worked.

I believe you have testimony later on five to one on comprehensive. Nationwide, the dollars have been five to one on comprehensive. So, I mean, if I were you as chairman and you are saying let’s

look at this realistically, then apparently the broad breadth of

these dollars, it is not working. I would submit to you that if you

are just going to peg in on the abstinence piece of this, OK, that

is fair enough, but then I can show you programs in the abstinence

field where it is working. I can show you places where it is not. The

idea there would be to target more appropriately how you get the

abstinence programs to work. But then you should also back up

and say obviously the overall approach has not worked. We have

to look at all of it. We can’t just tag in on the abstinence piece of

this because of whatever agenda.

Chairman WAXMAN. Thank you.

Mr. Souder.

Mr. SOUDER. Thank you, Mr. Chairman.

As you know, we have debated this subject before. We held a

hearing when I was chairman of the subcommittee and we issued

a report, Abstinence and its Critics. I would ask that this would

be inserted in the committee report of this hearing.

Chairman WAXMAN. Without objection.

[The information referred to follows:]

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Mr. SOUDER. I also would like to make a brief statement because

of my involvement. I would like to use some of my time for that

at this point.

I share some of Senator Brownback’s concerns that we are not

addressing the fact here that two-thirds of the money that goes for

education on this issue is not abstinence-only. This hearing seems

to be stacked against abstinence-only. If your intent was truly to

assess the evidence on abstinence education, then why are we hearing from only one single proponent of the important public health

approach? Where are the physicians who diagnose young girls, despite having used condoms, who now have the cancer-causing virus

HPV? Where is the official who will talk about twice the amount

of funding being used on things other than abstinence education?

Extreme interests groups believing in sexual freedom and sexual

justice have denigrated the debate over abstinence education by

turning it into a vehicle to promote their own ideological agenda of

radical sexual autonomy. We ought not to be persuaded by these

groups who, although adopting the language of science and reason,

are really just evangelists of a competing though tragically incorrect moral vision. This debate is not between those who on one side

are trying to impose their values on others and those who on the

other are proclaiming a purely disinterested and amoral rationality. Indeed, despite protests to the contrary, the other side, too,

makes more arguments tethered to a particular ideology.

While this hearing has been convened to assess the evidence, we

must also realize that this debate involves deep disagreements between competing values. Abstinence education is a medically accurate, age-appropriate method that promotes character, healthy relationship building skills, and self worth to young people. It is far

more than a just say no approach to public health.

The name of this hearing, for example, wrongly suggests that

teens who receive abstinence-only education are only taught to say

no to sex. Mr. Chairman, this simply is not true. Abstinence education is a holistic approach to preventing the physical and emotional distress that premarital sex can bring, especially to teenagers. Abstinence education does, in fact, teach teens about contraceptives. It does teach teens about HIV/AIDS. It does teach teens

about how to prevent pregnancy and disease. It encourages teens

who are already sexually active to get tested for STDs, unlike the

so-called comprehensive sex education curriculum, which often tells

teachers specifically not to raise the failures of condoms or STDs.

What abstinence education does not do, unlike contraceptionbased programs, is suggest to teens that they should ‘‘wear shades

as a disguise’’ when buying condoms so adults don’t recognize

them, or encourage teens to ‘‘fantasize’’ about using a condom.

The Department of Health and Human Services reports that

most popular so-called comprehensive programs spend less than 10

percent of their class time promoting important health message of

abstaining. The curriculum does, however, instruct girls on how to

help their partner maintain an erection and other graphic behaviors too explicit to submit to the record.

We can parade as many critics of abstinence education before

this committee as we want, and nothing will change the fact that

the only fully reliable way for young people to protect themselves

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from pregnancy or STDs is by abstaining from sex until a committed, faithful relationship with a partner who is also free of STDs.

To withhold this evidence from our young people and the members

of this committee is not only wrong but inexcusable and unjust. I

would like to ask our two witnesses—and I find some of these questions, quite frankly, shocking, but since it is used in schools down

to age 9—do you believe this is appropriate to ask kids these questions which are: do you think a person is abstinent if he or she

does the behaviors below: cuddle with someone with no clothes on,

give oral sex, masturbate with a partner, receive oral sex, touch a

partner’s genitals? Do you believe those are appropriate for kids in

school as an alternative to abstinence, or whether it should be defined as abstinence? Ms. Capps.

Ms. CAPPS. Do I think this is appropriate personally? Not at all.

I have been a part of many, many sex education classes, and I have

never had this or been a witness to any discussion anything like

this, particularly at the age that you are talking about.

Mr. SOUDER. My time is on yellow. Let me ask Senator

Brownback.

Ms. CAPPS. Surely.

Mr. SOUDER. This is a 2005 plan, Making Sense of abstinence

Lessons for Comprehensive Sex Education for New Jersey.

Senator BROWNBACK. No. I don’t think that is appropriate. And

as a parent, if that were being taught to my kids I would find it

very offensive. I think it is why most parents really get upset about

a lot of these things, is that there are things being put forward

that a lot of times are just really trying to encourage our kids, look,

let’s be responsible. We don’t do these sort of things. It goes against

what the parents are trying to teach.

Chairman WAXMAN. Thank you, Mr. Souder.

Mr. Sarbanes, I want to recognize you if you have any questions.

Mr. SARBANES. Not at this time.

Chairman WAXMAN. Ms. McCollum.

Ms. MCCOLLUM. Thank you, Mr. Chair.

I am wondering, Senator Brownback, I think there is great

agreement. As parents we all tell our children that they should

delay sexual activity for many reasons—emotional, health, our family values, and that. But knowing what the statistics are from the

CDC for the number of young adults that do engage in sexual activity, do you believe that we have a responsibility when Federal

dollars are being used, especially in abstinence-only programs, that

if they do refer to condoms—and there are examples in here that

the GAO cites in its report where inaccurate statements were made

that condoms are porous, therefore a condom doesn’t protect you

against sexually transmitted disease—that we should not allow

Federal dollars to be used to transmit misinformation, information

that is not scientifically accurate, that is not a good use of our tax

dollars? Would you at least agree with that, that we need to make

sure that anything that is said in these abstinence programs must

be scientifically accurate?

Senator BROWNBACK. I would. I would hope they would be applied to all sex education programs, the comprehensive ones, too.

I would tie back in to your earliest piece of your statement. What

about the emotional. There is an emotional issue that is involved

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here. Having three children either in or recently gone through

teenage time periods, this is a big emotional time period. I would

hope we would have scientific evidence on all of it.

Ms. MCCOLLUM. Reclaiming my time, my challenge is, as an appropriator, with the limited amount of dollars that are available for

public health, that every single penny that is spent should be made

sure that the information is scientifically accurate.

Ms. Capps, it is my understanding—and I am sure you have read

the GAO report—that is has only been recently that there has been

any scrutiny on these programs to make sure that they are scientifically accurate. As a nurse, as a mother, how do you feel about

that? As a taxpayer, how do you feel about that?

Ms. CAPPS. That distresses me because I have had personal experience in reviewing some of the abstinence-only materials. I will

agree with the ranking member that they do discuss contraception,

but I never saw one that said anything positive about it. It was always the failure rate. In other words, to infuse a sense of distrust

among the students that they should rely on anything like this.

I am concerned that we are spending Federal dollars on misinformation.

Ms. MCCOLLUM. Representative Capps, as a person who has

worked in public health, you know that we might have juniors and

seniors in high school who don’t have parents such as Senator

Brownback, myself, you, and other members of the panel who

would sit down and discuss fully options with our children as they

are getting ready to perhaps even enter marriage. So knowing that

we have 17 and 18-year-olds, do you feel that for many of these

young adults in committed relationships who might be getting married at a very early age, that this might be the only information

that is available to them?

Ms. CAPPS. I can tell you I have heard it with my own ears, I

have seen, and, as I mentioned in my testimony, I worked in a program for parenting teens. Teens already having chosen to keep

their parents (sic) and go to a comprehensive high school, we provided them with life skills. Many of them were married. They were

asking us for help because they got pregnant in the first place because they didn’t know enough, and now they wanted to make sure

that they took good care of the child that they had and were able

to plan their families in the future.

So there is a cry on the part of many teenagers for accurate information. Then, of course, we need to always be teaching them the

life skills in order to make the good decisions about it, as well. The

two go hand in hand.

Ms. MCCOLLUM. Thank you.

Chairman WAXMAN. Thank you, Ms. McCollum.

Mr. Burton.

Mr. BURTON. I can wait.

Chairman WAXMAN. Mr. Shays.

Mr. SHAYS. I thank the colleague.

Sometimes I think we are trying to repeal the law of gravity.

There are natural instincts that young people have, and they are

educated by their parents hopefully first to know proper conduct,

and hopefully are given informed information in their process of

going to school and so on. I am a chief cosponsor of the Responsible

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Education About Life [REAL] Act, which was introduced by Barbara Lee, and its whole purpose is to provide a comprehensive approach to sex education that includes information both about abstinence and contraception.

I read these questions and I thought, you know what? Maybe

they shouldn’t have been asked by someone in school in a program,

but they turn on their TV and they see it.

We have had testimony in Congress where young people didn’t

realize that oral sex they could transmit disease. They just weren’t

informed, and they thought that wasn’t sex, maybe as defined by

the former President of the United States.

But the bottom line is I don’t understand why you wouldn’t make

sure that young people had all the information to counteract all the

information they are getting every day from the news media, from

TV, from programs, from books. I mean, the books I used to read

were so ridiculous compared to what kids read today. But, frankly,

if it be told, probably every one of my fellow boys and young men

that were at school would have had sex if the girl had said yes. So

your parents basically tried to determine who you were going out

with, what kind of girl you were out with. It is a different world

today. It is a different world, Senator, than you grew up in.

I just don’t know how we are going to help young people if we

don’t give them the information they need to make the choices, to

know that they could get ill if they do certain things, to know the

benefits of abstinence in the context of truly loving someone.

I would like you both to speak to that, in terms of what kids get

every day in the media. So these questions aren’t shocking. They

get it every day. They see it. They read about it. Why shouldn’t

they talk about it?

Senator BROWNBACK. Well, first, thanks, Chris, and, believe me,

I know we are not in the world I grew up in. I have children operating in this culture. My older daughter is doing Teach for America

in Houston in 7th grade, and the things she hears, that does shock

me. So I am getting that.

But I think there is an issue here. What about setting a high expectation? What if she in that 7th grade class sets a very low expectation and, you know, whatever you want with it.

Mr. SHAYS. I don’t know what you mean by expectation. A high

expectation to me means treating a young people with respect that

they get the information they need to counteract the information

they are getting from somewhere else, so I don’t know what you

mean by respect.

Senator BROWNBACK. Well, what I mean by high expectation is

maybe buttressing the expectations of their parents instead of attacking them or saying, well, we don’t think you are really going

to make that, so therefore let’s go this route.

There is a downside to not having high expectations. There is a

clear downside. I think we should do that even in behavior areas.

What I am submitting here is that I think you can look at all

these abstinence programs and find ones that haven’t worked. I

think that is good. Let’s not do that. But let’s fund the ones that

do work so you really are buttressing what 80 percent of the parents want.

Mr. SHAYS. Thank you.

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Ms. Capps.

Ms. CAPPS. Again, I agree with so much of what the Senator is

saying, and I totally support you. I am on the same legislation that

you are co-authoring with our colleague, Barbara Lee. I would simply say that the studies are showing that the more information

young people have the better decisionmaking skills they can employ, if they are taught some decisionmaking skills along the way.

Schools are asked to do a lot of things today. They are asked to be

parents and they are asked to bring up, for those kids who come,

you know, with limited foundation at home, they are asked to teach

young people to make good decisions, how to do that. But I believe

that when you tie a hand behind your back when you are withheld

information, you set up a sense of lacking trust. In fact, comprehensive sex education classes have encouraged young people to

delay sex because they know all of the information.

Our teen program where the babies were there with the moms

in a classroom setting was a big deterrent for kids having sex.

They saw what happens when you do.

Mr. SHAYS. Thank you.

Thank you, Mr. Chairman.

Chairman WAXMAN. Thank you, Mr. Shays.

Mr. Welch, you are next.

Mr. WELCH. Thank you, Mr. Chairman.

Senator Brownback, in listening, everyone agrees that we want

to have kids protected as much as possible, so really it seems like

this is a tough discussion and debate about what is effective to help

kids make the right choices. But, as I understand your testimony,

your view is that there should be no sex before marriage?

Senator BROWNBACK. I am saying 8 of 10 parents surveyed want

that, and I am saying in our family that is what we talk about.

Mr. WELCH. And I obviously completely respect that. But I understand the statistics are that 95 percent of the American people

do have sex before marriage.

Senator BROWNBACK. Well, the material I was looking at and

that I think even the ranking member was citing was below 50 percent on teens, and I don’t know of the full number of what you are

talking about on before marriage activities.

Mr. WELCH. I think it was a USA Today survey, and my understanding is that is a pretty accepted figure. But the question here

I think that we have to resolve is effective use of taxpayer dollars

to achieve the goal of diminishing teen pregnancy and diminishing

sexually transmitted disease. Would you agree that is a shared

goal?

Ms. CAPPS. Yes.

Mr. WELCH. All right. So I would ask really both of you, bottom

line, whether it is a comprehensive sex education program or an

abstinence-only sex education program, that those programs should

be subject to strict scrutiny for effectiveness before we allocate a

taxpayer dollar. Do each of you agree with that?

Senator BROWNBACK. If I could, absolutely. But you can’t just

look then at abstinence programs, you need to look at comprehensive ones that get, by far, the lion’s share of the dollars, and obviously it has not worked.

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Mr. WELCH. I agree that they should be both looked at. That is

what I am asking. Any time we spend money, we have to do oversight to see whether the intended purpose is being achieved with

the money we are spending.

Ms. CAPPS. Can I respond to that? You are talking about tax dollars, and it has come up before. To my knowledge, I want to address something that has come up where these figures come around

like we spend $12 for comprehensive sex education, Federal dollars, for every dollar that is spent on abstinence-only education.

The truth is very different. To my knowledge the Federal Government has never funded comprehensive sex education as taught in

a classroom, but rather these dollars are lumped together which

are part of Title X, and all of the services, direct services that we

provide for every age group through the Federal programs that we

provide in family planning and contraception. I think those are

very different.

I am not so sure that we want the Federal Government doing

anything prescriptive about what curriculum my grandchildren and

your children would be taught in a school district. I think school

districts and school boards and parents have the right and obligation really to choose what is appropriate for them. What I think we

can lay out in these bills that I mentioned and that our colleague

Mr. Shays is a coauthor of talk about the importance of doing that

and making funds available so that districts can choose the appropriate methods that they want to teach.

Mr. WELCH. Thank you.

You know, we have been referring to this GAO report that has

done a study of abstinence education programs and come to the

conclusion that they are not effective. Now, if that is the report

that gives us guidance and money spent on these programs is not

achieving the intended result, would it be your position, Senator,

that we should continue to spend more money on programs that

are judged to be ineffective?

Senator BROWNBACK. My position would be I think you should

look at all the studies. There are studies that I cited. You are going

to have another witness here today that is citing studies of ones

that have worked. My position would be that you should look at

those that work so that you are really going in flow with what the

parents of the country want. The parents of the country want their

children to be abstinent. That is what they do in the survey results. So why would we flow against it? Why wouldn’t you find the

ones that are working well and then let’s fund those? And you really should look at comprehensive, because that is where we put

most of the money, and that hasn’t worked.

Mr. WELCH. Well, the dilemma we have is this: those of us who

advocate always find something to hang our hat on to justify our

position. That is you, it is me, it is all of us. But there are referees,

and the GAO, when they do these studies at our request, is, in effect, an arbiter, and we either can disregard their study or accept

the results and act accordingly.

My understanding is that the study that the GAO has done, kind

of a peer reviewed study, has concluded that these abstinence-only

programs are not achieving the results that you would like to see

achieved, so why would we spend more money?

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Senator BROWNBACK. I would hope you would look at all studies,

sir.

Mr. WELCH. OK. Thank you, Senator.

Chairman WAXMAN. Thank you, Mr. Welch.

Mr. Burton.

Mr. BURTON. Thank you, Mr. Chairman.

Let me just say I am going to yield to my colleague from Indiana,

Mr. Souder, but before I do let me just whistle into the wind a little

bit. Mr. Shays mentioned what children are exposed to all the time,

and I am sure this isn’t going to change, but one of the things that

disturbs me so much is there is a constant barrage of sex and violence on television all the time. I know that you can’t really stop

it, I guess, but that has to be a contributing factor to the violence

that we have seen in places like Columbine and this boy that was

stopped from blowing up his school the other day and these college

campus attacks. We have to figure out some way as a society to cut

back on the sex and violence that we are consuming, because as

long as we do that, the kids are going to get a steady diet and you

are going to have this thing go on and on.

With that, I yield to Mr. Souder.

Mr. SOUDER. I would first like to correct the record on a couple

of things. I didn’t use 12–to–1. I used 2–to–1 Federal funding

for——

Ms. CAPPS. I am sorry. I have seen 12–to–1.

Mr. SOUDER. And you said that. You said you have seen 12–to–

1. You didn’t say that I said that, but I wanted to point out that

I said 2–to–1 in direct Federal funding, 68 percent of the schools

offer contraceptive education compared to 25 percent offering abstinence education. Not all of that is Federal funding and not all of

it is even dollars, but that is also a fact. And there are 10 Federal

sources for funding for contraceptive education and just 1 for abstinence education.

Now, depending on what a school does with that funding, they

may not use it for the curriculum. They may be blending this with

local funding from different health groups, like in our community

part of it is funded by Planned Parenthood directly, maybe not

from Government funds, or from a health center, not from Government funds. But the fact is that the disproportionate amount of

money in the United States is, in fact, going to contraceptive education.

