Back Return to Curricula and Speaker Reviews    Printer Friendly Version Printer Friendly Version

Reasonable Reasons to Wait: Keys to Character is an abstinence-only-until-marriage curriculum developed under the Adolescent Family Life Act (AFLA). AFLA, one of three federal funding streams for abstinence-only-until-marriage programs, provides grants under Title XX of the Public Health Service Act.  Reasonable Reasons to Wait (RRTW) was written by Maureen Gallagher Duran and released by the Virginia-based organization, A Choice in Education. The edition SIECUS reviewed was revised in 2002–2003. It is our understanding that the curriculum has not been further revised and that it is no longer available for purchase. SIECUS chose to review this curriculum despite this fact, however, because it was part of a research study that is being touted by the abstinence-only-until-marriage industry as proof of the success of this restrictive approach. 
Specifically, researchers followed 550 seventh grade students from Northern Virginia middle schools, 357 of whom went through a program sponsored by the Virginia Department of Health that used RRTW, and 193 of whom received an alternative program.  Students completed surveys before and after the program as well as a survey one year later.  Initial data were collected during the 1999–2000 school year.[1]
Based on this research, the study’s authors concluded that “abstinence programs can achieve significant reductions in teen sexual initiation.”  This sounds like an important achievement, until we remember that the students in the study were 7th graders, (12–13 years old) and the success of the program was based on whether these students remained abstinent for one year.  In 2001, only 6.6% of high school students reported having sexual intercourse for the first time before the age of 13.[2]  Given that the average age of first sexual intercourse is 16.9 for men and 17.4 for women, keeping 12 or 13 year-olds abstinent for one year is admirable, but no great feat. Moreover, the findings are compromised by numerous methodological flaws including a quasi-experimental design.[3]
Still, proponents of a strict abstinence-only-until-marriage approach have been lauding this study as proof that their methods work. In fact, the study’s author was the sole representative of the industry at recent hearings on Capitol Hill. His arguments were countered by numerous scientists, medical doctors, and researchers who pointed to mountains of evidence, including a study by the federal government, that suggest that abstinence-only-until-marriage programs are ineffective at best.[4]
In addition to realizing that abstinence-only-until-marriage programs do not work, SIECUS believes that it is vital to look at the specific messages found in many of these programs, including RRTW. We believe that programs that rely on fear and shame, present inaccurate information, and foster biases and stereotypes are never appropriate even if they show some marginal success in delaying sexual debut. 
 
SIECUS’ reviews of curricula are based on the Guidelines for Comprehensive Sexuality Education, K-12 which were developed by a task force of professionals from the fields of education, medicine, youth services, and sexuality education. The Guidelines are a framework for comprehensive sexuality education programs and represent a consensus about the necessary components of such programs. Abstinence is one of the 39 topics included in the Guidelines.
 
As is typical of abstinence-only-until marriage curricula, Reasonable Reasons to Wait provides limited information on sexuality and does not appropriately cover basic topics such as puberty, sexual response, or reproduction. Other issues such as contraception, abortion, sexual orientation, STDs, and HIV/AIDS are presented in an unbalanced manner that seems designed to promote one point of view rather than simply inform students.
 
In addition to omitting important information, this curriculum relies on messages of fear and shame, inaccurate and misleading “facts,” and biased views of marriage, gender, pregnancy options, and sexual orientation. While the immediate goal of many sexuality education programs is to delay the initiation of sexual intercourse (possibly until marriage) or to increase the use of pregnancy- and disease-prevention methods, many programs also have the long-term goal of promoting sexual health. Because abstinence-only-until-marriage programs are often the only formal setting in which young people learn about sexuality, the information and messages in the curricula can have a life-long impact on how they view sexuality.
 
Relying on Negative Messages
 
Formal sexuality education offered in schools, community centers, or churches often represents the only opportunity that young people have to learn facts about sexuality and explore values regarding sexual activity. The messages they receive in these programs contribute to their sexual health, not only as adolescents, but also as adults. Rather than present a balanced, complete picture of both abstinence and sexual activity, Reasonable Reasons to Wait employs negative, fear-based messages, tries to instill shame and guilt, and portrays sexual behavior as an uncontrollable force.
 
Messages of FearPortraying Premarital Sex as Inevitably Harmful
 
RRTW is based on the idea that premarital sex will inevitably cause harm and damage. “Do you think it is possible to engage in premarital sex without anyone getting hurt?” it asks students rhetorically before going on to elaborate on the obvious answer: “There are three kinds of hurt that may follow premarital sex—physical, emotional and academic” (RRTW, Student Workbook, p. 40). It then lists the “risks associated with premarital sex” as “pregnancy, broken relationship, sexually-transmitted diseases, loss of self-confidence, contraceptive/prophylactic failures, doubt, and being used and dropped” (RRTW, Student Workbook, p. 52). The curriculum warns teenagers that if they do have premarital sex, there will also be negative social consequences: “What happens to couples who have been sexually active? When they stop dating, do they still respect, admire, and consider each other best friends? Premarital sexual relationships do not lead to mutual respect” (RRTW, Student Workbook, p. 89).
 
RRTW then tells teenagers that if they do engage in sexual behavior “their future is uncertain” (RRTW, Student Workbook, p. 52). The curriculum implies that one’s dreams and goals will be crushed by premarital sex, as shown in an activity that asks, “What can premarital sex do to an adolescent’s future? What are some long-term goals that pregnancy, STDs, or AIDS might affect?” The given answers are: “going to college, going to graduate school, starting a profession, getting married, and having children, etc.” (RRTW, Teacher’s Manual, p. 2.23).
 
Such fear-based messages about STDs are repeated throughout the curriculum. In fact, the introduction to the unit on STDs says, “many of the facts, figures and statements mentioned in this unit are frightening, because the problems associated with sexually transmitted diseases (STDs) are scary” (RRTW, Student Workbook, p. 116). The unit goes on to say that “sexually transmitted diseases affect teenagers’ dating relationships. AIDS can kill. It can kill you. It can kill your date” (RRTW, Student Workbook, p. 125).
 
These messages of fear are perhaps best dramatized in an activity, titled “A Game of Chance,” which directs the instructor to number seven different spots in the classroom and ask students to randomly choose a number and stand next to it. Next, the instructor is to take one die out of her pocket and explain, “premarital sex is a game of chance: you never know when it may result in an STD or pregnancy.” The instructor rolls the die and calls out a number: “Tell the students that if their number is called, that means they have acquired an STD or caused a pregnancy and they ‘lose’ out in achieving their future dream and must sit down.” The remaining students are given the opportunity to find a “safe” number before the die is rolled again (RRTW, Teacher’s Manual, p. 3.15).   
 
