The Boston Globe ran a story on the HPV vaccine on Monday. If you’ve been following the HPV debate you’ll already know that critics think the vaccine (which can protect against some strains of HPV and in turn protect against contracting cervical cancer) will make teens more promiscuous. But as one of the doctor’s interviewed for the article says, “If we have a safe and effective way to prevent a particularly prevalent form of cancer, then why wouldn’t we do that?”
Highlights after the jump.
“What I will probably do is point out that last year alone, more people died of cervical cancer, which was pretty much directly produced by Human Papillomavirus, than were killed in 9/11,” said Watson, president of Pediatrics West, a private practice with offices in Concord, Westwood, and Groton.
“I’ll probably focus on the fact that the vaccine prevents cervical cancer in my sell, and not on the fact that this prevents a sexually transmitted disease,” said Dr. Joseph Hagan, a Burlington, Vt., pediatrician active in the American Academy of Pediatrics. “You know why? Because my Dad sold insurance, and I know what to emphasize and what not to emphasize.”
Parents, too, say they might not get into awkward questions of sexuality. In general, said Lynn Randall of Concord, whose daughters are 12 and 15, when one of her girls gets a shot, “We’re not telling her what she’s being vaccinated against; usually it’s just a shot to her — one of many shots she gets in her pediatrician’s visits.”
Irene Freidel , of Littleton said that if her 11-year-old daughter, Claire, were vaccinated tomorrow, she would most likely tell the girl only that “it was something that was going to protect her, like any other vaccination, and is good for her health.”
“I adore my daughter more than anything in the world,” she said, “and I can’t predict what she’s going to do as a teenager, what risks she’s going to be exposed to. To me, this is just extra protection.”
“Most parents will be eager to have their daughters vaccinated against HPV as long as they know they’re sending the right preventive messages: that they still need to practice safe sexual behaviors, postpone sexual initiation as long as possible,” and the like, Kahn said.
Nonwhites and those with poor access to healthcare stand to benefit the most from the vaccine because they are the least likely to get annual Pap smears and follow-up care after a problematic test, said Dr. Elizabeth Garner, a gynecological oncologist at Brigham and Women’s Hospital.Yet they are precisely the people who will have the hardest time getting access to the vaccine and getting the full dosage, she said.
Great article on sex-ed in the April issue of Diablo. Renee Walker, an amazing activist out of CA was interviewed for the piece.
Buoyed by this victory and incensed to find that more abstinence-only programs were operating in area schools, Walker in 2003 founded Bay Area Communities for Health Education (BACHE), which is dedicated to supporting comprehensive sex education, encompassing both abstinence and contraceptives. She spends at least two hours a day on BACHE-related activities, much of it poring over literature used in abstinence-only sex education classes looking for inaccurate or misleading material.
And will your child pay the price
By Jonathan Kaminsky
It was an overcast afternoon, and San Ramon Valley High School had just let out. The nearby Starbucks was teeming with energetic teenagers. Boys and girls shuffled from table to table, talking, laughing, and exchanging glances. An anthropologist observing the scene would probably have labeled it a complex mating ritual.
One girl in her early teens, wearing a tight-fitting polo shirt and eyeliner, sat at a table next to the window with two girlfriends, recounting an earlier conversation. “She called me a whore,” the girl told her friends, referring to an exchange she’d had with another friend. Without a trace of irony in her chipper voice, she gave a quick glimpse into her adolescent persona: “I said, ‘Thanks. I take that as a compliment.’ “
A few minutes later, a smartly dressed middle-aged woman with shoulder-length brown hair and a cross hanging around her neck entered the coffee shop. By the time Linda Turnbull arrived, the crowd of young people had thinned. Those remaining were engaged in more subdued conversations.
Turnbull had come to talk to a Diablo reporter about Teen Esteem, an organization she founded more than a decade ago to keep teens from having sex. As she will tell you, if it’s a weekday during the school year, there’s a good chance she’s in a public school classroom somewhere in the Tri-Valley or Lamorinda explaining to teenagers why holding off for a few years is a good idea.
It’s what she’s not doing—giving equal time to discussing the benefits of condoms and other contraceptives—that state authorities say puts schools she visits in violation of California law. It also leaves more than 60 percent of the young people she comes into contact with—the percentage who are likely to become sexually active by age 18—more vulnerable to pregnancy and disease, health experts say.