And we are also really happy to see that a number of people here

seem to be expressing disappointment, even on the majority side,

that we aren’t looking at science on not only abstinence education

but on the other, because clearly study after study have shown that

contraceptive education hasn’t worked on HPV, has not worked, either. And you can’t just apply science when you ideologically oppose one goal but then not look at science, and we shouldn’t pretend like science, GAO, or otherwise has defended the effectiveness

of contraceptive programs.

But there is another fundamental question here that we are debating, and that is that 70 to 90 percent of American people oppose

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ually active; 70 to 90 percent want a strong abstinence message

taught.

Do you believe, Senator Brownback and then Ms. Capps, that the

public, what they want from the schools, is at all relevant in this

debate?

Senator BROWNBACK. I would hope it is relevant in this debate,

and if it is not, you are going to be running at counter purposes

and people are going to be arguing with it all the time and it is

not going to be effective. But if we will work in concert with parents, I think we can have an effective program moving on forward.

Ms. CAPPS. Thank you. I want to stress again that all of us—and

I am now going back to my past life as a school nurse—in the local

schools I don’t know a person who doesn’t favor abstinence-only

until it comes to the point of the knowledge that is available should

abstinence not work for a particular child. We can’t control what

happens to them after school. Most of us want not abstinence-only

but abstinence coupled with an understanding of available resources should they need it.

Now, I also would like to say that I have never been a part of

a plan or program that is called contraceptive education. I have

only been associated with anything in my schools where I worked

that was comprehensive sex education that included abstinence

and also gave other information.

Now, what I would say is that this decision, the public has its

way of recording its desires and what it believes in and so forth,

but really the important people in this conversation who we are

talking about are the parents who send their kids to public school

every day.

Mr. SOUDER. How do you handle this question, and that is that

those using the male condom at first sex has tripled from 22 to 67

percent, contraceptive use has nearly doubled since the 1970’s to 79

percent, and yet STDs and other problems are still increasing. How

can anything but abstinence be said to be working?

Ms. CAPPS. Abstinence works 100 percent, and that is why it

should be the core of any kind of comprehensive education that involves sexuality with teenagers. Again, the decision should be

made by the parents, and the young people are asking for information, and if they are asking they should get reliable information.

Chairman WAXMAN. Thank you very much.

I am going to now recognize Ms. Norton, but I want to indicate

that our second panel will discuss evaluations of both and all sex

education classes, which I think will be very helpful for the committee.

Ms. Norton.

Ms. NORTON. Thank you, Mr. Chairman.

I have had the pleasure of working with you both, and I want

to thank you both for very important leadership that I am personally aware of. Ms. Capps, you have become a particular leader on

health issues here in the Congress, and Mr. Brownback and I have

worked together on a number of issues, including issues that

proved controversial in some forms—the marriage issue, where

there has been a decline among African Americans. It is catastrophic. And I must say a similar decline among white people, except for people in the upper middle and upper classes.

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May I thank you, Mr. Brownback, for what you said about Best

Friends. Best Friends has done an extraordinary job in the District

of Columbia with its abstinence-only approach. The kind of caring

attention that it gives is rare for any program. I know you did not

mean to indicate that was what abstinence programs usually offered; nevertheless, this has been an extraordinary program of

great value to us and the children and the parents that have chosen it.

I don’t understand why this subject has been so contentious. I

agree with Mr. Brownback we ought to look at all the studies.

Don’t put a dime on comprehensive sex education programs that

don’t work. Test them in the same way that we test abstinenceonly programs.

The concern that many of us have with abstinence-only programs

is the notion that there would be any such matter where one size

could possibly fit all. It is so individual, so family oriented.

Mr. Brownback, you have been Chair of the D.C. Appropriations

Subcommittee. I don’t need to tell you that you would be laughed

out of many classrooms in the District of Columbia if you talked

about abstinence where the children come to junior high school and

high school already experiencing sex. This troubles me greatly. I

wish there were some way. I cannot imagine wanting my own child

to do anything but abstain until marriage. Frankly, that would be

my wish. I would do everything I could to encourage that to happen, and many parents find that is a failing effort today.

My question is particularly, Mr. Brownback, I know from my

friendship with you, from your own work, your respect for local

control, for the views of parents, the sensitive way you have handled the marriage funding that we did here, all with consent and

encouraging greater marriage in some of our poorer communities.

I am wondering why committing this to local control, where you

might have some people—and I can tell you there would be some

in the District that would say, I want a program like Best Friends

in my community, and where you would have others with parents

who are at their wits’ end. Many of them are poor parents and single parents. Many of them are single parents of boy children. They

can’t begin to even talk with them about sex. If there is somebody

in school that will give them the whole deal when this mother who

works every day as a single mother doesn’t even know how to approach the subject, is poorly educated, if you tell her that her son

or her daughter should have an abstinence-only program she will

be puzzled.

Would there be any harm in allowing local communities to make

this decision based on their own family needs, based on the composition of the community? Would that be consistent with your values and mine?

Senator BROWNBACK. First, let me say it has always been my

pleasure to work with you, and I was looking at you and thinking

there is nobody on your side of the aisle that has gotten more votes

out of me than you on a whole range of topics, and I can’t recall

me getting one back from you.

Ms. NORTON. There is one more I want from you, too.

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Senator BROWNBACK. I just want my first out of you. That is all

I am looking for. I can’t even get her to—I don’t know, did you

cheer for the Jayhawks in the final four?

Ms. NORTON. Don’t change the subject, Sam.

Senator BROWNBACK. I just wanted you to at least give me that.

You know, I have enjoyed working with you. I have enjoyed

working in D.C. I know you say I would get laughed out of the

classroom. I recall I think we were getting laughed out when we

were promoting marriage. There are certain areas that people getting married is unusual within that block or that area. Now we

have people that are getting married in some of these communities.

Ms. NORTON. Yes, but we don’t have marriage only. We encourage them to come in. It is the exclusivity of the approach.

Senator BROWNBACK. I know, but let me make my point on this.

Let me make my point, because you are very good at making yours.

Ms. NORTON. OK.

Senator BROWNBACK. Senator Moynihan, I took a lot of guidance

from him before he left this body and passed away, and his view

was the key thing we ought to be focused on is how you raise your

next generation. The key thing you ought to be focused on is how

you raise your next generation. I think for us, the Federal Government, to say, here are funds that we believe this is the high expectation approach is fully appropriate for the Federal Government to

do, of a high expectation.

Now, you are saying a bunch of States say we don’t want it.

Maybe the District of Columbia has said the same thing. We have

a lot of money going to the sex education programs. GAO says it

is 5–to–1 on comprehensive. There is a lot of funds going in there.

I think this amount that we are putting in, what I would be critical

of on it is that I think we need to make sure we are at ones like

Best Friends that work and not ones that don’t work. I think that

really is where our focus should be.

Chairman WAXMAN. Thank you, Ms. Norton.

Let me advise the members of the committee that our two witnesses have other responsibilities and are anxious to go to them.

I don’t want to deny or deprive any Member of an opportunity to

ask questions, because our rules do provide for 5 minutes.

Let me ask Members who are cognizant of that fact to try to

limit your questions, recognizing the time constraints of our witnesses.

Ms. FOXX. Mr. Chairman.

Chairman WAXMAN. Yes.

Ms. FOXX. I am having difficulty hearing people down here. I

would just like to ask if people could really put the mics close and

speak up. I just ask for clarity. I would really appreciate that.

Thank you.

Chairman WAXMAN. Good point.

Mr. Duncan.

Mr. DUNCAN. Thank you, Mr. Chairman. I have someone waiting

in my office, so I will be very brief.

Senator Brownback just said a few minutes ago that the culture

is pushing in the opposite or harmful direction at times, and someone else mentioned the TV shows and the movies, and they all

work together to almost seem to pressure young people into thinkVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00087 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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ing that they are odd if they don’t have early sex. But Senator

Brownback just mentioned Senator Moynihan, and Senator Moynihan made a famous statement several years ago. He said we

have been defining deviancy down, accepting as a part of life what

we once found repugnant. That seems to become more true with

each passing year. So I think Senator Brownback is right when he

says that we should encourage people to higher expectations or

higher or better goals.

There is some discrepancy that I don’t understand. Maybe the

witnesses can explain it later. But there is a Heritage study that

came out yesterday that said we spend 12 times this much on comprehensive sex education as opposed to abstinence-only education,

but the Zogby poll that has been mentioned showed that by more

than a 2–to–1 margin that parents want or prefer the abstinence

approach, and it seems rather elitist to me for people who maybe

have degrees in this field to feel that they, because they have studied it, somehow know better than the parents what is best. I still

think parents know what is best for their children.

The message that teens receive from abstinence is pretty simple

and very clear. The only way to avoid all the harmful consequences

of sexual activity is to abstain. Education about abstaining teaches

young people how to set goals and build healthy relationships. So

I don’t think it is something that we should abandon, which seems

to be sort of the thrust of where we are headed.

The people who want to encourage young people to abstain could

have produced numerous witnesses here to support or to show that

this type of training is working, and so with that I will yield whatever time I have left to Mr. Issa.

Mr. ISSA. I thank the gentleman, and I will try to use this time

rather than any further time.

Lois, Sam, if we can get you two to agree on things I think it

would go a long way toward this committee doing the right thing.

Nancy Reagan, a famous California lady, had the expression Just

Say No when it came to drugs. It didn’t work, did it? People still

use illegal drugs, don’t they?

Ms. CAPPS. Yes, they do.

Mr. ISSA. OK. We agree. But don’t we also agree that the message of not doing illegal drugs is a good one to continue having?

Ms. CAPPS. Are you asking me?

Mr. ISSA. Both of you.

Ms. CAPPS. All right. I will answer quickly.

Mr. ISSA. I am looking for all yeses, because I think in a sense

we are concentrating on what we disagree on rather than what we

agree on.

Ms. CAPPS. We agree on that, but I guess I would say knowing

why you are saying no is a good idea.

I apologize. I am going to have to leave the rest of this.

Senator BROWNBACK. I agree.

Mr. ISSA. So, Senator, continuing on with you, when we get to

what is being called abstinence here, aren’t we really just saying

no, but the reason it is a chorus and not just abstinence is that it

takes longer to explain to young and women why there are advantages health-wise, relation-wise, future-wise, that, in fact, abstiVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00088 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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nence training is a process of teaching why waiting makes sense,

isn’t it?

Senator BROWNBACK. Absolutely. And you didn’t touch on the

emotional side of it, but you are dealing with a teenage person generally with this, and the emotional side of this is so critical. And

you are finding, too, in these studies that I have reviewed, that the

abstinence programs that work the best generally spend the most

time. They spend a lot of time drilling into these concepts as to

why. And those are the ones that are more successful, not a superficial deal.

Mr. ISSA. So, just to conclude, because my time is limited, too,

or Mr. Duncan’s time is limited, two things: one, even though we

will not have 100 percent success in abstinence, even though the

figures will show that it does not work all the time, there is no reason not to continue doing it, for the same reason as we continue

to teach not to take illegal drugs because men and women are

dying in America.

Senator BROWNBACK. Agreed.

Mr. ISSA. And then, last, when it comes to the other side of the

issue, teaching people that transmittable diseases have to be prevented and teaching about the consequences of those, that has to

be done regardless of whether you are teaching it through abstinence or you are teaching it through other parts of sex education.

That is just as important for men and women for their protection,

young men and women.

Senator BROWNBACK. I have a book here that we could enter into

the record that is an abstinence education booklet that teaches

about that, as well.

Mr. ISSA. Thank you. Mr. Chairman, I would ask the chairman’s

consent that be entered into the record.

Chairman WAXMAN. Without objection, that will be the order.

Mr. ISSA. Thank you, Senator.

Thank you, Mr. Chairman.

Chairman WAXMAN. Ms. Watson, do you wish to take your time?

What some of the Members are going to be doing on the other side

is splitting their time.

Ms. WATSON. OK. I will be real quick. I would like permission

to submit my speech into the record, please.

Chairman WAXMAN. Without objection.

Ms. WATSON. I just wanted to say this. As I listened to these two

very fine, fine colleagues of mine, I see an ideological discussion

versus a reality discussion. Abstinence-only is more ideological

rather than comprehensive sex education programs. Reality.

I represent a community called Hollywood, and so many of the

young people in my District and in California look at these performers as idols, and we watch their behavior and they pattern

after that behavior. Abstinence-only does not reach in a comprehensive way these young people, because they take their lead

from what they see on the Internet, what they see on television,

what they hear in terms of music.

So my question is: how do we get to the range of experiences

when we talk about abstinence-only? Also, I represent an area

where there are no fathers in the home, and mothers are there taking care the best they can. They are busy working one, two, and

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three jobs. They don’t have time to focus on discussions of sex when

the youngsters are on the streets and they take the lead from their

peers. So my question to you, Senator Brownback: how do we then

convey with funding only for—California turned down the abstinence-only funds. How do we convey to our young people when we

don’t have an intact home, we don’t have a functioning home, we

don’t have two parents in the home, and we don’t have the resources to really address abstinence-only? We really need to look

at a comprehensive sex education program.

Senator BROWNBACK. Well, No. 1, I think you and the chairman

probably represent the Districts that could affect this debate more

than anybody else in the whole world, and your working with people in your Districts would probably do the most to change this

whole debate of anybody anywhere because of what is coming out

culturally——

Ms. WATSON. Taking back my time for a second, I have a bill out

there that we are using films as diplomacy. it happens to be down

in South Africa, because we are looking at the spread of HIV/AIDS.

I would like to talk to you about going on as an author, because

what we are trying to do is use those quality films to impress certain behaviors in other people and certain respect for us here in the

United States. I would like to talk to you about it, because we are

trying to use a media to give the right messages.

But I don’t see it in a narrow perspective of abstinence-only. We

have to face the reality of the audiences that we are dealing with,

and we are trying to do that through a means of communication.

We are going to use films, Hollywood.

Senator BROWNBACK. I work with a number of people from Hollywood a lot on African issues, because I have been involved a lot

with the African continent. They are the ones that could change

this debate more than anybody else. I would hope and pray they

would do it in an abstinence and be faithful setting.

Ms. WATSON. But, you see, that is not the only means.

Senator BROWNBACK. I know that.

Ms. WATSON. Yes.

Senator BROWNBACK. You know that. But there is an expectation

that we can set for society, we can set for our kids. You know, I

want you to make all A’s.

Chairman WAXMAN. And not see those movies and not listen to

those records.

Senator BROWNBACK. But my point is I don’t set a low

expectation——

Chairman WAXMAN. I think you can do t in Kansas, not only in

Hollywood.

Senator BROWNBACK [continuing]. And nor should the Federal

Government set a low expectation.

Ms. WATSON. Just the bottom line is I don’t think one size fits

all, and that is the reason why California turned, because we deal

with the realities of our various diversified segments of California,

and we have to send a comprehensive message out there and hope

that it can be backed up in the home and in the community as a

whole.

Senator BROWNBACK. The comprehensive message hasn’t worked.

We have one in two African American teenage girls with an STD.

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Ms. WATSON. Well, abstinence-only, and we have results from

other areas where it has not worked, so I don’t know if we are

using our money wisely.

Thank you, and I yield back my time.

Senator BROWNBACK. The current approach hasn’t worked.

Chairman WAXMAN. We are going to find out from the next

panel, because they have done actual measurements, not just given

us opinions. Let’s find out what has worked.

Senator, we still have some other Members who wish to ask you

some questions.

Senator BROWNBACK. I am way past due on another set of activities that I was supposed to go to. I need to move on if I can, Mr.

Chairman.

Chairman WAXMAN. Well, my colleagues, I don’t know what to do

here, but I think out of respect to the Senator, who has given us

very generously a great deal of his time, I think we ought to release him, unless there is objection.

Mr. SOUDER. Reserving the right to object, what I have said is

I will yield my time first on the next panel to the Members on our

side who didn’t get a chance.

Senator BROWNBACK. Mr. Chairman, thanks for your time and

thanks for your courtesy. I appreciate both greatly.

Chairman WAXMAN. Thank you so much.

For our next panel we have the following witnesses who will

share their assessment of the existing body of evidence on abstinence-only and comprehensive sex education programs.

Dr. John Santelli is a professor and Chair of the Halbren Department of Population and Family Health at the School of Public

Health at Columbia University and a senior fellow at the

Guttmacher Institute. He is a pediatrician, an adolescent medicine

specialist who has conducted research on HIV/STD risk behaviors,

programs to prevent STD, HIV, and unintended pregnancy among

adolescents, women, school-based health centers, and research ethics.

Dr. Georges Benjamin has been the executive director for the

American Public Health Association, the oldest and largest organization of public health professionals in the United States, since December 2002. His prior positions include chief of staff for Emergency Medicine at Walter Reed, and he is also a member of the Institute of Medicine, National Academies of Science.

Dr. Margaret J. Blythe is Chair of the Committee on Adolescence

for the American Academy of Pediatrics. She is a professor of pediatrics at Indiana University School of Medicine.

Dr. Stanley Weed is the director of the Institute for Research and

Evaluation, which he and colleagues formed in 1988 to focus on social problems and programs related to adolescence, including teen

pregnancy, drug abuse, and delinquency.

Finally, we are very honored to have Dr. Harvey Fineberg, president of the Institute of Medicine of the National Academies. At the

IOM he has chaired and served on numerous health policy panels

ranging from AIDS to new medical technology.

The last two speakers on this panel will help us put a face on

the scientific evidence we discuss here today.

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At the age of 15, Shelby Knox led a campaign to replace her high

school’s abstinence-only curriculum with medically accurate, comprehensive sex education after realizing the programs were ineffective in preventing rising teen pregnancy and sexually transmitted

diseases. Today she is a writer and speaker on youth and reproductive health.

And Max Siegel leads student-based HIV prevention interventions and is a policy associate at the AIDS Alliance for Children,

Youth and Families.

We are pleased to have you here us at this hearing. Your prepared statements will be made part of the record in its entirety. We

would like to ask each of you, however, to limit your oral presentations to no more than 5 minutes.

