Dr. Douglas Kirby is senior research scientist at ETR Associates, a nonprofit health education organization in Scotts Valley, California. He has served as chair of the Effective Programs and Research Task Force at the National Campaign to Prevent Teen Pregnancy, and is the author of numerous studies of sexual education programs, including Emerging Answers.

Dr. Rebecca Maynard is a professor of education and social policy and chair of the Policy, Management and Evaluation Division of the Graduate School of Education at the University of Pennsylvania.

Al Ferreira has been an art teacher in the Cambridge, Massachusetts public schools for 30 years. At Cambridge Rindge and Latin High School in 1987, he founded Project 10 East, which became a model for gay/straight alliance groups across the country. In 1992 he represented Massachusetts public schools on the Governor's Commission on Gay and Lesbian Youth, and he has provided advice on how to start gay/straight alliances to schools across the country.

The Education of Shelby Knox: Interviews: Sex and the American Teen

POV

19 years ago

Introduction

Dr. Douglas Kirby,
Former Director of Research
National Campaign to Prevent Teenage Pregnancy
"It's not easy to change adolescent behavior, and we've certainly made a lot of mistakes over the years." | Read more »

Dr. Joseph McIlhaney,
Medical Institute of Sexual Health
"Despite extensive academic studies, multiple reports for years have shown almost no impact [from comprehensive programs]. Clearly, it's time to try something new -- abstinence education." | Read more »

Dr. Peter Bearman,
Director of the Institute for Social and Economic Research and Policy and the Paul F. Lazarsfeld Center for the Social Sciences at Columbia University
"Many kids have sex whether they pledge [to remain abstinent] or not, [but] pledgers, when they have sex as adolescents, were much less likely than non-pledgers to use contraceptives at first sex. " | Read more »

Dr. Rebecca Maynard,
Professor, Education and Social Policy
University of Pennsylvania
"The first thing to note is that very few kids in this country take the virginity pledge. It's gotten lot of publicity, but nationwide it's under 10 percent." | Read more »

Ashlee Reed & Al Ferreira,
Executive Director, Project 10 East and Former Teacher, Cambridge Rindge & Latin High School
In 1987, Mr. Ferreira, a photography teacher at Cambridge Rindge & Latin, started the first Gay Straight Alliance program in a northeastern high school. Today, Ashlee Reed heads up Project 10 East. | Read more »

Dr. Douglas Kirby

Dr. Douglas Kirby on Comprehensive Ed

POV: Could you describe your work with the National Campaign to Prevent Teen Pregnancy, and particularly the study you authored in 2001, Emerging Answers?

Dr. Douglas Kirby: For a number of years, I was chairperson of the Effective Programs and Research Task Force for the National Campaign to Prevent Teen Pregnancy. The National Campaign has several task forces, and this one really focuses on research. One of many things that we did was to synthesize all the research that has been conducted in the field that meets certain scientific criteria. Emerging Answers was one of those products. Let me say, though, that although I was the author of it, it was critiqued and reviewed and read by all the members of the Effective Program and Research Task Force, and we intentionally created a task force that included a great diversity of members, in terms of gender, race, ethnicity, and also political persuasion, so there were some members that were conservative, and some that were more liberal. And we basically all agreed on the major conclusions.

POV: What were the conclusions?

Kirby: One is that many studies show that programs that emphasize abstinence as the safest approach, but also encourage those who are sexually active to use condoms and contraceptives do not increase sexual behavior; they do not do harm. They do not hasten the initiation of sex, they do not increase the frequency of sex, and they do not increase the number of sexual partners. In fact, to the contrary, some, but not all, of the programs, delay the initiation of sex or reduce frequency or reduce the number of sexual partners. In addition to that, some of these programs, but not all, also increase condom or contraceptive use. So basically, this is good news, and it's very strong news, very strong evidence, that those programs that emphasize abstinence as the safest approach, but also encourage condom and contraceptive use, those programs do not increase sexual behavior, can reduce sexual behavior, and can also increase condom and contraceptive use.

Coronado High School in Lubbock, Texas

POV: Are those programs considered "abstinence-plus" programs?

Kirby: Yes. But people use different words to describe them. Sometimes they're called abstinence-plus, sometimes people call them comprehensive sex or HIV education programs. "Comprehensive" meaning that they're talking not only about abstinence but also about condoms and contraceptive use.

POV: Did the study find that the successful programs had some characteristics in common?

Kirby: Yes. Among the programs or the curricula that did have a positive impact upon behavior, there tend to be roughly ten to thirteen characteristics, depending on the way you count them. [Read the full list of characteristics in the executive summary of Emerging Answers (PDF).] The effective programs, for example, really focused upon behavior. They talked about sex, they talked about condom and contraceptive use. They also talked about pregnancy and STD and HIV. So they were not real broad programs, but they really talked about and focused on behavior. They gave very clear messages about behavior, and a very clear message was one of the most important criteria. As I mentioned, typically that message was some version of "you should always avoid unprotected sex; abstinence really is the only 100 percent safe approach; if you have sex, you should always use a condom or contraception to prevent STD and pregnancy." A version of that was truly emphasized. The successful programs were also very interactive. They did not consist of having a teacher stand up there and just give [students] didactic material. The effective programs involved youth in a whole variety of activities so that they were engaged and involved. They played games, they did role-playing. They had small-group discussions. They did lots of things in which they were actively involved.

POV: Did you find that the unsuccessful programs had characteristics in common?

Kirby: The ineffective ones, for the most part, just lacked one or more of the ten characteristics. They did not give a clear message, they weren't interactive, they did not really focus on behavior or they focused too much upon knowledge. The effective programs did provide basic information, but they did not primarily provide knowledge. They tried to change personal values, they tried to change perceptions of peer norms. They tried to increase young people's confidence that they could say no to sex or use condoms if they did have sex. In the effective programs there's a lot of skill building, role-playing to say no, role-playing to insist on using a condom.

Something else that should be said about the abstinence-plus programs is that a couple of them actually have an impact for as long as 31 months. That's close to three years, so that's really very encouraging. It is not the case that they can only have an impact in the short term. They can have an impact in the long term if they're well designed and if they have booster sessions after the initial sessions.

POV: Can you give us an example of a program that was successful?

Kirby: One very successful program, for example, is Safer Choices, and it had ten sessions in the 9th grade, ten sessions in the 10th grade, and then it had school-wide activities during all the years, so that young people would receive a clear message and understand it in the 9th grade, it would be reinforced in the 10th grade, and then in the 11th and 12th grade those messages would be reinforced by assemblies, by posters that were put up around campus, by things in the newspapers, et cetera. And that's a good model.

POV: So that's an abstinence-plus program. What did you research tell you about abstinence-only programs?

