Back to School 2023: Education for educators

New Orleans, being in the conservative south, is no stranger to the myriad of negative effects that stem from abstinence-only sex education. For one, sexually transmitted infections such as chlamydia and gonorrhea may seem like a manageable inconvenience to sexually active young people with comfortable financial status and flexible work schedules, but those same infections can be devastating to those with lower socioeconomic status. Work and family obligations can make an afternoon spent waiting in line at Urgent Care an impossibility. A lack of knowledge about symptoms or a disinclination to screen regularly (even when asymptomatic) can lead to these STIs going untreated for long periods of time. The consequences of this can include lost work, insurmountable medical expenses, persistent health issues, ostracism within a community, and infertility down the line. Within the United States in 2019, Louisiana ranked 5th for gonorrheal infections, 3rd for chlamydial infections, and 9th for primary and secondary syphilis (Louisiana Department of Health 2021). Over time, the STI rates in New Orleans Parish have been significantly higher than any other region in the state (Louisiana Department of Health 2019).

Countless people walk down a downtown New Orleans street in the early evening. Photo by: Kendall Hoopes

City dwellers in general are more susceptible to STIs because networks of sexual partnerships are much larger than in rural environments. The two most commonly reported STIs in the United States, gonorrhea and chlamydia, are known to disproportionately affect individuals of a low socioeconomic class, especially people of color, individuals who are under 25, and individuals living in urban environments. The immensity of the resources that would be required to make a meaningful intervention in an underserved community of this size–not to mention the bureaucratic red tape–preclude many preventative measures that could work in smaller communities. At the same time, the size of these communities and frequency with which residents leave and nonresidents visit increases the repercussions of high urban STI incidence for large surrounding areas (Cattley et al. 2015).

Three condoms side-by-side on a white background. Photo by: Nataliya Vaitkevich

STI prevention starts with education, so the most obvious factor contributing to high rates of infection is a lack of comprehensive safe sex education. The majority of public schools in New Orleans being charters creates difficulty as there is no uniform approach to sex-ed within schools, except that it must be abstinence based and cannot distribute or discuss contraception. Although current law allows public school in Louisiana to teach sex education in grades seven and above, it does not require schools to have a sexual education curriculum. Lawmakers have tried to rectify this through proposed bills that would affect the entire state as well as through bills that would be limited to New Orleans. As recently as 2019, House Bill 359 failed for the third time to gain approval in the Louisiana House. If passed the bill would have required New Orleans public schools to teach sex education in grades seven to twelve and cover topics including pregnancy, sexually transmitted diseases, and contraception. The bill’s sponsor, State Representative Wesley Bishop, noted that parents could not be counted on to teach the fundamentals of safe sex to their children, especially if they had not been educated about it themselves (Sentell 2015)

Louisiana can be categorized as an “honor state” a term used to refer to states within the southern and western census regions of the U.S. in which a cultural ideology of honor is prevalent (Barnes et al. 2012). Linked to both religious devotion and economic deprivation, honor culture is associated with an expectation for aggression and risk-taking in men and submissiveness and “purity” in women. A frequently overlooked effect of these cultural expectations is that women are discouraged from seeking out regular STI screenings. Feminine honor endorsement in states such as Louisiana has been shown to decrease the likelihood of seeking out STI screenings due to the stigma of sexual impurity surrounding those screenings and puts more and more people at risk (Foster et al. 2021).

Conservative ideologies in Louisiana are unlikely to change any time soon. It will continue to be an honor state with many representatives and institutions opposed to sex education and the redistribution of funds to benefit sexual health clinics. The most vocal opponents of House Bill 359 were the Louisiana Family Forum and the Louisiana Conference of Catholic Bishops, which have had significant sway over state legislators for decades. Because of that, solutions to the issue of STI incidence which involve major changes in New Orleans school curriculum or public health care are unlikely to gain much traction. Nevertheless, New Orleans will continue to be a densely populated and socioeconomically disparate city for the foreseeable future, so the importance of productively addressing this issue will only increase over time. If a solution is not found, the health of young and impoverished New Orleans residents will continue to be in jeopardy.

