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Researchers Say CDC Sex Ed Conclusions May Mislead Policymakers
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Two external consultants have issued a dissenting opinion on a recently released CDC report on sex education because they believe its conclusions don't match key study findings. The CDC report — Group-based Interventions to Prevent Adolescent Pregnancy, HIV, and other STDs — reviewed 83 studies of U.S. sex education programs, and recommended comprehensive sex education (CSE) programs as generally effective in both community and school settings.

Irene Ericksen and Danielle Ruedt, two members of the study's External Partners panel, contend that CSE programs in school settings lacked demonstrable evidence of effectiveness on key outcomes of teen condom use, pregnancy prevention, and the spread of STDs. "The effectiveness of school-based programs is crucial since the school classroom is where most teens receive sex education," said Ruedt, the Public Health Programs Coordinator for the Georgia Governor's Office of Children and Families. "Yet the report's conclusion that comprehensive sex education programs are generally effective in school settings is contradicted by some of the data upon which the report is based."

Indeed, asserted Ericksen and Ruedt in their minority report, "a sizable percentage of CRR programs did not work" on stated outcomes of sexual activity, condom use, and STDs, "especially for school-based programs, which are the focus of the national policy debate about sex education."

The problem is that the study "suffered from a fundamental research error" in that it lumped together "widely divergent types" of sex ed programs into a single analysis, and then drew broad conclusions from the conflated types of programs, said Ericksen, a research analyst with The Institute for Research and Evaluation in Salt Lake City. The CDC report grouped programs into only two categories, abstinence-only education (AE) and comprehensive risk reduction (CRR) approaches. The AE programs were primarily school-based, but the CRR category combined data from 24 school/classroom settings with 36 community-based settings. The CRR community-based settings included STD clinics, youth shelters, youth detention centers, and housing projects with a wide variety of study populations, environments, and methods of disseminating information. From a research standpoint, lumping these programs together "undermines the validity of the entire study," said the researchers.

The researchers specifically question the study conclusion that CSE programs are generally effective at reducing STDs. That is because the conclusion appears to be based upon only two programs based in community health clinics, with no school-based programs demonstrating statistical effectiveness for that outcome. "This does not seem like adequate evidence upon which to base national policy about STD prevention," said Ruedt. Accurate conclusions are critical, because the CDC estimates that there are 19 million new sexually transmitted infections each year, with half occurring in 15- to 24-year-olds.

Erickson and Ruedt also charged that the CDC recommendations "fail to acknowledge the evidence for the effectiveness of AE programs at reducing teen sexual activity, and invite conclusions that CRR is a superior approach to AE, which is not supported by the evidence." They said the study discounted the significant reduction in sexual activity found with many AE programs "based upon a misplaced deference" to certain studies that had "important design problems." The CDC analysis also tested whether teens participating in an AE program were less likely to use condoms if they did become sexually active, and found no evidence to support that common criticism of AE programs. The dissenting consultants criticized the CDC Task Force because "this important finding was not included in the Recommendation Statement."

The pair also raised other issues about the Task Force's meta-analysis methodology which may have compromised the accurate measurement of CRR and AE outcomes. For example, they contend that the use of a one-to-three month minimum follow-up time for condom/contraceptive/STD outcomes while requiring a six-month minimum follow-up time for abstinence outcomes had the effect of requiring AE to meet a higher standard of effectiveness.

The minority report also calls upon the CDC to release to the public the full set of studies that underlie the Task Force's Recommendation Statements. The federal agency plans to eventually release all of the underlying data, but not until the CDC has scientifically cleared it for release to the public. The problem with this policy, according to Ericksen and Ruedt, is that it "prevents the public from scrutinizing the body of evidence underlying the CDC Task Force Recommendations in the same time frame in which the CDC recommendations will influence the decisions of policymakers and public health professionals." They note that public access to the full data set is "particularly important in the current climate of controversy and politicization that surrounds the public policy debate about sex education in America."

Ultimately, the researchers are concerned that the CDC study "invites an inappropriate comparison" between CRR and AE programs. The resulting statistical inconsistencies make "the study's recommendations potentially misleading to policy-makers who want to implement evidence-based programs, especially in schools" said Erickson.

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