Kirby: The sad news is that there are very few reasonably good studies of abstinence-only programs, and because there are so few good studies, we really cannot reach any conclusion about them. The Effective Program and Research Task Force created a set of criteria for what should constitute a reasonably good study, and should be included in Emerging Answers. And at that time only three abstinence-only programs met those criteria. Those three programs did not have any positive impact on behavior. But we should not conclude from that that abstinence-only programs do not work. Rather, the appropriate conclusion is that there is very little research, there's very little evidence. And we simply don't know whether or not abstinence-only programs work. Personally, I think that some abstinence-only programs probably are effective at delaying the initiation of first sex, but so far we don't have good evidence telling us which ones.

POV: Why are there so few studies of abstinence-only programs?

Kirby: It's primarily because of the limitation on funding for research. A lot of the existing funding came from a certain title, [a certain category of] federal government funds, and to do good research, to really measure the impact of a program, takes about five to eight years, and it takes a lot of money. And that source of funding limited it to only two or three years, and provided only small amounts of money. Consequently it was just not possible for people to do good research on these programs. That has now changed. There's a very good evaluation being done currently by Mathematica Policy Research on abstinence-only programs, but we don't have the results of that yet. [See related links for update.]

POV: Politically, sex education and government funding are consistently controversial topics. Does that make it more difficult to do the kind of research you're talking about?

Kirby: Well, it does make it a little more difficult to do good research. It makes it more difficult to publish research, particularly negative findings. And when things are so politicized, it makes it hard for researchers to present results saying something didn't work.

POV: What areas or subjects do you feel deserve further research or particular attention?
Kirby: Although the Mathematica Policy Research study, which is a big study, will partially fill the need, there's still a need for other studies [of abstinence-only programs] to be done. Of the hundred studies in the world, a large majority of them, probably 90 of them, deal with abstinence-plus programs. So we need more studies of abstinence-only programs to find out which ones really do work.

POV: Are there some practical implications to what your studies have found?

Kirby: Philosophically -- and speaking now as a citizen rather than just a researcher -- I believe that we should be implementing those programs that are demonstrated to be effective, and it's a real gamble of our taxpayers' dollars to be implementing programs that have not yet been demonstrated to be effective. A lot of money is being used to implement abstinence-only programs that have not yet been evaluated. It's very important to evaluate those programs and then to implement the abstinence-only programs that are effective.

POV: Over the course of your career, what long-term changes have you seen in sex education programs? What things remain constant?

Kirby: It's not easy to change adolescent behavior, and we've certainly made a lot of mistakes over the years. For the first 10, 12 years that I did work in this field, all the programs we evaluated failed to have an impact on behavior. They did other good things, but they didn't change behavior. It was not until roughly around 1988 or 1989 that we had a good study showing that a particular program was effective.

POV: This may be a little outside your specialty, but can you talk a bit about the differences between the United States and other nations in terms of teen pregnancy rates, STD infections, and sex education?

Kirby: It's pretty well known that teen pregnancy rates are much lower in Western Europe than they are here in the United States. The US has the highest teen pregnancy rate in the Western industrialized world. And so many people try to compare, or have examined, why rates are lower in Western Europe than they are here. And, in my mind, the answer is a complex one. It may be the case that they have better sex and HIV education programs. It's certainly the case that in most of the Western European countries they have a more homogeneous population, which has reached greater agreement on what values should be emphasized to young people. Those tend, typically, to be pretty liberal values. But there's much greater agreement upon them than there is in the United States, where we have real polarization. So in Western European countries, they're consistently given a common message, whereas in the US we give conflicting messages.

It's also true that they have access to health care more generally, and that given that access to health care that includes reproductive health care, so they'd be more likely to receive reproductive health care services when they do become sexually active. Poverty is an incredibly important predictor of high teen pregnancy rates. And the Western European countries have greater equality than we do in this country, and there's less poverty there. So that makes a difference. They tend to devote more resources there to young people, more generally, than we do in this country. They're more supportive; they have clearer pathways for them to move from secondary school on into career paths than we do in this country.

POV: When you're studying something as complex as sexual behavior, with so many different influencing factors, how do you try to isolate the effects of a sex education program?

UPDATE: The initial findings of Mathematica Policy Research studies were reported on June 14, 2005 and found that "abstinence education programs increased youth's support for abstinence. The evidence on whether programs raised expectations to abstain is less clear." Download a PDF of the report at the Mathematica Policy Research website.

Kirby: In general, all of those factors fall into 4 different broad groups. One group are biological factors -- things such as age, gender, physical maturity, etc. Even hormone level makes a difference; testosterone level makes a difference. Another broad category is social disorganization and poverty: things like drug use, divorce rates, community crime rates; the use of alcohol and drugs; a whole variety of things associated with social disorganization and disadvantage. The third very important group is values, sexual values, either verbally expressed or modeled by people in the teen's environment: parents' values, perception of peers' values, whether or not their parents gave birth when they were teens, things of that nature. And the last important group is connection to groups that have pro-social values regarding sexual behavior. (By "pro-social" I mean values against sexual risk-taking.)

Parents tend to want their children to behave responsibly, sexually. So if young people are attached to their parents, if they feel close to their parents, they're less likely to have sex and to have unprotected sex. If they're involved in faith communities, which also tend to have pro-social values, they're less likely to engage in sexual risk-taking. If they're attached to school, the same thing is true. So that's the four broad categories. Lots of things have an impact. It's a complex world.

There's no question that parents and media and peers have a huge impact upon young people's sexual behavior. The good news is that parents are part of that list. Parents do have a greater impact on their children, and children's sexual behavior, than parents sometimes realize. So that's good news. But it's also true that media and peers and other factors have a very large impact as well.

POV: What kind of advice would you give to parents or educators?

Kirby: I would encourage parents and educators and others to take a careful look at the research about what we know does and does not work to change sexual behavior -- what is effective, what produces a positive impact on behavior -- and to implement those programs that do have a strong record. That would be my first recommendation: implement effective programs. My second recommendation would be, if you can't do that, then implement programs that have the 10 characteristics of effective programs.

POV: Sex education policy is such a polarizing subject, and so volatile, that curricula can change from year to year even in a single school. Do you have any recommendations for schools on how to best approach these issues?

Kirby: When we do our studies, we have real control over what's implemented. For example, we'll identify 20 schools that agree to participate. We randomly assign ten of them a program that is very carefully implemented with fidelity, and the [other] ten continue doing what they're already doing. And then we measure the impact on behavior over the following three years. That's a good evaluation design. But that's when the study's underway. In a typical school, where there isn't a study, what often happens is that teachers will order a few different curricula, and they will pull activities from different curricula, and kind of do their own thing. And although I can understand why they do that, they end up failing to implement with fidelity a particular curriculum into which a huge amount of thought has gone.