According to the curriculum, the only safe number is seven as this can never be rolled with one die. In this game, seven represents premarital abstinence. Ultimately, students standing under any other number will be told that they lose. While it is true that abstinence is the best way to prevent STDs and unintended pregnancy, this game is purposely misleading as it suggests that anyone who chooses to have sex outside of marriage will inevitably experience one of these two negative consequences. Students need to understand that both pregnancy and STDs are real possibilities and then be given information about how to protect themselves. Nonetheless, it is not appropriate to exaggerate the risks to emphasize a point. 
 
This game, however, not only exaggerates the risks, it also emphasizes the shame that RRTW seems to hope students will associate with premarital sex. Teachers are told that “After several rolls, some of the students may realize that the number seven is sage because it will never be rolled on the die. The students under the number seven will proudly remain there while snickering at the other students racing from number to number and losing the game.” With comments like this the author seems to be condoning students making fun of each other for their personal decisions about whether or not to be abstinent. It is never appropriate for an educational program to encourage young people to deride their peers for any reason, let alone for holding one specific personal value, be that choosing to remain abstinent or choosing not to.    
 
Messages of ShameInstilling Embarrassment and Guilt
 
The curriculum spends a great deal of time discussing character and suggests that some important traits that lead to good character are “honesty, respect, courage, self-control, justice, humility, responsibility, and kindness.” It gives young people the opportunity to explore how these character traits play out in numerous situations that have nothing to do with sexual behavior such as overcoming procrastination, being nice to your parents, and keeping promises. These could be valuable activities if the curriculum did not go on to suggest that the ultimate sign of good character is the decision to wait until marriage to have sex. In fact, in one activity in which students are asked to evaluate their role models on a variety of values “doesn’t promote sex outside of marriage” is listed right up their with “has deep respect for all living things” and “avoids degrading others, including children, race, women, etc.” (RRTW, Student Workbook, p. 31).
 
In fact, throughout the curriculum, the author points to the decision of whether or not to engage in premarital sex as the ultimate measure of morality. She sets up a dichotomy between those who wait until marriage to have sex (who are portrayed as virtuous and good) and those who do not wait (who are portrayed as flawed and unhealthy).  The curriculum underscores this by saying that human values are not subjective: “Values are immutable, unchanging, non-negotiable. A person may choose not to act according to values (also called ethical standards). The person’s choice, however, does not change the validity of the value” (RRTW, Student Workbook, p. 35). While this may be true of some values, not all values are universal. Specially, not all people hold the value that premarital sexual activity is wrong.
 
Nonetheless, RRTW likens premarital sex to drinking, smoking, and drug use. “On the other hand, there are some good things which ‘feel’ good. You may jump into a cold pool on a hot day, drink hot chocolate after a walk in the snow or enjoy a movie with a group of friends. However, some things that people do may feel pleasurable, but may have negative consequences. Using drugs or alcohol and premarital sexual activity are such activities” (RRTW, Student Workbook, p. 38).   
 
The curriculum then tells teens that while it might seem like everyone is engaging in these pleasurable activities, they should not compromise their values. “No matter how many people accept a dumb idea, it is still a dumb idea.” Two of the examples used to illustrate this point are: 
 
Slavery—At one point in our country’s history, a majority of people believed it was acceptable to own slaves. They were wrong. It took civil war, as well as a lot of time to help people see this.
 
Hitler—There were people in Germany and other places who went along with his plan to exterminate “inferior” people. When the reality of this was made known, near the end of World War II, people’s mind changed. (RRTW, Student Workbook, p. 39).  
 
Comparing premarital sex to drinking and drug use, and worse, to slavery and genocide is dangerous and offensive. While excessive drinking and drug use are activities we never want our young people to engage in, most adults agree that they want their teenager to grow up to have a happy and healthy sex life. And, while all moral authorities can agree that holding slaves or summarily executing people is wrong, many throughout the world think it is wholly appropriate for two adults to have consensual sex outside of marriage.
 
Despite this, RRTW continues to suggest that choosing abstinence is the ultimate test of virtue and that young people who have had premarital sex should be ashamed of their behavior. Among the “probable effects” of premarital sex, the curriculum lists these feelings: “used, disappointed, glad, worried, guilty, confused, ashamed” (RRTW, Student Workbook, p. 52).   The curriculum then suggests that sexually active young people will be undesirable when it comes time to marry. It quotes “several studies” that claim that “both males and females have shown marked preference for partners who have not had sexual intercourse before marriage” (RRTW, Student Workbook, p. 158). Though cited to legitimate sources, the curriculum completely misinterprets these studies, one of which was published in 1985 in the Journal of Marriage and Family. This study actually found, “both male and female respondents were shown to prefer moderately experienced partners, regardless of respondent’s own experience level.”[5] In fact, research consistently shows that people generally prefer partners with some level of prior sexual experience.
 
Still, the curriculum uses the story of Kelly and Marcus to further illustrate this point of undesirability. Kelly tries on her mother’s wedding dress and parades it in front of her boyfriend, Marcus:
 
At first, Marcus was overwhelmed at how beautiful Kelly looked. He treated her special, like a person of real honor. Kelly, on the other hand, stopped caring for the dress. She no longer placed it in its protective covering and valued it like a cherished possession. Because of Kelly’s new attitude, the dress lost its beauty and charm. The dress began to look different to Marcus. It had lost its appeal and attractiveness. He saw Kelly in it all the time. She wore it rollerblading, biking, bowling and in clubs. The wedding dress had changed its appearance. It was dirty, ripped in some places and simply looked used. The dress now looked like any other dress. After several weeks, Kelly and Marcus broke up.
 
The teacher then asks students to analyze this thinly veiled analogy by comparing “how Kelly and Marcus treated the wedding dress and what happens to a couple when a person gives in to premarital sex and loses his or her virginity” (RRTW, Student Workbook, p. 168). The obvious conclusion is that young people who have been sexually active are damaged, dirty, used, and no longer appealing. Other sections of the curriculum instill similar ideas: “if an adolescent is sexually active, he is no longer a challenge or different from the crowd. After a while, the teenager is no longer respected” (RRTW, Teacher’s Manual, p. 3.27).
 
It is important to remember that 48% of all high school students and 65% of high school seniors have engaged in sexual intercourse, and it is therefore likely that some of RRTW’s participants will be sexually active.[6]  It is unfair and inappropriate to imply that these teens are impure or lack self-control and that others should lose respect for them.
 
