Moral Ideology and Sex Education: Does Abstinence-Only Education Make Sense? - Wendy Chan
Introduction
Over the past two decades, teenage pregnancy rates have dropped significantly in the United States with 75% of the drop attributable to contraception use and 25% to a reduction in sexual activity (Guttmacher Institute, 2006). Despite these positive trends, teens in the United States still experience the highest birth rates and one of the highest rates of sexually transmitted disease (STD) among industrialized nations. Each year, almost 750,000 women aged 15-19 become pregnant (Guttmacher Institute, 2006) and nearly half of all new STD infections occur in young people between the ages of 15-24 (CDC, 2004). Both teen pregnancy and adolescent STD infection rates remain major public health challenges in the United States.
In 1996, Congress passed the Personal Responsibility & Work Opportunity Reconciliation Act, which was a piece of legislation aimed at welfare reform. Attached to the Act was a provision, later set out in Title V of the Social Security Act, appropriating $50 million per year for state educational initiatives promoting abstinence-only until marriage. This provision was attached to the Act during the final hours of negotiation and reconciliation and passed without any public debate and with little notice (Kantor & Bacon, 2002). Under the Act, states were required to match every $4 of federal funding with $3 of state funding, bringing the total amount of public funding for abstinence-only programs to $87.5 million per year. Abstinence-only education promotes abstinence until marriage as the only “sure” way to prevent teen pregnancy and STD infection. Despite mounds of contrary evidence and obvious lack of public support, federal funding continues to be appropriated for abstinence-only education and has even increased under the Bush administration (Kantor & Bacon, 2002).
To receive Title V federal funding, state abstinence education programs must meet a specific set of requirements. The federal definition of abstinence education is an educational or motivational program that:
Has as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
Teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children;
Teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, STDs, and other associated health problems;
Teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity;
Teaches that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects;
Teaches the bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society;
Teaches young people how to reject sexual advances and how alcohol and drug use increase vulnerability to sexual advances;
Teaches the importance of attaining self-sufficiency before engaging in sexual activity.
(Personal Responsibility and Work Opportunity Reconciliation Act of 1996)
Some of the requirements provide helpful skills and information, such as teaching young people how to reject sexual advances and the importance of attaining self-sufficiency prior to engaging in sexual activity. However, others clearly seem to impose certain beliefs and ideologies, including that marriage is the only context in which sexual activity is acceptable and that sex outside of marriage is morally wrong and physically dangerous to oneself, one’s children and even society. Even more interesting is what abstinence-only programs are not permitted to teach. The program does not allow for the dissemination of any information on contraceptives and only allows mention of contraceptives when discussing their failure rates. For these programs, abstinence is the only effective way to prevent pregnancy and STDs.
Currently, the federal government does not support any other sex education programs besides abstinence-only education. The only more comprehensive programs that exist are funded by state, local or private funds. Abstinence-only education that omits information about contraception and provides misleading information regarding the effectiveness of contraceptives leaves young teens vulnerable to unintended pregnancy and STDs. Federal funding for sex education should not be appropriated exclusively towards abstinence-only programs because: 1) abstinence-only education has not been proven effective in reducing rates of sexual activity, pregnancy or STDs in adolescents; 2) federally funded studies touting the success of abstinence-only programs mistakenly assume that intentions to abstain from sexual activity translate to actual behavior; and 3) abstinence-only education that promotes abstinence until marriage completely ignores the reality of homosexual youths because the federal government defines marriage as between a man and a woman.
Argument 1
Abstinence-only education, which calls for complete abstention from sexual activity until marriage, is not effective in reducing rates of sexual activity, pregnancy or sexually transmitted disease in adolescents because such programs censor contraceptive and STD prevention information rather than teaching youths to make educated decisions. Abstinence-only education does not allow teens to make their own choices regarding pre-marital sex and gives teens an extremely limited set of tools to protect against unintended pregnancy and STDs. These programs force upon teens the ideology that marriage is good and that sex outside marriage is dangerous and unacceptable, no exceptions. This approach goes against Erik Erikson’s theory of psychosocial development, which states that the formation of identity is the essential and fundamental task of adolescence (Thambirayah, 2005). Telling teens that abstinence is the only option does not give them the freedom to establish their own personal identity because it presents them with only one very narrow view on a person’s sexual identity. It does not make teens feel like they are an active participant in the development of their own moral standards and personal identity.