Dr. Santelli, we will start with you. There is a button on the base

of the mic. Please be sure it is pressed in so that the mic is working. We will start with you.

STATEMENTS OF JOHN SANTELLI, DEPARTMENT CHAIR, PROFESSOR OF CLINICAL POPULATION AND FAMILY HEALTH,

MAILMAN SCHOOL OF PUBLIC HEALTH, AND PROFESSOR OF

CLINICAL PEDIATRICS, COLLEGE OF PHYSICIANS AND SURGEONS, COLUMBIA UNIVERSITY; GEORGES BENJAMIN, EXECUTIVE DIRECTOR, AMERICAN PUBLIC HEALTH ASSOCIATION; MARGARET J. BLYTHE, M.D., CHAIR OF AMERICAN

ACADEMY OF PEDIATRICS’ COMMITTEE ON ADOLESCENCE;

STANLEY WEED, PH.D., DIRECTOR, INSTITUTE FOR RESEARCH AND EVALUATION; HARVEY FINEBERG, M.D., PH.D.,

PRESIDENT, INSTITUTE OF MEDICINE OF THE NATIONAL

ACADEMIES; MAX SIEGEL, POLICY ASSOCIATE, AIDS ALLIANCE FOR CHILDREN, YOUTH AND FAMILIES; AND SHELBY

KNOX, YOUTH SPEAKER

STATEMENT OF JOHN SANTELLI

Dr. SANTELLI. Thank you, Chairman Waxman, distinguished

members of the committee, and guests. Thank you all for the opportunity today to speak to you about the health needs of adolescents and my own research on abstinence-only education.

My name is John Santelli, as the chairman indicated. I am a pediatrician, a father, and chair a department at Columbia.

Importantly, before moving to New York City I worked for 13

years with the CDC and, in fact, 5 years as a school health doctor

for Baltimore City, worked extensively in research ethics.

In the past few years I have conducted research that seeks to understand adolescent sexual behavior and the reasons for the recent

declines in teen pregnancy rates. That is what I would like to

speak with you about today.

My written testimony goes into some of the other important scientific and ethical critiques that have been raised about abstinence-only education for young people. I brought slides today, so I

hope this works.

[Simultaneous slide presentation.]

Dr. SANTELLI. First I would like to speak about some of the demographic realities for young people. I would suggest to you that

the current U.S. emphasis on abstinence-only or abstinence-untilVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00092 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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marriage is out of touch with the broad demographic trends and

the realities of young people’s lives. Premarital sex is nearly universal among young people. Based on CDC data, by the time one

reaches age 44, 99 percent of Americans have had sex, and 95 percent have had premarital sex.

This reality is the result of both trends toward an earlier age of

sex, beginning in the 1960’s at some point, but also later trends in

marriage. So, as the slide shows, in 1970 there was a gap, a small

gap of only about a year-and-a-half between first sexual intercourse

and marriage, but by 2002 the gap for young women was a full 8

years. For young men it is more like 10 years. This is a fairly universal phenomenon. It is seen around the globe, this rising age at

marriage. And it suggests that trying to get young people to wait

until marriage is going to be somewhat unrealistic.

This is just to remind you of the statistic that has already been

mentioned today. Teen pregnancy rates really declined fairly dramatically. Beginning around 1990 both teen birth rates and teen

pregnancy rates declined pretty dramatically. The biggest declines

have been among young people, often among minority youth, and

that is all good news.

Of course, there is this worrisome trend that is a little hard to

see, but in 2006 the birth rates went up. Let me then talk about

some of the explanation for that.

Recent declines in teen sexual activity appear to be unrelated to

the Federal program. According to data from CDC, rates of sexual

experience among high school kids grades 9 to 12 declined from

about 54 percent in 1991 to about 47 percent in 2002, and essentially have been flat since 2001.

Much of the reduction in the rates of adolescent sexual activity

occurred before the Federal Government began widespread funding

of abstinence education in 1998. You can see the points at which

the two Federal programs were instituted.

My own research suggests that most of the decline in teen pregnancy rates, about 86 percent among 15 to 19-year-olds between

1995 and 2002 was the result of improved contraceptive use. Not

surprisingly, abstinence played a somewhat greater role for the

younger kids, those 15 to 17, but even in that group three-quarters

of the decline was the result of improved contraceptive use. This

is data based on the CDC’s National Survey of Family Growth, but

we have recently repeated that data using the Youth Risk Behavior

Survey data, and again we found about 70 percent of that decline

was the result of improved contraceptive use, consistent, I would

suggest, with the European experience where European teens have

much lower pregnancy rates, similar rates of sexual involvement,

but much, much better contraceptive use, and therefore much lower

pregnancy rates.

Unfortunately, these positive trends in contraceptive use reversed in 2005. Again, the top line is condom use, but you can see

many of the other methods listed there. And you can see that in

2005, again in the high school data, condom use declined somewhat. Use of no method increased somewhat. This lines up precisely with the increase in birth rates. It is only a 1-year change,

but we need to keep monitoring this.

Chairman WAXMAN. Thank you very much, Dr. Santelli.

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Dr. SANTELLI. Am I out of time?

Chairman WAXMAN. You are.

Dr. SANTELLI. OK.

Chairman WAXMAN. Do you want to make a concluding statement?

Dr. SANTELLI. Let me just say one thing. I think a lot of what

we are going to hear today or we have already heard today are differences of opinion about the facts. Good commonality on our goals.

We all care about young people and I am glad to hear that. I think

the panel today represents the folks who put together scientific and

medical consensus in this country, and I hope we will stop arguing

over the facts and move on to what we know works.

Thank you.

[The prepared statement of Dr. Santelli follows:]

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Chairman WAXMAN. Thank you very much.

Dr. Benjamin.

STATEMENT OF GEORGES BENJAMIN

Dr. BENJAMIN. Good morning, Mr. Chairman and members of the

committee. Let me just first of all thank you very much for having

this hearing and just say that I am here representing the American

Public Health Association, and we adopt policies every year looking

at very, very important public policy issues. We have addressed

this issue in 1990, 2003, 2005, and then again in 2006.

Let me just say the bulk of our policies certainly recognize the

critical, critical importance of ensuring abstinence. I think every

public policy person and every parent certainly wants to do that.

But we have expressed significant concern about abstinence-only

programs, and actually would call for their termination in terms of

Federal funding in their current form.

We have had three areas of concern. Area of concern No. 1 is fundamentally do they work. We think certainly that the weight of the

evidence today, as they are currently constructed they do not work.

What I mean by work means that do they create abstinence and

do they create the public health outcomes that we really need in

the long term. We don’t think that they do that.

Second, just to point out that we do believe that the alternative

is comprehensive health education, particularly around sexuality

issues, and we do think they work. We think that certainly nothing

is perfect, but when you compare the two, that the comprehensive

approach is much better.

Second, do the abstinence-only programs complicate other public

health measures? The answer to that we certainly think is that

they do, and they do in a variety of ways. One, they cause a great

deal of confusion. One of the things I have learned, both in my time

practicing clinical medicine, and, of course, certainly my time as a

parent, that our kids are much farther along than we think they

are. They know much more and they are a whole lot more curious

than we think. So when you give them only a single message, they

are going to seek the stuff we don’t tell them in other places.

These programs in many cases don’t give the kids the tools that

they need, the facts that they need to combat inappropriate or inadequate or unscientific information that they may hear or pick up

amongst their peers or in other places. We think there are lots of

problems with that.

We think that there has been real targeting on the efficacy of

condoms as an alternative, again, for those children for which abstinence has now failed. It really doesn’t give them the tools to go

about that, because of the lack of facts.

We think that certainly the fact that 17 States have now said

that they are not going to take funding, having been a health officer in two jurisdictions, here in the District of Columbia and in the

State of Maryland, I can tell you for a health department to give

up funding is a very, very significant act. That is money that could

go for very important public health efforts.

And then I think finally significant ethical concerns. As a clinician, one of the challenges that I have always is figuring out what

to tell people, what to tell patients, what to tell the community. I

154

have discovered the best answer to that is to tell them what I

know, tell them what I don’t know, to be very clear with them, to

tell them at a level, either if I am writing, at a literacy level, or

in speaking, in a language that they will understand, that is culturally appropriate, that is age appropriate, and to deal with that

in the most honest way that I can.

My real concerns, I think the concerns of APHA, is that, at least

as currently constructed, these abstinence-only programs on bulk

don’t do that, and so we have real significant concerns about their

continuation.

With that I will stop. Thank you.

[The prepared statement of Dr. Benjamin follows:]

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Chairman WAXMAN. Thank you very much, Dr. Benjamin.

Dr. Blythe.

STATEMENT OF MARGARET J. BLYTHE

Dr. BLYTHE. Chairman Waxman, Ranking Member Davis, members of the committee, good morning and thank you for inviting me.

As a current Chair for the Committee on Adolescence, I have

been asked to give testimony regarding the position of the American Academy of Pediatrics on Abstinence-Only Education and comprehensive sexuality education and the evidence supporting this

decision.

The American Academy of Pediatrics supports age-appropriate,

comprehensive sexuality education and wants to ensure that our

Nation’s resources are being allocated toward educational approaches that are science based, emphasize abstinence, but also

provide medically accurate information for those teens contemplating or already having sexual experiences. That support for comprehensive education is apparent in the policies that we have written and endorsed and listed in this testimony.

Nearly all teens experience pressure to have sex at some time,

and therefore nearly all teens are at risk for having a pregnancy

or a sexually transmitted infection. Abstinence-only programs have

not been proven to change or impact adolescent sexual behaviors

in an effective way, as documented by five reviews, which include

the federally funded evaluation. Yet, vast sums of Federal moneys

continue to be directed toward these programs.

In fact, there is evidence to suggest that some of these programs

are even harmful and have negative consequences by not providing

adequate information for those teens who do become sexually active. Comprehensive sexuality education supports abstinence as the

best strategy in which a teen can use to decrease the risk of unintended pregnancy and sexually acquired infections. Those adolescents who choose to abstain from sexual intercourse should obviously be encouraged and supported in their decisions by their families, peers, and communities. But abstinence should not be the only

strategy that is discussed. Rigorous scientifically valid research

supports the effectiveness of comprehensive sexuality education in

delaying the initiation of sexual intercourse and reducing risky sexual behaviors.

When the information presented is straightforward, that means

real or relevant to their life experiences and specific. That means

medically accurate and correct. This means that sex education

must include information on contraception and condom use.

Providing information to adolescents about contraception does

not result in increased rates of sexual activity, earlier age of first

intercourse, or result in a greater number of sexual partners. Emphasizing both abstinence and protection for those who do have sex

is a realistic, effective approach that does not appear to confuse

young people, only perhaps sometimes the adults around them.

But, despite the encouraging results that have been reported

when using comprehensive approaches, there have been no Federal

moneys directed specifically toward education programs. Getting

teens to delay having sex or to use safer sex practices remains a

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challenge, as there are many factors that determine sexual behavior, and estimates suggest that there are over 500 different factors.

The most recent data suggests for the first time in 14 years the

birth rate for teens in the United States has increased across virtually all racial and ethnic groups. A recent report by the Center

for Disease Control estimates that one in four girls between the

ages of 14 to 19 has at least one sexually transmitted infection,

and, as already indicated this morning, citing the ineffectiveness of

abstinence-only programs, 17 States have opted out of Federal

funding.

Adolescence is a time of growth both physically, psycho-socially,

and emotionally. Developing a healthy sexuality is a key developmental task for adolescents. As a physician, I spend the majority

of my professional time in the trenches. Each week I personally see

teens in consultation clinics, three different community sites, a

school-based clinic, and the county juvenile detention center. I also

serve as the medical director of the clinical program that provided

over 40,000 visits to teens last year in these different settings. In

every venue teens are trying to figure it out—who they are, where

they want to go, and what they want to be.

Adolescence is a time of trial and error, and, frankly, sometimes

they get burned even when appropriate information has been offered or given. But we do not want them to get burned just because

the information given or offered was inaccurate or distorted or not

available at all. We need available to us in the trenches evidencebased approaches that support healthy decisionmaking regarding

sexuality, which will benefit not only the health of the teens we

work with on a day-to-day basis, but ultimately the health of our

society and Nation as a whole.

Thank you.

[The prepared statement of Dr. Blythe follows:]

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Chairman WAXMAN. Thank you very much, Dr. Blythe.

Dr. Weed.

STATEMENT OF STANLEY WEED

Mr. WEED. Thank you, Mr. Chairman, for inviting me here today.

I have been working in this field for almost 20 years. I have

learned some things about abstinence education programs. I started with a very skeptical attitude thinking how in the world could

this work, given the culture and the society that kids live in. Since

that time I have learned that it can work. Not all of them do, but

many of them do, and we have learned which ones do and why.

I have also seen that there is a lot of misunderstanding and

misperceptions. Let me give you two examples.

One young man who was asked about if he was abstinent said,

No, sir. I am here every day. Another example, I have heard the

phrase abstinence-only maybe 100 times here today, and in the 100

programs that I have evaluated I wouldn’t classify any of them as

abstinence-only. They are much broader, they are much richer, and

they are much deeper than an abstinence-only just say no kind of

message.

[Simultaneous slide presentation.]

Mr. WEED. With chart No. 4 I would like to illustrate some examples of programs that work. This is out of Virginia. This program, the comparison group without the program, their initiation

rate 12 months later was 16.4 percent. The program kids, their

transition rate was 9.2 percent. That is a fairly substantial and significant difference in terms of impact on initiation rates.

Patterns of evidence are critical in terms of understanding program and policy effects. One rigorous study along is not sufficient.

Informed decisions require multiple studies with replication of results across populations, programs, and settings. Our goal should

be to look for patterns of research results that can inform best

practices for risk avoidance programs.

Here is another example. This one comes from Georgia. Our comparison kids, the transition rate for this group is 20.9 percent, and

for our program kids it was 11.1 percent—again, 47 percent is likely to initiate sexual activity, a fairly substantial impact in terms

of initiation rates.

The next example, this one comes from South Carolina, a large

study of kids where the comparison group initiation rates of sexual

activity is 26.5 percent, and in our program group it was 14.5 percent.

Again, in all three cases cutting initiation rates in half in a 1-

year time period.

Now, there is a public perception that abstinence education

doesn’t work and that contraceptive education does work. In fact,

there is a brochure out by the national Campaign to Prevent Teen

Pregnancy. There is a brochure that says we have strong evidence

about what works in preventing teen pregnancy. They list 28 programs, the impression being any 1 of these 28 will reduce teen

pregnancy; 20 of those 28 never measured the impact on teen pregnancy. The 8 that did measure it, 3 had results 12 months or beyond; 1 of the 3 was not a sex education program, 1 was retested

later and failed to find results, and 1 of 28 reported pregnancy reVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00179 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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duction beyond 12 months. That does not constitute, in my opinion,

strong evidence, nor does it support the public perception that we

have mounds of evidence that this works.

Douglas Kirby, a colleague of yours and mine, I think, reviewed

115 programs—released in 2007 called Emerging Answers—108

could be considered, could be categorized as comprehensive in

terms of providing contraceptive education to kids. However, only

22 of those 115 measured the most important measure of condom

use, which I think we all agree is consistent condom use. Of those

22, 1 reported an increase in consistent condom use, and this occurred in a clinic setting not in a public school education setting.

One reported no increase, but it did better than the comparison

group; 1 out of 115 does not constitute compelling evidence favoring

contraceptive education.

There is an important point here about measurement and impact

and effects. This critical measure of consistent condom use is the

best indicator of success. Anything less than this standard of effectiveness cannot be considered success. Inconsistent use, according

to the CDC, failure to use condoms with every act of intercourse,

can lead to STD transmission because transmission can occur with

a single act of intercourse.

So when we look at these programs, we are trying to compare

them and weigh the evidence—which I think is your goal and I applaud you for it—we have to look at these programs in terms of do

they have similar behavioral outcomes, and abstaining from sexual

activity is a clear one, and consistent condom use is as close as we

can come in comprehensive sex to that behavioral short-term kind

of outcome. We have to have similar target populations and appropriate and similar timeframes.

Based on comparability categories—that is, population and program settings are the same, followup is the same, outcome measures are the same—we have only got 8 studies in the abstinence

category, we have 34, and not all of them measure CCU.

Here’s the bottom line: even when we have comparable programs, the abstinence education in Kirby’s review showed 5 out of

7 increased abstinence and 9 out of 34 increased abstinence in the

comprehensive program. However, consistent condom use, zero out

of 34 in the comprehensive side, zero out of 34 that decreased STD

rates. It was three that decreased pregnancy, but one of them was,

as I mentioned, not replicated.

I see my time is up. I can hold my last two slides if there are

questions. Thank you very much.

[The prepared statement of Mr. Weed follows:]

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Chairman WAXMAN. OK. Thank you very much, Dr. Weed.

Dr. Fineberg, good to see you again.

STATEMENT OF HARVEY FINEBERG

Dr. FINEBERG. Thank you very much, Mr. Chairman, members of

the committee. I am Harvey Fineberg. I am the president of the Institute of Medicine. Prior to becoming the president of the organization, I did serve as the chair of the committee that was looking

into ways to reduce the risk of HIV infection, produced a report in

1999, No Time to Lose. Before that I served as dean at the Harvard

School of Public Health, and prior to that practiced part time in

neighborhood health centers in Boston. I have seen this issue from

a variety of perspectives.

I would like to make five points in my oral presentation to supplement the written testimony that I have submitted.

First point I would like to make is that we are dealing with very

complicated and variable interventions when we talk about sex

education. Even though we are lumping them in two big categories

of abstinence-only or abstinence-plus, the variety of elements in

these programs should be a cautionary note to us in trying to interpret their effects. Exactly what is included? Exactly who is taught?

Exactly how often? Exactly by whom? Over what timeframe? What

exactly is being measured as the outcome that you are interested

in? And how are you deciding whether or not the program is successful? These are all highly variable enterprises.