The curriculum routinely assumes that the decision to become sexually active is one born out of low self-esteem, a lack of self-control, and inherent character flaws, and that all young people who have been sexually active are damaged. While it is possible that some teens may have had negative experiences with sexual behavior, instilling guilt does nothing to help them cope with such experiences. It is also possible that sexually active teens have had consensual, safe, and protected sexual experiences for which they feel neither guilt nor shame. Suggesting that they should feel bad may produce emotional distress where there was none before.
 
Sexual ArousalDescribing Sex as an Uncontrollable Force
 
After telling students that sexual behaviors lead to inevitable physical, emotional, and social harms, and that sexually active young people should feel shame, RRTW describes sex as a force out of young people’s control. It explains that when “intimacy does not end in intercourse, a young man can become frustrated. Many young women say that they never meant to go as far as they did, that they felt unable to stop, and intercourse just happened. It is far better, and safer, to avoid long-term and close intimacy such as fondling genitals” (RRTW, Teacher’s Manual, p. 3.10).
 
One particularly morbid illustration of this notion is called “Frog Soup.” The instructor has a collection of transparencies that show “Fred the Frog.” First the instructor shows Fred being dropped into hot water, and promptly jumping out. Then, however, Fred jumps into lukewarm water and stays in even as the water is gradually made hotter and hotter. The teacher’s explains, “Fred cannot sense when ‘hot is too hot.’ Eventually Fred will turn into frog soup. Physical intimacy is like the gradually heated water. A person does not notice the heat until it is too hot. At this point, it is difficult to listen to the mind because of the physical and emotional stimulation” (RRTW, Teacher’s Manual, p. 4.16).
 
This is perhaps the most dangerous message teens can be given about sexual activity: by suggesting that teens have no control over their actions, it actually discourages them from making wise sexual decisions and taking responsibility for their actions. Young people need to know that at any point in a relationship, and at any point during sexual activity, they have the right and the ability to set their own sexual boundaries and that it is their responsibility to do so.
 
Instead students are shown a chart depicting the “progression of sexual feeling with increased physical intimacy.” The chart lists the following stages: “being together, hand holding, simple good night kiss, prolonged kiss, necking, petting, heavy petting, sexual intercourse, end of relationship in current form” (RRTW, Student Workbook, p. 97). The illustration of this progression shows that from “being together” to “simple good night kiss” there are no “genital feelings” aroused but it labels prolonged kiss to be the “beginning of danger,” and suggests that males will be aroused at necking and females at petting. The same section says, “girls need to be aware they may be able to tell when a kiss is leading to something else. The girl may need to put the brakes on first in order to help the boy” (RRTW, Student Workbook, p. 96).
 
This overly simplistic illustration of a progression of sexual behavior is problematic in many ways. By suggesting that there is a correct order of behaviors and a right time in which to become aroused, the curriculum may confuse students who have had different experiences or become aroused by different activities. And, by being extremely vague about sexual behavior (and using terms such as necking that haven’t been used by teenagers in generations), the curriculum is missing an important opportunity to discuss the level of risk associated with various sexual behaviors that today’s teens are engaging in, such as oral sex. In fact, oral and anal sex are growing concerns for health educators because recent research shows that many teenagers who have engaged in vaginal intercourse have also engaged in oral and anal sex, but are not aware of the risk for STD transmission involved in these behaviors.[7] Most upsettingly, however, by suggesting that girls and guys become aroused at different levels of sexual behavior and blatantly putting the responsibility of avoiding sexual activity on young women, the curriculum is reinforcing dangerous stereotypes about gender. 

Again, young people need to know that, regardless of what they are doing or what they may have previously done, they have the right, the ability, and the responsibility to set their own boundaries. Moreover, young people need to know that this right and responsibility extends to both partners regardless of gender. 
 
Providing Misinformation
 
Reasonable Reasons to Wait provides very little information on the basics of sexuality such as puberty, reproduction, or sexual health. Some information on puberty is woven into lessons on adolescent development in which students are told that the physical changes to boys include “growth of facial hair, increase in strength, and the ability to create a new life.” Young women are told that their changes “…happen to prepare the body for future child-bearing” (RRTW, Student Workbook, p. 36). These statements are accurate but clearly insufficient to explain the complicated facts of puberty to young teens. Moreover, their focus on procreation reveals the curriculum’s underlying purpose.  
 
Apart from these types of facts thrown into to larger discussions, the curriculum provides some detailed information on STDs and briefly mentions condoms. More often than not, the information it provides on these subjects is inaccurate and misleading. 
 
Sexually Transmitted DiseasesMisleading Students
 
Although RRTW contains an impressive amount of detail about STDs, the information provided is often incorrect and builds on the messages of fear and shame that run throughout the curriculum. As mentioned earlier, the curriculum begins its unit on STDs by telling young people that STDs are scary, but saying it’s important to provide a “realistic view of the health consequences of STDs” (RRTW, Student Workbook, p. 116).  Unfortunately, the curriculum seems more fixated on providing a frightening view than a realistic or accurate one.  
 
Creating Confusion
 
Some of the information the curriculum provides on STDs is blatantly incorrect. Most notably, the Teacher’s Manual says, “AIDS can be transmitted by skin-to-skin contact” (RRTW, Teacher’s Manual, p. 5.19). This is untrue. AIDS can only be transmitted through bodily fluids: blood, breast milk, semen, and vaginal secretions.
 
Other information about HIV/AIDS is misleading. The curriculum seems intentionally to confuse young people as to whether or not French kissing can transmit HIV. First, it quotes a study from a 1989 issue of the Journal of the American Medical Association entitled “Passionate Kissing and Microlesions of the Oral Mucosa,” which apparently studied 45 heterosexual couples who collected their own saliva before and after passionate kissing. The study found that “91% [of couples] had blood in their saliva after passionate kissing.” According to RRTW, the conclusion from this study is that “passionate kissing cannot be considered protective safe sex for the transmission of the AIDS virus” (RRTW, Student Workbook, p. 136). 
 
To help clarify this information the curriculum then quotes a Question and Answer brochure written by the Centers for Disease Control and Prevention (CDC). In answer to the question, “Can I become infected with HIV from ‘French’ kissing’?” the CDC states “Not likely. HIV occasionally can be found in saliva, but in very low concentrations–so low that scientists believe it is virtually impossible to transmit infection by deep kissing.” The excerpt from the CDC also says that there has never been a documented case in which HIV was transmitted by kissing. It ends, however, with the caution that scientists cannot absolutely rule out the possibility.   The curriculum goes straight from that caution to a reminder for students: “even sexual intimacy without intercourse can create an environment that will allow an STD to be transmitted” (RRTW, Student Workbook, p. 137).  And, a true and false quiz asks the questions “Public health officials caution against an exchange of body fluids, including saliva (open mouth kissing) for the general public concerning the prevention of STDs (RRTW, Student Workbook, p. 120).  (The curriculum does not include an answer in the Teacher’s Manual and no further explanation is given.) 

