Articles, Reports, and
Position Statements
The Lancet
l
The Lancet is the world's leading independent general
medical journal.
www.thelancet.com
Sexual and Reproductive Health - a matter of life and death
Sexual behaviour in context
Family Planning: the Unfinished Agenda
Unsafe abortion: The Preventable Pandemic
Global control of sexually transmitted infections
Sexual and reproductive health for all - A call for action
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American Academy of Pediatrics
The Society for Adolescent
Medicine
Read what this organization of health professionals
believe is best for the sexual and reproductive health of adolescents.
Position Papers: http://www.adolescenthealth.org/PositionPapers.htm
Abstinence-Only
Education Policies and Programs
HIV
infection and AIDS in adolescents: An update of the position of
the Society for Adolescent Medicine
Media
and Contraception
Protecting
Adolescents: Ensuring Access to Care and Reporting Sexual Activity
and Abuse
Reproductive
Health Care for Adolescents
School-Based
Health Clinics
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American Academy of Pediatrics
Position Papers & Other Sexuality Health
Resources:
Policy statement regarding adolescent pregnancy:
http://pediatrics.aappublications.org/cgi/content/full/116/1/281
The American Academy of Pediatrics endorses and
accepts as its policy the Protecting Adolescents -
Ensuring Access to Care and Reporting Sexual Activity and Abuse:
http://www.adolescenthealth.org/PositionPaper_Protecting_Adolescents_Ensuring_Access_to_Care_and_Reporting_Sexual_Activity_and_Abuse.pdf
Adolescents and Human Immunodeficiency Virus Infection:
The Role of the Pediatrician in Prevention and Intervention:http://www.aap.org/healthtopics/stages.cfm#adol
Sexuality Health Topics:http://www.aap.org/healthtopics/sexuality.cfm
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Centers for Disease Control & Prevention,
Community Guide Branch
CDC Community Guide Branch's Task Force on Community
Preventive Services selected Prevention of HIV, STD's and Unwanted
Pregnancy as a priority topic for development
of a systematic review of evidence of effectiveness regarding selected
population based interventions. See their recommendations. http://www.thecommunityguide.org/sex/default.htm
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FDA Solicits Comments about Condoms
Released:November 14, 2005
The Food and Drug Administration (FDA) has developed
this draft guidance as a special controls guidance for male condoms
made from natural rubber latex (latex
condoms). Follow this link
to see the draft.
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Trends in Sexual Risk Behaviors Among High
School Students: United States, 1991--2001
MMWR September 27, 2002 / 51(38);856-859
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5138a2.htm
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Below are abstracts
and full articles for a number of peer-reviewed scientific articles
on important topics.
Journal of Adolescent Health 38 (2006) 72–8
Abstinence and abstinence-only education:
A review of U.S. policies and programs
John Santelli, M.D., M.P.H., Mary A. Ott, M.D., Maureen
Lyon, Ph.D.,
Jennifer Rogers, M.P.H., Daniel Summers, M.D., and Rebecca Schleifer,
J.D., M.P.H
Reprinted with permission from Society for
Adolescent Health.
Click
here for entire article
Abstract: Abstinence from sexual intercourse is
an important behavioral strategy for preventing human
immunodeficiency virus (HIV), other sexually transmitted infections
(STIs), and pregnancy among
adolescents. Many adolescents, including most younger adolescents,
have not initiated sexual
intercourse and many sexually experienced adolescents and young
adults are abstinent for varying
periods of time. There is broad support for abstinence as a necessary
and appropriate part of
sexuality education. Controversy arises when abstinence is provided
to adolescents as a sole choice
and where health information on other choices is restricted or misrepresented.
Although abstinence
is theoretically fully effective, in actual practice abstinence
often fails to protect against pregnancy
and STIs. Few Americans remain abstinent until marriage; many do
not or cannot marry, and most
initiate sexual intercourse and other sexual behaviors as adolescents.
Although abstinence is a
healthy behavioral option for teens, abstinence as a sole option
for adolescents is scientifically and
ethically problematic. A recent emphasis on abstinence-only programs
and policies appears to be
undermining more comprehensive sexuality education and other government-sponsored
programs.