My second point: if you are looking for penicillin to treat pneumonia, something that has proven to work and is demonstrably

successful almost all the time, no one has yet found that magic formula for sex education. Programs can be variably successful for

variable times on variable outcomes, but fundamentally the dominant problems that we have in sexually transmitted infections in

our young people and the continued risks of exposure to infection,

as well as these other problems, are still very significant and still

the most important problem that I believe you, as Members of the

Congress, should be concerned with and attempting to help our Nation do better with.

My third point: because of all the variability and because of the

emotionality and the prefixed positions about what works or should

work, what do we want to work, one has to be especially scrupulous

in examining the evidence in order to try to discern what does it

tell us to date beyond this fundamental conclusion that there is no

dominant, clearly victorious, magic strategy that will solve all of

these problems.

And if you look at the studies that have tried to separate out the

most rigorous evaluations and combine them in these broad clusters of abstinence-only or abstinence-plus and ask them, when they

have looked at behavioral interventions, that is behavioral outcome

reports by individuals in the studies—are they having sex earlier,

are they having more or less sex, are they using protection—when

you apply those standards and look at the studies in that light, two

very significant reviews from the Cochrane Collaborative give us

the following bottom-line information: If you look at the abstinenceonly studies of the 13 that they included, none of those studies that

passed this rigorous methodologic standard demonstrated to have

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enduring behavioral affects. If you look at the 39 studies that they

classified as abstinence-plus—and there is a lot of variability of

what counts as abstinence-plus—23 of the 39 of those studies in

this rigorous review found at least some benefit reported on one or

another measure of behavior as a result of exposure to the programs.

Now, that doesn’t mean they worked very, very well, and it

doesn’t mean that it is impossible that other programs could be

constructed that would work better. In fact, my hope is and my

urging is that we will look for those.

So my fourth point is: if you want to base your judgment on the

evidence and where your dollars will go the furthest, to hamstring

the interventions and the assessments, to limit them to abstinenceonly education does not, in my judgment, comport with the evidence. It does not seem wise.

And my final point is that it is incumbent, I believe, to have a

more flexible, substantive, careful, evaluative approach, allowing

more different strategies to be tried that are built upon the evidence to date so that we can learn better what works over time,

and in another 10 years, when another committee is looking at the

question of sex education, we will not be in the same position that

we are today.

Thank you very much, Mr. Chairman.

[The prepared statement of Dr. Fineberg follows:]

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Mr. SARBANES [presiding]. Thank you.

STATEMENT OF MAX SIEGEL

Mr. SIEGEL. Good morning. My name is Max Siegel. Thank you

for the chance to address abstinence-only until-marriage, a policy

that has transformed my life.

I share my recommendations on how to improve sexuality education programs as a 23-year-old living with HIV who has spent

the entirety of his young adulthood working to prevent new infections. My goal is to portray the personal impact of this flawed policy, while explaining how the lessons I have learned may apply to

other young people who today make up 15 percent of all new HIV

infections.

Thank you to Chairman Waxman and the Committee on Oversight and Government Reform for including HIV-positive young

people in today’s hearing.

I experienced abstinence-only until-marriage education taught by

my junior high school gym teacher. In his class he told me and my

male classmates that sex is dangerous and that we should think

more seriously about it when we grow up and marry. He made

clear that only one kind of sexuality, heterosexuality, ending in

marriage was acceptable to talk about. Already aware of my sexual

orientation, I found no value in his speech. It did not speak to me

in my life. It might as well not have happened.

While most formal abstinence-only programs are more extensive

than the class I experienced, they rely on similarly exclusive and

stigmatizing messages that lack basic information about sexual

health. Multiple studies, including a recent Federal evaluation,

have found that the more expansive abstinence-only programs do

not work either.

When I was 17 I began seeing someone 6 years older than me.

The first time we had sex I took out a condom but he ignored it.

I did not know how to assert myself further. I knew enough to suggest a condom, but I didn’t adequately understand the importance

of using one. And even if I did, I had no idea how to discuss

condoms with my partner. The abstinence-only message did not

prepare me for life, and I contracted HIV from the first person with

whom I consented to having unprotected sex. I was still in high

school.

I was diagnosed with HIV a few months after becoming infected.

My friends and family were devastated. We didn’t know about HIV,

and we quickly developed false and damaging beliefs about my situation. It seemed as though I had done something particularly

wrong, but it never occurred to us that I, in fact, engaged in fewer

risk behaviors for HIV infection than most of my peers.

My parents were in no position to dispel these beliefs or otherwise educate me about HIV or AIDS because they, too, lacked sufficient knowledge of sexual health. Instead, they mourned the loss

of their child.

I decided to pursue a career in the prevention and treatment of

the virus, and one role I assumed was the role of an HIV test counselor. Over 3 years I gained a great deal of insight into the shared

experiences of individuals living with HIV. I have not allowed discomfort to prevent me from addressing the needs of those around

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me, and as an educator from reacting in ways that are proven to

be helpful. Sexuality education shouldn’t be different. Adults

should not allow their moments of discomfort to trump the needs

of youth for complete and accurate information.

Sexuality education programs must be as focused as my counselling sessions. Programs must be designed to meet the needs of individual students, most of whom will be sexually active before high

school graduation. Students of all ages should know abstinence as

the primary method to maintain one’s sexual health, but they must

be given additional tools to equip them for later life. Those tools

should be discussed in a way that is age appropriate by educators

with whom students can identify and communicate openly. We

must facilitate critical thought about sexuality in terms of keeping

students healthy and ultimately alive.

Today’s hearing is not about abstinence being a prevention tool—

I think we all agree it is—but rather whether abstinence-only programs are deserving of Federal resources, and the answer is no.

More individuals have this virus now than ever before in history.

Most children born with HIV no longer die, they go into adolescence and adulthood. Within and outside of marriage, these young

people must know how to prevent transmission of HIV to their sexual partners and how to protect themselves from further co-infection, other infections, and unintended pregnancy.

Abstinence-only curricula fail to meet the needs of individuals

who are living with HIV. They further disparage HIV-positive

youth by suggesting that they are dirty, dying, and unfit to be

loved.

What I experienced in junior high gym class is a routine example

of the messages of abstinence-only until-marriage programs that

children across the country still experience today. These programs

ignore the needs of lesbian, gay, bisexual, and trans-gender youth

who are at particularly high risk for HIV infection, and use Government dollars to condemn them. They also compromise young

women’s safety by portraying sexually active females as scarred

and untrustworthy.

From the health care perspective, it is essential that congressional scrutiny of these programs focus on the consequences of abstinence-only’s condemnation of young people.

HIV prevention must respond to the state of our domestic epidemic now. I have worked with many women who contracted HIV

within marriage. A woman asking her husband to respect her decision to abstain from sex or to use a condom is not supported by abstinence-only’s teaching that sex is an expectation within marriage

and that condoms do not work. There is no sufficient reason why

this completely preventable infectious disease should have impacted any of our lives.

After 6 years of living with HIV and striving to prevent this

virus in others, I strongly believe that it is society’s responsibility

to give young people all the tools they will need to lead healthy

lives. Any American infected with HIV is a societal failure. I see

no room for abstinence-only in this time of shrinking public health

budgets and increased accountability. Please end the failed experiment of abstinence-only until-marriage education.

[The prepared statement of Mr. Siegel follows:]

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Mr. SARBANES. Thank you very much, Mr. Siegel.

Ms. Knox, please, 5 minutes.

STATEMENT OF SHELBY KNOX

Ms. KNOX. Thank you.

Good morning distinguished members of the committee. My

name is Shelby Knox, and I am a 21-year-old speaker and sexual

health educator. It is an honor to be here to share my personal experience with abstinence-only until-marriage programs and to provide a youth perspective on their appropriateness and effectiveness.

I was born and raised in a Southern Baptist family in Lubbock,

TX, a city with some of the highest rates of sexually transmitted

infection and teen pregnancy in the Nation. At 15, in accordance

with my faith, I took a virginity pledge at my church. The same

pastor who officiated at my religious pledge ceremony also presented a secularized abstinence-only program to students in my

school district. Many students were already having sex and needed

information to protect their health; however, he expounded on the

ineffectiveness of condoms, explaining in graphic detail and with

even more graphic pictures the sexually transmitted infections one

could get if we trusted our health to a flimsy piece of latex.

We were all too intimidated or embarrassed to ask for clarification, but it seemed as if sex with a condom was the equivalent of

sex without a condom.

He also touched on the ills of masturbation and warned against

homosexual sex. One demonstration he used left little doubt as to

our worth as a future spouse or partner or person if we were to

engage in sexual activity before marriage. He pulled an often

squirming and reluctant and always female volunteer onto the

stage, took out a toothbrush that looked like it had been used to

scrub toilets, and asked her if she would brush her teeth with it.

When she predictably refused, he pulled out another toothbrush,

this one pristine, in its original box, and asked her if she would

brush her teeth with that toothbrush. When she answered in the

affirmative, he turned to the assembly and said, If you have sex

before marriage, you are a dirty toothbrush.

Many of my peers were struggling with questions, and most were

not abstaining from sex. The statistics became alarmingly personal

when the girl who sat next to me in math class got pregnant. She

told me her boyfriend had said she couldn’t get pregnant the first

time she had sex. Her growing belly was the result of that first and

only time.

Another friend, trying to be responsible, used two condoms at

once. He had been taught that using a condom wouldn’t work, so

he tried two. Only later did I find out that using two condoms together was likely to cause both to break.

I believed in abstinence in a religious sense, but it was clear that

abstinence-only as a policy for students who simply were not abstaining was dangerous. Even if we did wait until marriage, we

still lacked a basic understanding of our bodies, reproduction, and

how to prevent pregnancy, as well as a long list of sexually transmitted infections, including HIV, and the skills to have conversations about sex and protection. I felt betrayed by the people who

I trusted to tell me the truth—my pastor, my teachers, the school

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district, and the elected officials who deemed an ineffective policy

good politics if not sound science.

I got involved with a group urging the school district to change

the abstinence-only policy to a more comprehensive sexuality education curriculum that would include abstinence, as well as medically accurate information on a wide range of human sexuality topics.

My parents, proud conservatives who encouraged my virginity

pledge, joined me in asking the school board to change the curriculum, because they wanted me to have complete and accurate information about my body and sexuality. They didn’t see a conflict with

encouraging me to remain abstinent while at the same time ensuring that my classmates and I received the tools in school to make

healthy and responsible decisions about our lives. They were in

good company—85 percent of parents believe that teens should receive information about abstinence as well as how to protect themselves.

Abstinence works. Abstinence-only until-marriage does not. It is

morally unethical to leave young people without the information

they need to protect themselves. Studies have shown a more comprehensive approach to sex education that gives us a strong message about abstinence and information about condoms and contraception does a better job helping young people abstain than do abstinence-only until-marriage programs.

So why is it that not a single Federal dollar has ever been dedi- cated to a comprehensive approach while more than $1 billion has

been spent on abstinence-only education? As a young person with

first-hand experience about the misinformation, shame, guilt, and

intolerance propagated by these programs, I urge you to eliminate

funding for abstinence-only until-marriage programs and to, instead, allocate those funds to comprehensive, medically accurate

sex education that provides young people with the tools they need

to make responsible, informed decisions about their sexual health.

Once again, it was an honor to speak to you today, and I will be

happy to answer any of your questions at the appropriate time.

[The prepared statement of Ms. Knox follows:]

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Mr. SARBANES. Thank you very much for the testimony, everybody on the panel, in particular Mr. Siegel and Ms. Knox for relating your personal perspective on these issues.

I share the concern of a number who have already spoken today

about the failure of these programs to demonstrate success, the abstinence-only programs, to demonstrate success, and the fact that

we plow over $1 billion now into these programs.

One of the questions that I wanted to ask you, Dr. Benjamin, you

noted—and I have taken note of this, as well—that 17 States have

now refused to take this funding because of the restrictions that accompany it, and you mentioned that is a huge decision. I mean,

States are strapped. They need as many dollars as they can to support their public health initiatives. I was curious if you could

maybe expound on that a little bit. What would go into a decision

at the State level to pass up that kind of funding? what would the

discussion process be inside the department?

Dr. BENJAMIN. You know, we would first of all look at the program guidance and see if a particular program strapped our hands

around our other programs. That would be the first thing we

looked at. If that did, that creates a real problem for us.

Second, we have lots of programs already in place, and the question is would it create a dilemma for us to have a program where

our citizens were going into Door A and getting one kind of program, which was maybe State funded and supported, which was

more comprehensive, and then Door B, where they could only get

another particular program. That creates logistical, ethical, and

programmatic problems.

I think at the end of the day are the reporting requirements and

are the logistical problems and ethical problems not worth taking

the money, quite frankly. At least that is what we would do at my

health department. We would have sat down and had those discussions.

We would certainly also ask ourselves how can we effectively

evaluate these programs. In other words, you know, we are always

doing pilots. As you know, I am from Maryland, so we love pilots

in Maryland, at least we did. We might have even tried to do a

pilot program. Let’s see if they work. But then, of course, we would

have to have adequate funds to evaluate that program. And then,

of course, if it didn’t work we would stop.

Mr. SARBANES. Beyond the logistics of it, presumably these

States have made a judgment, based on the research and the success or lack of success of these programs, that it is not worth the

funding.

Dr. BENJAMIN. I think from a programmatic and policy perspective, absolutely.

Mr. SARBANES. Right.

Dr. BENJAMIN. And the more evidence that comes out that suggests they may not work, the more States you will see not taking

the dollars.

Mr. SARBANES. This is a question I would put to anyone on the

panel who would like to answer it, including Mr. Siegel and Ms.

Knox, and that is: I am getting the impression that there has been

a lot of testimony that the comprehensive sex education programs

are more effective, and the debate is largely a false one because we

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keep hearing people interpret the objection to abstinence-only programs as an objection to abstinence education, when, in fact, I

don’t think that is what anyone is saying here who opposes abstinence-only. So we kind of dance around the concept, but not landing on it four square yet, and that is this: listening to testimony

and reading the research, it strikes me that the abstinence education actually is advanced and reinforced when it is inside of a

comprehensive program, so that those who feel strongly about the

message of abstinence—and I echo the parents who have spoken

here today. I have a 17-year-old, a 14-year-old, and a 9-year-old, so

all these statistics are ones that catch my attention, and I understand what my own kids are grappling with. But as somebody who

would like them to get that message of the benefits of abstinence,

I come away from this discussion believing strongly that if they get

that message inside a larger program it is going to be more effective.

I invite anybody to address that. We can just go down the line

here.

Mr. WEED. I would like to respond to that, Mr. Chairman.

Looking at the evidence in terms of abstinence in the context of

the broader, there are some studies that have produced effects in

terms of initiation of sexual activity, but those effects have been

smaller for initiation than the effects that we find in programs that

are abstinence centered, and I will use that term advisedly rather

than abstinence-only. The effects are smaller when it is in the context than they are when it is done well and separately.

Mr. SARBANES. Let me get some other perspectives on that, going

down the line.

Dr. SANTELLI. I guess I would firmly agree with you. I draw the

attention of the committee to the written testimony of Doug Kirby,

who is, I think, the leading expert at reviewing sexuality education.

It is fully consistent with what Dr. Fineberg was talking about, the

Cochrane reviews. Those evaluations suggest that many of the comprehensive sexuality education programs are effective when they

deliver both messages, if you will, are effective at getting kids to

delay initiation.

Now, on the other hand I would point out that across these programs, even the best ones, we are talking about a delay of maybe

4 to 6 months, sometimes smaller, and that really begs the question: what are we doing for kids for the rest of their lives? So if

we delay from 15 to 151⁄2 or 17 to 171⁄2 or 18, we need to make sure

that those young people are ready.

Dr. BLYTHE. Can I have another comment?

Mr. SARBANES. Yes.

Dr. BLYTHE. As a physician in the field, in the trenches, one of

the issues that has come up is the teaching that we give in clinics,

and even families give to their young people, are being revoked by

the education in school. We had a clear example of this last week

when a young man was being pulled into the clinic by his Mom,

16-year-old, with an obvious genital infection, and his comment to

her was, But, Mom, I was told in school they don’t work. So when

our clinical messages are being revoked by the education that they

are getting in the schools, it is clearly counterproductive to the

health of these young people.

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Mr. SARBANES. I have run out of time, but maybe if you two have

a brief response.

Mr. SIEGEL. It is a blatant indication of policymakers’ distrust of

youth to make responsible decisions about their sexual health, and

it is not empirically supported. It has been shown repeatedly in

Federal evaluation that comprehensive sexuality education is better at leading to abstinence, which should be the goal of these programs, along with preventing HIV and other STIs and unintended

pregnancy.

Mr. SARBANES. Thank you very much.

Mr. Sali.

Mr. SALI. Thank you, Mr. Chairman.

First of all, I have a written statement that I had intended to

give at the beginning of the meeting but wasn’t allowed the opportunity. I would ask unanimous consent that be added to the record.

Mr. SARBANES. Without objection.

[The prepared statement of Hon. Bill Sali follows:]

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Mr. SALI. As a part of this, as well, Senator Brownback referred

to a Heritage Foundation study that was released yesterday, and

I would ask unanimous consent that be included as part of the

record of the hearing today, as well.

Mr. SARBANES. Without objection.

[The information referred to follows:]

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Mr. SALI. Thank you.

Dr. Benjamin, a moment ago I was hearing some discussion

about the delay of sexual activity, and I think I heard a number

of 4 to 6 months delay. I think in your testimony you refer to a

delay from abstinence pledges by up to 18 months, delaying the

sexual activity. Am I correct, No. 1, in your statement? And can

you tell me why we are getting that disparity in the figures that

we are hearing here?

Dr. BENJAMIN. The answer is yes, that is what we said.

Dr. SANTELLI. I mean, one has to look at programs that are attempting and a curriculum that are attempting to change something and a study that is following kids who then self report. OK?

So the 18-month delay which was found by Peter Bearman and his

colleagues was a study where kids said they signed up for a virginity pledge. If you intend to be abstinent, you are more likely.