The focus on French kissing is a clear example of how the author uses true information and legitimate sources, but attempts to steer students towards inaccurate beliefs. Much of the discussion on AIDS is similar. While the author includes some important information (much of which is only in the Teacher’s Manual), she tends to blur the line between HIV and AIDS and, as a result, many of her statements on AIDS are confusing at best. For example, the following “fact” comes from a work sheet: “It is possible for a person to carry AIDS and not know it” (RRTW, Student Workbook, p. 124). In truth, it is possible for a person to carry HIV, Human Immunodeficiency Virus, and not know it unless he or she is tested. AIDS, however, is a diagnosis that is made when HIV-positive individuals meet certain medical criteria including experiencing a number of illnesses known as “opportunistic infections.” People do not carry AIDS, they are diagnosed with it, and this is not something that happens without their knowledge. 
 
The curriculum goes on to quiz students on “the percentage of people that will die from AIDS.”   The answer is 100%.   This question is misleading in many ways. First, it does not acknowledge that to be impacted by AIDS an individual must be HIV-positive. Clearly 100% of mankind will not die from AIDS. The number the curriculum might have been trying to seek is “the percentage of HIV-positive individuals who will die from AIDS.” Such a question is clearly trying to impress upon young people the fact that there is no cure for HIV or AIDS. Still, even this iteration would be misleading. Technically no one dies from AIDS; AIDS weakens the immune system and makes individuals vulnerable to certain illnesses and diseases. It is these illnesses that may ultimately be fatal. It is also worth noting that some HIV-positive people will die of completely unrelated causes such as automobile accidents. While this may seem like splitting hairs, it is imperative that health curricula be 100% accurate all of the time. It is not acceptable for authors to cut corners or oversimplify facts in an effort to control behavior. 
 
Worst Case Scenarios
 
The majority of the discussion on STDs focuses on worst case scenarios. The curriculum tells young people, “After death from AIDS, the most serious complications resulting from these diseases are pelvic inflammatory disease, sterility, ectopic pregnancy, cancer associated with HPV, fetal and infant death, birth defects, and mental retardation.” It adds, “The most serious complication of STDs is that women can die from overwhelming infections” (RRTW, Student Workbook, p. 129). 
 
To its credit, the curriculum does note that “most STDs are treatable if diagnosed in time” (RRTW, Student Workbook, p. 116).  Nonetheless, it focuses on the long term adverse affects of untreated STDs. One chart labeled “STDs and Your Future” is divided into two columns “You or Your Partner” and “Infected Babies.” Each lists potential consequences. The “You or Your Partner” column includes examples such as “STDs can lead to cervical cancer,” “STDs can cause damage to major body organs,” and ‘STDs can lead to death.” The other column states that “Babies can suffer from blindness,” “Babies can suffer from mental retardation,” and “Babies can die from acquiring an STD from their mothers if the mother is infected while pregnant” (RRTW, Student Workbook, p. 127).
 
By focusing on these long term possibilities, the curriculum misses the opportunity to help young people understand the early signs and symptoms of STDs and the importance of early testing and treatment. It is important for students to know that untreated gonorrhea can lead to PID and untreated PID can lead to sterility, but it is equally important to tell young people that if they experience any itching, burning, or discharge they should be tested and, if necessary, treated as soon as possible. It is true that certain strains of HPV can lead to cervical cancer, but it also true that most HPV infections resolve spontaneously and that regular Pap tests can detect abnormal changes to the cervix long before cancer develops. And, it is true that untreated STDs can pose a danger to developing fetuses, but it is also true that prenatal care (which includes testing and treatment for STDs) is vital to the health of any pregnancy. Clearly, RRTW is not trying to educate students and help them manage their future health, but is instead trying to scare students and spread blame. 
 
The Shame of STDs
 
In fact, the entire section on STDs is simply used as a means to reiterate the curriculum’s central point: that sex outside of marriage is wrong. The authors suggest that learning about STDs, “...may also cause you to think about why sex belongs within the context of marriage” (RRTW, Student Workbook, p. 118). In addition to descriptions of some of the most common STDs, this section includes definitions of “responsible sex” and “irresponsible sex.” “Responsible sex is based on fidelity, commitment, and maturity, placing sexuality within the context of marriage. Irresponsible sex is any other sexual activity” (RRTW, Student Workbook, p. 118). STDs, the curriculum explains, are one consequence of irresponsible sex (RRTW, Student Workbook, p. 118).
 
Not surprisingly, the curriculum then seems to blame individuals who become infected and suggest they should feel ashamed. It lists the freedom from embarrassment, guilt, worry, and shame as a benefit of “a disease-free lifestyle.” It then asks students to consider these questions “Would anyone want to talk to friends, family members, current or future boyfriend/girlfriend about an STD one had contracted?”; “Would this be something a person would want to discuss with family at the dinner table?”; “Or boast about to a neighbor?” It also suggests that people will pay for their irresponsible behavior, “cervical cancer is positively correlated with promiscuous behavior and kills approximately 5,000 women a year” (RRTW, Student Workbook, p. 119).  Given that “promiscuous behavior” is a judgment rather than a scientific term, there is obviously no way that such a correlation could have ever been legitimately determined. 
 
Yet, to further illustrate this idea of shame and embarrassment, the curriculum tells Emily’s story, which is about a young woman who was sexually active with three people up until the point of meeting her fiancé. The curriculum explains that since each of those partners had had a few partners prior to having sex with Emily, if her fiancé chooses to have sex with her it would be like he was having sex with 18 individuals. “The young man who is considering marriage with Emily must also consider the fact that he may be a victim of an STD. Even if his fiancée does not see or feel any symptoms of an STD she may have acquired one” (RRTW, Student Workbook, p. 126). The story seems to suggest that Emily is no longer good marriage material simply because she may have been exposed to an STD at some point in her past. The implications for those young women who have actually contracted an STD are clear. 
 
The irony of this story, however, is that it actually undermines one of the curriculum’s main points, which is that sex inside of marriage is safe and that married couples do not have to worry about STDs. Emily’s potential fiancé “wanted his first sexual experience to occur within marriage” but “because he loved this girl so much, he was still willing to marry her.” This means that even if he does not have sex until his wedding night, he needs to know about the ways in which STDs are and are not transmitted, the importance of testing and treatment, and methods of protecting himself other than abstinence. For example, if Emily did contract an incurable STD such as Herpes during her premarital sexual experiences, her husband will want to know about the benefits of condoms. As this story proves, marriage is not, in and of itself, a method of STD protection.
 