We believe that abstinence-only education programs, as defined by
federal funding requirements,
are morally problematic, by withholding information and promoting
questionable and inaccurate
opinions. Abstinence-only programs threaten fundamental human rights
to health, information, and
life. © 2006 Society for Adolescent Medicine. All rights reserved.
Accessed at: http://www.jahonline.org/article/PIIS1054139X05004672/fulltext
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Sexually Transmitted Diseases, January 2006,
Vol. 33, No. 1, p.36–51
Condom Use and Risk of Gonorrhea and Chlamydia:
A Systematic Review of Design and Measurement
Factors Assessed in Epidemiologic Studies
LEE WARNER, PHD, MPH, KATHERINE M. STONE, MD, MAURIZIO
MACALUSO, MD, DRPH,
JAMES W. BUEHLER, MD, AND HARLAND D. AUSTIN, DSC
Background: Studies of condom use to reduce
risk of most sexually
transmitted infection provide inconsistent results. This inconsistency
is
often attributed to methodologic limitations yet has not been assessed
systematically.
Objectives: The objectives of this study
were to review studies of
condom use and risk of gonorrhea and chlamydia, and to evaluate
the
importance of 4 key design and measurement factors on condom
effectiveness estimates.
Design: We reviewed studies published 1966–2004
to assess risk
reduction for gonorrhea and/or chlamydia associated with male condom
use.
Results: Of 45 studies identified, most found reduced risk
of infection
associated with condom use. All studies reviewed had methodologic
limitations:
only 28 (62%) distinguished consistent from inconsistent use; 2
(4%) reported on correct use or use problems; 13 (29%) distinguished
incident from prevalent infection; and one (2%) included a population
with documented exposure to infection. Eight of 10 studies with
2 or more
of these attributes reported statistically significant protective
effects for
condom use versus 15 of 35 studies with zero or one attribute (80%
vs.
43%, P 0.04).
Conclusions: Condom use was associated
with reduced risk of
gonorrhea and chlamydia in men and women in most studies, despite
methodologic limitations that likely underestimate condom effectiveness.
Epidemiologic studies that better address these factors are
needed to provide more accurate assessment of condom effectiveness
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Annals of Internal Medicine 2005;143:707-713
The Relationship between Condom Use and
Herpes Simplex Virus Acquisition
By: Anna Wald, MD, MPH; Andria G.M. Langenberg, MD; Elizabeth Krantz,
MS; John M. Douglas Jr., MD; H. Hunter Handsfield, MD;
Richard P. DiCarlo, MD; Adaora A. Adimora, MD, MPH; Allen E. Izu,
MD; Rhoda Ashley Morrow, PhD; and Lawrence Corey, MD
BACKGROUND: Few studies have evaluated the relationship
between condom use and herpes simplex virus type 2 (HSV-2) and
HSV type 1 (HSV-1) acquisition.
OBJECTIVE: To assess the relationship between condom
use and acquisition of HSV-2 and HSV-1 among men and women.
DESIGN: Analysis of data collected as part of a
clinical trial of an ineffective candidate vaccine for HSV-2.
SETTING: Sexually transmitted disease clinics.
PARTICIPANTS: Men and women at risk for HSV-2 acquisition,
defined as having 4 or more sexual partners or having a sexually
transmitted disease in the past year.
MEAUREMENT Acquisition of HSV-2 and HSV-1 as measured
by viral culture or change to positive HSV serostatus.
RESULTS: Of 1843 participants, 118 (6.4%) became
infected with HSV-2. In multivariate analyses, participants reporting
more frequent
use of condoms were at lower risk for acquiring HSV-2 than participants
who used condoms less frequently (hazard ratio, 0.74 [95% CI, 0.59
to 0.95]);
categories of increasing condom use were 0% to 25%, 25% to 75%,
and greater than 75% of sexual acts. Nineteen (2.9%) of 659 participants
at risk for
infection with HSV-1 became infected. No
statistically significant association between condom use and infection
with HSV-1 was found (hazard ratio, 0.79 [CI, 0.48 to 1.31]).
LIMITATIONS: Use of condoms was measured by self-report,
and persons who used condoms may have differed from those who
did not.