Abstinence-only programs merely tell teens what to do and such a paternalistic approach will likely be a turn off to teens, making the programs much less effective. A study examining the long-term impacts of abstinence-only programs on sexual behavior found that of the six abstinence-only programs studied, none had produced a statistically significant change in sexual behavior (Hauser, 2004). California, the only state to decline Title V funding, conducted its own abstinence-only pilot program in the early 1990s and eventually terminated the program in 1996 because evaluations showed abstinence-only education to be ineffective. A recent study by the Guttmacher Institute attributed the 36% decline in teen pregnancy rates to a combination of both increased abstinence and changes in contraceptive practice (Guttmacher Institute, 2006). Clearly, an effective approach to reducing the rates of teen pregnancy and STD infection requires teaching teens about the benefits of both abstinence and contraception.
Argument 2
Administration-funded studies on the efficacy of abstinence-only programs are flawed because these studies assume that program attendance, intention and attitudes of adolescents are accurate proxies of actual behavior. In June 2005, the results of a federally funded study on the impacts of Title V abstinence-only education program were released. The study reported that the programs increased participants’ support of abstinence, decreased their support of teen sex and increased their perceptions of the adverse consequences of teen and nonmarital sex (Maynard et al., 2005). While these results seem to indicate the effectiveness of abstinence-only education, the study contains major flaws that call the true meaning of its results into question. The study merely measures changes in beliefs and attitudes towards sex and does not measure actual changes in sexual behavior. Also, the study does not compare the effectiveness of abstinence-only programs against the effectiveness of more comprehensive programs that include contraception education. The study only compares youths who participated in the abstinence-only programs with those who did not participate in such programs.
A great deal of research contradicts the belief that changes in knowledge and attitudes alone will necessarily result in behavior change. Beliefs, attitudes and intentions are notoriously weak proxies for actual behaviors. The flaws in the Health Belief Model show that even if a person perceives the benefits and costs of a health behavior and indicates an intent or desire to engage in that health behavior, such perceptions and intentions do not always result in behavioral change (Salazar, 1991). Just like the Health Belief Model, these studies mistakenly assume that people will behave rationally, based on their intentions. This assumption is dangerous and can lead to unsuccessful programs as it ignores the fact that spontaneous activity characterizes much of human behavior, particularly when it comes to sex.
The majority of teens engage in some kind of sexual behavior by the time they graduate from high school. Telling them to completely abstain until marriage may seem like an impossible request and many teens may just decide give up (ex. 5-a-day campaign), despite having every intention to abstain. A Columbia University study showed that 88% of teens who took virginity pledge as part of an abstinence-only program broke that pledge (Connolly, 2004). Not only that, of the teens that broke their pledge, one-third were less likely to use contraceptives when they engaged in sexual activity than teens who did not sign pledges (Ireland, 2004). The results of this study fall directly in line with the Theory of Self-Efficacy, which states that one’s belief in the ability to perform a behavior is an important link between knowing what to do and actually doing it (Salazar, 1991). No matter what a person’s intentions are, a person is less likely to engage in a certain health behavior if they do not belief they are capable of successfully executing the behavior. Abstinence-only programs are ineffective because they are not functioning within the reality of teenagers in the United States. Abstinence-only programs set the bar impossibly high, provide teens with no way to protect themselves if they do decide to engage in premarital sex and misinform teens as to the effectiveness of contraception. The programs end up placing teens at even more risk than those who never received such education in the first place.
Argument 3
Abstinence-only education promotes abstinence until marriage and is not effective in reducing sexually transmitted disease or sexual activity because the message ignores the reality of homosexual youths and therefore, does not apply to the broadest possible audience. Abstinence-only programs promote the message that sex outside of marriage is never okay. The program presents a very narrow view of sexuality, such that the program essentially sends the message that gay teens must remain abstinent forever because they are not currently permitted to legally marry and therefore will never be able to have sex within the context of marriage.