I would also point out that in Dr. Bearman’s own work, that the

long-term followup of that was that STD rates were the same

among the pledging group and among the non-pledging group, and,

in fact, there was—what shall we say, a displacement phenomenon? So anal sex was increased in the pledging group. So yes, there

is one study that shows this long delay, but in terms of the outcomes that Stan was mentioning, we are not seeing them.

Mr. SALI. That would lead me to believe that the information

about abstinence was incomplete. Is that what you are saying? In

other words, nobody told the kids that if they deviate from regular

intercourse, heterosexual intercourse, that wouldn’t be abstinent?

Is that the message you are telling?

Dr. BENJAMIN. That is correct. I think the point is that if you

don’t give kids all of the information, then they misinterpret vaginal intercourse and they totally associate that with abstinence, and

yet then they have these other risky behaviors, which they do continue because they don’t think that is sex.

Mr. SALI. Thank you.

Dr. Weed, you had a couple slides you didn’t get to. Is there any

way we could see those at this time?

Mr. WEED. I could tell you something. Put No. 15 up there. There

are effective programs, there are less-effective programs when it

comes to abstinence education. Just to clarify, however, on the

Bearman study, we wouldn’t call that an abstinence education program. It was kind of a rally and a pledge deal, but it didn’t fulfill

the kinds of requirements we think that effective programs need.

I have listed them up here. First of all, an effective program has

adequate dosage. Successful programs attend to the critical factor

of adequate dosage and deliver that dosage on an effective schedule.

The pledge programs don’t meet that criteria. There are important mediating factors, and this goes beyond the simplistic notion

of providing information, but effectively addressing the key predictors of adolescent sexual risk behavior that are amenable to intervention, and we have identified at least a half dozen of these important mediating variables, and if a program doesn’t address

those it will not, in all likelihood, produce an effect on sexual activity.

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We have also determined that the messenger in a program is at

least as important as the message. I am thinking of Max’s example.

I think he didn’t have a very good messenger in that gym teacher.

Effective teachers make more of a difference in program outcomes

than do printed materials. These teachers engage students in the

learning process, gain their respect, model their message, and believe in their ability to impact students.

Finally, effective programs conduct quality program evaluation

and take seriously the lessons learned, especially those that identify program shortcomings.

So it is a process of growth and development and maturation,

and effective programs that follow even those basic steps are within a 12-month period, after a 12-month period are reducing transition rates by 50 percent.

Mr. SALI. Dr. Weed, if I understand you correctly, your message

here is that an effective abstinence program will make a difference,

but the program in most of what has been passing for abstinence,

that message is either not the message, it is not delivered in the

correct manner, or the people who are delivering it are not doing

a good job at it. Is that accurate?

Mr. WEED. That is correct.

Mr. SALI. Thank you.

Mr. WEED. And there are good ones, there are weak ones. They

vary.

Dr. BLYTHE. Can I just hasten to make a comment?

Mr. SALI. Quickly.

Dr. BLYTHE. That particular study is good, but we also have to

realize that was in 7th graders, and so when the rate of sexual experience is very low we need to look at programs that carry forth

the message of abstinence in a realistic way into the high school

years in terms of as kids get older. I just hesitate to say that this

gives a good example of all the information that kids need, obviously.

Mr. SARBANES. Thank you.

Mr. Hodes.

Mr. SIEGEL. May I also respond to the personal statement about

my personal experience?

Mr. SARBANES. Let me just get to Mr. Hodes, because I know he

has to get to another hearing.

Mr. Hodes.

Mr. HODES. Thank you very much, Mr. Chairman.

I want to thank the panel for your testimony. We are dealing

with what strikes me as a public health crisis, and we are doing

so in a society which has an extraordinarily uneasy relationship

with the issues of sexual activity, given what we see in the media,

given the messages our kids get, given my experience prior to coming to Congress as a family lawyer where I saw divorce rates above

50 percent, so marriage isn’t always working the way it should.

But our Nation is facing a crisis in adolescent reproductive

health—750,000 pregnancies among teens aged 15 to 19 annually,

nearly one in three teen girls becomes pregnant before reaching the

age of 20. Last year, as we have heard, the teen birth rate rose for

the first time in 15 years, and the CDC is telling us that one in

four teen girls has a sexually transmitted disease.

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In terms of an effective response to this public health crisis, does

the impartial, peer-reviewed, scientific evidence support abstinence-only programs as an effective response to this crisis? Dr.

Santelli.

Dr. SANTELLI. No. You would have to say no. I mean, I think

science operates by a number of mechanisms, one of which is peer

review, another of which is weight of the evidence, so one realizes

that it is difficult to establish cause and effect, that the program

actually worked. These are not easy things, and so scientists work

together through their professional associations, through journals,

medical and scientific journals, to establish what we understand is

the weight of the evidence. And then people like the Cochrane

Group in Great Britain, people like Doug Kirby then try to review

the evidence.

The answer, from both Cochrane and Dr. Kirby, is no, these programs are not working. I know we have heard some evidence presented today. I would take exception to some of the specifics that

I heard today. At least one of the studies was passing out condoms

that is represented as an abstinence-only study. I think that the

work of Mr. Rector and Stan’s review here needs to be subjected

to peer review, and I don’t think it is going to hold up.

Mr. HODES. Dr. Benjamin.

Dr. BENJAMIN. I think the answer is not as currently constructed

for the abstinence-only programs. May I go further by saying that

I do think that we have a crisis. I agree wholeheartedly with you.

And I believe that means that we need to structure, fund, and fully

support a more comprehensive approach. I do believe those programs should be evaluated, and then we should continue to fund

those things that work, and they need to have a very strong abstinence component to them.

Mr. HODES. Dr. Blythe.

Dr. BLYTHE. I think the short answer is no, obviously both from

the reviews that are being mentioned, but also from a clinical perspective, as well as a policy perspective.

Mr. HODES. Dr. Weed.

Mr. WEED. Thank you. It is true that there is a small amount

of evidence even available on abstinence education. There is not a

lot of people that do that kind of work. Our company probably does

more than anybody in the Nation. But if you look on balance, you

look at where we are with contraceptive programs, contraceptive

education, and after 115 peer-reviewed studies they haven’t been

able to demonstrate an impact on STD rates, then we are not very

good in that camp, either. So let’s look at both, figure out what is

going to work, and be fair about how we compare them.

Dr. Fineberg mentioned that there were nine studies that

showed some positive outcomes. Well, that is great, but if they

don’t produce consistent condom use they are not going to be protected, and we can’t find any studies in a school or community setting, never mind the clinic, but in a school or community setting

where consistent condom use has been increased by contraceptive

and comprehensive sex education.

Mr. HODES. Dr. Weed, could I just drill down for a moment?

Mr. WEED. You bet.

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Mr. HODES. One thing I would like to ask you. You understand

the importance and value and general accepted standard of impartial peer review of studies, do you not?

Mr. WEED. Sure.

Mr. HODES. Has an impartial peer review journal ever endorsed

or reported your findings?

Mr. WEED. Yes. The three that I put up, two of them have been

peer reviewed and the third one is in the pipeline.

Mr. HODES. Could I ask one last question, just finish this with

Dr. Fineberg?

Briefly, Dr. Fineberg, my question: does the impartial peer-reviewed scientific evidence support abstinence-only as an effective

response to our public health crisis?

Dr. FINEBERG. It does not.

Mr. HODES. Thank you.

Thank you, Mr. Chairman.

Mr. SARBANES. Mr. Jordan.

Mr. JORDAN. Thank you, Mr. Chairman. I would ask unanimous

consent that my statement and some accompanying abstinence

education material be included in the record.

Mr. SARBANES. Without objection.

[The prepared statement of Hon. Jim Jordan and referenced information follow:]

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Mr. JORDAN. Thank you.

I want to thank the panel for being here, too. I have two fundamental questions that I want to ask, and I was going to ask

these of the Senator and I should say at the start I kind of share

the Senator’s perspective on this entire issue, but I want to get to

two fundamental questions. Do you really think the Federal Government should be involved in this area to begin with, the same

Federal Government that can’t secure the border, loses your tax return, the same Federal Government that is going to spend $3.1 trillion this year? Do you really think this is an area that the Federal

Government should be involved with to begin with, regardless of

which one it is, but particularly, in my judgment, the comprehensive approach?

And then the second question—and you can all jump in on both

of these when I finish—the premise of all this, particularly the

comprehensive approach is—and we have heard this discussed here

all morning long—the premise is the culture is such young people

are bombarded with all kinds of messages, they are already engaging in some of this risky behavior, so we need to talk about a comprehensive approach, we need to give them the facts on how to prevent disease, etc.

But do you ever think that by the fact we are having educators,

people in positions of authority, talk about this, we actually might

contribute to the problem? I think, Doctor, we talked about effective educators versus those who aren’t. Maybe this is just a country

boy from ohio talking, but I have heard this from constituents: the

more you talk about it, the more it happens, particularly when

someone in positions of authority giving mixed messages to young

people.

I want to just cite one example of that, and then I will be happy

to hear your response.

This is material our office obtained. It is called, Be Proud, Be Responsible: Strategies to Empower Youth to Reduce the Risk of HIV

and AIDS. It was put together by a grant. Are any of you familiar

with this curriculum? Heads shaking. OK.

I look at one of the worksheets here. Talk about mixed messages

and are we maybe even contributing to some of the figures that

were given to us. This is an HIV risk continuum worksheet, lists

different things. Then it has on the side here red light, yellow light,

green light. Red light, don’t do; yellow light caution, obviously. And

we are all familiar with this green light, or some of us view yellow

lights as different than caution, but I understand.

But I will list just a couple. One says having sex with multiple

partners and not using a condom, red light. Two others, though,

showering together, green light. So maybe there is a green light,

but think about the message that indirectly sends to young people.

The third, doing drugs but not sharing needles and syringes, and

the correct placement here on the side says yellow or green light.

Again, I think sometimes we get so focused on what is happening, but we might be sending the wrong kind of message, and that

has always been my concern with the comprehensive approach, the

mixed messages we are sending out there to people.

I would also argue that folks in west-central Ohio, which I get

the chance to represent, when you talk to them about the Federal

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Government getting involved—I made a statement yesterday to a

group of folks I made a speech to, and I said 15 months on the

job—I am just a rookie—has confirmed what I suspected: with the

exception of the military, the Federal Government doesn’t do anything very well. And now we are going to get into this whole area.

With all that, fire away and tell me if I am wrong or tell me if

you agree with me.

Mr. SIEGEL. Can I respond? It is great to hear someone from

Ohio speak. Ohio recently rejected the Title V funding and applied

for CDC–DASH funding, so they are moving in the direction of

comprehensive from what I can tell.

Responding to your first question about Government involvement, I definitely understand what you are saying. I mean, if Government is a consumer they have two products to buy from. They

can buy from the abstinence-only program or they can buy from the

comprehensive sexuality education program.

Mr. JORDAN. My point is this, though: should they be buying

from the Federal Government, or would we be better served if they

bought from the State and local government, parents, school

boards, teachers, and folks at the State level.

Mr. SIEGEL. Which I agree with. I definitely think that local level

they need to make those decisions, which Ohio is doing, from what

I can tell.

Also, as far as mixed messages, I don’t totally understand that

logic and never have as an educator. I mean, I feel like if you teach

students about fire extinguishers, you are not encouraging them to

start fires. I don’t see what the mixed message is and I don’t think

that shows up in the research as frequently.

Mr. JORDAN. Most everywhere else educators set the standard,

recognizing that 100 percent of the students won’t meet the standard, but we set the standard and that is what we aim for. We don’t

say, oh, because we know some of you aren’t going to get there,

here’s what you should. Everywhere else in our culture, everywhere

else in life, everywhere else in education we set the high standard.

This is coming from someone that spent years in the coaching and

teaching profession. That is what we do. Yet this area is different.

Mr. SIEGEL. It hasn’t been different, though, is the thing.

Mr. JORDAN. I would argue it has.

Ms. KNOX. May I respond, as well? Could I say that west Texas

is a lot like Ohio. That is where I come from, west Texas. My parents, who are no fans of Government involvement in anything, always told me that they wanted the school to be teaching this information because they didn’t have that information themselves. They

wanted me to have complete and accurate medical information

about my sexual health, but neither of them had been to medical

school, neither of them had gotten information about the up-to-date

information to protect yourself, so they wanted a reliable sex education program within the schools to be teaching me that information. That is just coming from my perspective with my parents.

I also wanted to add really quickly——

Mr. JORDAN. I want to hear from two others up there.

Ms. KNOX. I have always liked the analysis that umbrellas don’t

cause rain. Young people are smart enough to make responsible deVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00289 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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cisions, especially when they are given the tools to interpret those

complex messages that we are receiving.

Mr. JORDAN. Let me hear from Dr. Weed and Dr. Santelli.

Mr. WEED. The question I think you are asking—let me get back

to it—is should the Federal Government be involved in trying to

promote good health and preventive medicine. If we could do it

right, if we could do it well, I would say yes. So far we haven’t done

that. I think there are ways that we can structure policies and programs and funding strategies to be more effective.

For example, in the abstinence education area I have some suggestions on how that money could be better spent. I have also got

some suggestions on how we could do better with our comprehensive sex dollars and hold them to a standard and evaluate them the

same way we are doing with the abstinence programs.

I think there is a role, but it is that the responsibility is so huge

and the impact is so large it has to be done extremely well, and

we haven’t been very good at it.

Mr. SARBANES. Thank you.

Ms. McCollum.

Ms. MCCOLLUM. Thank you, Mr. Chair.

I was in my office, and people were kind of watching this along

with me, so I didn’t get all of the testimony but quite a bit of it.

Dr. Blythe, if I could pull from the back end of your testimony,

the Society of Adolescent Medicine summarizes its expert review of

sexuality education with the following: ‘‘Abstinence from sexual

intercourse represents a healthy choice for teenagers. As teenagers

face considerable risk to their reproductive health from unintended

pregnancies, STIs, including infection with HIV. Remaining abstinent—’’ and I am quoting from your words. I think this is wonderful. ‘‘Remaining abstinent, at least through high school, is strongly

supported by parents and even adolescents, themselves. However,

few Americans remain abstinent until marriage. Many do not or

cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents. Abstinence as a behavioral goal is not

the same as abstinence-only programs. Abstinence from sexual

intercourse, while theoretically is fully protective, often fails to provide against pregnancy, disease, and actual practice because abstinence is not maintained.’’ In other words, it is having all the information available to you.

We talked to the earlier panel. There is a continuum of sex education. I mean, parents with different skill sets feel more comfortable talking to their children. We just heard Ms. Knox say her

parents liked having accurate, scientific information made available to their daughter.

I would like you to address why it is so important that age-appropriate, parent-involved—and I think school boards need to involve the parents when they do this—why this is so important to

a whole child’s health, because pediatrics doesn’t end when they

are 10, 12, 13, or 14.

And then to the two women on the panel, I am kind of concerned

about some of the things that have been said both in testimony and

by some of my colleagues up here. One in four girls having sexually

transmitted diseases. Well you know, folks, it just isn’t the girls

that have the sexually transmitted diseases. You know, checking

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out who my son was going out with or who my daughter is going

out with, with the implication one gender is more temptuous or

whatever. I hope we can leave those stereotypes behind, because

the stereotypes are also in some of the abstinence-only, such as the

man’s role is to protect the woman, or that women need financial

support. Women, we need to protect ourselves and we need to support ourselves.

Doctor, would you please?

Dr. BLYTHE. Well, obviously the statement stands, as we believe.

I think a couple comments. Abstinence is part of comprehensive

sexuality education, and we have heard several comments this

morning about parents want abstinence for their children, and that

is correct, but in all the surveys that we have available—and the

most recent one actually just came out of Minnesota—is that 89

percent of parents of school-aged children want their young people

to have comprehensive, age-appropriate sexuality education, with

abstinence as a center stage, but also giving them the tools to deal

with the complexities of life that they are faced with on a day-today basis.

So in young people, meaning in the middle school age, strong

messages of abstinence often work. But as they get older and they

become more cognitively complex, then they need more answers

than just this or that, so we need to be able to give them the tools

to deal with the different issues, the different situations that come

up on a day-by-day basis as they get older.

Ms. MCCOLLUM. Thank you.

Thank you, Mr. Chairman.

Mr. SARBANES. Thank you, Ms. McCollum.

Ms. Foxx.

Ms. FOXX. Thank you, Mr. Chairman.

There is so much to try to get on the record in so little time. I

want to ask the panel a question. Mr. Hodes a few minutes ago

made the comment that 50 percent of marriages end in divorce.

How many of you have heard that before and think that it is the

commonly accepted fact in our country? Would you hold up your

hand? Just hold up your hand if you believe that.

Mr. WEED. That was 50 percent of what?

Ms. FOXX. That 50 percent of marriages end in divorce. How

many of you have heard that comment over and over in our country and believe it? You believe it, hold up your hand.

[Show of hands.]

Ms. FOXX. All right. Well, let me tell you, in 1987 pollster Lew

Harris has written, ‘‘The idea that half of American marriages are

doomed is one of the most specious pieces of statistical nonsense

ever perpetuated in modern times. It all began when the Census

Bureau noted that during 1 year there were 2.4 million marriages

and 1.2 million divorces. Someone did the math without calculating

the 54 million marriages already in existence, and presto, a ridiculous but quotable statistic was born.’’ Harris concludes, ‘‘Only one

out of eight marriages will end in divorce. In any single year, only

about 2 percent of existing marriages will break up.’’ Task order

my point on that is to support what Mark Twain said: figures often

beguile me, particularly when I have the arranging of them myself,

in which case the remark attributed to Desraili would often apply

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with justice and force. There are three kinds of lies: lies, damn lies,

and statistics. Both of those things I think sort of the framework

for what we have been listening to this morning.