CONCLUSIONS: Consistent use of condoms is associated
with lower rates of infection with HSV-2 and should be routinely
recommended.
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National Campaign to Prevent Teen Pregnancy
2001
Emerging Answers: Research Findings on Programs
to Reduce Teen Pregnancy
By Douglas Kirby, Ph.D.
Abstract:
This comprehensive review of evaluation research offers information
on "what programs work" to prevent teen pregnancy. In
addition to examining traditional
sex education, the study covers abstinence-only education programs
for teens, contraceptive and family planning services, early childhood
programs,
youth development, and service learning interventions. The report
cites eight programs as having strong evidence of success - five
are sex education programs,
two are service learning programs (i.e., community service combined
with group discussions and reflection), and one is an intensive
program that combines sex education,
comprehensive health care, and activities such as tutoring. One
particular service-learning model is the "Teen Outreach Program"
(TOP) which has had
especially impressive results. Program participants had a 41 percent
lower rate of teen pregnancy, regardless of race, socioeconomic
status, or grade level.
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Perspectives on Sexual and Reproductive Health
Volume 36, Number 2, March/April 2004
Parents' Beliefs About Condoms and Oral
Contraceptives: Are They Medically Accurate?
By Marla E. Eisenberg, Linda H. Bearinger, Renee E. Sieving, Carolyne
Swain and Michael D. Resnick
CONTEXT: Parents are encouraged to be the primary
sex educators for their children; however, little is known about
the accuracy of parents' views
about condoms and oral contraceptives.
METHODS: Telephone surveys using validated measures
provided data on beliefs about the effectiveness, safety and usability
of condoms and the pill among 1,069 parents
of 13-17-year-olds in Minnesota and Wisconsin in 2002. Pearson chi-square
tests and multivariate logistic regression models were used to compare
beliefs according
to sex, age, race, religion, education, income and political orientation
RESULTS: Substantial proportions of parents underestimated
the effectiveness of condoms for preventing pregnancy and sexually
transmitted diseases (STDs). Only 47% believed
that condoms are very effective for STD prevention, and 40% for
pregnancy prevention. Fifty-two percent thought that pill use prevents
pregnancy almost all the time;
39% thought that the pill is very safe. Approximately one-quarter
of parents thought that most teenagers are capable of using condoms
correctly;
almost four in 10 thought that most teenagers can use the pill correctly.
Fathers tended to have more accurate views about condoms than mothers
did;
mothers' views of the pill were generally more accurate than fathers'.
Whites were more likely than nonwhites to hold accurate
beliefs about the pill's safety and effectiveness; conservatives
were less likely than liberals to hold accurate views about the
effectiveness of condoms.
CONCLUSION: Campaigns encouraging parents to talk
with their teenagers about sexuality should provide parents with
medically accurate information on the effectiveness,
safety and usability of condoms and the pill.
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Perspectives on Sexual and Reproductive Health
Volume 36, Number 1, January/February 2004
The Estimated Direct Medical Cost of Sexually
Transmitted Diseases Among American Youth, 2000
By Harrell W. Chesson, John M. Blandford, Thomas
L. Gift, Guoyu Tao and Kathleen L. Irwin
CONTEXT: Each year, millions of U.S. youth acquire
sexually transmitted diseases (STDs). Estimates of the economic
burden of STDs can help to quantify
the impact of STDs on the nation's youth and on the payers of the
cost of their medical care.
METHODS: We synthesized the existing literature
on STD costs to estimate the lifetime medical cost per case of eight
major STDs—HIV, human papillomavirus (HPV),
genital herpes simplex virus type 2, hepatitis B, chlamydia, gonorrhea,
trichomoniasis and syphilis. We then estimated the total burden
of disease by multiplying
these cost-per-case estimates by the approximate number of new cases
of STDs acquired by youth aged 15-24.
RESULTS: The total estimated burden of the nine
million new cases of these STDs that occurred among 15-24-year-olds
in 2000 was $6.5 billion (in year 2000 dollars).
Viral STDs accounted for 94% of the total burden ($6.2 billion),
and nonviral STDs accounted for 6% of the total burden ($0.4 billion).