Abstinence-only programs are not just singling out gay teens, the programs flatly ignore the fact that gay teens exist and never even address the impossibility of sex in the context marriage for these individuals. This aspect of abstinence-only programs goes against Mercer’s theory of early adolescence, which names acceptance and comfort with body image as one of the six developmental tasks of adolescence (Blinn-Pike, 1996). This includes the fulfillment of an adolescent’s need for belongingness, to feel that one is accepted as part of a group. Abstinence-only programs exclude gay teens because the program’s definition leaves out any real options for this group and provides no practical education on contraception use. This is likely to significantly diminish the health and safety of gay teens under the program because they do not feel like they are part of group or audience that the program intends to reach.
In addition, the program does nothing to make gay teens comfortable with their body image and probably accomplishes just the opposite. The programs insinuate that homosexuality is not acceptable sexual behavior and sends the message that they do not care enough about gay teens to develop a program that promotes safe and healthy sexual behavior, regardless of orientation. Numerous studies have pointed out the connection between negative conceptions of the self and risky sexual behavior among adolescents (Blinn-Pike, 1996). The program seems much more focused on pushing a particular ideology of acceptable sexual behavior and morals than on the health and safety of teens. If the government were really concerned about teen pregnancy or STD infection rates, federally funded programs would not completely ignore gay teens because doing so leaves this particularly vulnerable group with no real option but to remain abstinent forever.
Conclusion
There are three main reasons why the federal government should no longer provide such widespread support of abstinence-only programs. First, abstinence-only education has not been proven effective in reducing rates of sexual activity, pregnancy or STDs in adolescents. Second, federally funded studies claiming the effectiveness of abstinence-only programs mistakenly assume that intentions to abstain from sexual activity translate to actual behavior. Thirdly, abstinence-only education promotes abstinence until marriage and therefore, completely ignores the reality of gay youth. Abstinence-only programs leave adolescents vulnerable to unintended pregnancy and STD infections by promoting ignorance and denying adolescents the tools they need to protect themselves and make informed sexual choices. Therefore, the federal government should not continue to funnel public funds towards such programs without, at least, providing equivalent funding to comprehensive sex education programs.
Sources and References
Blinn-Pike, Lynn, Preteen Enrichment: An Evaluation of a Program to Delay Sexual Activity Among Female Adolescents in Rural Appalachia, Family Relations, Vol. 45, No. 4, pp. 380-386 (Oct. 1996).
Centers for Disease Control, Sexually Transmitted Disease Surveillance 2004 (Sept. 2005) available at http://www.cdc.gov/std/stats/trends2004.htm.
Connolly, Ceci, Some Abstinence Programs Mislead Teens, Report Says, Washington Post (Dec. 2, 2004), available at http://www.washingtonpost.com/ac2/wp-dyn/A26623-2004Dec1?language=printer.
Guttmacher Institute, Get “In the Know”: 20 Questions about Pregnancy, Contraception and Abortion (May 2006) available at http://www.guttmacher.org/in-the-know/index.html.
Guttmacher Institute, U.S. Teenage Pregnancy Statistics: Nation and State Trends and Trends by Race and Ethnicity (Sept. 2006), available at http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf.
Hauser, Debra, Title V State Evaluations: Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact, Advocates for Youth (2004).
Ireland, Doug, Condom Wars: New guidelines gut HIV prevention – and endanger young people’s lives, L.A. Weekly (June 24, 2004).
Kantor, Leslie M. and William F. Bacon, Abstinence-Only Programs Implemented Under Welfare Reform are Incompatible with Research on Effective Sexuality Education, Journal of American Women’s Medical Association, Vol. 57, No. 1 (Winter 2002).
Kristof, Nicholas D., Bush’s Sex Scandal, New York Times (Feb. 16, 2005).
Maynard, Rebecca, et al., First-Year Impacts of Four Title V, Section 510 Abstinence Education Programs (June 2005).
Salazar, Mary Kathryn, Comparison of Four Behavioral Theories: A Literature Review, American Association of Occupational Health Nurses Journal, Vol. 39, No. 3 (March 1991).
Thambirayah, M.S., Psychological Basis of Psychiatry (2005).