I want to also make a comment about what Ms. Knox said in her

comments: ‘‘So why is it that there is not a single Federal dollar

dedicated to a comprehensive approach, while more than $1 billion

has been spent on abstinence-only until-marriage?’’ This from

someone who sat through all of the testimony this morning on the

fact that seven times more money is going into comprehensive programs than abstinence programs.

I have one other question I would like to ask you, and I just want

a yes or no answer from each member of the panel. I will start on

that end.

If, provided evidence of abstinence education programs are as or

more effective than comprehensive sex education, would you support optional Federal funding for such programs? I just want a yes

or no.

Dr. SANTELLI. No.

Ms. FOXX. Next person.

Dr. BENJAMIN. No.

Dr. BLYTHE. No.

Mr. WEED. Yes.

Dr. FINEBERG. Yes.

Mr. SIEGEL. No.

Ms. KNOX. No.

Ms. FOXX. OK. Thank you very much. The record will show how

each person answered.

To me I think this shows the situation that we are dealing with

here. I also find it very interesting that the word scientific has

been used a lot. Do we have scientific studies that prove the abstinence issue? Well, I would like to say to you that there is no more

scientific fact than that abstinence is the only sure way to avoid

pregnancy and sexually transmitted diseases. I don’t know how

anybody could argue that is the scientific fact. Yet, people keep

saying we need scientific evidence that these programs are working, and we don’t have the scientific evidence that they are working.

I want to tell you I come from a background of being a social scientists, so I know a little bit about how these things can be used.

I have one more question. Dr. Weed, you stated about goals, intensity, content, all of those things vary across all types of sex education programs. Do we have any kind of evidence as to the effectiveness of the programs? And, Dr. Fineberg, you can answer this,

too, but, Dr. Weed, would you answer it? I believe you have a study

that shows that; is that correct?

Mr. WEED. I am trying to sort the question out. The studies that

we have done, if the program is designed well, implemented well,

has the right kind of teachers, focuses on the right kind of issues,

and is not narrowly defined and prescribed as an abstinence-only,

which I think is a terrible misnomer, if it is done well, if it is done

right we see impact. However, programs that are fairly new, fresh

out of the block, they are trying to figure it out, it sometimes takes

them about 3 years to work out the kinks and get on a track where

they have an impact.

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Ms. FOXX. Thank you.

Dr. Fineberg, would you like to say anything?

Dr. FINEBERG. Again, the most rigorous comparisons with very

strict methodologic requirements to look at the studies find that

the more comprehensive and inclusive programs do have approximately two-thirds of the time in those studies some positive effects.

That was 23 of 39 studies.

Of the studies that were looked at, the 13 that were more narrowly framed as abstinence-only, they found in none of those cases

that there were positive behavioral effects. That was in, again, applying this very strict, rigorous, methodologic screen for studies

aimed at preventing infection of HIV and sexually transmitted infections.

Ms. FOXX. Who did that study?

Dr. FINEBERG. These are studies by the Cochrane Collaboration,

the lead author is Underhill. I did include the citations in my written testimony.

Ms. FOXX. Mr. Chairman, I have just one other comment to

make.

We have thrown again a lot of statistics around here, and much

has been made about the fact that 17 States are not taking the

funding, but let me point out 33 is more than 17.

Thank you, Mr. Chairman.

Chairman WAXMAN [presiding]. Mr. Yarmuth.

Mr. YARMUTH. Thank you, Mr. Chairman. I thank all the witnesses.

Doctor Weed, you showed us some studies that indicated that

in—I guess you call them abstinence-centered programs?

Mr. WEED. Abstinence-centered would be the preferred term.

Mr. YARMUTH [continuing]. Succeeded in reducing the rate of initiation of sex by 40 something percent, which I think people would

say that is a benefit. That would be successful. But in the most optimum case, the rate of those who, if I read the chart correctly, who

did initiate sex in spite of that was still around 10 percent. That

was the best performance. So my question is, While we may say

that the program was successful in one respect, was it a failure

with regard to the 10 percent or more, and, in fact, did we not do

them a disservice and maybe even put them at risk because we

didn’t give them other information?

Mr. WEED. I think that is a good question, because—by the way,

it applies broadly. If we want to apply that standard of success, we

say yes, we had a 10 percent failure, whereas in terms of consistent

condom use we have 100 percent failure. So let’s kind of balance

it and look at both sides.

Mr. YARMUTH. I get that, but would not the real followup to that

be: did you do any damage by including comprehensive? Did you

make it worse for anyone by including comprehensive sex education, because, as I understand all the rest of the studies, there

really isn’t any evidence that comprehensive sex education increases the rate of sexual activity.

Mr. WEED. We can apply one standard that says it doesn’t increase the rate, and we can apply the other standard that says it

fails 10 percent of the time. Those are two different standards. I

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am just asking for using the same standards when we do the comparison.

Mr. YARMUTH. All right. Let me ask Mr. Siegel and Ms. Knox,

because they both alluded to things that have intrigued me, and I

only focus on you because you are the youngest among us.

Is sex education, whether it is abstinence-only or comprehensive

or anything else they learn in school the only thing kids learn

about sex?

Mr. SIEGEL. Absolutely not.

Mr. YARMUTH. So what you may learn in abstinence-only education or in comprehensive sex education actually is considered,

and it is input that is taken against a backdrop of a lot of different

input about sex, including peers, information from your peers, including media, all sorts of things.

Ms. KNOX. Yes, I would agree, although let me point out quickly

that I have undergone both abstinence-only and comprehensive sex

education. Only comprehensive sex education gave me the tools,

gave me the information to go out and interpret the other messages

that I was getting from the media, from my peers, other things

that I was hearing.

Mr. YARMUTH. So if you are getting information, let’s say you are

getting abstinence-only education in school or abstinence-centered

education, there is a real danger that it is going to run up against

a lot of different contrary input that you are getting from your

friends. I mean, you may be talking to your friends who are having

sex every weekend, unprotected, protected, but you are getting different information from them than you are getting in school. My

question would be: how does that make you feel about the rest of

your education? Does it undermine the credibility of what you are

getting in other areas?

Ms. KNOX. It would be the same to me as if I went into math

class and my teacher said two plus two is five. I mean, that doesn’t

jive with anything that I have ever heard out there in the world.

That is what abstinence-only education was to me. It was not in

reality as to what was happening in my live and in the lives of

other people in my community.

Mr. SIEGEL. May I also add abstinence-only education teaches

stigma. If you can’t get married, how is abstinence ever going to

help you? That is reinforced by the rest of society as a young person when you go out there, and it doesn’t serve the needs of young

people living with HIV, because they will need to know how to use

condoms even if they get married. So once again it is neglected. It

is neglected in greater culture and it is neglected in the classroom.

Mr. YARMUTH. I am not sure exactly how this relates, but I know

it relates in some way. I was a journalist before I entered politics,

and the paper that I worked with did a story several years ago

about oral sex among 12 and 13-year-olds, and we sent actually

teenage reporters out into the community and talked to them. The

response that we got or our reporters got most frequently was they

didn’t consider that sex. This was just fun and games. It was no

different than hugging.

So I wonder whether, when we talk about educating some of

these programs starting in 7th grade, whether even that is early

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enough, whether the horse is out of the barn on this issue even by

that time.

Dr. Weed.

Mr. WEED. We found, of course, lots of variety. There are some

places where 7th grade could be too late and other places where

it wouldn’t be. I think that the good programs really do take into

account the cultural context in which they are being delivered, and

the program that might work well in an inner city, high-minority,

high-risk population, lots of broken families, might be a different

kind of strategy than the one you would do in middle America

where it is pretty calm and peaceful.

Mr. YARMUTH. My time is up. Thank you, Mr. Chairman.

Chairman WAXMAN. Thank you, Mr. Yarmuth.

Mr. Burton.

Mr. BURTON. Dr. Fineberg, you talked about these studies. Have

they ever included in these studies that you are referring to the

Peers program in Indiana?

Dr. FINEBERG. Not to my knowledge, Mr. Burton. The studies

that I talked to were premised on peer-reviewed, published studies

that were randomized or quasi-randomized, and so these other experiences would not have been included.

Mr. BURTON. Gotcha. I understand. But you are not familiar with

the Peers program in Indiana?

Dr. FINEBERG. I am not.

Mr. BURTON. The Peers program was started in 1994 by St. Vincent’s Hospital in Indiana, and it is an abstinence program. I have

been watching on television and listening to the debate on this

issue. I just want to read you a little bit about this particular program that has been in effect since 1994.

‘‘Does abstinence education really work?’’ This is one of their brochures. ‘‘Compared to non-participants, the Peers project participants were four times more likely to have remained virgins. Seventy percent of peers program participants reported that they have

remained committed to abstaining from sexual activity at the conclusion of a 3-year, independent evaluation.’’

Then the brochures go into some other details about it. Since

1994 nearly 15,000 peer mentors—they use students that they

train, come in and work with them at St. Vincent’s—15,000 peer

mentors have taught the Peer Educating Peers curriculum to

150,000 program participants throughout Indiana. Organizations

and other States have replicated the Peers model.

The result in my Congressional District—they sent this to me—

was in Miami County there was, for 15 to 17-year-olds between

2000 and 2005 there was a decrease in teen birth rates and sexually transmitted diseases by 34 percent. In Wabash County the decrease for that age group was 28 percent. So it has been very beneficial.

It was students talking to students after they had been made

aware and trained in the Peers program. So abstinence programs

do work. I know you can go across the country and do these national studies and come up with these statistics, like my colleague

was talking about, which make it sound like it is a waste of money

to train and create abstinence programs, but this is a fact in IndiVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00295 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
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ana. This is my Congressional District. It does work. I think that

funding these programs does create some real positive results.

I know some of my colleagues say we ought to just have a complete sex education program, we don’t need abstinence training, but

it does work, and it is helping in Indiana, and I think it is something that we ought to continue to fund.

Dr. Weed, you are moving around there. Did you have anything

you would like to comment on that?

Mr. WEED. Well, a point that I think is relevant is that we have

heard discussion about embedding abstinence and comprehensive

sex education together, and that may be more effective. But I think

I have heard agreement, which I am encouraged by, that abstinence ought to be the central message and the major emphasis.

If you look, however, at the programs that claim to be abstinence-plus, the ratio of a contraceptive and condom education to

abstinence education is about 9–to–1, so it is really not the major

emphasis, it is kind of an afterthought. It is kind of stuck in there

to meet, I think in some cases, the political correctness of yes, well,

we teach abstinence.

If you look at the reality of the ratio, however, of what gets the

most attention, that is not what is happening.

Ms. KNOX. Could I respond quickly, as well? Congresswoman

Foxx was talking about the statistics we use and the studies that

we use. The study that Mr. Weed is referencing I believe was a

study that looked at how many times the word abstinence was

mentioned on a page of comprehensive sex education curricula.

Now, that is just the word abstinence. That is how they got that

statistic.

When the Federal Government does their abstinence PSAs, public service announcements, they don’t use the word abstinence.

They use wait for sex until marriage. So I think that we have to

re-look at the studies that we are using, and I just want to point

that out there to correct the congressional record.

Mr. BURTON. I think this has been a very interesting hearing.

You know, when you represent 700,000 people, like we do, and you

see some positive results in a program in your District, and it is

irrefutable as far as the statistics are concerned in my District, it

sounds like to me, at least in my District, and I think across the

country, as well, but at least in my District abstinence programs

specifically designed for that do work. They have reduced by 34

and 28 percent the pregnancy rates and the rates of communicable

diseases. I think that is something that we should continue to support.

Thank you, Mr. Chairman.

Chairman WAXMAN. Thank you, Mr. Burton.

I am going to take my time.

My view is that if the local area wants to try something that

they think is best, let them spend their money on it; but if we are

going to use Federal dollars, I want to be sure those Federal dollars are being used for a program that works and is successful. If

we have had studies showing they are not successful, as we have

with the abstinence-only programs, then I think we ought to let the

local governments decide whether they are going to pay for it.

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Dr. Weed, there is one thing I wanted to ask you about. In explaining the evidence for some or these abstinence-only programs,

you referred to them in your testimony as abstinence-centered programs. One of the studies has an abstract that states, ‘‘The intervention is not an abstinence-until-marriage intervention. The target behavior is abstaining from sexual activity until later in life

when the adolescent is more prepared to handle the consequences.’’

Would a program that is not focused on abstinence until marriage qualify for Federal funding under the State or communitybased abstinence-only programs?

Mr. WEED. Would it qualify for funding if it did not target abstinence until marriage?

Chairman WAXMAN. Yes.

Mr. WEED. Well, of course, you know how the A3H guidelines are

written, but I think one of the things that helps us in this area is

that young people who are fairly concrete——

Chairman WAXMAN. I am asking a very specific question, because

my understanding is the answer would be no, that teaching abstinence until marriage is the sole and mandatory purpose of these

programs. This illustrates some of the concerns I have with the

current policy. It isn’t just for a committed relationship or later in

life, as valuable as I think that might be in and of itself. There are

programs that appear to have real success, but they are being excluded from Federal funding because they don’t meet this strict ideological test. It has to be until marriage, itself.

Mr. WEED. Well, I guess I don’t see that these other programs

are being excluded because 68 percent of our school systems are

using comprehensive and contraceptive education, as compared to

25 percent who get abstinence education, so I think it is probably

a misunderstanding to think that abstinence-centered education is

displacing and replacing all this other stuff. I think it is still there.

Kids can——

Chairman WAXMAN. It is certainly still there, but it is being

funded at the local level, while these abstinence programs are

being funded exclusively at the Federal level with over $1 billion.

Dr. Santelli, did you want to comment?

Dr. SANTELLI. Yes. I think Stan is absolutely wrong on that. I

mean, the research we did, which was based again on national data

between 1995 and 2002, showed that virtually every 15 to 19-yearold young woman in this society and the young men as well are

getting abstinence education. They are getting it. What we found,

though, was education about contraception declined sharply, so

many fewer. So almost 100 percent of young people are getting abstinence education. It may not be abstinence-only. We don’t know

whether it is abstinence-only, but they are getting the abstinence

message, but only two-thirds are getting the message about contraception, and that is going down.

Chairman WAXMAN. I appreciate that point.

Now, you were asked, all of you, a few minutes ago by Ms. Foxx

to give a yes or no answer only to a more complicated question of

whether you would support abstinence-only if evidence became

available that it was successful, and you had to say yes or no. A

number of you said no and you didn’t have a chance to explain, but

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I presume that you would have said because it is not public health

information, it is not the full story.

Dr. Blythe, is that accurate?

Dr. BLYTHE. I totally agree. It was, I felt, like a trick question

almost. I think that none of us at this table deny the importance

of abstinence as a major part of the message, but it is, again, including all that other information that will help young people develop healthy sexual lives.

Chairman WAXMAN. Thanks. I presume that was also—without

responding, because I have very limited time already to go to other

questions.

One of the major concerns of opponents of comprehensive sex

education is that teaching teens about condoms and other contraceptives will encourage them to have sex. The suggestion is that

teaching about contraception will delude or confuse an abstinence

message.

Dr. Benjamin, is there any scientific evidence that comprehensive

sex education encourages sexual activity?

Dr. BENJAMIN. The answer is to the contrary, that it does not.

Chairman WAXMAN. Dr. Weed, do you think it encourages sexual

activity to talk about more comprehensive approach than just the

abstinence-only?

Mr. WEED. I haven’t seen evidence that addresses that directly.

We are currently doing a study where both messages are combined

in the classroom. It is very early, but the evidence looks like that

the impact of the program gets minimized when the combination

is in place.

Chairman WAXMAN. OK. Well, let me ask the two young people,

Shelby and Max. In your experiences now as young adults who

speak with young people, what is your understanding—does comprehensive sex education cause teens to have sex, or is this kind

of education effective in encouraging teens to delay sexual activity?

Ms. KNOX. I would say once again umbrellas don’t cause rain.

Young people are smart enough to make responsible decisions

when they are given all the information. Myself, the young people

that I talk to, we actually are encouraged to make more responsible

decisions when we understand about contraception, when we understand about using condoms, when we are not confused, when we

don’t have misinformation, then we are more likely to make responsible decisions.

Chairman WAXMAN. Thank you very much.

Mr. SIEGEL. I would assert that when we are being told that

condoms and contraceptions do not work we are less likely to use

them if we do choose to go about that path.

Chairman WAXMAN. Thanks.

Mr. Shays.

Mr. SHAYS. Thank you, Mr. Chairman. I am sorry I was away.

I was speaking on the floor of the House and then I was meeting

with a mother whose daughter was raped allegedly by a Marine

and then killed. I was meeting with that family, with her, talking

about that issue.

I know Mr. Burton has one quick thing he wants to say and I

will yield to him for that purpose.

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Mr. BURTON. Real briefly, I think one of the reasons the Peer

program in Indiana has been successful is they are training students to work with students, and peer to peer I think really has

a tremendous impact on the attitudes of these young people. I

think that is why these statistics show some dramatic results.

I thank the gentleman for yielding.

Mr. SHAYS. What I am struck with is that young people learn

from TV, the movies, the books they read, the magazines they read,

they learn from the Internet, they learn things from their peers. I

think that there is a natural interest on the part of young people

to know about things about sex. They are going to learn it. The

question is: are they only learning part of it, and what part are

they learning?

Dr. Weed, where I have my problem is that you would object to

them having the armor they need in the daily battle of life. You

want to tell them one way, one kind of armor, but you don’t want

to protect them, it seems to me, in all the other ways.

Would you agree that some young people are going to not practice abstinence?

Mr. WEED. Yes. Some will not, and I would say that the armor

is great, but if it is flawed armor we don’t give them the kind of

help you need.

Mr. SHAYS. You tell them it is flawed, but you tell them risks

and you tell them information, so what you are doing is basically

saying if you are going to abstain you are going to be protected, but

if you do anything else you are on your own. It seems to me that

borders on cruelty, and the young man to your left dealing with

HIV is one of the outcomes. That is tragic.

I just don’t get it. I don’t understand why it has to be only. Why

only? Tell me why only?