Turnbull’s involvement with teen abstinence was sparked by two and a half years of volunteering at the Valley Crisis Pregnancy Center (since renamed Valley Pregnancy Center), a Christian clinic in Dublin where she advised young, pregnant women on alternatives to abortion. She encountered so many heartbreaking cases there, she says, that one day, after a particularly terrible counseling session, she told the clinic director that they had to do something to stop women from coming to them in such a state.
“Do something about it,” the director told her. Shortly thereafter, in 1994, the self-described stay-at-home mom, whose younger daughter graduated from San Ramon Valley High School last spring, got her start in what she calls “the prevention side” of teen sex. After getting permission from the San Ramon Valley Unified School District, she started talking to students about what she terms the emotional and physical consequences of sexual activity and the value of committed, monogamous relationships.
“Our agenda is the health and well-being of teenagers,” Turnbull says.
Over time, her organization has grown. Teen Esteem is now in 25 middle and high schools in five districts: San Ramon, Livermore, Pleasanton, Dublin, and Acalanes. And while she’d love to reach more young minds, she says, “we can’t keep up with the districts we’re in.”
Every year, Turnbull and her twenty or so volunteers talk to between 10,000 and 13,000 students, either in two-day classroom presentations or in all-school assemblies. Their message, provided free of charge, is clear: Sex now can lead to emotional distress, unwanted pregnancy, and diseases that can impact you for a lifetime; condoms aren’t as effective as most people have been led to believe and are in some cases completely ineffective; the only sure way around all this is to avoid sexual activity until you’re in a committed, monogamous relationship that for most people will be marriage.
“We don’t tell the kids what to do,” she says. “We give them information. What they do with it is their choice.”
It goes without saying that any parent would prefer that his or her teenager or preteenager put off having sex—and not risk pregnancy or exposure to sexually transmitted diseases. However, with studies showing that well over half of all teenagers have sex before finishing high school, the question becomes whether that parent would want to limit the information about condoms and contraceptives available to a young person who becomes sexually active.
Sex education experts say that a full and frank discussion about condoms and other contraceptives helps prevent sexually transmitted diseases and teen pregnancy. Moreover, research also shows that such a message doesn’t get in the way of encouraging abstinence.
Douglas Kirby, Ph.D., a senior research scientist at ETR Associates in Scotts Valley who is generally cited as the leading expert on evaluating sex education programs, says that the dozens of studies he has reviewed show that promoting teen abstinence and encouraging condom and contraceptive use are “not inconsistent goals.” The dual message, he says, is “something that young people can understand.”
This refutes Turnbull’s contention that encouraging abstinence while also promoting condoms and other contraceptives sends teenagers a confusing mixed message.
But although these findings don’t help Turnbull’s cause, Teen Esteem may face a more immediate threat: a 45-year-old mother of two teenage boys who lives in Concord.
Renee Walker is trim, with green eyes and short blond hair. She looks like a gymnastics instructor, which, in fact, she is, when she’s not working from the office in her garage to put Turnbull and others like her out of business.
Walker’s engagement with sex education arose from parental experience. Nearly four years ago, the Walker family was having dinner when her younger son, then 11, said something startling. The wet, crumpled paper straw wrapper on the table, he said, reminded him of the seaweed a doctor inserts into a woman’s cervix to soften it before an abortion.
Upon discovering that her son had learned this in school, from a presentation made by an outside group that was supposed to be talking about abstaining from sex, Walker set out to do something.
She complained to the school, then to the Mt. Diablo Unified School District. Both told her the program, called CryBabies and run by a Christian pregnancy center called First Resort, was popular and posed no problem. Then she went to the state’s Department of Education.
The state referred the matter to the California Healthy Kids Resource Center. After a thorough review, the center released a 22-page report stating that the CryBabies program was “designed to frighten adolescents into abstinence” and that it had a “generally one-sided approach” to teen parenting, adoption, abortion, and STDs. The schools using CryBabies, the center found, were in violation of state law. Although the center can’t tell districts what to do, the black mark on CryBabies, which was being used in about two dozen schools in the Bay Area, was enough to shut the program down.
Buoyed by this victory and incensed to find that more abstinence-only programs were operating in area schools, Walker in 2003 founded Bay Area Communities for Health Education (BACHE), which is dedicated to supporting comprehensive sex education, encompassing both abstinence and contraceptives. She spends at least two hours a day on BACHE-related activities, much of it poring over literature used in abstinence-only sex education classes looking for inaccurate or misleading material.