RRTW would better serve students by relying less on fear and shame, and instead providing information on how STDs are transmitted, the signs and symptoms one should look out for, the importance of testing and treatment, methods of prevention beyond abstinence, and the communication skills necessary to talk about STDs with a partner. It is only with this information that students can make responsible sexual decision throughout their lives. 
 
CondomsExaggerating Failure
 
Like its discussion on STDs, RRTW provides information about condoms that is confusing at best and inaccurate at worst. In the unit on STDs, RRTW says this about condoms:
 
Prophylactics are not completely effective in preventing sexually transmitted diseases. Prophylactics reduce the risk of acquiring an STD. Correct condom use does not completely stop the exchange of bodily fluids. Condoms only protect the part of the body they cover. Other parts of the body that are bathed with the secretion of the female during the sex act are not protected. Condoms sometimes have holes in them or break during use. Most significantly is the fact that some people may not use them every single time they have sex. Hence the AIDS virus may be transmitted despite the use of condoms (RRTW, Student Workbook, p. 131).
 
This hard-to-follow stream of “facts” contains some truth but numerous errors and misleading statements, and it is worth trying to sort them out. It is true that condoms reduce but do not completely eliminate the risk of acquiring an STD.  It also true that condoms can only protect the area of the body that they cover. This means that they may be less effective in preventing the spread of diseases transmitted by skin-to-skin contact such as Herpes or HPV because contagious sores and warts may be present on areas of the body not covered by the condom. However, research has shown that, even with these STDs, condoms reduce the risk of transmission. For example, research has shown that HPV is most often found on areas covered by a condom and recent research found that young women who used condoms were 70% less likely to contract HPV.[8] 

What is odd, however, about RRTWs discussion of condoms is that instead of talking about skin-to-skin transmission and this new research, the authors jump from the idea that condoms don’t cover all skin to a focus on bodily fluids and a rather graphic description of why condoms do not protect against STDs transmitted through fluids. This description does not accurately represent what the research says about these types of STDs. The CDC refers to such STDs, including gonorrhea, Chlamydia, and HIV, as discharge diseases. According to the CDC, “latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS.” The CDC also states that “Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea, Chlamydia, and trichomoniasis.”[9]
 
Perhaps the most disturbing “fact” listed in this passage, however, is the suggestions that condoms have holes and break frequently. Condoms do not routinely have holes and condom breakage is quite rare. The U.S. Food and Drug Administration (FDA) regulates manufacturers who sell condoms in the United States. As a quality assurance step, condom manufacturers sample each lot of finished condoms and examine them for holes using a water leak test. The FDA recognizes domestic and international standards that specify that the rate of sampled condoms failing the water leak test must be less than one in 400 for each manufactured lot of condoms. Manufacturers also test lots for physical properties using the air burst test and the tensile (strength) property test.[10] Not only do condoms not come riddled with holes, it is estimated that condoms break only 2% of the time during vaginal intercourse.[11]
 
One thing that RRTW does get right in this passage is the fact that some people don’t use condoms every single time they have sex. Unfortunately, the curriculum follows this by saying that “Hence the AIDS virus may be transmitted despite the use of condoms.” This is an illogical conclusion. Condoms cannot be blamed for HIV transmission if a couple failed to use one. What the curriculum should have told young people is that correct condom use can reduce the risk of HIV and STDs and that it is imperative that sexually active individuals use a condom every time. 
 
Instead, the curriculum seems to be deliberately undermining young people’s confidence in this method of protection. The above passage ends by suggesting sex with a condom is risky: “By risking an STD adolescents are not only jeopardizing their own health, but the health of their future spouse and children. They are risking the futures of people they love” (RRTW, Student Workbook, p. 131). In the same section there is a chart with a list of a number of STDs that includes columns on symptoms, treatment, and prevention. Regardless of the disease being addressed, however, the prevention column has only one suggestion: “Sexual self-control before marriage” (RRTW, Student Workbook, p. 121). There is absolutely no mention of condoms. Similarly, a true/false quiz states “Common sense indicated that the condom is inadequate and that abstinence prior to marriage and faithfulness within marriage are the best means of STD prevention” (RRTW, Student Workbook, p. 120).  
 
While it is true that abstinence is the only certain method of preventing all STDs, we have to remember that a majority of high school students are sexually active and this number grows as young people get older. It is important to provide these sexually active young people with information about alternative methods of protection. Instead, the curriculum discourages condom use. Later in the Student Workbook, for example, the curriculum states: “Although prophylactics may reduce the risk of some STDs, the couple is still vulnerable to other problems. Premarital sexual activity puts stress on the participants. Stress is associated with biological changes and linked to cognitive, emotional, and behavioral dysfunction. Guilt, depression, and rejection are some of the emotional problems individuals may experience when their relationship is based on physical attraction and sexual activity” (RRTW, Student Workbook, p. 148). Condoms were never intended to protect against guilt, depression, or rejection. They were intended to prevent STDs and pregnancy and years of scientific research suggest they do a very good job at that. 
 
Undermining young people’s faith in condoms will not prevent them from becoming sexually active, it may, however, prevent them from using condoms when they do, therefore increasing their risk of STDs and unintended pregnancy. This runs counter to the goals of any health curriculum.  
 
Promoting Biases
 
According to the Guidelines, one of the main goals of sexuality education is to provide an opportunity for young people to question, explore, and assess their own and their community’s attitudes about sexuality. This can help young people understand their family’s values, develop their own values, and improve critical-thinking skills. Rather than providing this important opportunity, however, RRTW promotes specific viewpoints about marriage, pregnancy options, and sexual orientation.
 
The Marriage MandatePromoting One Lifestyle
 
Throughout the curriculum, the author reiterates the idea that there is one proper way to live life. One should date, build a strong relationship based on abstinence, get married (to a member of the opposite sex), and start a family. This point is made clear in an activity called “The Rest of the Story,” which asks students to fill-in-the blanks in the story of Marcello and Karen. The two had planned to wait until marriage to have sex but one New Year’s Eve after dancing and drinking they “were not capable of using their self-control and ended up having sex.” They were both “ashamed and disappointed” but reasoned that since they already had sex they could keep going. Marcello even decided that to save money they should move in together. Karen, however, became unhappy with the way her relationship had been going after she gave in to sex. One day she realizes the problem: “She was supposed to build a strong foundation in her relationship with Marcello, get married, have sex and several children and be happy. Her life is out of order…”
 
The authors seem to believe, or at least to assert, that all lives should follow one route and that all individuals wish for the same thing. It tells students that “people establish their goals and dreams in 3 major areas: school, career, and marriage,” and that “most teenagers have dreams about getting married and having a family” (RRTW, Student Workbook, p. 26, 97). One section on dating explains that one of the purposes and responsibilities of dating is “to find a husband or wife” (RRTW, Teacher’s Manual, p. 4.6). RRTW simply does not acknowledge that some individuals do not wish to marry. 
 