It's also true that schools typically do not allow many classroom periods to be devoted to HIV education or sex education, and consequently there's not enough time to implement some of the more effective curricula. So [I would recommend] allowing more time in the classroom for this topic. We can change behavior. We can reduce teen pregnancies that cause young people to drop out of school. We can reduce STD and HIV rates. [But] we need more time in the classroom. My second recommendation is that we need a process, or oversight, to make sure that teachers really do implement effective curricula with fidelity. Sometimes they start off implementing a particular curriculum with fidelity, but then maybe they go to a conference and they drop some of the old activities and add some new, and then maybe they move away to a new school and a new teacher comes, and a program that was very effective ends up dissipating, even though that was not anyone's intent.

Dr. Joseph McIlhaney

Dr. Joseph McIlhney on Abstinence-Only Ed

POV: Tell us a little about the work that you do at your organization and your background as an in-vitro fertilization specialist. What made you decide to start the Medical Institute? When was your organization started?

McIlhaney: I'm a gynecologist with a specialty in reproductive medicine. I became aware in the mid '80s that about a third of the patients that we were bringing into our in vitro fertilization program were sterile from sexually transmitted disease (STD). So people that became sterile from their sexual activity -- by which they got infected with primarily chlamydia but also with gonorrhea -- most of those people would never have a chance to have a child of their own. So I wrote a 700-page book for lay women about hysterectomy and menopause and childbirth and one of the chapters was on STD.

So I started [doing interviews], because of the book and other books that I wrote. I got on national radio and national TV multiple times and then we'd get flooded with phone calls. Most of my physician friends, most of my patients and certainly most parents didn't really have any information about the problem of STD. There was a lot of information about non-marital pregnancy, particularly teen pregnancy, but almost nothing about STD. And so because of this and the flood of questions we'd get every time I would talk about this on the media, I finally had to make a decision.

Reproductive medicine is a highly demanding practice. People that are seeing you for it are spending a lot of money, a lot of time and a lot of emotion, and you can't compromise them. By this time I'd put together a set of about 100 slides that was very graphic showing diseased genitalia and so forth. I thought we could write about each of those slides and start a little organization to make these available to people, and then I could get back to my practice. I didn't want to go around being the big guru talking about this all over the country. So we opened the office.

Students from the Lubbock Youth Commission

Instead of that taking the pressure off in 1992, it made us look like we were [the] experts about the problem of STD. And we even got more calls. I'd put together an advisory board of primarily medical school professors from around the country, because I knew I didn't want to do this by myself . [and] in 1995 a couple of them said, "You need to quit your practice and do this full time." At first I was terrified of that but pretty soon my wife and I realized that this was what I was supposed to do. And so I left my medical practice and started being involved full time with the organization in early 1996.

POV: What are the goals of the Medical Institute?

McIlhaney: [The board] made the decision at that time that it was going to be a medical and a scientific organization. And [that] we would follow the data wherever it went. But we were going to be more than just information [providers]. We were going to be very much like a good physician -- that is, we were going to advocate for the healthiest life for people. And that's really the guidance for our organization in that we're saying, "Okay, here's the data but we're going to give you guidance for making the healthiest decision you can for your life." Our goal is to see a dramatic drop in the instance of and prevalence of STDs, of HIV and of non-marital pregnancy.

UPDATE: Since conducting this interview, several articles debunking the Medical Institute of Sexual Health statements about condom efficacy have been published.
Viral Effect: The campaign for abstinence hits a dead end with HPV, Slate magazine, July 3, 2006
Chastity, M.D.: Conservatives teach sex-ed to medical students. Thanks, Congress, Slate magazine, April 11, 2006
- Updated July 21, 2006

POV: And how successful, over the past 10 years or so that the Medical Institute has been in existence, have you been in achieving that goal?

McIlhaney: I wouldn't say that we're the only group or maybe even the primary group, but I think we have contributed to bringing the problem of STD to the attention of the American public. HIV has done its own thing, because it's such a dramatic disease. Teen and adolescent non-marital pregnancy issues have been discussed in society, but I believe that one of the things that we have helped bring to the attention of the American people has been the problems of STD and the damage they cause -- and also their incredible prevalence. We have an epidemic. So I think that the first thing that we wanted to and do want to continue to accomplish is bringing that [fact] to the attention of people. It wasn't there back in the late '80s when we started the work.

I think that we still are a long way from people facing the reality of the association of these diseases with behavior choices, but I do believe that we have the attention of a lot of people now. The group I'm still most concerned with [is parents]. There are a lot of parents that don't yet have the picture of how common STD are and how different the world is now than it was when they grew up.

Today there are about 1 in 4 adolescents infected with STD. Back in the days that [today's]parents were growing up in -- say, the '70s -- only about 1 in maybe 40 or 50 adolescents was infected with an STD. Back then there were only two diseases that were of great concern to us and both of those were treatable with penicillin -- syphilis and gonorrhea. Today there are, according to the Institute of Medicine and our own data, there are over 25 STD that have become diseases to be concerned about. Parents today have not quite gotten the fact that if their kids are involved sexually they're in a world of disease that's much more dangerous than it was for them back when they were younger.

POV: What is your position on abstinence-only, abstinence-plus and comprehensive sex education in America's high schools? What type of sexuality education would you recommend?

McIlhaney: Our thought is that what we should have programs that work. I won't just say any program that works, because that program has to be evaluated in different ways. But the first and the fundamental issue is, does a program work? For example, if I was talking to Shelby, I'd say, "Okay Shelby, now I know that you mean well" -- and I believe she does, from what you've described and from what I've read about the movie -- "Now I want you send me a program, a model of a program or a curriculum, that has shown an appreciable decline in STD rates and non-marital pregnancy rates, since that's what you want."

That being said, what she'll find is that comprehensive sex-ed programs, are not among the [programs] that have ever lowered HIV rates, STD rates or non-marital pregnancy rates -- except for one program in New York (Children's Aid Society-Carrera), which did it by becoming basically mothers to the girls in the program there. This program was able to get the girls in to get their Depro-Provera shots every three months. That's the only program that's lowered pregnancy rates in the country that's based on a comprehensive approach, the kind of thing that [Shelby's] advocating.

Teens hanging out at a Lubbock shopping mall

So what we say and what I believe is that if that's so and those are the programs that have had the majority of the money, the best teachers, the best curriculum writers, the best researchers for years, is that they basically have all failed. In fact, most of them haven't even measured the pregnancy rates and STD rates. And if that's so then it's only good wisdom to try something different. And the obvious other direction to go is in the direction of abstinence education.

We don't like the term abstinence-only because we believe it's a pejorative term. It's sort of saying, "Well, these are just stupid programs that are denying kids information." Well, that's just flat out not true. If you look at most of the new abstinence education programs, they're actually more comprehensive than most of the comprehensive programs are as far as the information they provide.

