Learning To Say No
"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 Naomi Pettaway, one of the other leaders. "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.
These instructors--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 futures and condemn another generation of babies to poverty, illiteracy, and second-class citizenship. To accomplish 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,'' Shawntaz Crawford, a 13-year-old student at Bazoline Usher, says of his mentors. "It's very informative.''
This sex education program, the product of a partnership between Henry Grady Memorial Hospital and the Atlanta public schools, is not only informative, but effective, as well. Studies offer strong evidence that young teenagers who participate delay sexual activity longer than others, 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.
The Clinton administration has touted the effort as a model for the president's welfare-reform proposal, which includes a $300 million grant program to help schools run teenage-pregnancy-prevention initiatives. The prospects for that plan dimmed after the fall elections, but stemming teenage pregnancy has emerged as a central theme of welfare-reform debate 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 more than a decade ago. In the 1970s, the two ran a program called Teen Services, which operates a family-planning clinic at Grady for adolescents. The clinic was created to stem the high rates of infant mortality and morbidity that go hand in hand with adolescent pregnancy and to bring down the high dropout rate among pregnant teenagers.
But the Teen Services' original approach proved less than effective. A late 1970s evaluation of the program, which also provided health and sexuality education to Atlanta 8th graders, stated 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 that had been shown to curb not only teenage pregnancy but also other problem behaviors such as drinking and smoking. In addition, they conducted their own studies 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, 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, says 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 Postponing Sexual Involvement program includes five classes on human sexuality, 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.
The high school students 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 are credible role models, they must stipulate 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 "more and more kids [are visiting the clinic] who have not begun to have sex.''
After their slide presentations at Usher, April, Naomi, and Demiris skillfully shift the focus of the class to a discussion on everyday dilemmas teenagers face. By posing questions and offering 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 eloquently laid out 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 youngsters 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 be sexually involved. At the end of the 9th grade, they were three times less likely to be sexually active. The gap narrowed considerably by the end of 12th grade. But the study, while cautioning that the sample size was too small to be definitive, suggests that program girls were still three times less likely to become pregnant by the end of high school than those in the comparison group.
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 some form of birth control than students who had not been exposed to the program.
The downside is that while the program works well for adolescents 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'd had intercourse before entering the program were no more likely than members of the comparison group to reduce their sexual involvement or increase their use of contraceptives. And they didn't have any fewer pregnancies.
To reach students 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 preteen 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 instructors say they relish the experience they've gained as role models. "It's a chance to influence them,'' Naomi says, "to give them a positive perspective.''
Not everyone is receptive, Demiris adds, but "you try to get to the ones who are going to listen.''
As for April, the leadership role has given her a different take on some important people in her own life. "It helps you appreciate your teachers more,'' she says. "I give my teachers the utmost respect.''
--Deborah L. Cohen
Vol. 06, Issue 06, Page 1-24