Promoting Marriage
 
The authors explain that there are four components of a good marriage: commitment, compatibility, self control, and trust. These components are then used to emphasize two points. First, that married people and relationships are superior to all others. “Married couples practice self-control in other ways as well. Self-control is necessary for financial well-being as well as physical well-being.” While much of this is presented as positive statements about married people, the implications of these messages are that unmarried couples do not possess these positive traits (RRTW, Student Workbook, p. 173-177).
 
There are over 93 million adults in the United States who are classified as single because they have never married or are separated, widowed, or divorced.[12] It is inappropriate for an education program to suggest that these individuals are inferior to their married peers.
 
The Importance of Pre-marital Abstinence
 
The second point that is emphasized repeatedly is that abstinence before marriage is vital if one wants a marriage built on these traits: “When a person is committed to abstinence from premarital sex, his commitment in marriage is taken very seriously” (RRTW, Student Workbook, p. 173). Again, the flip side of such statements is clearly that people who were not abstinent prior to marriage do not take this commitment seriously. The curriculum enumerates what problems these people may have once they do become married. According to RRTW, people who have engaged in premarital sex are likely to associate sex with guilt, shame, or fear (“from knowing that they’ve done something wrong”), are less likely to have trust in their marriage, more likely to be talked into cheating on their spouse, and will suffer from the inevitable urge to compare their spouse with former sex partners (RRTW, Student Workbook, p. 178). 
 
People who abstain from sex before marriage are also less likely to suffer divorce, according to the curriculum. The curriculum suggests that marriages end in separation or divorce because of weak commitments and implies that such commitments are common in couples who have had sex before marriage: “Each person needs to lead a chaste life both before or during marriage…(Chaste means the proper or appropriate use of one’s sexuality to one’s state of life. For an unmarried person, this means not engaging in sexual intercourse)” (RRTW, Student Workbook, p. 171). 
 
While some people may believe that premarital abstinence is the only morally appropriate behavior, this is clearly not a value held by all Americans. The vast majority of Americans begin having sexual relationships in their teens, fewer than seven percent of men and 20 percent of women 18 to 50 years old were virgins when they were married, and only 10 percent of adult men and 22 percent of adult women report their first sexual intercourse was with their spouse.[13]It is likely this “standard” was never true in America; a third of all Pilgrim brides were pregnant when they were married.[14]    It is not appropriate for an educational program to suggest that this majority of the American public has “done something wrong” or declare that they will inevitably have unhappy marriages. 
 
The Problems with Cohabitation and Divorce
 
The curriculum takes particular aim, however, at couples who cohabitate before marriage. It includes these “fascinating facts”: “The relationships of those who simply live together are not as healthy as those of married couples” and “Cohabitating couples and couples who live together before they marry break up 50-100 percent more often than couples who get married without living together first” (RRTW, Student Workbook, p. 149). While these assertions seem to be referenced to legitimate sources, the brief explanations given are insufficient to help students think critically about cohabitation. For example, the fact that cohabitating couples are more likely to divorce may be true but this does not necessarily mean that cohabitation in any way caused the divorce. It is possible that those individuals who believe it is acceptable to live together before marriage are more likely to believe that it is acceptable to leave an unhappy marriage than their peers who do not believe in cohabitation. Still, the curriculum seems intent on painting a negative picture of cohabitation. According to RRTW, “the most common complaint of unmarried women who lived with men is, ‘I sometimes get the feeling I’m being used’” (RRTW, Student Workbook, p. 149). It is worth noting that this “fact” is not cited to any research.
 
In 2006, six million couples in the United States reported living together without being married. It is unfair of the curriculum to suggest that these relationships are any less important or valuable than those that include a marriage license. 
 
The author also makes it clear that divorce is wrong and damaging to children. “Compared to those from intact families, children from divorced families are more likely to be depressed, withdrawn and do poorly in school. It is not surprising that these same children may be afraid of the commitment involved in marriage” (RRTW, Teacher’s Manual, p. 66).  This discussion seems meant to impress upon students the importance of getting married and selecting a marriage partner carefully. However, many students will likely think of their own family when they read these statistics. 
 
It is unfair to put the burden of family structure on students who, as children, have no control over their current family situation. There are many reasons—including divorce, death, desertion, cohabitation, and gay and lesbian partnerships—that students may live in a family that does not match the ideal model espoused by RRTW. Suggesting that these young people will face a lifetime of difficulty will undoubtedly distress and alienate many students. 
 
Although it is important to help young people explore possible future relationships, RRTW does so in a limited and directive way that presents marriage as the only appropriate life path and suggests that individuals who choose otherwise are making the wrong decision for themselves and their children. Again, it is not the place of education programs to mandate such choices for students.
 
Virginity Pledges
 
RRTW, like many fear-based, abstinence-only-until-marriage curricula, includes a virginity pledge, in which students vow to remain abstinent until they marry. One activity included as part of the section on “marvelous marriages” asks students to sign the following pledge: “Believing in The Vision of Marriage, I make a commitment to myself my family, my friends, my future spouse, and my children to be sexually abstinent from this day forward until the day I enter a lifelong, committed, monogamous marriage” (RRTW, Student Workbook, p. 188).
 
Research has found that under certain circumstances virginity pledges could help a select group of young people delay intercourse. Pledges taken by an entire class as part of a lesson or presentation, however, were not effective. Moreover, even when they work, pledges help this select group of adolescents delay the onset of intercourse for an average of 18 months—far short of marriage.
 
In fact, virginity pledges may be detrimental to some teens. The study also found that those young people who took the pledge were one-third less likely to use contraception when they did become sexually active than their peers who had not pledged.[15] Further research has confirmed that although some students who take pledges delay intercourse, ultimately they are equally as likely to contract an STD as their non-pledging peers.[16]
 
Far from providing a solution to the complex problems of unintended pregnancy and disease transmission, these simplistic pledges are undermining the use of contraception among teens, potentially exposing them to greater harm.
 
