Sex Sells Analysis

Question 1-9 are to be answered using the Introductory section.

  1. Why is the area of research important and worth funding?

This area of research is worth funding because the US “has primarily funded and promoted abstinence education despite the fact that “few randomized controlled trials have tested their efficacy.”  Trials are needed to determine if abstinence programs are having the desired effect.  If not, they are a waste of money.

  1. Why is it important to specifically study African American teenagers?

It is important to specifically study African American teenagers, because “60% of adolescents with HIV/AIDS (are) African American,” and rates of STIs “are the highest among African American individuals…particularly adolescent girls.”  Pregnancy rates have also been higher among African American girls than their Hispanic and white peers.

  1. How are the two major reduction interventions defined?

The two major reduction interventions are defined as “abstinence only” and “comprehensive.”  The comprehensive intervention includes abstinence and safer-sex instruction, including apropriate condom use.

  1. How have researchers traditionally operationalized abstinence reduction?

Abstinence reduction has traditionally offered “inaccurate information,” which “portray(s) sex in a negative light, using a moralistic tone, and risking adverse consequences.”

  1. In what ways are these authors asserting that they have improved upon the traditional operationalization of abstinence only reduction.

The authors assert their operationalization is “ideal,” incorporating “principles of efficacious…risk reduction behavioral interventions….draw(ing) on formative research…and behavior-change theory to address motivation and build skills to practice abstinence.”  They claim theirs is not moralistic, and does not “stress the inadequacies of condoms.”

  1. What is the first limitation of the study? (Hint look in the last paragraph of the first section.)

The first limitation of the study is that “efficacy…disappears at longer-term follow-up.”  Everyone is expected to eventually have sex.  Therefore, it seems the number abstaining for a set period of time might not be the best measure of effectiveness.  Rather, the age at which teens do finally have sex might better determine how effective abstinence education is.

  1. What is the primary hypothesis?

The primary hypothesis is that “fewer participants in the abstinence-only interveion than in the control group would report ever having sexual intercourse by the 24-month follow-up.

  1. What is the secondary?

The secondary hypothesis “was that the intervention-maintenance program would enhance intervention efficacy.”

  1. Are we satisfied with the literature review?

Was there one?  Technically, lots of stats about teen sexuality and statements about the beliefs surrounding reduction methods obviously came from cited literature.  Resources were synthesized to make the introductory arguments surrounding the need for the research.  However, I would not say this amounted to a formal literature review.

Questions 10- 16 are to be answered using the first 3 paragraphs of the Methods section: Participants, Procedures, and Experimental Conditions

  1. Describe what we know about our participants.

Quoting the article, “The participants were 662 African American students in grades 6 and 7.”  They live in low-income, African-American communities, in the northeastern United States.

  1. What three approvals were explicitly stated as needed for each student to participate?

Students needed written parent or guardian approval to participate.  And the Institutional Review Board of the University of Pennsylvania and the Research Ethics Board of the University of Waterloo approved the study.

  1. What approval was implied but not stated?

The approval of the participating middle schools was implied but not stated.

  1. How do the authors define who is African American?

They don’t.  They simply state that their participants are African-American, and that they were recruited from middle schools that serve low-income, urban, African-American communities.

  1. What does it mean to stratify the study population by age and sex(gender)?

This means they separated the students into these categories, for the purpose of assuring that age and genders would be evenly randomized across all interventions.

  1. What is the importance of randomly assigning the students to the four experimental groups?

It’s important to randomly assign students to the four groups so that results cannot be attributed to the makeup of the group.

  1. What are the four experimental groups?

The four experimental groups were an 8-hour abstinence only, an 8-hour safer-sex only, an 8-hour comprehensive, and a 12-hour comprehensive.  The fifth group was the control, an 8-hour health-risk reduction program unrelated to sexual activity.

Questions 17 to 19 are to be answered using the next 3 paragraphs of the Methods section: Abstinence-Only, Safer Sex, and Comprehensive Interventions.

  1. What are the 3 main areas of education targeted by the Abstinence-Only Intervention?

The three main areas of education include increasing HIV/STI knowledge, strengthening beliefs supporting abstinence, and increasing skills to negotiate abstinence.

  1. Do you think this variable was appropriately operationalized?

I don’t.  The authors state that the program was not designed to meet federal criteria for abstinence-only programs.  If the point of the study is to determine if federal funding of abstinence education is justified by efficacy, then the efficacy of the programs meeting federal criteria need to be studied, not the efficacy of some other program the researchers created which would not likely ever be implemented.

  1. How do the authors feel that have improved upon the traditional operationalization?

I think the authors feel they have minimized the risks to participants of participating in the study, by changing the traditional operationalization.  However, in doing so, they aren’t actually researching the problem they set out to research.

Questions 20 to 23 are to be answered using the next three paragraphs of the Methods section: Health-Promotion Control Intervention, Intervention-Maintenance Program and Facilitators and Facilitator Training

  1. What the heck is a Hawthorne effect? Is Hawthorne Bradley’s friend?

The Hawthorne effect is also known as the observer effect.  It relates to the possibility that results can be affected by the participant’s awareness of being observed.  In this study, it relates to “the likelihood that effects of the HIV interventions could be attributed to nonspecific features including group interactions and special attention.”   Yes, the Hawthorne effect is related to the Bradley effect, as the Bradley effect also relies on the participant’s awareness of being observed when surveyed, and anonymity when actually voting.

  1. Why are the authors worried about the Hawthorne effect and are controlling for it?

They are worried that participants might perceive social advantages to participation in the program, and that this perception might influence their behavior, affecting outcomes.