“If someone says, ‘We’re going to teach your kids how to abstain from drinking alcohol,’ you’re going to go, ‘Absolutely,’ ” she says. “But if they tell kids that drinking will make their tongues fall out, parents are going to oppose that.”
When asked if her actions are motivated by politics, she is quick to respond. “I’m a swim-team mom. I work with little kids. What’s my agenda?”
Indeed, she says, getting teenagers to abstain from sex is a noble goal. When her son came home with a permission slip to take the abstinence course back in 2002, she happily signed it. She assumed it would be age appropriate and based in science. However, she says, it turned out to be something different. He was compelled to take a virginity-until-marriage pledge and was told that abortion is bad because “it kills babies,” tearing off their arms and legs.
“Somebody miseducated my kid,” she says. “These are Christian evangelical missionaries passing themselves off as educators.”
After vanquishing CryBabies, Walker turned her attention to Teen Esteem. She handed out flyers at a Teen Esteem meeting for parents that questioned the program’s compliance with state law and pointed out Turnbull’s ties to the overtly Christian pregnancy center.
Turnbull, in an e-mail response to Walker, said that while Teen Esteem was born out of the pregnancy center, it had become its own nonprofit organization.
“We do not promote contraceptives and have never represented that we do,” she wrote in the e-mail. “We do not support condoms because there is still a great risk involved.”
Turnbull also distances herself from CryBabies.
“I was very disappointed when I heard what they were doing,” she said during the Starbucks interview. “We sort of got lumped together. But we’re not doing the same thing they were doing.” Unlike CryBabies, Teen Esteem doesn’t address abortion except to say that it is one legal option for a pregnant woman, and it doesn’t have kids take virginity pledges.
And despite the strong moral beliefs of many of her volunteers, Turnbull says, she makes sure that “we don’t cross any lines” by discussing religion when speaking in public schools.In her e-mail to Walker, Turnbull was explicit: “We do fulfill the state requirements regarding sex education.”
That is just not so, says Sharla Smith, the State Department of Education’s HIV/STDs prevention education consultant. California law requires that sex education, when taught in public schools, include medically accurate information about condoms and other contraceptives. Programs like Teen Esteem must discuss the benefits of contraceptives as well as abstinence, she says, even if kids are getting information about contraceptives elsewhere. Failing to do so, she says, “places undue emphasis” on one over the other.
This said, Smith has no plans to audit districts that use Teen Esteem in her annual on-site appraisal of HIV and sex education this spring. Audits can force districts to change their curricula and, by extension, could compel Teen Esteem to change its message or stop going into public schools entirely. Resources are limited, however, Smith says, and the state typically focuses on schools with higher rates of teen pregnancy, which tend to be in poorer districts.
With the state on the sidelines, administrators whose districts use Teen Esteem have not voiced concern about the program. San Ramon administrator Scott Gerbert, for one, welcomes it with open arms.
“I feel very lucky” to be working with Turnbull, says Gerbert, who oversees sex and HIV education for the San Ramon Valley Unified School District’s 23,000 students. “She’s got a lot of good information, and she’s very passionate about what she does.”
However, he acknowledges, “there are parts of what she says in her presentations that are in compliance with state education codes, and there are parts of it that the education code says something a little different.” For instance, he says, Teen Esteem “glosses over birth control.”
Despite that, Gerbert does not intend to ask Turnbull to alter what TeenEsteem does.
“From a district perspective, we don’t expect [Teen Esteem] to change their message to say, ‘Here’s 50 percent on abstinence and 50 percent on birth control.’ That is not their focus,” he explains.
Gerbert sees Teen Esteem as one component of the district’s sex education curriculum. The teachers in charge of sex education, he says, have up-to-date information about the efficacy of different forms of birth control, and they share that information with the students to supplement what Teen Esteem teaches them.
However, at least three such teachers in the San Ramon district who have Teen Esteem come into their classrooms say they don’t significantly add to its message. Randy Cahn, who teaches ninth grade health at California High School, says that he mentions that condoms can be purchased at the supermarket, but little else. In the classroom, he says, “abstinence is our focus.”
Tavie Knapp, who teaches eighth grade science at Charlotte Wood Middle School, says that she doesn’t talk to her students about contraceptives at all. The same goes for Laura Finco, an eighth grade science teacher at Stone Valley Middle School, who says that time constraints keep her from doing so.