Finally, it is important to note that it is not the place of any educational program to mandate choices for students. Instead, students must make their own decisions based on their personal values, the values of their family, and the values of their community. By endorsing the pledge and suggesting that students use class time to sign it, the teacher is putting undue pressure on students. Education programs should foster critical-thinking and decision-making skills rather than pressuring students to make one choice.
 
Ignoring Same-Sex Couples
 
The emphasis RRTW places on marriage as the only appropriate venue for sexual activity also shows clear bias against same-sex couples. The curriculum consistently ignores the fact that gay and lesbian individuals cannot legally marry in most areas of this country (and could not marry anywhere in the U.S. when it was originally published) [17] Students are told unequivocally that sex outside of marriage is always wrong: “Some actions are inappropriate, or wrong. They go against values. Examples of inappropriate actions are: stealing, lying, cheating, abusing drugs, and engaging in premarital sexual activity.” (RRTW, Student Workbook, p. 69). Quotes such as this tell gay and lesbian students that they can never have an appropriate sexual relationship. And, the curriculum’s overall presentation of marriage as the only place for true love tells them that they will never have a responsible, caring, loving, committed relationship.
 
In addition, virginity pledges that ask young people to promise to follow the curriculum’s marriage guidelines show blatant disregard for gay and lesbian students as signing this pledge is tantamount to agreeing to a lifetime without sexual behavior. It is unfair and unrealistic to ask a middle or high school student to make such an agreement.
 
Of course, these are messages that students will read between the lines, RRTW never actually acknowledges same-sex relationships. Instead, all references to sexual activity and arousal within the curriculum are specific to male-female couples. And, all stories and examples about couples use heterosexual individuals. 
 
Curricula written exclusively for heterosexual students are not appropriate for a classroom setting in which some students are likely to be gay, lesbian, bisexual, or questioning their sexual orientation. Such curricula will only further marginalize and alienate these students. Gay, lesbian, and bisexual students, especially young men who have sex with men, are at increased risk for STDs, including HIV, yet RRTW fails to provide these students with any realistic strategies for protecting themselves from those risks.
 
Gender BiasesPerpetuating Gender Stereotypes
 
RRTW is riddled with stereotypical messages about men and women and sexist ideas about how each can and should behave. The most blatant example of gender bias is likely the juxtaposition of two poems:
 
A Woman’s Poem
I met him; I liked him.
I liked him; I loved him.
I loved him; I let him.
I let him; I lost him.
 
A Man’s Poem
I saw her; I liked her.
I loved her; I wanted her.
I asked her; She said no.
I married her.
After sixty years, I still have her (RRTW, Student Workbook, p. 64).
 
The Teacher’s Manual asks the instructor to explain, “The woman in the poem based love on her feelings. She felt since she loved him, it was okay to have sex. She discovered that the man lost respect for her as soon as she gave in to sex.” On the other hand, the man “…discovered the woman may have loved him but had self-control and respected herself. He loved her self-respect and wanted to be with her forever” (RRTW, Teacher’s Manual, p. 3.12).
 
These poems present numerous sexist ideals. First, there is the idea that women do not desire sex but often “give in” because they want love. This is followed by the suggestions that only women who lack self control or self respect will give in, and that once women lose their virginity they are of no worth. While the man in these poems comes out ahead despite having desired sex and asked for it, the women is left ruined and alone. These are dangerous messages that place unequal responsibility on women to stay “pure” and refuse any advances. As said earlier, it is important that young people realize that partners in relationships are equal—they have an equal right, an equal ability, and an equal responsibility to make choices about their sexual behavior.
 
It is also worth calling attention to the last line of A Man’s Poem which states “After sixty years, I still have her.” This view of women as possessions of men—be it their fathers or their husbands—is outdated and offensive. The curriculum shares similar outdated beliefs in its conversations on how husbands and wives should relate to each other. For example, the curriculum suggests some of the questions couples should answer before they get married are “Will the wife work after marriage or will the husband be the sole breadwinner?” and “Will the wife return to work after they have children?” (RRTW, Student Workbook, p. 185). And, an exercise on problem solving includes this potential “marital difficulty”: “The wife wants to work for a few years. The husband wants to have children right away” (RRTW, Student Workbook, p. 186).
 
It is important for couples to discuss these types of issues prior to marriage and think critically about their relationship and the kind of life they want. The specific questions RRTW poses, however, clearly illustrate the values and gender stereotypes inherent in this curriculum. Why not ask students if the wife will be the sole breadwinner or if the husband would stay home and look after the children? 
 
Perhaps more disturbing than these sexist views of marriage, however, are the gender biases that are seen in the curriculum’s discussion on sexual abuse and rape. RRTW explains, “A girl’s attire can arouse sexual feelings in boys…A boy can get the wrong message from what a girl might wear. A boy never has the right, however, to attack a girl, even if she is wearing clothes that arouse his sexual feelings” (RRTW, Student Workbook, p. 96). Though this statement rightly ends with the acknowledgement that sexual attack is wrong, it nonetheless places some blame on young women. While the authors could have said “even though his sexual feelings are aroused” they chose instead to turn it back on the woman and blame her outfit. The notion that boys will be boys and can’t help themselves and that it is therefore the responsibility of women to dress modestly and refuse advances is unfair, dangerous, and has absolutely no place in a discussion on rape.  
 
RRTW perpetuates long-standing gender stereotypes, without any discussion of how these stereotypes can be harmful. Students are not challenged to question the nature, validity, or origin of these gender stereotypes, or to explore how stereotypes affect communication within friendships or sexual relationships. Such a presentation is detrimental to all young people by limiting their options, influencing their behavior, and coloring their expectations for future relationships. Instead, students need to learn that both men and women are sexual beings and are equally responsible for making decisions regarding sexual activity.
 
Pregnancy OptionsMandating Choices
 
RRTW also shows clear biases when discussing pregnancy options. It touts adoption as the ultimate loving decision, suggests that children would be better off adopted than being raised by their unmarried birth mothers, and stops just short of calling abortion murder. 

Throughout the curriculum, the authors use language that shows a clear anti-choice bias. They tell students that “One act of sexual intercourse begins the life of a child,” (RRTW, Student Workbook, p. 211) and that “A human life begins at conception when the sperm, with its chromosomes unites with the ovum and its chromosomes to form a whole new set of chromosomes” (RRTW, Teacher’s Manual, p. 9.4). Although presented as part of a discussion of the scientific facts of human development (one entire section at the end of the Student Workbook focuses on the development of a fetus, including development of its fingernails, heart, and skeleton), this language is neither medically nor legally accurate. It represents one set of values and opinions that is not universally held. 

