Getting the gist of sex ed.

In the United States we have higher rates of teen pregnancy than in many other Western countries. We also know that our teenagers are at high risk for STIs, sexually transmitted infections. To combat these problems, we often require teens to participate in sexual education programs. However, the type of program that is most effective is still debated. This week's meme offers a humorous suggestion:

Because even the most mature adult parents can be worn down by incessant crying and endless repetition, the joke implies that if teenagers experienced these things it would be unforgettable and they would abstain from sex. The joke also implies that teaching statistics like, "six week old babies spend 30% of their awake time crying," is not necessary; instead teenagers will remember a take home message like, "babies cry a lot."

This emphasis on gist, or take home message, over specific quantitative facts is applied more formally to sexual education by Reyna and Mills (2014). These authors investigated if concepts from Fuzzy Trace Theory could make a pre-existing sex ed. curriculum more effective. Past research on Fuzzy Trace Theory suggests that better memory of ideas and better decision-making comes from understanding the the gist, the take home message, as opposed to weighing the pros and cons based on detailed facts or figures that are more forgettable. Because these gist-based thoughts are related to one's emotions and values, they allow for very rapid decision-making.

Their experiment followed more than 700 adolescents, ages 14-19, during a 16 session intervention period and for one year after its completion. The participants were randomly assigned to three types of interventions: an existing sexual education program called Reducing the Risk (RTR); a version of Reducing the Risk that had been modified to add ideas from Fuzzy Trace Theory (RTR+); a Control group focusing on communication skills unrelated to sexuality.

Reducing the Risk (RTR) teaches teens how to recognize situations of sexual risk, how to resist pressure to have sex, and how to reduce risk of pregnancy with contraception and infection by using condoms. Teens enrolled in this program should come to realize that they are personally at risk and that they possess the ability to avoid or reduce sexually related risk. The sessions usually include a factual presentation by an adult leader followed by activities such as guided role playing. For example, the leader might present detailed factual data like, "60% of teenagers report that they used condoms during their most recent sexual experience," followed by guided role play of how to reason with a partner who does not want to use a condom. This program is considered to be effective at delaying first sexual experiences and increasing the use of birth control and infection protection. However, Reyna and Mills note that there is little evidence to show if these effects are lasting.

Because Fuzzy Trace Theory predicts that gist thinking should have a lasting effect on decision making, the authors modified RTR with ideas from this theory to create RTR+. This version is identical to RTR with two additions that emphasize gist. First, at the end of every lesson students are presented with one line summaries of the take home ideas of risk from the lesson. For example, "You should use a condom every time you have sex." Second, the participants in RTR+ receive a checklist of possible values, such as, "I will use condoms every time I have sex," that they are asked to rate themselves on after every lesson. Because gist related decision making is closely influenced by our values, asking students to repeatedly clarify their values should also provoke attention to generalized risks related to sex.

All participants' sexual experience, and beliefs about sex and disease prevention were measured during the intervention, and at three months, six months, and 12 months after the intervention ended. The results demonstrated that the teenagers who had been randomly assigned to RTR and RTR+ showed overall lower risk in their behavior and beliefs than the teenagers who had been assigned to the Control condition.

When the results from RTR and RTR+ were compared, overall RTR+ was considered to be more successful. RTR+, that included Fuzzy Trace Theory's emphasis on gist, was related to:
*a lower rate of students who started having sex during that 12 month period.
*the lowest increase in the number of sexual partners during that 12 month period.
*the smallest increase in positive attitude toward sex (thinking that having sex at this age is a good idea).
*the smallest increase in beliefs that parents and peers think sex was okay for them to experience at this age.
*the highest belief that they were at risk for generalized (take home message) risks associated with sex. This is a measure of gist thinking - so it is not surprising that the teens in RTR+ demonstrated more of this.
*the highest knowledge of sex related risks lasting up to six months after the intervention.
*the highest recognition of warning signals of sexual risk.