 

A student in biology class stands next to her teacher. Photo by: Time Miroshnichenko

There are numerous sex education programs geared toward urban youth. Many boast of success in reducing rates of STIs and pregnancies among participants, including glowing testimonials from participants and parents. For those who have become hopeful about instituting similar programs in New Orleans, the lack of real data to support these positive claims may be disheartening. The first meta-analysis of school-based interventions designed to reduce STIs in the United States not only found that very few studies met its basic inclusion criteria, but it also found that the data presented in those studies reviewed showed very little evidence of effectiveness (Mirzazadeh, Ali, et al. 2017). So, since mandatory sex education is unlikely to be added to the New Orleans public school curriculum, and independent intervention are unlikely to gain the support of parent whose children would benefit from them the most, sex education programs may not be the solution at all.

The ideal program to institute in New Orleans would be based on a predecessor with data demonstrating positive results and would also be acceptable to the conservative and religious forces which have blocked other proposed interventions (Lonczak 2002). The framework for such a program can be found in the Seattle Social Development Project (SSDP). This three-part intervention trained teachers in proactive classroom management, offered parents strategies for child behavioral management and academic support, and provided children with training on interpersonal problem-solving skills. The program focused on 808 public school children in urban Seattle–specifically in neighborhoods with above average crime rates–and ran from first grade until sixth grade during the 1980s. Notably, no content related to sexual behavior was provided in any part of the intervention.

Even though sex education was not part of the program, participants were shown to make more responsible sexual choices through adolescence and early adulthood. When surveyed at 21 years of age, SSDP participants reported significantly fewer pregnancies and lower total numbers of sexual partners. Most notably, only 7% of African American participants reported being diagnosed with an STI over their lifetime, in contrast with 34% of African American 21-year-olds in the broader population. More statistically significant than the existing data surrounding school-based sex education interventions and clearly related to our population of interest in New Orleans, this result shows that valuable lessons can be learned from the success of the SSDP.

There are major differences between sexual behavior in the 1980s and sexual behavior today. Modern adolescents are both encouraged to and shamed for exploring their sexuality in ways that would have been incomprehensible to most teenagers thirty to forty years ago. Not only that, but conversations surrounding sex are no longer limited to neighborhood and school communities. The advent of social technology means the conversations about sex and sexual interactions can occur with people as far away as the other side of the world. Taking that into account, it could be difficult to modify a program like SSDP for the twenty-first century. Additionally, the program involved less than one thousand participants. In contrast, nearly 20,000 students are currently enrolled between first and sixth grade in the New Orleans public school system. It would be a monumental undertaking to find the resources necessary to institute such a significant intervention for the at-risk population in all New Orleans public schools.

Regardless of the difficulties inherent in adapting the SSDP for this new context, the original project’s positive impact cannot be understated. On average, along with achieving academic and career success to an extent that their peers did not, the participants involved avoided STIs to an extent that their peers did not.

Modern students pose next to old technology. Photo by: cottonbro

Sex education does not occur in a vacuum; it is inextricably tied to numerous other aspects of development. The promotion of academic success and social competence has the power to effect responsible sexual behavior. All young adults, even more so today than when the SSDP was undertaken, have access to information about safe sex, STI screening and treatment resources. If they are encouraged to embrace knowledge, talk through problems, and make responsible choices, there is no reason why they would be unable to apply those skills to sexual situations, even if stigmas surrounding sex education and STI treatment remain prevalent in their communities.

 

The best way to gain support for a version of the SSDP adapted to New Orleans would be to emphasize its broad appeal. The conservative organizations that oppose sex education and the social-justice-oriented organizations that support it could find common ground in an intervention geared toward academic and interpersonal success which also happens to effect responsible sexual behavior. If a portion of the resources that those groups devote to combating each other could be diverted to this enterprise, the first stage of the New Orleans Social Development Project (NOSDP) could be undertaken. Failing that, other nonprofits–such as the Rand Corporation, which sponsored the SSDP–could be approached.