Nonetheless, RRTW goes on to push adoption as the only logical and moral choice for young women facing an unintended pregnancy. It tells young people that single parenting is a difficult path and points out that “approximately, 60% of welfare recipients are, or were, at one time teenage mothers.” It goes on to espouse the benefits of adoption by giving facts such as “… women who chose adoption for their children, had education advantages, were more likely to delay marriage, and were more likely to be employed and have higher income…” and that “adopted children enjoy more socioeconomic advantages than children who remain with their unmarried birthmothers” (RRTW, Teacher’s Manual, p. 8.20). The author refers to adoption as a “very mature decision.”(RRTW, Teacher’s Manual, p. 8.15).

To underscore this point, students participate in an activity entitled “I Love My Baby,” in which they read two letters written from birth parents to the baby they gave up for adoption and answer questions based on these letters. Question number two reads: “Many young pregnant women state, ‘I’d rather abort my baby, than give it up for adoption.’ These women think that no one could love their child like they could. After reading the two letters above, why do you think these two young parents choose adoption?” The suggested answer in the Teacher’s Manual is, “These two young parents put their child’s interest ahead of their own. If a young parent [would] rather kill their child than put it up for adoption it’s an indication of selfishness and a lack of visions for their child” (RRTW, Teacher’s Manual, p. 8.21).
 
Abortion is a safe and legal option that all women facing an unintended pregnancy are entitled to consider. It is unconscionable that an educational program for use in public schools would suggest that terminating a pregnancy is tantamount to killing an infant or call the more than one million women who undergo this procedure each year selfish and short sighted. 
 
It is not the place of education programs to mandate choices for students. Instead, students need unbiased information about the options they have, should they experience an unintended pregnancy as a teenager or an adult. It is then up to students to make choices consistent with their own values and the values of their families and communities. By presenting clearly biased and inaccurate information about abortion and adoption, RRTW does not allow individuals to make informed, personal decisions. 
 
Conclusion
 
Despite research suggesting that Reasonable Reasons to Wait may be marginally successful, SIECUS believes that it remains inappropriate for young people. In order to convince young people to remain abstinent until marriage, RRTW relies on messages of fear and shame, inaccurate and misleading information, and biased views of marriage, gender, sexual orientation, and pregnancy options. In addition, RRTW fails to provide important information on sexual health, including how students can effectively use contraception or seek testing and treatment if they suspect they may have an STD. Finally, the format and underlying biases of the curriculum do not allow for cultural, community, and individual values, and discourage critical thinking and discussions of alternative points of view in the classroom.
 
Ultimately, this curriculum falls far short of helping young people develop the skills and knowledge they need to become sexually healthy adults.


[1] Stan E. Weed, PhD, et al., “An Abstinence Program’s Impact on Cognitive Mediators and Sexual Initiation,” American Journal of Health Behavior, 32:1 (2008): 60-73.
[2] Jo Anne Grunbaum, et al., “Youth Risk Behavior Surveillance – United States, 2001,” Surveillance Summaries, Morbidity and Mortality Weekly Report 51.SS-04 (28 June 2002): 1-64, accessed on 2 October 2008, <www.cdc.gov/mmwr/preview/mmwrhtml/ss5104a1.htm>.
[3] For more information on this study see, SIECUS’ Research Update: Marginally Successful Results of Abstinence-Only Program Erased by Dangerous Errors in Curriculum, SIECUS, at http://www.siecus.org/index.cfm?fuseaction=Feature.showFeature&featureid=1030&pageid=682&parentid=478 .   
[4] For more information on the hearing see SIECUS’ Policy Update, Committee on Oversight and Government Reform Holds First-Ever Hearings on Abstinence Only Until Marriage Programs, at http://www.siecus.org/index.cfm?fuseaction=Feature.showFeature&featureid=1144&pageid=483&parentid=478.
[5] Arthur Jacoby and John Williams. “Effects of Premarital Sexual Standards and Behavior on Dating and Marriage Desirability,” Journal of Marriage and the Family, 47.4 (1985): 1059-1065.
[6] Danice K. Eaton, et. al., “Youth Risk Behavior Surveillance — United States, 2007,” Surveillance Summaries, Morbidity and Mortality Weekly Report, vol. 57, no.SS-04, June 6, 2008, pp. 1-131, accessed at: <www.cdc.gov/nccdphp/dash/yrbs/>.
[7]Laura Duberstein Lindberg, Rachel Jones, and John S. Santelli, “Non-Coital Sexual Activities Among Adolescents,” Journal of Adolescent Health (July 2008): 1-14; T. Hoff, et al, National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes, and Experiences, (Menlo Park, CA: Henry Kaiser Family Foundation, 2003), 14, accessed 2 October 2008, <www.kff.org/youthhivstds/3218-index.cfm>.  
[8] Rachel L. Winer, et al., “Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women,” New England Journal of Medicine, 354.25 (June 22, 2006): 2645-2654.
[9] U.S. Centers for Disease Control and Prevention (CDC), Latex Condoms and Sexually Transmitted Diseases-Prevention Messages (Atlanta, GA: CDC, 2001), p. 2.
[10] National Institute of Allergy and Infectious Diseases, National Institutes of Health, U.S. Department of Health and Human Services, Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention, July 12-13, 2000, Hyatt Dulles Airport, Herndon, VA. (Released 20 July 2001).
[11] R. A. Hatcher, et al., Contraceptive Technology, (New York: Ardent Media, Inc., 2007), p .24.
[12] America’s Families and Living Arrangements: 2004 (Washington, DC: Census Bureau, 2004), accessed 17 September 2005, < http://www.census.gov/population/socdemo/hh-fam/cps2004/tabA1-all.csv>.
[13] Edward Laumann, et. al., The Social Organization of Sexuality—Sexual Practices in the United States (Chicago: The University of Chicago Press, 1994).
[14] John D’Emilio and Estelle Freedman, Intimate Matters: A History of Sexuality in America (New York: Harper and Row, 1988).
[15] P. Bearman and H. Brückner, “Promising the Future: Virginity Pledges and the Transition to First Intercourse," American Journal of Sociology 106.4 (2001): pp. 859–912.
[16] P. Bearman, et al., “The Relationship Between Virginity Pledges in Adolescence and STD Acquisition in Young Adulthood,” American Journal of Sociology 110.1(2004): pp. 44-92.
[17] Recent legislation and court decisions in Massachusetts, California, and Connecticut have granted same-sex couples the right to marry in those states. Some legal and legislative challenges remain though and it is therefore unclear whether this right will be permanently guaranteed in these states or other states in the country.