POV: We interviewed Dr. Douglas Kirby and he said that he feels that there haven't been enough studies of abstinence-only, or abstinence, programs to know whether they work. Would you agree with him?

McIlhaney: There are two [studies] that have been published in peer-reviewed literature and there's another one coming out about the Best Friends program -- it's been accepted by a peer-reviewed journal [Adolescent & Family Health] and it will be coming out pretty soon. [See related links.] There's a program in a county in Georgia that has had a 47% decrease incidence of sexual intercourse among the kids and a program in Amarillo, Texas that has had a measurable decline in pregnancies. So there are abstinence programs that are beginning to show some real appreciable impact, an impact that has never been shown by comprehensive sex ed programs. And I think we need an open mind to see what these programs actually show us.

POV: Dr. Kirby's study, Emerging Answers concluded that several comprehensive sex ed programs had a positive impact on teen behavior. What would be your response to that?

McIlhaney: Well, anyone can set their own standards for what they want to look at, which is what he did. There are lots of other ways to evaluate than the evaluation standards that he set. He set good high standards but the particular design of the program or the evaluation that he was looking at, there are other types of evaluations that are equally legitimate that he ignored.

POV: What do you consider to be appropriate evaluation standards? In other words, by what standards would you assert that a program is successful? What would be your standards?

McIlhaney: Appreciable and practical declines in pregnancy rates. Most of the time, sex ed programs are brought in because prgnancy rates are too high and STD rates are too high. I would like to see appreciable declines in teen pregnancies, the number of kids with STDs, and also a decline in the number of kids having sexual activity, so that a parent can say, "they told me the pregnancy rates are too high here. I can send my girl or my son to this rogram and be fairly well assured that they will have a good chance of not getting involved sexually and not getting pregnant or not getting a disease."

UPDATE: Since conducting this interview, two reports that Dr. McIlhaney referenced have been Abstinence program shows results, The Washington Times, April 28, 2005
5 abstinence programs receive favorable reviews, The Washington Times, May 28, 2005
- Updated June 17, 2005
The ten year Mathematica study funded by Congress released it's final report in April 2007, concluding that abstinence education programs had "no effect on the sexual abstinence of youth. But it also finds that youth in these programs were no more likely to have unprotected sex, a concern that has been raised by some critics of these programs." Download the PDF of the full report. Read the Medical Institute's response to the Mathematica Report.
UPDATE: May 10, 2007

POV: How would you define an "appreciable decline"?

McIlhaney: Okay, I would say where you see a 50 percent drop in pregnancy and disease. And I would think ultimately the goal for all of us in this country ought to be an 80 percent decline. I think that's achievable, but it would only happen in a community where the whole community surrounds the children and their families to support those choices.

For instance, there's a program that was done in Denmark, South Carolina that was funded by the Office of Adolescent Pregnancy Prevention, the OAPP, by a guy that was a comprehensive sex ed-oriented person, Murray Vincent, but because OAPP was an abstinence program, he saw a pot of money and designed a program that was abstinence-based. Now, Dr. Kirby denies that it was an abstinence program because there was a nurse in the high school that was recommending condoms and giving out condoms but he personally told me way back in the early days of our argument about this that he didn't really think it made any difference whether she was there or not in his eventual outcome because pregnancy rates weren't going down until he came in with his program.

Vincent's program is a program of the kind that I would advocate, that I would say is probably going to be the most successful. He got a whole community -- the churches, the newspapers, the healthcare providers, the teachers and the parents -- all on board with saying to young people, "You should not be having sex as a young person -- as a young unmarried person. You just shouldn't be doing that." And that was the message in the whole half of the county where he did his program. Everybody got on board. The instance in pregnancy in that part of the county dropped dramatically in comparison to the other half of the county and to the counties that were surrounding. So as an organization, we believe that the solution to this is where everybody in a community -- and perhaps even everybody in the whole country -- is associating sexual behavior with risk behavior for kids, as they should.

I don't know if you're familiar with the fact that when kids are involved in one risk behavior, they're more likely to be involved in other risk behaviors. There are good studies that show this. The risk behavior that is the most risky for the most kids right now is sexual behavior. Yet, when communities are talking about risk behavior it's so easy for them to leave the sexual behavior out and only track drugs or tobacco use or violence. We believe that the data's pretty clear that until all the risk behaviors are being impacted, including sex for kids, that we're really not going to have success with all the other behaviors.

POV: I'd like to follow up on your comments about "abstinence programs being more comprehensive" than comprehensive programs. What do you mean by that?

McIlhaney: I think the first thing is that there is a misunderstanding about the funding for -- for example, the Title Five programs -- that are federally funded programs. That is, that they can't talk about contraceptives. They can talk about them, which means telling people what they are and how they work. It's just that they can't promote them. But, and I think this is appropriate personally, they are to tell people the true failure rates of them. And there is absolutely no evidence that telling young people the failure rates of condoms and contraceptives causes them not to use them. [Critics] will say that if you tell them that they won't work, then they won't use them. Well, there is no data to show that at all.

We have not seen, as a matter of fact, a single comprehensive sex ed program that gives accurate data about the effectiveness of condoms and the failure rates of condoms. That is where I think that the abstinence programs are more comprehensive than the comprehensive programs, because they are actually more truthful. The kids need to know what they can and cannot expect from condoms. As a matter of fact, it's real easy to tell. That's what's so confusing about it when they won't do it. If condoms are used 100% of the time, condoms reduce the risk of HIV by 85%. If they are used 100% of the time they reduce the risk of common diseases for kids, for example, herpes and syphilis and gonorrhea and chlamydia by about 50%. And as far as HPV goes, there is no evidence that condoms reduce the risk of HPV infection at all. It is the most common viral infection. There is one study that came out last year that showed there is some decreased incidence of HPV for guys, but it is only a study. Most studies show no decreased risk of infection from HPV even when condoms are used every single time.

Except for herpes and HIV, if condoms are not used 100% of the time, there is no evidence that they provide any risk reduction at all for things like chlamydia -- which is, for a reproductive medicine guy like I am, the most horrendous disease a woman can get, because it is what is associated so much in fertility. STD are the most common reason for infertility in America today.

And by the way, most of those studies on condoms were only carried out for a year or two. So if a kid at 16 starts having sex, they usually are not going to stop. They'll then have sex, you know, off and on for the next few years, of which, as time goes by, there probably is a higher failure rate of condoms in college as young adults if they continue the sexual behavior.

We really do have this epidemic. So we believe that for their best health, young people shouldn't be involved sexually. It's just like we recommend that they not be using drugs. And that, obviously applying to the homosexual youth too, that they shouldn't be involved sexually either as far as their health is concerned. We're talking pure health, not morals or values here, but just as far as their health is concerned.