Title IX, Section 912 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Over the past two decades, teenage pregnancy rates have dropped significantly in the United States with 75% of the drop attributable to contraception use and 25% to a reduction in sexual activity (Guttmacher Institute, 2006). Despite these positive trends, teens in the United States still experience the highest birth rates and one of the highest rates of sexually transmitted disease (STD) among industrialized nations. Each year, almost 750,000 women aged 15-19 become pregnant (Guttmacher Institute, 2006) and nearly half of all new STD infections occur in young people between the ages of 15-24 (CDC, 2004). Both teen pregnancy and adolescent STD infection rates remain major public health challenges in the United States.
In 1996, Congress passed the Personal Responsibility & Work Opportunity Reconciliation Act, which was a piece of legislation aimed at welfare reform. Attached to the Act was a provision, later set out in Title V of the Social Security Act, appropriating $50 million per year for state educational initiatives promoting abstinence-only until marriage. This provision was attached to the Act during the final hours of negotiation and reconciliation and passed without any public debate and with little notice (Kantor & Bacon, 2002). Under the Act, states were required to match every $4 of federal funding with $3 of state funding, bringing the total amount of public funding for abstinence-only programs to $87.5 million per year. Abstinence-only education promotes abstinence until marriage as the only “sure” way to prevent teen pregnancy and STD infection. Despite mounds of contrary evidence and obvious lack of public support, federal funding continues to be appropriated for abstinence-only education and has even increased under the Bush administration (Kantor & Bacon, 2002).
To receive Title V federal funding, state abstinence education programs must meet a specific set of requirements. The federal definition of abstinence education is an educational or motivational program that:
Has as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
Teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children;
Teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, STDs, and other associated health problems;
Teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity;
Teaches that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects;
Teaches the bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society;
Teaches young people how to reject sexual advances and how alcohol and drug use increase vulnerability to sexual advances;
Teaches the importance of attaining self-sufficiency before engaging in sexual activity.
(Personal Responsibility and Work Opportunity Reconciliation Act of 1996)
Some of the requirements provide helpful skills and information, such as teaching young people how to reject sexual advances and the importance of attaining self-sufficiency prior to engaging in sexual activity. However, others clearly seem to impose certain beliefs and ideologies, including that marriage is the only context in which sexual activity is acceptable and that sex outside of marriage is morally wrong and physically dangerous to oneself, one’s children and even society. Even more interesting is what abstinence-only programs are not permitted to teach. The program does not allow for the dissemination of any information on contraceptives and only allows mention of contraceptives when discussing their failure rates. For these programs, abstinence is the only effective way to prevent pregnancy and STDs.
Currently, the federal government does not support any other sex education programs besides abstinence-only education. The only more comprehensive programs that exist are funded by state, local or private funds. Abstinence-only education that omits information about contraception and provides misleading information regarding the effectiveness of contraceptives leaves young teens vulnerable to unintended pregnancy and STDs. Federal funding for sex education should not be appropriated exclusively towards abstinence-only programs because: 1) abstinence-only education has not been proven effective in reducing rates of sexual activity, pregnancy or STDs in adolescents; 2) federally funded studies touting the success of abstinence-only programs mistakenly assume that intentions to abstain from sexual activity translate to actual behavior; and 3) abstinence-only education that promotes abstinence until marriage completely ignores the reality of homosexual youths because the federal government defines marriage as between a man and a woman.
Argument 1
Abstinence-only education, which calls for complete abstention from sexual activity until marriage, is not effective in reducing rates of sexual activity, pregnancy or sexually transmitted disease in adolescents because such programs censor contraceptive and STD prevention information rather than teaching youths to make educated decisions. Abstinence-only education does not allow teens to make their own choices regarding pre-marital sex and gives teens an extremely limited set of tools to protect against unintended pregnancy and STDs. These programs force upon teens the ideology that marriage is good and that sex outside marriage is dangerous and unacceptable, no exceptions. This approach goes against Erik Erikson’s theory of psychosocial development, which states that the formation of identity is the essential and fundamental task of adolescence (Thambirayah, 2005). Telling teens that abstinence is the only option does not give them the freedom to establish their own personal identity because it presents them with only one very narrow view on a person’s sexual identity. It does not make teens feel like they are an active participant in the development of their own moral standards and personal identity.
