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Learning to Say No

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The attractive young woman on the screen looks coyly at a young man she encounters in an elevator and brushes against him as she leans over to press the button for her floor. The caption below proclaims: "If he's got the time, I've got the place."

Although the scene depicted on the slide is an advertisement for a popular junior sportswear line, its sexual message is not lost on a class of 8th graders at Bazoline Usher Middle School.

And that's the point. Their teachers are using slides like this, along with skits, discussions, and role-playing sessions, to debunk the myths such messages carry.

"What does this say about women?" asks April Spencer, one of the instructors. "The message is that to get what she wants, she has to use sex. And that message is false."

"When you see these types of ads, you get the idea that a woman is more of a woman if she's having sex," chimes in one of the other leaders, Naomi Pettaway. "But I do not have to have sex to feel good about myself as a woman."

Demiris Gates, a male instructor, uses other slides and examples from class literature to expose the messages society projects about men and sex--and to offer up strategies for resisting societal pressures.

April, Naomi, and Demiris command a certain level of respect from the students when they discuss these topics for a very simple reason: They are teenagers themselves.

Postponing Sexual Involvement for Young Teens, an 11-year-old program for 8th graders throughout Atlanta, aims to help teenagers avert pregnancies that can crimp their own futures and condemn another generation of babies to poverty, illiteracy, and second-class citizenship.

To do that, it turns the tables on teenage sexual politics by tapping the positive potential of peer pressure; its high school mentors teach younger students how to say no.

"They're closer to our age, and they know what we're going through," says Shawntaz Crawford, a 13-year-old male student at Usher. "It's very informative."

An Effective Partnership

This sex-education program, which is the product of a partnership between the Henry W. Grady Memorial Hospital and the Atlanta public schools, is not only informative, but effective.

Studies offer strong evidence that teenagers who participate delay sexual activity longer, and the data suggest they are less likely to get pregnant before finishing high school. The program reaches more than 4,000 students a year.

White House officials have touted the effort as a model for the Clinton Administration's welfare-reform proposal, which includes a $300 million grant program to help schools run teenage-pregnancy-prevention programs.

And while the prospects for that plan dimmed when the fall election results rolledin, stemming teenage preg~nancy has become a central theme in the welfare-reform debate now raging in the Republican-controlled Congress.

Marion Howard, a professor at Emory University, and Marie Mitchell, a nurse at Grady Memorial, were not thinking about welfare reform when they designed Postponing Sexual Involvement. In the 1970's, the two got involved in running the Teen Services program, which operates a family plan~~~~ning clinic at Grady for adolescents.

The clinic is an outgrowth of a joint effort by the Emory University school of medicine, Grady Memorial, and the Atlanta schools to stem the high rates of infant mortality and morbidity that go hand in hand with adolescent pregnancy. Another goal was to bring down the high dropout rate among pregnant teenagers.

A late 1970's evaluation of that program, which also provided health and sexuality education to Atlanta 8th graders, showed that "simply providing young teenagers with such information was not effective in changing sexual behavior."

So Howard, Mitchell, and others scoured the research on prevention programs, examining interventions to curb not only teenage pregnancies, but such behaviors as drinking and smoking. They also conducted their own surveys to find out what kind of help adolescents wanted.

In a survey of more than 1,000 sexually active girls ages 16 and younger who visited the Grady teen-services clinic, they found that the largest share--84 percent--wanted to learn "how to say no without hurting the other person's feelings."

Another thing that became clear from working with the youths, reflects Mitchell, who manages the Teen Services program, was that "the best way to prevent a subsequent pregnancy was to prevent the first." That was an important factor, she notes, because the highest rates of infant mortality and morbidity were showing up in teenagers who gave birth more than once.

She and Howard set out to design a new curriculum based on these findings, and in 1983, the Ford Foundation pitched in funds to implement it throughout the Atlanta schools.

The 10-session program includes five classes on human sexuality, including information on family planning and sexually transmitted diseases, taught by adult counselors from Grady's Teen Services program.

The other five sessions, taught by "teen leaders" from the 11th and 12th grades, get to the nitty gritty of how to say no.

Teen leaders are tapped for their leadership qualities and communications skills. They receive 25 hours of training over the summer and earn $5 an hour.

To make sure the teen leaders provide credible role models, one stipulation for the job is that they've never been pregnant or caused any pregnancies. The program fits the rubric of what's known in sex-education parlance as "abstinence plus," an approach that stresses resistance and refusal skills while also offering students information on and access to contraceptives.

If students in the program visit the Teen Services clinic, they are assigned to the same nurse or counselor who teaches human sexuality at their school.

One hopeful sign, says Saundra Harris, a nurse involved in the program at Usher, is that "we're getting more and more kids who have not begun to have sex" visiting the clinic.

Everyday Dilemmas

April, Naomi, and Demiris skillfully shift the focus of the class discussion from the slides on the screen to the everyday dilemmas teenagers face. By posing questions and exploring various scenarios, they get students to talk about good and bad ways of winning popularity, what they look for in friends and romantic relationships, and why it's important to maintain their own values and morals.

In a delicate but frank way, they also query students on what they think are appropriate sexual limits--and how they can enforce them.

The teen leaders sometimes have trouble getting their charges to obey the ground rules they laid out eloquently at the start of class, especially the one about not interrupting when someone else is speaking.

Some students giggle and chatter among themselves, others blurt out unsolicited comments, and the rambunctious ones keep the noise level high. Others seem too shy to participate. But survey data suggest that some or all of the message is getting through.

A five-year evaluation that surveyed more than 500 youths showed that at the end of the 8th grade, students who had completed the program were more than four times less likely than other students to become sexually involved.

At the end of the 9th grade, those who had the program were still one-third less likely to be sexually active. That gap narrowed considerably by the end of 12th grade.

But the study, while cautioning that the sample size is too small to be definitive, suggests that program girls were one-third less likely to become pregnant by the end of high school.

The study also showed that, at least for the first year and a half after the program, participants who did become sexually active had fewer partners and were more likely to use birth control than students who had not been exposed to the program.

Reaching Younger Students

The downside is that while the program works well for youths who have not yet had sex, it hasn't done much to change the behaviors of those who are already sexually active. Study results show that students who had had intercourse before entering the program were no more likely than members of the control group to reduce their sexual involvement or increase their use of contraceptives. And they didn't have any fewer pregnancies.

To reach youths earlier, some schools are using a version of the program aimed at 10- to 12-year-olds, and Atlanta school officials are exploring the idea of training teachers to offer the pre-teen program systemwide.

"A lot of people didn't realize how serious the problem was" with younger children, says teen leader April. "I think it's important that we come in even earlier."

Recounting stories of students who have let them know their advice made a difference, the teen leaders say they relish the experience they've gained as role models.

"It's like a flashback," says Naomi. "A chance to influence them, give them a positive perspective."

Although not everyone is receptive, "you try to get to the ones who are going to listen," adds Demiris.

"It helps you appreciate your teachers more; I give my teachers the utmost respect," April says.

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