POV: What advice would you give to parents?

McIlhaney: Well, first I would want them to be aware of how much disease there is among the adolescent population. If your kid starts getting sexually involved, among that group of kids that are doing that, there is a lot of disease and the child probably will ultimately get infected with one of these things.

Most kids do not even know what the values of their parents are or what is expected of them in the area of risky behavior. They pretty well know it about tobacco and drugs, but they don't know it about sex. It's just as important for parents to communicate their values about this. Parents need to make clear what they expect the kids to do and not do in this area.

The Adolescent Health Study -- the biggest study ever done on adolescent behavior in America -- showed that kids who are most likely to avoid risky behaviors, were those who had a good connectiveness with their parents. And connectiveness was defined very clearly. The fact that the parents were there when the kids got up in the morning, they were there when they came home from school, they were there with them for meals in the evening and they were there when they went to bed.

So I would advocate that parents do that with their kids. Be there with them. Communicate your values and what you expect, and then support your kids in making good decisions. Then applaud them.

Joe S. McIlhaney, Jr., MD, is a board-certified obstetrician/gynecologist who resides in Austin, Texas, with his wife, Marion. In 1995, he left his private practice of 28 years to devote his full-time attention to working with the Medical Institute for Sexual Health, a non-profit medical/educational research organization he established in 1992. In December 2001 Dr. McIlhaney was appointed to the Presidential Advisory Council on HIV/AIDS, and he is currently serving as an active participant.

Dr. Peter Baerman

Dr. Peter Baerman: Do Virginity Pledges Work?

POV: You've done two studies of virginity pledges, based on the data in your survey, the National Longitudinal Study of Adolescent Health (Add Health). In your first study, you found that taking a virginity pledge had some delaying effect for many adolescents, but that certain conditions applied. Could you talk about that?

Dr. Peter Bearman: The first project was published in 2001. When we controlled for all the usual determinants of what we call "the transition to first sex," we were able to show that taking virginity pledges delayed sex by about 18 months. We also found that the delay effect worked for some kids but not all kids. It worked for kids in mid-adolescence, not young adolescents or older adolescents. If there were no pledgers in a students' community, taking a virginity pledge had no effect. And if there were too many pledgers in a student's community -- that is, more than 30 percent -- pledgers didn't benefit. Pledging works when it embeds kids in a minority community, when it gives them a sense of unique identity. And it doesn't work when it's a national policy that everybody follows. If everybody pledged, pledging would have no effect.

Danny, Paula, and Shelby Knox at Shelby's pledge ceremony

Then, of course, many kids have sex whether they pledge or not, and pledgers [who broke their pledge and had sex] were much less likely than non-pledgers to use contraceptives. So the benefits of delaying sex wash out, because of enhanced risk. Kids likely do benefit from delaying sex. But from a public health point of view, the pledge doesn't reduce pregnancy or STD acquisition rates for adolescents.

POV: Your more recent project, just published in the Journal of Adolescent Health, involved following up on the teens from the original Add Health study. What did you learn about the longer-term effects of taking a virginity pledge?

Bearman: We looked at the consequence of a virginity pledge on the rates of STDs. Although pledgers have slightly fewer partners than non-pledgers [on average], and are more likely to be married at a young age than non-pledgers, pledgers have STD rates that are statistically the same as non-pledgers. There are three reasons for that.

The first reason is, they are less likely to use condoms [when they first have sex]. Condom use at first sex is a huge predictor of condom use subsequently. So the fact that pledgers don't use condoms the first time they have intercourse has this long-term consequence. Secondly, pledgers are less likely than non-pledgers to think they have an STD when they have one; they are less likely to see a doctor to get diagnosed for an STD; and they are less likely than non-pledgers to get treated for an STD that they do have. And then the third reason is that kids who took virginity pledges and remained virgins were more likely to engage in what we call "substitutional sex" -- including acts that can put them at higher risk for STDs, such as anal and oral sex.

POV: Are there some other characteristics or causes that might explain the differences between pledgers and non-pledgers?

Bearman: Pledgers are more likely to be religious than non-pledgers, and religious kids are more likely than non-religious kids to delay sex, anyway. Pledgers are more likely to come from two-parent intact middle-class households, and kids from two-parent middle-class households are also more likely to start having sex at a slower rate than other kids. But you can control statistically for these characteristics and still discover that pledging has an effect.

POV: Are there other characteristics that distinguish pledgers from non-pledgers? Are there differences between pledgers who are totally abstinent and pledgers who engage in other kinds of sexual activity?

Bearman: Just to take a pledge means that in some fundamental way you're thinking about sex. Twelve-year-olds who take virginity pledges are thinking about sex in a different way than twelve-year-olds who are playing in the backyard, and therefore not thinking about sex at all. The interesting thing about pledgers is that they are more romantic than non-pledgers -- pledging is built on an ideology of romantic love. Pledgers are also more likely to be in romantic relationships than non-pledgers. So they are kids who are actively thinking about the world of intimacy, and the pledge is a rhetorical device that helps them negotiate the grey zones of that world of intimacy in a very easy manner. It allows them to say, 'Well, I like you, but I don't intend to have sex.' So kids who find it difficult to talk about intimacy, for example, benefit from the pledge because it draws a firm line for them.

As far as pledgers having substitutional sex, one idea is that they took a public pledge to remain a virgin and the thing that they're fearful of is getting pregnant -- which is the clearest sign of violating the pledge. So if you're trying to avoid getting pregnant, which is a mark of having sex, you might engage in other kinds of sex activities. But of course, the thing about STDs is that you can't see them. So [these substitutes] seem safe, but obviously they're not.

POV: What are the implications of these findings for parents and policymakers? What can they take away from your findings?

Bearman: Pledging works for some kids in some contexts. There's absolutely nothing wrong with being abstinent; in fact, it's a great thing for public health. So, if pledging is useful for kids, they should do it. The problem is that eventually, pledgers and non-pledgers alike are going to have sex, and some pledgers who have sex and don't protect themselves put themselves and other people at risk. The sex that pledgers eventually have is riskier, because they are less likely to use condoms. It's really important that everybody have the information that's necessary to protect themselves from the negative consequences of sex, which are STDs and unwanted pregnancy. And [on the whole] pledgers don't get any benefit with respect to those risks. So, as a national policy, it doesn't really impact public health.

POV: Research on adolescent sexuality, and particularly on virginity pledges, has provoked a great deal of political argument. Does such controversy make it more difficult to do good research?