Abstinence-only programs merely tell teens what to do and such a paternalistic approach will likely be a turn off to teens, making the programs much less effective. A study examining the long-term impacts of abstinence-only programs on sexual behavior found that of the six abstinence-only programs studied, none had produced a statistically significant change in sexual behavior (Hauser, 2004). California, the only state to decline Title V funding, conducted its own abstinence-only pilot program in the early 1990s and eventually terminated the program in 1996 because evaluations showed abstinence-only education to be ineffective. A recent study by the Guttmacher Institute attributed the 36% decline in teen pregnancy rates to a combination of both increased abstinence and changes in contraceptive practice (Guttmacher Institute, 2006). Clearly, an effective approach to reducing the rates of teen pregnancy and STD infection requires teaching teens about the benefits of both abstinence and contraception.
Argument 2
Administration-funded studies on the efficacy of abstinence-only programs are flawed because these studies assume that program attendance, intention and attitudes of adolescents are accurate proxies of actual behavior. In June 2005, the results of a federally funded study on the impacts of Title V abstinence-only education program were released. The study reported that the programs increased participants’ support of abstinence, decreased their support of teen sex and increased their perceptions of the adverse consequences of teen and nonmarital sex (Maynard et al., 2005). While these results seem to indicate the effectiveness of abstinence-only education, the study contains major flaws that call the true meaning of its results into question. The study merely measures changes in beliefs and attitudes towards sex and does not measure actual changes in sexual behavior. Also, the study does not compare the effectiveness of abstinence-only programs against the effectiveness of more comprehensive programs that include contraception education. The study only compares youths who participated in the abstinence-only programs with those who did not participate in such programs.
A great deal of research contradicts the belief that changes in knowledge and attitudes alone will necessarily result in behavior change. Beliefs, attitudes and intentions are notoriously weak proxies for actual behaviors. The flaws in the Health Belief Model show that even if a person perceives the benefits and costs of a health behavior and indicates an intent or desire to engage in that health behavior, such perceptions and intentions do not always result in behavioral change (Salazar, 1991). Just like the Health Belief Model, these studies mistakenly assume that people will behave rationally, based on their intentions. This assumption is dangerous and can lead to unsuccessful programs as it ignores the fact that spontaneous activity characterizes much of human behavior, particularly when it comes to sex.
The majority of teens engage in some kind of sexual behavior by the time they graduate from high school. Telling them to completely abstain until marriage may seem like an impossible request and many teens may just decide give up (ex. 5-a-day campaign), despite having every intention to abstain. A Columbia University study showed that 88% of teens who took virginity pledge as part of an abstinence-only program broke that pledge (Connolly, 2004). Not only that, of the teens that broke their pledge, one-third were less likely to use contraceptives when they engaged in sexual activity than teens who did not sign pledges (Ireland, 2004). The results of this study fall directly in line with the Theory of Self-Efficacy, which states that one’s belief in the ability to perform a behavior is an important link between knowing what to do and actually doing it (Salazar, 1991). No matter what a person’s intentions are, a person is less likely to engage in a certain health behavior if they do not belief they are capable of successfully executing the behavior. Abstinence-only programs are ineffective because they are not functioning within the reality of teenagers in the United States. Abstinence-only programs set the bar impossibly high, provide teens with no way to protect themselves if they do decide to engage in premarital sex and misinform teens as to the effectiveness of contraception. The programs end up placing teens at even more risk than those who never received such education in the first place.
Argument 3
Abstinence-only education promotes abstinence until marriage and is not effective in reducing sexually transmitted disease or sexual activity because the message ignores the reality of homosexual youths and therefore, does not apply to the broadest possible audience. Abstinence-only programs promote the message that sex outside of marriage is never okay. The program presents a very narrow view of sexuality, such that the program essentially sends the message that gay teens must remain abstinent forever because they are not currently permitted to legally marry and therefore will never be able to have sex within the context of marriage.