Mr. WEED. I think that maybe you weren’t here when I mentioned this. I think that is a poor definition of abstinence education

programs.

Mr. SHAYS. It is an accurate one.

Mr. WEED. No, it is not. Abstinence-centered is a very different

picture than abstinence-only.

Mr. SHAYS. Let me just say why. You can’t rest on the laurels

of saying the States do it and someone else will tell you the rest

of the story. The reason why my State chooses not to be part of it

is they think it is going to ultimately result in young people being

deprived of knowledge that could save their lives.

Mr. WEED. We do have a premise, sir, that if we give kids more

and better information they are going to be better decisionmakers.

The recent research in the last 5 to 10 years on the adolescent

brain makes us rethink that conventional wisdom. It is a whole different kind of picture that is happening with young people.

Mr. SHAYS. Isn’t it an interesting concept. Really what you are

saying is abstinence-only works better if they don’t know all the information, so we are going to deprive them. But you know what?

Some of them are going to then try to find it on their own and it

is going to be incomplete information, it is going to be from the

wrong places. It seems to me it would be better that they get the

right information from the right place.

292

Mr. WEED. That is part of the misunderstanding, that abstinence-only, as we use that label, assumes that they don’t learn

anything else. The fact is they do.

Mr. SHAYS. Yes, but they learn it from the wrong places.

Mr. WEED. I am saying within an abstinence program, a good abstinence program isn’t that narrow kind of definition that you——

Mr. SHAYS. Is there anyone on the panel that would disagree

with that? And tell me why? Do you agree that Dr. Weed is correct

when he says that they are going to learn all that they need to

know——

Mr. WEED. I didn’t say all. I said that it is not narrow the way

you have defined it.

Mr. SHAYS. Well, if they are not going to learn all they need to

know, then your comment to me is disingenuous.

Mr. WEED. I don’t think they are going to learn all they need to

know in any program, including a comprehensive sex education

program. And, as we have seen, as I have shared with you, we

don’t have any program yet that has shown a reduction in STD

rates that is a comprehensive education program.

Mr. SHAYS. Well, even if that were true——

Mr. WEED. And it is. Yes.

Mr. SHAYS. Even if it were true, I would say to you that at least

we gave them the information. So if Mr. Siegel decides to do something and he takes risk, at least he did it with the knowledge that

he was taking the risk and that he wasn’t ignorant of it.

Mr. WEED. And I think good abstinence programs do that.

Mr. SHAYS. Well, all that I have read about it would totally refute that.

Mr. WEED. You know, I have been there in them. I have watched

them. I have observed them. I have interviewed thousands of kids.

It is not this narrow kind of——

Mr. SHAYS. Could I just make one more point.

Mr. WEED [continuing]. Perspective that we are hearing here.

Mr. SHAYS. If you are telling me that an abstinence-only program

is compromised by telling them about other ways to deal with the

issue of sex and not having a pregnancy and not having an illness,

if you are telling me that then encourages them to do it, you have

this conflict, because you are telling me on one hand that weakens

the program, and then you are telling me the program does it.

Mr. WEED. I am saying that you can do both if you do it right

and if you do it well. But most of the time, as we have seen in a

lot of these programs that are now on the CDC Web site as being

effective and proven, the information that is in both programs I

think is going to be harmful to kids, not helpful.

Mr. SHAYS. Thank you.

Chairman WAXMAN. The gentleman’s time has expired.

Mr. Souder.

Mr. SOUDER. Thank you.

Mr. Siegel and Ms. Knox, were the programs at your school funded by the Federal Government?

Ms. KNOX. Yes.

Mr. SIEGEL. I believe so. I am not certain.

Ms. KNOX. I believe so.

Mr. SOUDER. What years were they?

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Mr. SIEGEL. Sorry?

Mr. SOUDER. What year were you in the program?

Mr. SIEGEL. What year was I in the program? It must have been

12 years ago. I believe——

Mr. SOUDER. There was not abstinence education——

Ms. KNOX. I was in the program from 2001 to 2004, so it was

within the funding.

Mr. SOUDER. And you are sure that your school——

Ms. KNOX. I cannot say absolutely sure, but I can get the information to find out.

Mr. SOUDER. And we would like that for the record, because a

description that you had of your program, that a church came in,

did an independent program, is not likely a Federal program.

Ms. KNOX. Can I just make the clarification? That was a secular

program. It was done by a local pastor. He was operating within

a secular capacity within the school. That was made sure of by the

school district.

Mr. SOUDER. Because most likely that your two programs—you

have both been very articulate, very passionate—but are mostly irrelevant to this debate, because, in fact, what you are advocating

is what everybody on the Republican and Democratic side said is

that these should be State and local decisions, and abstinence education programs coming out of Washington, abstinence-centered,

which I agree with Dr. Weed, have to meet certain criteria. They

go through certain bid process, and they generally aren’t random

at a local level. Most likely you are dealing with something that,

were it done out of the Federal Government, you wouldn’t have had

the experiences that you had at your school.

In response to Mr. Jordan, one of the questions, if we are going

to get into this, how much do we decentralize and wind up with

all sorts of variations, or how much do we centralize. This is an interesting debate back and forth, but for the most part your experiences, if they were Federal funded, none of us would have ever supported, and that really weren’t relevant.

Further, you had a major factual error, Ms. Knox, and Chairman

Waxman and I have been going around this. It is incorrect to say

that the Federal Government funds no programs. The Federal Government plans—a statement that Dr. Weed made and was debated—12 times as much money goes into family planning. Not all

of that goes into schools. I use the figure 2–to–1 into the schools.

In addition, I know from my own home town that displacement of

other funds go—for example, in safe and drug-free schools—if you

get your money for drug-free schools from other programs, that you

can then use the money for other health programs, which then they

use for a comprehensive sex education and health care program in

the schools with direct Government funding, because under our

Education Committee rules, if you cover one category then it becomes fungible funding for the school.

It is absolutely false to assert that no Federal money is in. The

only question is whether it is twice as much in the so-called comprehensive or twelve times as much, but clearly far more is spent

of Federal dollars in this category, and it is important that the

record shows that.

294

We are going to try to sort out exactly how that funding goes,

but that is just not true.

Ms. KNOX. Can I ask you for a minute to respond, as well, about

the——

Mr. SOUDER. There is not really a response to that.

And let me say one thing else, Mr. Chairman. We have six witnesses on the majority side and one on the minority side.

Dr. Weed, I would take you in any battle with me to do a course

with six people, but this is as stacked a panel as I have ever experienced as a staffer or Member in the House to only have one person on one side and six.

Furthermore, this was represented as a scientific panel. Mr.

Siegel and Ms. Knox have been very articulate, but they are not

scientists. Out of the others, from what I can tell, Dr. Santelli is

a scientist who has worked with it directly, but he is on, as he says

in his testimony, he is a senior fellow at the Guttmacher Institute,

very tied in with Planned Parenthood. He clearly has a bias, just

as others would have a bias.

It isn’t clear to me, did you do field research yourself or were you

summarizing studies, Dr. Santelli?

Dr. SANTELLI. I have worked in public health for 20 years. I

worked in Baltimore for 5 and did a lot of field studies and I

worked at CDC for 13 years and was involved in a whole bunch

of studies.

Mr. SOUDER. Reclaiming my time, your charts did go to direct

questions, while I may not agree with them, may not agree with

your summary.

Dr. Fineberg clearly has summarized a group of studies, but did

you do any of those yourself? Are you a scientist who has been out

in the field and studied this issue?

Dr. FINEBERG. No.

Mr. SOUDER. And Dr. Blythe and Dr. Benjamin basically read

ideological statements on the behalf and summarized other people’s

studies. But this was supposed to be a panel of scientists who were

going to show us the true science debate that was occurring, and

that has not happened today. It was false representation.

Dr. Weed, I happen to remember you from another life of mine

three jobs ago when I was the Republican staff director on the

Children and Family Committee, and I believe in the mid-1980’s

you did a study in Baltimore on teen pregnancy; is that correct?

Mr. WEED. Yes.

Mr. SOUDER. That is how you more or less got started in this

field, by showing some of the ineffectiveness of the teen pregnancy

programs in Baltimore that was astounding and resulted in programs being put in in Baltimore because their teen pregnancy was

totally—it was 90-some percent in some of the schools. I went up

there and met with them. You are actually a field researcher.

Mr. WEED. Yes. All my work has been on the ground. I have

interviewed thousands of kids. I have personally evaluated over

100 programs. I have data on 500,000 teenagers in my files.

Chairman WAXMAN. The gentleman’s time has expired.

The Chair wants to indicate that the witnesses who are here

were invited because either they have done the research or they

represent organizations. I don’t think it is fair to criticize them if

295

they represent groups like the pediatricians or the OB/GYNs or the

American Medical Association or the Institute of Medicine. I also

think it is unfair to say that they are not only unbalanced because

they represent medical organizations, but that they in some way

lack credibility because they represent—and the American Health

Association and others—because they represent these organizations. That is why they have been invited.

Second, we have accepted every witness that has been recommended to us from the Republican side of the aisle. Matter of

fact, we have never turned down a request from the Republicans

on any witness at any hearing.

Third, I just think that an attack on people’s views by calling

them ideological when they are scientists and they are medical professionals is trying to turn tables by calling them ideological when,

in fact, I think that you are attacking them from an ideological perspective.

Do you want to say anything, since I have jumped on you?

Mr. SOUDER. I wasn’t questioning the organizations. What I was

questioning is that you earlier stated this was a scientific panel,

and I was trying to establish that you only have two people who

appear to have done scientific research; others were summarizing

or giving their personal opinions. In fact, Dr. Weed was criticized

for being ideological. I certainly criticized a number of people here

for being ideological—making the point again that this is not really

a scientific debate but a heavily ideological one.

Chairman WAXMAN. OK.

Well, we have the positions set out.

Dr. Santelli, we are going to have to move on. We have a third

panel waiting. Yes?

Dr. SANTELLI. I just spent 2 days, because I am here the 3rd day

missing part of the meetings. The American Public Health Association and the Academy of Pediatrics, I have served on committees

on both of them, spend a lot of time trying to review scientific evidence. I mean, they also filter it through their clinical wisdom.

Maggie is a great example of combining the two. All the professional medical groups in the country are very attuned to the

science and try to represent the best science.

Chairman WAXMAN. I think that is an important statement to

make.

I want to thank all of you very much for your presentation to us

and your willingness to answer questions from members of the

committee. Thank you very much.

Our third panel, I want to call forward Charles Keckler, who is

the Acting Deputy Assistant Secretary for Policy at Administration

for Children and Families at the Department of Health and Human

Services. His department coordinates the two largest Federal abstinence-only programs.

Dr. Marcia Crosse is the director for the Healthcare Group in the

U.S. Government Accountability Office. She has been with GAO’s

Healthcare Group since 1996, and since then has led a variety of

assignments on public health issues.

I want to welcome you to our hearing today. Your prepared statements will be in the record in full. We would like to ask if you

would to limit your oral presentation to 5 minutes.

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It is the policy of this committee that all witnesses be sworn in

before they testify, although it was pointed out to me that perhaps

that didn’t happen with the last panel, but I am not sure. But we

will continue the practice with you two, if you would please rise

and raise your right hands.

[Witnesses sworn.]

Chairman WAXMAN. The record will indicate that both witnesses

answered in the affirmative.

Mr. Keckler, why don’t we start with you?

STATEMENTS OF CHARLES KECKLER, ACTING DEPUTY ASSISTANT SECRETARY FOR POLICY, ADMINISTRATION FOR

CHILDREN AND FAMILIES, U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES; AND MARCIA CROSSE, PH.D., DIRECTOR, HEALTHCARE, U.S. GOVERNMENT ACCOUNTABILITY

OFFICE

STATEMENT OF CHARLES KECKLER

Mr. KECKLER. Mr. Chairman and members of the committee,

thank you for the opportunity to discuss abstinence education programs administered by the Department of Health and Human

Services.

The administration continues to support abstinence education

programs as one among several methods to address the continuing

problems created by adolescent sexual activity, the result of which

includes unacceptably high rates of non-marital child-bearing and

sexually transmitted diseases among America’s youth. Remarkable

progress has occurred in this area over the last 15 to 20 years.

Pregnancy among 15 to 17-year-old girls declined over 20 percent

since the early 1990’s, although it remains above the rates for

other industrialized nations.

Teenage sexual activity and non-marital child-bearing have serious consequences for teens, their families, their communities, and

our society. The two greatest risk factors for teen pregnancy and

transmission of STDs are age at first onset and number of partners. In other words, if a teen delays the onset of sexual activity

and reduces the number of partners, they are much less likely to

become pregnant or get someone pregnant.

By definition, abstinence education programs aim to address

these two risk factors. Abstinence is the only 100 percent effective

method to prevent pregnancy and sexually transmitted diseases.

Through education, mentoring, and peer support, abstinence education helps teens delay the onset of sexual activity and reduce the

number of sexual partners they have. In addition to the serious

risks of disease, early child-bearing often limits later opportunities

for both the parents and the children involved, creating risks of a

fragile family structure, poverty, and welfare dependence.

HHS’ abstinence education programs are part of a broader strategy to combat teen pregnancy and STDs. Over the last 5 years, the

Department estimates that it has expended billions of dollars toward this effort.

HHS funds a variety of interventions, both primary models,

which include a risk avoidance message provided through abstinence education programs, as well as secondary models, which inVerDate 11-MAY-2000 14:49 Feb 17, 2009 Jkt 000000 PO 00000 Frm 00304 Fmt 6633 Sfmt 6633 C:\DOCS\46712.TXT KATIE PsN: KATIE
297

clude a risk reduction message. These interventions provide information about the risks of sexual activity and the ways to eliminate

or reduce these risks, with the goal of altering adolescent attitude

and behaviors in ways that lead to healthier outcomes.

Other interventions can provide direct health services to adolescents, including administering contraception and providing information about its proper use. Beyond abstinence education, the Department provides at least $300 million annually to administer a

variety of pregnancy prevention or STD/HIV prevention and awareness programs. Some of these programs may include information

about abstinence or encouraging delayed sexual activity, but are

not subject to the Title V, Section 510 A-H definition of abstinence

education in the Social Security Act.

Curriculum often called abstinence-plus or comprehensive sex

education could be supported under these funding streams. Additionally, the Department provides hundreds of millions annually in

family planning services to adolescents through a variety of programs. Of the total Federal resources devoted to combatting teen

pregnancy and STD prevention, abstinence education accounts for

a fraction.

As a general matter, health education interventions have a

record of mixed success. While the majority of studies have shown

a limited impact on sexual behavior, some programs have shown

evidence for effectiveness. This became increasingly apparent during the 1990’s, as studies showed certain programs had effects of

delaying the age at first intercourse and sometimes reducing the

frequency of sexual activity or the number of partners involved.

The use of abstinence education curricula as such has a shorter

history of evaluation, but the results have been similar. Some peer

reviewed research has shown an effect in delaying intercourse

among program participants. Other studies have shown some effect

on partner number, even if intercourse is not delayed.

We are using the results of these studies to identify the characteristics that distinguish effective from ineffective implementations.

There is no strong evidence for a decline in the use of contraception

as a consequence of these programs.

The administration believes that the abstinence education program sends the healthiest message, as it is the only certain way

to avoid out-of-wedlock pregnancy and sexually transmitted diseases. The great majority of American parents agree. A 2007 poll

conducted by the National Campaign to Prevent Teen Pregnancy

found that 90 percent of teens age 12 to 19 and 93 percent of

adults agree that it is important for teens to be given a strong message that they should not have sex until they are at least out of

high school.

The administration appreciates the opportunity to update the

committee on the progress we are making in this important area

of adolescent health and remains committed to providing accurate

information that effectively assists young people to make healthy

and responsible choices as they mature toward adulthood.

I would be pleased to take any questions that you may have.

[The prepared statement of Mr. Keckler follows:]

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Chairman WAXMAN. Thank you very much.

Dr. Crosse.

STATEMENT OF MARCIA CROSSE

Ms. CROSSE. Mr. Chairman and members of the committee, I am

pleased to be here today as you examine abstinence education programs.

My testimony is based on GAO’s report on this topic that we prepared for you and other congressional requesters in October 2006,

and we have updated certain information for today’s hearing. You

asked that we examine efforts to assess the scientific accuracy of

materials used in abstinence education programs and efforts to assess the effectiveness of these programs.

I will also discuss a Public Health Service Act requirement regarding medically accurate information about condom effectiveness

that may be relevant for abstinence education materials.

We reported 18 months ago that efforts by HHS and States to

assess the scientific accuracy of materials used in abstinence education programs have been limited. At the time, HHS’ Administration for Children and Families [ACF], did not review its grantees’

education materials for scientific accuracy in either the State or the

community-based programs, nor did it require the grantees in either program to do so. Further, not all States that received funding

from ACF had chosen to review the accuracy of their program materials.

In contrast to ACF, HHS’ Office of Population Affairs [OPA], had

reviewed the scientific accuracy of its grantees’ proposed education

materials and any inaccuracies that were found had to be corrected

before those materials were used.

The extent to which federally funded abstinence education materials are inaccurate wasn’t known, but both OPA and some States

reported finding inaccuracies. For example, one State official described an instance in which abstinence education materials incorrectly suggested that HIV can pass through condoms because the

latex used in condoms is porous.

To address concerns about the scientific accuracy of materials

used in these programs, we recommended in our report that the

Secretary of HHS develop procedures to help assure the accuracy

of such materials. In response to our recommendation, ACF is currently implementing a process to review the accuracy of community-based grantees’ curricula and has required those grantees to

sign assurances that the materials they propose using are accurate.

HHS reported to us that in the future State program grantees’ will

also have to sign written assurances and provide ACF with descriptions of their strategies for reviewing the accuracy of their programs.