Bearman: It doesn't make it more difficult, but I find the comments by so-called abstinence-only supporters offensive. People who have no scientific credentials should in general refrain from assessing whether science is done properly or not. Leslee Unruh from the National Abstinence Clearinghouse, for example, has called the work that we do 'bogus' and 'lacking scientific credibility.' When they agree with the results, they celebrate the science. When we came out with the result that the pledge delayed sex, these same groups that are criticizing us today put that result all over their web pages, and established that study as the most scientific study ever. These are the same data, the same researchers, the same standards, so I find the politicization of this issue offensive. It also just makes it unattractive as a research area.

POV: The National Abstinence Clearinghouse claims that you are "twisting the study's results to fit" an "ideological agenda," and argues that your results actually demonstrate the opposite of what you've described. How do they reach that conclusion from your study?

Bearman: They're just misrepresenting data in a really fundamental way. For example, it's well known that STD rates vary significantly by race. Blacks, for example, have six times higher STD rates than whites. So any analyses that you do need to be separate for blacks and whites. [The NAC] looks at the overall STD acquisition rate for pledgers and non-pledgers, and they see that it looks like pledgers have lower STD rates than non-pledgers. When we say that these rates are statistically similar, the lay language is that the estimates are within a margin of error that overlaps. So when the two ranges overlap, for pledgers and non-pledgers, there's no difference. So [groups like the NAC] find little pieces of data and misrepresent them. And they should know that that's irresponsible. If we had results that agreed with them, they wouldn't do that. Just as we had results that they liked four years ago.

UPDATE: The final findings of a recent study about the impact of abstinence-only education and virginity pledges were reported in April 2007 and found that the programs had "no effect on the sexual abstinence of youth. But it also finds that youth in these programs were no more likely to have unprotected sex, a concern that has been raised by some critics of these programs." Download a PDF of the report at the Mathematica Policy Research website.
Here are links to some articles that appeared about the report.
No More Virginal: Spend $1 Billion Dollars on Abstinence Education. Get Nothing, Slate magazine, April 20, 2007
- Updated May 10, 2007

POV: What you're saying is that the STD rates were statistically identical, right? Could you elaborate on that point?

Bearman: Well, let's say that we do a political opinion poll for a presidential race, and we discover that 48 percent of the population would like candidate A, and 52 percent of the population would like candidate B, with a margin of error of 6 percent. So then we would say that candidate A is preferred by 45 to 51 percent of the people; any value in between there is equally likely. And candidate B is preferred by 49 to 55 percent of the people, with any value in between there equally likely. And you can see that there's an overlap of values. So from a statistical point of view, those confidence intervals overlap, and so there's no difference between them. The estimates of STD infection for pledgers and non-pledgers overlap completely, so there is no significant difference between them.

POV: What kind of research remains to be done on this subject? Does your work suggest any particular avenues for further inquiry?

Bearman: One of the things that we know is that pledgers get married younger than non-pledgers. It's too early to see whether that leads to higher fertility, or greater divorce, to happier marriages or sadder marriages. It's too early to see what the long-term consequences of pledging are. We know that people that marry very young are more likely to get divorced, because they marry on the basis of romantic love, or they grow differently, or for whatever reason they're not ready. So actually, there's a whole set of interesting studies that someone could do in four or five years.

Dr. Peter Bearman is director of the Institute for Social and Economic Research and Policy and the Paul F. Lazarsfeld Center for the Social Sciences at Columbia University, where he is also chair of the Department of Sociology. With J. Richard Udry, he designed and directed the National Longitudinal Study of Adolescent Health (Add Health), the largest, most comprehensive survey of adolescents ever undertaken, including 20,000 adolescents aged 12 to 18. His most recent article on adolescent virginity pledges appears in the April 2005 issue of the Journal of Adolescent Health.

Dr. Rebecca Maynard

POV: There's been a lot of interest in the role of abstinence and virginity pledges in sex education in recent years. You're currently supervising the largest research project to date, evaluating different abstinence-centered programs -- in particular, programs sponsored by Title V grants from the federal government. Understanding that you can't talk about the results of your study yet, since it's still in progress, can you give us an overview of what is known so far?

Dr. Rebecca Maynard: The first thing to note is that very few kids in this country take the virginity pledge. It's gotten a lot of publicity, but nationwide it's under 10 percent. It's also the case that if you look at the proportion of kids that are taking the pledge it's much higher in the younger ages than in the older ages. And that may be due in part to the fact that the pledge has gotten more prominent, gotten more press recently than it had earlier. But in part it just may be that it's pretty easy to get a fourth or fifth or sixth grader to take a virginity pledge because they hardly know what it means at [that] point.

In terms of the research on the pledge, the main research that's been done is the research done by Peter Bearman. His research is based on the select group of kids who have taken the pledge, which is a relatively small fraction, and then what he does is he goes and tries to find kids who [resemble] the kids who took the pledge, and ask the question, what's different in their behavior. And, you know, he's got a story around the pattern of results, and it's one that makes sense; but I don't know that it's the only one that makes sense, in explaining the results.

POV: Could you elaborate on that? Do you have a different view of what happens with virginity pledges?

Maynard: I think that the pledge itself is probably a much less relevant intervention than a lot of other things that are going on, because the pledge comes in very different forms. It comes in private settings such as churches, and it comes in public settings. There are two [approaches]. One is, you take a public pledge, let everybody know you're a virgin, and wear it on your sleeve. That has some very positive attributes. Then there's another version that says, let kids take the pledge or not as they want -- reasoning that if you make this a public ordeal, then you may be intimidating some kids into taking a pledge that they really didn't [want to].

It's not clear which is better. Psychologists and sociologists could come up with different theories on both sides of this. And the original form, the True Love Waits, is a very public kind of pledge. But there are all kinds of variants right now -- I think I could probably log on to the Internet and take a pledge.

POV: At the opposite end of the spectrum, what's an example of a program that involves much more than taking the pledge?

Church on the Rock of Lubbock, Texas

Maynard: We're looking in-depth at [four] programs, and they have different degrees of involvement with the pledge. One of them is a very intensive year-long program where the kids meet every day, where they've got parent involvement, they've got weekend retreats. They've got all kinds of things that go on -- around skill building, around self-awareness, around interpersonal relationships, and it all leads up to something much more than a pledge of personal abstinence. It's a pledge to some ideals and the application of skills that one has gained. And in the end there is a public ceremony, but in fact all kids do not have to publicly pledge. There's a part where the kids are all onstage for pieces of this event, none of which actually results in the kid having to do something like walk to the front table and say in front of parents or friends 'I do this.' There's sort of an assumption that that's all going to happen [privately].

Others have the pledge as a very public part of their program, and have a lot of things that lead up to that pledge. One of the programs has a whole year of learning about relationships and partners, and the qualities of families that are healthy. And all of this culminates in a mock wedding, and vows of chastity. There's a lot more to that kind of intervention than one that just says, 'Okay, we're having a rally this afternoon, let's march, let's sing, now let's sign the pledge.'