Abstinence-only programs are not just singling out gay teens, the programs flatly ignore the fact that gay teens exist and never even address the impossibility of sex in the context marriage for these individuals. This aspect of abstinence-only programs goes against Mercer’s theory of early adolescence, which names acceptance and comfort with body image as one of the six developmental tasks of adolescence (Blinn-Pike, 1996). This includes the fulfillment of an adolescent’s need for belongingness, to feel that one is accepted as part of a group. Abstinence-only programs exclude gay teens because the program’s definition leaves out any real options for this group and provides no practical education on contraception use. This is likely to significantly diminish the health and safety of gay teens under the program because they do not feel like they are part of group or audience that the program intends to reach.
In addition, the program does nothing to make gay teens comfortable with their body image and probably accomplishes just the opposite. The programs insinuate that homosexuality is not acceptable sexual behavior and sends the message that they do not care enough about gay teens to develop a program that promotes safe and healthy sexual behavior, regardless of orientation. Numerous studies have pointed out the connection between negative conceptions of the self and risky sexual behavior among adolescents (Blinn-Pike, 1996). The program seems much more focused on pushing a particular ideology of acceptable sexual behavior and morals than on the health and safety of teens. If the government were really concerned about teen pregnancy or STD infection rates, federally funded programs would not completely ignore gay teens because doing so leaves this particularly vulnerable group with no real option but to remain abstinent forever.
Conclusion
There are three main reasons why the federal government should no longer provide such widespread support of abstinence-only programs. First, abstinence-only education has not been proven effective in reducing rates of sexual activity, pregnancy or STDs in adolescents. Second, federally funded studies claiming the effectiveness of abstinence-only programs mistakenly assume that intentions to abstain from sexual activity translate to actual behavior. Thirdly, abstinence-only education promotes abstinence until marriage and therefore, completely ignores the reality of gay youth. Abstinence-only programs leave adolescents vulnerable to unintended pregnancy and STD infections by promoting ignorance and denying adolescents the tools they need to protect themselves and make informed sexual choices. Therefore, the federal government should not continue to funnel public funds towards such programs without, at least, providing equivalent funding to comprehensive sex education programs.
Sources and References
Blinn-Pike, Lynn, Preteen Enrichment: An Evaluation of a Program to Delay Sexual Activity Among Female Adolescents in Rural Appalachia, Family Relations, Vol. 45, No. 4, pp. 380-386 (Oct. 1996).
Centers for Disease Control, Sexually Transmitted Disease Surveillance 2004 (Sept. 2005) available at http://www.cdc.gov/std/stats/trends2004.htm.
Connolly, Ceci, Some Abstinence Programs Mislead Teens, Report Says, Washington Post (Dec. 2, 2004), available at http://www.washingtonpost.com/ac2/wp-dyn/A26623-2004Dec1?language=printer.
Guttmacher Institute, Get “In the Know”: 20 Questions about Pregnancy, Contraception and Abortion (May 2006) available at http://www.guttmacher.org/in-the-know/index.html.
Guttmacher Institute, U.S. Teenage Pregnancy Statistics: Nation and State Trends and Trends by Race and Ethnicity (Sept. 2006), available at http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf.
Hauser, Debra, Title V State Evaluations: Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact, Advocates for Youth (2004).
Ireland, Doug, Condom Wars: New guidelines gut HIV prevention – and endanger young people’s lives, L.A. Weekly (June 24, 2004).
Kantor, Leslie M. and William F. Bacon, Abstinence-Only Programs Implemented Under Welfare Reform are Incompatible with Research on Effective Sexuality Education, Journal of American Women’s Medical Association, Vol. 57, No. 1 (Winter 2002).
Kristof, Nicholas D., Bush’s Sex Scandal, New York Times (Feb. 16, 2005).
Maynard, Rebecca, et al., First-Year Impacts of Four Title V, Section 510 Abstinence Education Programs (June 2005).
Salazar, Mary Kathryn, Comparison of Four Behavioral Theories: A Literature Review, American Association of Occupational Health Nurses Journal, Vol. 39, No. 3 (March 1991).
Thambirayah, M.S., Psychological Basis of Psychiatry (2005).
Title IX, Section 912 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
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