‘Tis a bittersweet post that marks the end of using this blog for my class. While I will miss the opportunity to blog about epidemiology I yearn for sun, fun, and a break from homework. I have every intention of a self imposed week long hibernation following the semester, to catch up on my sleep and days that don’t involve me staring at my computer screen till my eyes begin to water and I drop my head on my laptop.
But perhaps it is fate (or purely planned by my professor) that the last blog may be one of the most importance, at least to me. I know there are lots of people who turn the other direction when the words “politics” or “policy” comes out of anyone’s mouth. I mean there is a reason they say it’s never good class or etiquette to talk politics. But while some want to pull their hair out as people talk scream or yell politics, I am the person who frequents ALL political websites and has the cable news from all sources on in the background at all times.
So it would seem this would be the easiest blog to write, but for some reason this has been taking me a long time to write (and I don’t think it’s just because at the end of the semester my brain feels like goo). I think this has been hard to write because when you peel away all the other stuff in policy and try to look at what role epidemiology plays, you realize that it can be the most important role and sometimes gets overlooked or ignored because of all the other hoopla.
So when I googled (why “googled” is not yet allowed in my spell check I don’t know, but it is a fatal flaw to Word and my BlackBerry) “epidemiology and policy” this very easy to read yet very cool article came up from Merrill & White titled “Why Health Educators Need Epidemiology” (citation below—the full article is on google). I read one section of the article that talks about how epidemiology helps health educators entitled: “Assessing Individual and Community Needs for Health Education” (Merrill & White, pg 218) and I instantly had my topic.
A topic close to my heart is sexual education. This may be because I am on the board of ChoiceUSA, which among other things is a strong proponent of young people getting involved in trying to advocate comprehensive sex education (I know shameless plug, but they do some great things, and if you are a college student wanting to get involved they are the place to start).
But how does epidemiology fit into sex ed? Epidemiology is everywhere in this topic.
Throughout this blog we have talked about the different things epidemiology is used for and the wide range that the study of epidemiology encompasses, and in the push for policy and federal funds for sex education in high schools epidemiology has been cited by many. Politicians and advocates for sex education point to epidemiological studies that show correlations between lower teen pregnancy rates or lower teen STI rates and sex education. Or conversely show no statistical change or decrease in rate of teen pregnancy or STI rates in areas that only teach abstinence only education. Much of this was used to encourage more federal funding for sex education programs in the Patient Protection and Affordable Care Act (Kaiser 2010—full citation below). The proponents of sex education argue that the evidence based results pointing towards sex education in schools is the most important reason to make policy changes nationwide and increase the funding. Though it’s important to note sex education isn’t perfect (because the programs are not universal) and there is data that suggest there is important differences on the effect on young girls and boys (here is some audio about some new research released from the government about sex education).
But that doesn’t mean other stakeholders, or those for abstinence only education, don’t try to point out more than just the moral issues surround teaching sex ed to those in schools. In social health behavior we talk about harm reduction programs and arguably (if you paint harm reduction with a broad stroke) sexual education could fit in this category (but very much to a lesser degree than other programs), which is why I understand the hesitation in teaching sex education, believing it could be encouraging teens to engage in sex (click here for a good site that looks at harm reduction theory and sexual health).
What is clear is the use of epidemiology by both sides. Each side uses data about incidence rates (number of new cases) of teen pregnancy and STIs mainly from the CDC’s Youth Risk Behavioral Surveillance System, to advocate each side, to try measure effectiveness of programs. And while there has been a decline in teen pregnancies over time (though you would not know that if you watch shows like Teen Mom), there is still debate about what has caused these decline. There are some who use ecological studies to point to introduction to sexual education, some do not believe this to be true and there are studies that have tried to show there is no correlation.
While I think there is a lot of epidemiological data out there that would lead to policy that promotes sex education, I think we can’t ignore the lessons from abstinence education either. Perhaps that’s why I am more inclined to be impressed and interested in the new studies coming out that look at the relationship between abstinence education and comprehensive sexual education (Jefferies, Dodge, Bandiera, & Reece—full citation below). I think this could a call for more epidemiological research that better defines comprehensive sex education (exposure) to make sure it includes abstinence and the impact on sexual health outcomes (disease).
I definitely think the evidence points to comprehensive sex education, but I also think we live in a time where the increased polarity of ideas causes more strife than anything. If deep down the two methods share a common goal, even if they don’t want to agree on that (to keep teens healthy), maybe this is a time to take lessons from both. At first I was very frustrated that the new health care bill still had funding for abstinence only education, but I really think if we teach them both together at the same time there is room for us all to agree (if only it wasn’t “abstinence only” and instead “abstinence &” sex ed). For some reason I think we have forgotten what compromise really means in politics, and maybe we can use epidemiology to show that we can provide comprehensive sex education to teens that also teaches them that abstinence is the only way we know to avoid teen pregnancy and STIs 100%. I think what needs to be clear is that real comprehensive sex education is that, comprehensive, and should include abstinence as well. No matter what I am still going to go out there and get involved to allow comprehensive sex education in schools, but even with the data and the funding there are still those who don’t want to do it in exchange for abstinence only. So maybe this blog is a plea for us all to remember how to compromise.
Here are some great articles about the complexities of sex education and abstinence only education, so you can make your own decisions:
Kaiser Family Foundation. (2010). Impact of health reform on women’s access to coverage and care. Focus on Health Reform, Retrieved from http://www.kff.org/womenshealth/upload/7987.pdf
Merrill, R.A., & White, G.L. (2002). Why health educators need epidemiology. Education for Health, 15(2), Retrieved from http://www.educationforhealth.net/EfHArticleArchive/1357-6283_v15n2s14_713665105.pdf
Jeffries, W. L., Dodge, B., Bandiera, F. C. & Reece, M. (2010). Beyond abstinence-only: relationships between abstinence education and comprehensive topic instruction. Sex Education: Sexuality, Society and Learning, 10(2), 171-185. doi:10.1080/1468181100366631