POV: In the film "The Education of Shelby Knox," Shelby and the other students take a public pledge through True Love Waits, in an organized ceremony with her parents. Can you tell us where that program fits in this spectrum?

UPDATE: The final findings of Dr. Maynard's study were reported in April 2007 and found that the programs had "no effect on the sexual abstinence of youth. But it also finds that youth in these programs were no more likely to have unprotected sex, a concern that has been raised by some critics of these programs." Read a press release about it and download a PDF of the report at the Mathematica Policy Research website.

Maynard: True Love Waits, I believe, is a relatively brief curriculum that culminates in this kind of a ceremony that you mentioned, and I think that potentially has aspects of the peer pressure and the parental pressure to make this commitment. It's like telling your kid, 'Don't drink and drive,' and the kid says 'I won't.' Because what else are you going to do, are you going to look at your parents and say I'm going to go drink and drive? And everybody else is doing it, so you would really stand out if you didn't do it.

So there's True Love Waits, and at the other end of the spectrum, we've got another program in our study that has three years of different curricula that look at issues of health and safety and relationships, and then ends up with opportunities for kids to go individually to an instructor or counselor or confidant, and sign a pledge, should they choose to do so. So it's an encouragement. It's something that builds on what they've been learning in class. But the program doesn't shame anybody into doing it, it doesn't put peer pressure on them to do it. There isn't that public display. And this program had some pretty strong feelings that they didn't want to put kids in compromised positions.

Another one of our programs is one that's an everyday afterschool program that has all kinds of good stuff for kids in it. In addition to having an abstinence education curriculum, it deals with things like relationships and human development, stuff like that, and has a pledge that the kids sing every day. It's a little chant that they do, and if the kids listen to the words, they are committing to abstinence until marriage, and if they don't listen to the words, they're singing a song that's got a nice rhythm. Then they have other kinds of events that are public, community events, where there will be a whole-city rally on abstinence, and they'll have food and ballgames, and speakers, and among the things that they'll have is tables set up so that kids can go and sign their pledge, and get their little stickers or ropes to go around their neck, or whatever it is that's going to be the demonstration of pledging.

POV: What kind of data will you look at in your study to evaluate the different abstinence programs?

Maynard: We look at a lot of things. We look at the services they get, because these kids aren't just getting the abstinence program or nothing, they're getting lots of stuff plus the abstinence program. In some cases, the fact that they're getting the abstinence program means they're not getting something else in that same genre; in other cases it just means they're getting abstinence instead of, or in addition to, everything else. So we look at the services they get in order to understand what change really went on. We then go on to look at all the intermediate markers -- things like their views, their attitudes, their knowledge, their expectations. And then we will also look at their sexual activity, their drug use, their involvement in delinquent behavior, and so on. Eventually, what we'll be able to do is look at those big outcomes that we care about -- their abstinence, their exposure to STDs, exposure to pregnancy, their actual pregnancies -- and we'll be able to say how large are the differences between the groups, and how much are those differences related to intermediate things that went on, like changing drug use patterns, changing peer group patterns, changing of basic core values, their core expectations about themselves, et cetera. The idea is to be able to see not only what impact the programs had, but the mechanisms through which those impacts took place. And to also understand which kids were affected, in which ways; and which kids were not affected.

POV: It seems like it could be confusing for a parent, a student, or a teacher to know what to think about these kinds of programs. Even skeptics acknowledge that the pledge can have a positive impact on some kids -- like Shelby Knox -- but that it might not work as a policy for all kids. So how should we evaluate programs like this?

Maynard: I think the way you should evaluate them is the way we're evaluating the Title V programs. The pledge is a perfect example of something where you can go in and explicitly target that -- you can randomly assign groups of kids. There are lots of ways you can design a study and actually see what difference this makes. Looking at one individual, or a small number of individuals, that's a case study, that's an anecdote, and it represents what one person did, and we don't know anything from looking at that one person about the average effect, or even the numbers -- what fraction of kids follow her trajectory versus some other trajectory. I mean, it's an important way to look at the problem, because that lets you understand different sides of the issue, to track kids who are going right with the odds, and track kids who are defying the odds, and to look at this in the context of outside forces that may have come to bear is something that one should do inside an experiment as well. You shouldn't just look at the averages, because that masks an awful lot, too. So you need to look at it both ways.

Ashlee Reid & Al Ferreira

POV: Describe the origins of Project 10 East, the gay/straight alliance you helped found at Cambridge Rindge and Latin High School in 1987.

Al Ferreira: In the mid-80s I started a photography program at Cambridge Rindge and Latin High School. And one of my students, who I had taught for four years -- he was one of these Renaissance types of young men, he was an athlete, he was a great photographer, just very popular -- right after graduation he committed suicide. And a friend of his came to me afterwards and said the reason he committed suicide is that he realized he was gay and he thought he was alone in the high school. And his friend said, 'Well, I tried to convince him that there were other gay and lesbian people among the students and faculty, but I couldn't tell him who they were.' Because at that point nobody was really out. I realized that my silence and my invisibility as an educator who happened to be gay really led to his feeling of isolation and loneliness.

I was so distraught at that that I went to the principal, and I said I have two choices: either I'm going to quit teaching or I'm coming out as a gay man, and I want to provide safe spaces for kids to come to talk about gender identity and sexual orientation. At that point I started talking to some of my students, and a couple of students said that they wanted to meet and just discuss issues of gender identity and sexual orientation. I had heard that Virginia Uribe, who had started Project 10 in Fairfax High School in Los Angeles, was speaking at Harvard University. Virginia was very wonderful, very inspirational. The difference was that her program was a rescue effort to take kids who were transgendered or gay, who had been abused in the school system, to a separate program that was isolated from the mainstream. And I had always been a strong advocate that separate but equal doesn't work. I wanted to hold the institution responsible for the safety and well-being of gay youth. So that's sort of how our group started.

Members of the Lubbock High School Gay Straight Alliance

POV: Practically speaking, what did you do first? Did you put up signs, or call for students to come and meet?

Ferreira: The first thing I did -- and it's critical for any educator -- is I went to the parent organization first. So I went to the parents and said these are my concerns, how can you help me make sure the school is safe for kids? And they were phenomenal. One of them said, you should go to the local clergy association, and ask them for a letter of support. So I went [to the school administration] with a letter of recommendation for the work that I wanted to do from the parents' association and from the local clergy association. I presented that to the principal of the high school, so that he knew I wasn't doing this in isolation.

So we started meeting after school, initially, and things started to grow really quickly. I put up notices around the school about the meetings. It was always an open meeting; I never required anyone to identify themselves, their sexual orientation or their gender identity. It had to be open to all students: gay students, straight students, transgender, transsexual, anything. It didn't matter. It was a place to discuss these issues, and to feel safe about doing it.