“There are times when I feel like I’m shortchanging my students,” Finco says.
Gerbert, though, is so impressed with Turnbull that he asked her to help him review textbooks for inclusion in the district’s health education curriculum.
Phyllida Burlingame, a leading consultant and advocate for comprehensive sex education, says that such a relationship between Turnbull and the district is inappropriate.
Says Burlingame: “It’s like the fox guarding the henhouse.”
Debates over what to teach kids about sex have raged ever since Chicago schools, back in 1913, responded to a surge in venereal disease by instituting the country’s first sex hygiene curriculum. They did so over loud protests by local politicians.
The current row began in earnest when Congress, in a rider to the welfare reform bill of 1996, earmarked $50 million a year for the states to preach abstinence. California, with its comprehensive sex education requirement, isthe only state never to have taken the money. Now other states, including Pennsylvania and Maine, are turning down the federal funding.
In 2000, another federal program started doling out money directly to private organizations that strictly adhere to an abstinence-only message. The Community-Based Abstinence Education program will pay out more than $140 million nationwide this year. Among the groups that have received this funding is Teen Esteem; Turnbull declined to say how much money her organization has received. Another pro-abstinence organization called Await & Find has also used the money to run a sex education program, Peer CHAOS, throughout Alameda and Contra Costa counties. Teen Esteem and Await & Find have worked together on a series of television ads in those counties targeting parents and teens with an abstinence message.
According to the state’s Department of Education, organizations that receive the federal money shouldn’t be talking to kids about sex in public schools.
“Groups in California get direct funding from the federal government to pursue abstinence-only education,” says the education department’s Smith. “And that’s fine, as long as they don’t do it in the public schools.”
Federal backing has given courage to those who object to teaching teenagers about contraceptives and safe sex measures. The evidence, however, indicates that this approach is misguided. In the last decade, teen pregnancy both in theUnited States and in California has declined sharply. According to scientific studies, this is chiefly due to the increased use of condoms and other contraceptives, rather than to decreased sexual activity.
In a report published in January, the Journal of Adolescent Health strongly criticized the abstinence-only approach to sex education, calling it prone to “withholding information needed to make informed choices.” Groups includingthe American Medical Association,the American Academy of Pediatrics, and the Institute of Medicine have also come out in favor of comprehensive sex education.
Moreover, the citizens who pay for California’s public schools favor it. Apoll of Californians conducted in December by the Public Policy Institute of California, a nonpartisan San Francisco think tank, found that 78 percent of respondents favored kids being taught about both abstinence and contraceptives and said that the federal government should help foot the bill for it. These numbers cut across racial, ethnic, and regional lines.
Meanwhile, Teen Esteem has relied on an organization called the Medical Institute as one of its official sources of information. A conservative, abstinence-based organization, its materials have been removed from the Mt. Diablo Unified School District’s resource library. One Medical Institute handout provided by Teen Esteem says that because condoms are often used incorrectly, and as they can fail even when used properly, they are not adequate for those “who truly wish to avoid getting STDs.”
Cynthia Harper, Ph.D., of the Center for Reproductive Health Research & Policy at UCSF, says that dismissing condoms as not safe enough to be worth using is bad for public health.
“No one ever thought the condom protected against every disease possible,” she says. “But it’s a very useful way to prevent a lot of common diseases,” including chlamydia and HIV, as well as unwanted pregnancy.
One of Turnbull’s key criticisms of condoms is that they do nothing to prevent the spread of human papillomavirus (HPV), more commonly referred to as genital warts, which can lead to cervical cancer.
“That’s a red herring,” says Thomas Broker, Ph.D., president of the International Papillomavirus Society. Because nearly 90 percent of American adults are infected with some form of HPV, he says, the medical community focuses not on preventing infection but on controlling any damage it can cause. Condom use, he says, “has been demonstrated to reduce disease progression.” Annual Pap smears, he adds, can detect precancerous cell changes caused by HPV before cervical cancer develops.
Despite all this, with the support of local school districts, the financial and moral backing of the federal government, and the state staying out of it, Teen Esteem and other organizations like it will most likely continue to spread their well-meaning but flawed message to teenagers in public school classrooms. Turnbull says that in 10 years she hopes to be doing the same work as today. “Teenagers,” she says, “are my passion.”