On the other hand, RTR, the original sexual education program, was related to:
*more favorable attitudes toward condom use during that 12 month period.
*more agreement with gist-based summaries of sexual risk as measured three months after the intervention. This is another measure of gist thinking - so it IS surprising that the teens in RTR demonstrated more of this

The results were further influenced when the participants' races were taken into account. Reyna and Mills compared results from the three most prominent groups represented in their sample: African American; Hispanic; and White. Curiously, the authors decided to add data from Asian participants into the category White because the responses from those groups were similar. So data reported in relation to White participants should be understood as White and Asian. However, an improvement to this study would have been to further diversify the sample so that Asian adolescents were properly represented.

How did race influence the results? For example, RTR+:
*initially improved African American participants' attitudes toward condoms, but that effect disappeared after the intervention was over.
*increased White participants' beliefs that they could successfully use condoms.
*was related to higher sexual risk knowledge for Hispanic and White teens.
*increased African American and White participants' belief that they were at risk for generalized (take home message) risks associated with sex. This is a measure of gist thinking - so it is not surprising that some teens in RTR+ demonstrated more of this. However, it is surprising that Hispanic participants did not demonstrate more of this in RTR+.

Race also influenced the results of the other intervention. For example, RTR:
*increased Hispanic and White participants' belief that parents and peers think condoms should be used when having sex.
*increased Hispanic and White participants' belief that they were at risk for generalized (take home message) risks associated with sex. This is a measure of gist thinking - so it IS surprising that some of the teens in RTR demonstrated more of this.

Taken together, the results suggest that including an emphasis on the gist of sex related risks could be a positive addition to sexuality education if we want to encourage teenagers to delay sexual experience and to use condoms to prevent infection. This statement is based on results that reached statistical significance, meaning that the differences between teens assigned to RTR and RTR+ were not simply due to chance.

Some of these differences seem substantial. For example, Reyna and Mills note that being enrolled in RTR+ was 84% more effective at delaying the start of sexual activity when compared to the Control condition. At the same time some the differences were often very small even though they reached statistical significance. For example, teens assigned to RTR+ had fewer sexual partners than teens assigned to the regular RTR program. This result seems less impressive when you read that the teens in RTR+ reported an average of  2.15 partners while the teens in RTR reported an average of 2.21. In terms of a practical difference that would be of interest to parents and educators, this is almost nothing: both groups had about two sexual partners during that year.

Another issue is that interventions need to be tailored to the characteristics of the audience to be effective. The influence of race in the present study is especially important to note because teenagers from different racial groups differ in: how old they are when they start having sex; their risk of pregnancy (or getting somebody pregnant); and their risk of contracting a sexually transmitted infection (STI). Reyna and Mills also acknowledge that further research needs to focus on how and why concepts from Fuzzy Trace Theory may impact the sexual behaviors and beliefs of adolescents from diverse backgrounds.

Further Reading:

The Reyna and Mills (2014) article can be accessed through your local college library.

Watch a lecture by Dr. Valerie Reyna (one of the authors of this week's article) on "Risky Decision Making in Adolescence." This talk, given at Cornell University, covers, "...developmental differences in the way adolescents make decisions and reviews her research regarding why adolescents perceive risks and benefits and yet take more risks."

If you are interested in decreasing adolescent pregnancy and STIs, The National Campaign to Prevent Teen and Unplanned Pregnancy website includes statistics (state and national) and an excellent comparison of effective programs aimed at decreasing these problems. 

BONUS: The Reyna and Mills (2014) article includes a particularly cringe-worthy example used in RTR (and RTR+) as a warning sign that, "...unsafe sex may be imminent...": "being alone with a significant other, lights low and soft music playing..." (p. 1631). As goofy as that might sound to a modern teenager, I suppose that we do have evidence of its truth from the classic 1955 Disney film, "Lady and the Tramp."