POV: What were your expectations for Project 10 East, and how were they realized? Were you surprised by any of the early developments?

Ferreira: We started the group, and I didn't know what was going to happen. I relied on students [to tell me what they wanted] more than anything else. At the secondary level, high school students are incredibly sophisticated, and they pretty much laid out what they wanted. They wanted a safe space, and they also wanted to do social events. And I just hadn't thought of doing social events, because I had never had a social life as a gay teen -- there just weren't any organizations like Project 10 East.

Members of the Lubbock High School Gay Sraight Alliance

POV: As one of the first gay/straight groups in a high school, P10E encountered some criticism when it started, from religious groups and others in the community. Did those criticisms diminish, or change over time?

Ferreira: Initially there were some hostile responses -- not from Cambridge but from Boston. That did change a little bit. One of the criticisms that came about early was that we shouldn't be discussing sex in high school like that. The focus was on the sex part of it, and I always tried to deflect that, explaining that I didn't provide sex education for my students. I wasn't qualified to do that. We had sex educators in the school system, and when students had questions about that, I was a referral person, whether it was psychiatric services or sex education or anything else. I had to constantly explain that. And my response was, don't sexualize the kids in this program. It's not about sex. It's about personal identity and the role that sexual identity has in our culture. And of course some people understand that and some don't.

POV: P10E came to serve as a model for other gay/straight alliance groups in schools both public and private. Did other groups contact you or the group for advice? What did you tell them?

Ferreira: A lot of teachers would contact me, saying I just got a job, and I want to start a gay/straight alliance, what do I do? I would say, whoa, your intentions are really good. But first of all, get into the community, get to know people, and establish yourself professionally. It was not an accident that I got the support I got. I established myself as an outstanding teacher, and someone that [parents and administrators] could rely on and trust. I think it's really important that you don't go into a school your first year of teaching and think that you're going to be the change agent for a whole system. There's an amount of humility and caution that you need to take. You need to find out where people are coming from. You find out who the allies are in the community -- who are the people who are concerned about kids being harassed, or bullied, or whatever. There's always somebody. It might be the school nurse, it could be anybody, a guidance counselor. So that's the approach that you take.

And you don't do it alone. When you're ready to approach the leadership about a gay/straight alliance, you go with a plan of action, which involves parental notification, local organizations like clergy or other local groups supportive of providing education about gender and sexual orientation. Even if you go with a group that's not a major denomination, like the Unitarian Universalists or an independent church -- you're certainly not going to get a letter of support from the Catholic Church. Nobody has to do this alone, and it's an issue that enough people care about, and there are enough gay and lesbian kids out there who have parents who have witnessed the difficulties that they've experienced. And they want to make things different. There are enough gay and lesbian people that want things to be different.

POV: Project 10 East began as one of the first gay/straight alliances in the nation, at Cambridge Rindge and Latin High School. How has the organization's work changed in recent years?

Ashlee Reed: At times, we'll start to branch off and do different things, but we always end up coming back to our mission, which is to create and sustain safe space in schools and communities. That's really what we're doing now. Over the past three years, we've begun working a lot more with Boston public schools. And because we're now working with a much more racially and ethnically diverse group of students, we've found that that brings a whole new realm of issues to light. It's definitely a population that has been underserved for a long time, and so over these past couple years, we've received some funding specifically to work with LGBT youth of color.

POV: When you talk about creating safe space, what do you mean? How do you do that?

Reed: Our mission is to create and sustain safe space, but our main tool in fighting oppression is creating and sustaining gay/straight alliances (GSAs) in Massachusetts schools. Ideally, what we like to do is go into a school and work with them for a year, and leave them with a format and a structure, so that we can kind of walk away and know that they're going to be able to sustain themselves independently, and not need us as a resource anymore. But what happens, because of teacher and staff turnover, and leadership turnover with the young people graduating and new people coming in, there's always a need to pull us back in. What we'll do is send in a facilitator -- a volunteer or intern or staff member -- to go to the school on a weekly basis and help coordinate the meetings with them, help set up the structure with them, and really be there to help them to start the gay/straight alliance and to get it moving.

POV: Who typically initiates these contacts -- students or teachers?

Reed: The majority of the time it's teachers contacting me. When it's young people, they've usually heard about us through their friends. They may have friends in neighboring communities, and they may talk about what's going on at their school, and someone may say, we've got Project 10 coming into our school, why don't you call them and they'll come help you guys out. But the majority of times it's teachers contacting us. I get phone calls from teachers on a weekly basis.
POV: You said that gay/straight alliances were your main tool. What else does P10E do?

Find out more about Gay Straight Alliance programs at the Project 10 East website. Take a look at the Project 10 East Resources for FAQs, a glossary and tips for how to reduce homophobia in your neighborhood.

Reed: We definitely stay in touch. We have a network of GSA advisors that we communicate with via email and phone calls. We have monthly GSA advisor meetings, where GSA advisors are invited to come together and talk about what's going on in their communities. But at the same time, ideally, after the year of us working with them, they're able to sustain themselves and we're able to step back and move into new communities. The other things that we do branch off from the GSAs. They may hold events or community forums, or panel discussions, or workshops at local conferences. They may have poetry slams, or dances, things to kind of network with each other. But our main tool is the gay/straight alliances. And that's what makes us kind of different from other Boston area LGBT youth organizations: we work directly with the young people in their schools.

POV: If I came to you for advice on how to start a GSA in my school, what would you tell me?

Reed: What I would do first is to learn more about you, and to learn about your school specifically. So I might ask you questions: Why do you want to start this program? What's going on at your school that makes you think that this would be something that your school needs? Have you spoken with teachers or staff or administration about the possibility of starting a program? The big thing that happens when teachers and students come to me initially is to talk about, first of all, where their school is at -- what they're doing now, and what's going on that makes them want to start this GSA. And talking about what levels of support they have. One of the most important things is to get the administration's support. Because if you don't have your administrators behind you, you're going to run into a lot of trouble.

And then once you get approval but if they do get the administrators' approval, which is ideal, then the next step would be to start organizing and advertising and looking a month ahead and getting information out in the daily bulletins and over the announcements, and trying to make sure as many people as possible know about the group, and that they understand that the group is going to be meeting, and what the purpose of the group is going to be. And then once the initial group gets together, a lot of times it's just like two or three students and one staff member. So those initial conversations are about thinking what we can do for the school. What does the school need to be a safer place for LGBT youth? Do we need to change policies? Do we need to create a coed bathroom? Do we need to put up information in the hallways saying harassment is against the law? It depends on what's going on at that school, and what the needs are for that school.

Ashlee Reed earned her master's degree in social work at Boston College. She has been the executive director of Project 10 East since 2002.