HIV and HPV were by far the most costly
STDs in terms of total estimated direct medical costs, accounting
for 90% of the total burden ($5.9 billion).
CONCLUSIONS: The large number of infections acquired
by persons aged 15-24 and the high cost per case of viral STDs,
particularly HIV, create a substantial economic burden.
Perspectives on Sexual and Reproductive Health,
2004, 36(1):11-19
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Perspectives on Sexual and Reproductive Health
Volume 36, Number 1, January/February 2004
Sexually Transmitted Diseases Among American
Youth: Incidence and Prevalence Estimates, 2000
By Hillard Weinstock, Stuart Berman and Willard Cates,
Jr.
CONTEXT: In the United States, young people aged
15-24 represent 25% of the sexually experienced population. However,
the incidence and prevalence
of sexually transmitted diseases (STDs) among this age-group are
unknown.
METHODS: Data from a variety of sources were used
to estimate the incidence and prevalence of STDs among 15-24-year-olds
in the United States in 2000.
The quality and reliability of the estimates were categorized as
good, fair or poor, depending on the quality of the data source.
RESULTS: Approximately 18.9 million new cases of
STD occurred in 2000, of which 9.1 million (48%) were among persons
aged 15-24. Three STDs (human papillomavirus,
trichomoniasis and chlamydia) accounted for 88% of all new cases
of STD among 15-24-year-olds.
CONCLUSIONS: These estimates emphasize the toll
that STDs have on American youth. More representative data are needed
to help monitor efforts at lowering the burden
of these infections.
Perspectives on Sexual and Reproductive Health,
2004, 36(1):6-10
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Journal of Adolescent Health Volume 36 (2005)
271-278
After the Promise: the STD consequences
of adolescent virginity pledges
By: Hannah Bruckner, Ph. D. , and Peter Bearman,
Ph.D.
PURPOSE: To examine the effectiveness of virginity
pledges in reducing STD infection rates among young adults (ages
18–24).
METHODS: Data are drawn from the National Longitudinal
Study of Adolescent Health, a nationally representative study of
students enrolled in grades 7–12 in 1995.
During a follow-up survey in 2001–2002, respondents provided urine
samples, which were tested for Human Papilloma Virus, Chlamydia,
Gonorrhea, and Trichomoniasis.
We report descriptive results for the relationship of pledge status
and sexually transmitted disease (STD) rates as well as health behaviors
commonly associated with STD infection.
RESULTS: Pledgers are consistently less likely to
be exposed to risk factors across a wide range of indicators, but
their STD infection rate does not differ from nonpledgers.
Possible explanations are that pledgers are less likely than others
to use condoms at sexual debut and to be tested and diagnosed with
STDs.
CONCLUSIONS: Adopting virginity pledges as intervention
may not be the optimal approach to preventing STD acquisition among
young adults.
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Journal of Pediatric Psychology, Vol. 28, No.
4, 2003, pp. 243-249 © 2003 Society of Pediatric Psychology
Adolescent Oral Sex, Peer Popularity, and
Perceptions of Best Friends' Sexual Behavior
Mitchell J. Prinstein, PhD, Christina S. Meade, MS
and Geoffrey L. Cohen, PhD
OBJECTIVE: To provided initial descriptive information
regarding adolescents' engagement in oral sex and to investigate
adolescents' perceptions of their best friends'
sexual behavior and peer-reported popularity as two social mechanisms
that may influence engagement in oral sex.
METHODS: A total of 212 tenth graders reported their
engagement in oral sex and intercourse, number of sexual partners,
and use of sexually transmitted infection (STI)
protection, as well as perceptions of their best friends' sexual
behaviors. Sociometric assessment yielded peer-reported measures
of adolescents' preference- and
reputation-based popularity.
RESULTS: Adolescents were more likely to report
engagement in oral sex than intercourse, report more oral sex partners
than intercourse partners, and were unlikely to report
use of STI protection during oral sex. Perceptions of best friends'
behavior were significantly associated with adolescents' own oral
sex behavior, but not intercourse.
Adolescents who reported sexual activity had high levels of reputation-based
popularity, but not likeability among peers; however, sex with more
partners was associated
with lower levels of popularity.
CONCLUSIONS: Implications for prevention programs
are discussed.
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