Initially, the program would start with a single public school especially welcoming of the intervention. Working with a few hundred students, teachers, and parents would not place the enormous demand on resources that working with the entire New Orleans elementary school student population would. Another benefit for conserving resources is the possibility of virtual training sessions with teachers, parents, and students, so that education and communication professionals need not be physically present in schools and homes and can more easily work without disrupting the regular schedules of participants.

Academic success, demonstrated through standardized test scores, would be the most readily available metric for the program’s success. If test scores improve as expected, additional funds could be sought from the Louisiana government or from education nonprofits. Training videos could be made using lessons that worked especially well at the trial school. Incorporating these videos into the program would substantially reduce the strain on resources incurred by expanding to other New Orleans public schools. Eventually, a bill to officially incorporate the program into New Orleans public schools could be proposed.

The development of this program, from the initial search for funding to the bill proposal, would take quite a few years, and the impact on STI prevalence would likely not be apparent for at least a decade after that.

Several students high-five in a library. Photo by: Yan Krukov

Sometimes the best solutions to an issue involve tackling the issue’s root causes. In the case of a divisive issue like STI education and prevention, one way to cut through the political noise is to present a cause that everyone can support. An intervention involving productive communication training for parents, teachers, and students would not receive the same backlash that a sex education intervention would receive. Honor states, political leanings, and city-dweller status notwithstanding, nearly all decision-makers can find positives in helping to improve children’s lives and future and creating a better, safer New Orleans for all.

 

 

Works Cited

Louisiana Department of Health, Office of Public Health, STD/HIV/Hepatitis Program. Louisiana 2018 STD/HIV Update. July 2019.  https://ldh.la.gov/assets/oph/HIVSTD/hiv-aids/2019_STD_FACTSHEETS/LA_HIV_STD_Update_2016_2018.pdf

Louisiana Department of Health, Office of Public Health, STD/HIV/Hepatitis Program. 2019 National CDC STD Rankings. April 2021.   https://louisianahealthhub.org/wp-content/uploads/2021/04/2019_STD_SurveillanceReportSummary.pdf

Cattley, Catherine, et al. “Incidence of Gonorrhea and Chlamydia in Urban Settings: The Case for Neighborhood Level Analysis in Boston.” Advances in Infectious Diseases, vol. 05, no. 04, 30 Nov. 2015, pp. 162–166., https://doi.org/10.4236/aid.2015.54020.

Sentell, Will. “Sex Education Bill for New Orleans Public School Students in Grades Seven to 12 Fails in Louisiana House.” The Advocate, 21 May 2015, https://www.theadvocate.com/baton_rouge/news/education/article_8b5083c9-86a7-5fce-931a-78e915a228ee.html.

Barnes, Collin D., et al. “Living Dangerously: Culture of Honor, Risk-Taking and the Nonrandomness of ‘Accidental’ Deaths.” Social Psychological and Personality Science, vol. 3, no. 1, 2012, pp. 100–107. SAGE, https://shareok.org/bitstream/handle/11244/25500/10.1177.1948550611410440.pdf?sequence=1

Mirzazadeh, Ali, et al. “Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-Analysis.” Prevention Science, vol. 19, no. 4, 8 Aug. 2017, pp. 490–506., https://doi.org/10.1007/s11121-017-0830-0.

Lonczak, Heather S., et al. “Effects of the Seattle Social Development Project on Sexual Behavior, Pregnancy, Birth, and Sexually Transmitted Disease Outcomes by Age 21 Years.” Arch Pediatr Adolesc Med., vol. 156, no. 5, 2002, pp. 438–447., https://doi.org/10.1001/archpedi.156.5.438.

Foster, Stephen, et al. “Feminine Honor Endorsement and Young Women’s STI Screenings.” Psychology, Health & Medicine, 2021, pp. 1–6., https://doi.org/10.1080/13548506.2021.1883693.

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