We also examined efforts to assess the effectiveness of abstinence

education programs. At the time of our report, we found that HHS,

States, and researchers had made a variety of efforts to assess effectiveness. For example, ACF analyzed national data on adolescent birth rates and the proportion of adolescents who report having had sexual intercourse. Additionally, 6 of the 10 States in our

review worked with third party evaluators to assess the effectiveness of their programs.

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However, the conclusions that can be drawn from these efforts

are limited because most of the efforts to evaluate program effectiveness have not met certain minimum criteria, such as random

assignment of participants and sufficient followup periods and sample sizes that are necessary for such assessments to be scientifically valid.

Further, the results of some efforts that do meet such criteria

have varied. Since our report was issued, a key HHS-funded study

has been completed which found few differences on a variety of

measures of sexual activity between youth who participated in abstinence education programs and control group youth.

Finally, while conducting work for our 2006 report we identified

a legal matter that required the attention of HHS. A section of the

Public Health Service Act, Section 317 P, requires certain educational materials to contain medically accurate information about

condom effectiveness. At the time of our review, an ACS official reported that materials prepared by abstinence education grantees

were not subject to this provision. However, we concluded that this

requirement does apply to abstinence education materials prepared

and used by Federal grant recipients, depending on their substantive content. In other words, for materials that meet the statutory criteria, HHS’ grantees are required to include information on

condom effectiveness, and that information must be medically accurate. Therefore, we recommended that HHS adopt measures to ensure that, where applicable, abstinence education materials comply

with this requirement.

HHS has told us that they have accepted our recommendation.

The fiscal year 2007 community-based program announcement provides information about the applicability of this requirement, and

future State program announcements will also include information

on this requirement.

In conclusion, when we reported to you 18 months ago on this

topic we identified several concerns and information gaps in HHS’

abstinence education programs and made recommendations to the

Department. HHS has now begun to make changes in response to

our recommendations which could improve the accuracy of the materials used in these programs.

Mr. Chairman, this concludes my prepared remarks. I would be

happy to answer any questions that you or other members of the

committee may have.

[The prepared statement of Ms. Crosse follows:]

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Chairman WAXMAN. Thank you very much for your presentation

to us and the hard work that you have done at our request.

Mr. Keckler, I have some questions about your characterization

of the evidence on abstinence-only programs. You acknowledge that

the data supports the effectiveness of teen sex education programs

in delaying sex and reducing sexual frequency or the number of

partners. You then said that ‘‘the use of abstinence education curricula has a shorter history of evaluation, but the results have been

similar.’’

But this isn’t the view of medical experts. The American Medical

Association, the American Public Health Association, the American

Academy of Pediatrics have all looked at abstinence-only programs

and found that they are not as effective as comprehensive sex education. Why is it that what you are telling us is so different from

the expert medical bodies? You are drawing one conclusion, and

they look at the same evidence and draw a completely different

conclusion.

Mr. KECKLER. Thank you for the question, Mr. Chairman.

Well, I think that we need to be, when we say one works better

than the other, that comparison has never been done. We have a

study ongoing that will compare the two treatments side by side.

But some of these statements and some of the collections of studies

which were referred to earlier are something else. They are accumulations of studies of, on the one hand, studies that have been

done of comprehensive sex education over the years, and some

studies that have been done on abstinence until marriage.

Chairman WAXMAN. Well, OMB, for example, the Office of Management and Budget at the White House, does program assessments of different Government programs called PART assessments.

Mr. KECKLER. Yes.

Chairman WAXMAN. In its assessment of the abstinence-only programs, OMB gave the program a very low score of 33 out of 100

for program results and accountability. The answer to, ‘‘Has the

program demonstrated adequate progress in achieving its longterm goals’’ was ‘‘small extent.’’ The answer to whether the program achieves its annual performance goals was ‘‘no,’’ because the

programs won’t even set baselines until March 2009, so basically

we have no idea if individual programs are having any impact on

participant behavior and health. Why are we continuing to fund

programs where even OMB is saying there is virtually no evidence

of effectiveness?

Mr. KECKLER. Mr. Chairman, with regard to the OMB PART assessment, the PART assessment ultimately of these programs was

ranked as adequate with the conditions that we make certain evaluation changes that OMB recommended. We are making those

changes, which include standardized reporting from CBA grantees

on the outputs of their programs and, starting in the upcoming

year, standardized survey of participants, which will include outcomes of the programs, including whether or not the participants

are having sexual activity.

Chairman WAXMAN. Let me ask Dr. Crosse about that evaluation. Do you think the administration is doing enough to establish

baselines and other measurement goals for these programs so we

can measure them and see whether they are succeeding?

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Ms. CROSSE. Well, they are currently funding some well-designed

studies, and the one study that I cited that had been completed

since our report was issued was one of the studies that the Department funded that did meet the standards for a scientifically valid

study that was a situation where they had random assignment.

I think some of our concerns are some of the measures that the

Department has been using are ones that cannot be clearly linked

back specifically to the program. The national rates of pregnancy

is not something where you can say that the impact on that is specifically because of the program, because you don’t have any information about the differences in the rates between those who have

received that information and those who didn’t.

Chairman WAXMAN. Let me get into another question.

Mr. Keckler, we know some teens are going to have sex. We can

talk to them about abstinence until marriage, but let’s say a young

person comes to you and says, I put a lot of thought into it, but

I am going to go have sex. I have reached a point that I am going

to do this. The question comes to you, Should I use a condom?

What would you say to him or her?

Mr. KECKLER. Well, I am not sure that my personal response to

a teen in my life is germane, but I think——

Chairman WAXMAN. What do you think somebody running a program should say to that individual?

Mr. KECKLER. Well, I can tell you what they will say in the CBA

programs, which is that if somebody is in need of other services,

our grantees are asked and encouraged to give them referrals to

other services. Our grantees, of course, are bound by the A through

H requirements to focus on abstinence, but they will make referrals

for other services, and that is what they would say.

Chairman WAXMAN. I find that nonsense, nonsensical. If somebody is coming to you and asking in one of these programs, admitting that they are going to be sexually active—which probably

means they already are sexually active—to tell them, I am going

to refer you to someone else will probably mean that, if they go to

someone else, it will be after they have already had enough sexual

contact where they might have contracted HIV or some other sexually transmitted disease. That is one of the big problems I have

with this separation. We can only talk about abstinence. We can’t

talk about the rest of the information that is pertinent.

I just know, if the Members will forgive me—and I will allow

them a little extra time, as well—I know a lot of people have said

over the years we ought to let States and local governments make

the decision. Maybe we ought to just have a block grant. Let the

States and local governments decide if they want an abstinenceonly program or if they want to use the money for a broader comprehensive program. But here we have Washington, DC, saying,

‘‘We know what is best, and if you want money for sex education

in the schools, you have to use abstinence-only funds.’’

When we hear about these other programs being funded, most of

them are at the local level. The others are extrapolations of Medicaid funding for family planning services—they are not going to

schools, they are not going to teenagers. They’re funding for Title

X clinics, well, they are clinics. They are not in the schools. They

may have some relationship. The Indian Health Services and some

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of these others, I think that is being used to say we have a lot more

dollars going to these other programs. Well, they are not Federal

dollars for the most part.

Is that an accurate statement, Dr. Crosse? Have you looked at

the funding mechanisms?

Ms. CROSSE. My understanding is that the only Federal money

that specifically is targeted for sex education programs is through

these programs that we focused on, these three big programs at the

Department—the State program, the community-based program

[CBA] program, and the adolescent family life program. There may

be small amounts in other areas, but the targeted areas for sex

education are abstinence-only ones.

Chairman WAXMAN. Thank you.

I have used 7.4 minutes, but I am going to yield to the gentleman and each of the other gentleman on the panel 8 minutes so

we will be fair. They don’t have to use it all, but each will get 8.

Mr. SOUDER. It won’t be entirely fair because it is two against

one again.

Chairman WAXMAN. Well, I haven’t used the full 8.

Mr. SOUDER. First, let me say sometimes I get in trouble for this,

and I have complained about a number of hearings that we have

had here, including today, but I find the chairman very fair. We

have a good personal relationship. It concerns some of my colleagues that I speak highly of him many times, but, in fact, he attempts to be fair. Sometimes liberals have a tough time understanding our perspective enough to what we consider fair or not,

but I believe he is genuine in his ability to desire to do that.

Chairman WAXMAN. Time’s up. [Laughter.]

Mr. SOUDER. Mr. Keckler, we have had a lot of discussion today

about the Federal funding for sex education. I would appreciate

your getting back to the committee with the specifics here. You

chose your words carefully. You said that the Federal Government

funds money for Planned Parenthood, family planning, and other

types of things. What we really need here is how much of that actually goes to schools. Dr. Crosse picked her words very carefully

there, said the dedicated stream. But, in fact, we all know these

programs are in the schools, have been in the programs for many

years. They are funded through the Federal Government, through

the family planning that comes through. There are also health

grants that come through that may not be in your area, but if you

could break that out. I mentioned Safe and Drug-Free Schools because I wrote that section and allowed it to be fungible funding,

and I know that in school districts people use it there. But we need

some kind of a read with this, because this has, in my opinion,

been a false track that we got off to. I think it is a legitimate debate that the chairman said should any be specifically dedicated.

That is a fair debate.

But partly what Dr. Crosse, whose recommendation seemed pretty reasonable, has suggested is that when we, the Federal Government, give the funds without any guidelines, then we get charges

like came up from the two younger people here today that clearly

those wouldn’t have met Federal standards to do a program like

that.

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It would be very helpful if you can get us a funding stream, not

only of this much goes in family planning, but to see if we can do

a down-stream track of where that funding breaks out. I don’t

know whether this is a school survey working with the Department

of Education, but I think it is very important for us to understand

how these programs are funded in the schools.

Mr. KECKLER. I agree with you, Congressman, and the problem

has been that, because the other forms of comprehensive sex education and prevention programs are folded into, sometimes they are

block granted, they are folded in throughout the Department of

Health and Human Services in a variety of ways, and some of them

are also directed both to young adults and to adolescents in order

to get a real apples-to-apples comparison.

There is some work that needs to be done with our budget people, but we will be happy to get you firmer estimates along those

lines.

Mr. SOUDER. Because without that it is hard for anybody to allege scientific comparisons if, in fact, we don’t even know what

Federal funding is where. I support block grants, but I also have

historically believed there should be accountability. We have run

into huge problems with the No Child Left Behind with this, because then nobody likes the accountability measures and we argue

over the accountability measures. But the fact is that if the Federal

Government is going to be tasked with raising the taxes and spending the funding, we shouldn’t dictate how a local district meets it,

but there ought to be requirements that meet basic standards so

that we know tax dollars are being spent.

If you are a Libertarian and don’t want the Federal Government

to do it, that is one thing, but if the Federal Government is going

to do it, in the day and age of the computer reporting system it

seems like this would be not that hard to put a designation on a

form for the data to come back of did this go into school, how many

dollars went to the school, the schools to report back. I mean, they

already deal with mounds of reports, and I understand that, but if

we are going to have—how are people alleging scientific comparisons here, because there are controlled programs and non-controlled programs.

I heard data thrown out today not comparing, when they were

comparing abstinence programs, comparing it to the universe rather than the schools around it, may have had an alternative program, which in science would have been mandatory. What is the

universe? What is the comparison? What are the control groups?

One of the most famous early studies in the 1980’s was in Minnesota, where a school that had a family planning program said

they reduced teen pregnancy. A quick check showed that every

other school in Minneapolis went down more, because there were

cultural variables and other things happening in the community,

not just that program. So you have to have multiple control groups.

We are having this debate today sounding like the science is in

one direction when, as Dr. Crosse has pointed out, and I think fairly, that there should be factual information in any abstinence program. They shouldn’t be able to put out false information. There

ought to be accountability to it.

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One other question I had that was raised by—I forget her name,

the young girl on the first panel—she said, as I understood her to

say—Shelby—it was a secular program and a pastor came in as

part of that. In these programs, are they allowed to invite guest

speakers in? And if guest speakers come in, are they held to any

accountable standards, which is something else that ought to be

looked at. Did you look at that, Dr. Crosse?

Ms. CROSSE. We did not look at the specifics of the structures.

And our recommendations are to the general information that are

distributed for the programs. There is certainly always the possibility that someone can come in and write something up on a blackboard that would not be under any kind of control or review.

Mr. SOUDER. Because when we are dealing with these social, controversial issues, often somebody will be invited in from a local

church, or somebody will be invited in from the other side. If, in

fact, it is a religious community they will invite somebody in from

Planned Parenthood to present that. The question is: how factbased are we going to have this? Is there an accountability procedure? But I would think we should at least know in the presentation of a grantee whether they intend to do that, because otherwise it becomes hard. Do you know whether that is done now?

Mr. KECKLER. Well, there are a variety of methods. I think Dr.

Fineberg talked about the great variety of methods that people are

using, and we as a Department are going through this process to

try to identify best practices, along with many other people in the

field. So could somebody come in and speak? Yes. The grantee,

however, is responsible under our current rules for ensuring medical accuracy, and when we make a site visit there, either because

we think there are good practices there or we have heard some

problems with the grantee, medical accuracy is looked at, as well.

So it is their assurance and their responsibility to maintain medical accuracy.

Our efforts on that have been welcomed by all the grantees. They

want to be medically accurate. They appreciate our help.

Mr. SOUDER. I need to get another factual question on the record

here. We have heard about the 17 States opting out, 33 are in.

Have you had a drop-off in application rates?

Mr. KECKLER. The CBA grants have not shown any particular

drop-off in that program. There have been this year fewer States

applying for the State funds.

Mr. SOUDER. But there is still more demand than there is

money?

Mr. KECKLER. Oh, yes. The CBA grants are probably the most

competitive grant program that is currently making grants in ACF.

In the last 3 years——

Mr. SOUDER. You are saying of all the programs——

Mr. KECKLER. In ACF, all the grant programs.

Mr. SOUDER. So the demand for this is huge.

Mr. KECKLER. Right. We have funded between 8 and 14 percent

of grant applications in the last 3 fiscal years, so there is tremendous unmet demand.

Chairman WAXMAN. Thank you, Mr. Souder.

Mr. Shays.

Mr. SHAYS. Thank you.

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I don’t intend to use my full 8 minutes, given I missed a good

chunk of this hearing, but I want to ask you an ethical question,

both of you. I think it clearly matters if a program is successful or

not, and we determine success based on certain outcomes. I guess

the first outcome, are young people having premarital sex or not.

The outcomes disease, pregnancy, emotional issues, as well.

But the ethical question for me is let’s just say that an abstinence program was equal to, in terms of outcome, as one that was

more comprehensive. Let me even say it this way. Let’s just say an

abstinence program was even better. Don’t young people have a

right to know the truth? And it seems to me that we are almost

suggesting that if we can just focus on abstinence-only and leave

out the rest of the story, because if we leave out the rest of the

story they may have more sex, so we leave out the rest of the story.

But it seems to me that is unethical. It seems to me maybe when

you are talking to a 6th grade kid I don’t know, but it seems to

me by the time a young people is a junior in high school they just

deserve to know the truth, whatever the truth is. And you try to

have impact on their young minds to do what we as adults thinks

is responsible.

The irony, I was speaking to some of my colleagues here and

asked them if they had premarital sex. They said they did. And

when they started to talk about it, it was almost like it was a good

thing. I mean, the irony, the hypocrisy of this is kind of interesting,

too. So I am just asking you about the ethics of denying people information. Do they not deserve to know it? Or if they do know it,

do you think they are going to do the wrong thing, so they

shouldn’t have it?

Chairman WAXMAN. Before you answer that question I want to

indicate for the record that the gentleman did not ask me that

question. [Laughter.]

Mr. KECKLER. Well, Congressman Shays, that is a very important question. Clearly, teens need to know the truth about their

lives and about this area. The question, though, is do they need to

know it all at once and in the same place. The Department supports a risk avoidance message and a risk reduction message.

There is important programmatic and practical reasons why we

should have the capacity to be able to keep those messages distinct.

There is a lot of jurisdictions and there is a lot of grantees that

want to help and want to give the risk avoidance message but they

don’t want to be compelled to include with that a risk reduction

message.

So being able to deliver those separately is useful from a programmatic context. There are hypotheses out there on both sides

of whether it is more effective to deliver a focused, pure risk avoidance message or whether it might be more effective some way combining it. As I have mentioned, that direct comparison of whether

it is better to put them together or keep them separate has never

fully been done, but it is important that both messages be out there

and that both messages be accurate.

Ms. CROSSE. Just for the record, GAO has no position on this,

but I will answer your question in that I think it is important and

it is ethical for students, teenagers to be given complete information. I think it is a policy question where they get that information.

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I think the heart of the ethical issue that we spoke to in our work

is whether they be given any misleading information, and that

clearly we have taken a position would not be ethical, and certainly

not that the Federal Government would be supporting the dissemination of the information that is not accurate to these teenagers in

the programs.

Mr. SHAYS. I thank both of you.

Mr. SOUDER. Mr. Chairman, very briefly?

Do you favor the same policy for cigarettes, that low-tar cigarettes, that we would show kids the level of nicotine and tar in the

cigarettes between the different brands so that, since a high percentage of them smoke anyway, we can give them better information on which cigarettes would be better to smoke?

Mr. SHAYS. I would do this. I would make sure they had total

knowledge, because if a young person is going to smoke, then I

want to make sure that they have a sense of the degrees of harm

they are causing themselves, so in that answer, yes, but I would

be working overtime to have them understand that it would be a

pretty bad thing to smoke.

Chairman WAXMAN. Does the gentleman yield back the balance

of his time?

Mr. SHAYS. I do yield back.

Chairman WAXMAN. I thank you very much. I thank the two of

your for your presentation.

Without objection, we are going to keep the record open for an

additional 7 days so that Members may ask all the witnesses or

any of the witnesses additional questions and get a response in

writing, and then others may be able to submit additional information for the record.

Thank you very much. This hearing is adjourned.

[Whereupon, at 1:50 p.m., the committee was adjourned.]

[Additional information submitted for the hearing record follows:]

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