  1. Why are the facilitators mostly women? How did the one Puerto Rican get selected? Why are the facilitators African American?

These questions were not answered in the article.  But because the authors state that they “hired facilitators with the skills to implement any of the of the interventions, it’s likely they recruited teachers from the participating schools.  The facilitators are African-American so that participants can better relate to and trust the provided information.  And also, probably, because they have recruited teachers from the participating schools, which are more likely to have many African-American teachers.  Teachers are also more likely to be female.

  1. Why have the facilitators been randomized and stratified?

Facilitators must also be randomized so that ages and genders don’t influence outcomes.

Questions 24 to 28 are to be answered by Outcomes and Social Desirability Response Measure

  1. How was the data collected in this study? One method was used in three different ways. What was the method and what are the three ways?

Data was collected by questionnaire before the program, immediately after the program, and at regular longer-term periods over two years.

  1. Over what period?

Between January 2002 and August 2004.

  1. What is the purpose of a pilot study?

The purpose of a pilot study is to ensure the validity of the questions.  In this case, to “ensure that (the questions) were clear, and that the phrasing was appropriate for the population.”

  1. What are the data collectors blind to? Why?

Data collectors were blind to which program each participant attended.  This is to ensure that the collectors’ biases don’t influence their collection methods and thereby the results.

  1. What is your assessment of the authors’ attempt to control for the Bradley effect?

I can’t imagine how their efforts could have any significant influence.  While certainly, if individuals are going to guess in response to research questions, of course they’re going to do so in a socially desirable manner, purely without intent.  However, I don’t believe it’s possible for people to self-report behavior honestly.  They simply don’t remember accurately, even if they’re certain that they do, unless the question addresses immediate single instances of behavior (did you have sex last night?) rather than multiple instances over a longer term, no matter how recent (how many times did you have sex in the last week?)  It just isn’t possible these answers are going to be accurate.  Visually defining the time frame with calendars, and stressing the importance of accuracy makes no difference.

Question 29 is to be answered using the section Sample Size and Statistical Analysis

  1. What reasons did the authors give for choosing these statistical methods? 

Honestly, I have no idea how to interpret the word salad that comprises this section.  But if I were to guess, it would have to do with “analyz(ing) attrition,” testing “intervention effects,” “the efficacy of the HIV interventions” and/or correcting for error, and deciding what results would indicate significance.

Questions 30 to 31 are to be answered using the first two paragraphs and Table 2 of the Results Section.

  1. What are the independent variables? What are the dependent variables?

The independent variables are the education sessions.  The dependent variables are the number of times the girls had sex afterward, and the behaviors that might have changed as a result.

  1. What are some of the reasons a student, average age of 12, would participate in this study? Remember this is Bookstein’s first concern of his three concerns related to surveys/questionnaires/volunteering for studies.  

Plainly, they were all paid to attend.   Participants were not highly invested in the outcome, beyond just showing up to collect the payment, and this fact might skew the results.  It’s possible, though unlikely, that the participants are interested in the information.  The subject is somewhat taboo, and that fact might compel their participation.  Pressure from parents and teachers might also compel participation, and also skew results, out of fear of observation.

Question 32 is to be answered using the final four paragraphs of the Results section.

  1. What are the primary outcomes or effects on the dependent variables (hint sexual behaviors) CAUSED BY the independent variables (hint the different types of intervention programs).

Per Table 3, abstinence-only intervention caused participants to delay having sex longer than other groups.

Per the last four paragraphs of the results section:

“Abstinence-only intervention participants did not differ from the control group in reports of multiple partners.  Participants in the 8-hour and 12-hour comprehensive intervention groups were significantly less likely to report having multiple partners than were those in the control group. No other differences were statistically significant.  None of the interventions had significant effects on consistent condom use or unprotected intercourse.”

In other words, abstinence-only intervention did not affect any of the of the other behaviors.  Comprehensive intervention showed a decrease in the number of partners.

Questions 33 to 34 are to be answered using the Comment section.

  1. Looking at the last sentence of the first paragraph, answering these two questions. What is the gap in the literature these authors are claiming to have filled? Why do the authors use the word “demonstrate” rather than “prove?”

The gap in the literature is the lack of randomized controlled trials.  The authors use the word “demonstrate” rather than “prove” because any self-reported response is not objective, and therefore cannot be considered proof.

  1. Looking at paragraph three, where dear reader would you have liked to have been provided with citations to other research studies to back up the authors statements?

I would have liked citations provided for the first and third sentences, “A common shortcoming of health behavior change is….” and “Although many trials have used booster intervention sessions, this one of few trials….”

Questions 35 to 40 are to be answered looking both at the final paragraphs of the Comment section and the NY Times (if it’s fit to print) Editorial.

  1. Does the Times piece mention the fact that this study would not meet the Federal criteria for the very abstinence program the President cut? 

The Times piece does mention that the program in this study differs from the federally-supported programs.  However, it does not mention that it would not meet the federal criteria.

  1. What do the authors say are the limitations of the study? Are these limitations mentioned in the Times?

The limitations include self-reported data, the “relatively small number of sexually active adolescents,” and the “limited generalizability of the results.”  The editorial does not mention these limitations.

  1. Does anyone else find it interesting that national policy could be influenced by a study that “MAY BE” generalizable only to African American students in grades 6 and 7 who are willing to participate in a health promotion project on the weekends? Who by the way don’t seem to that interested in sex in the first place?

The publishing journal, the Archiives of Pediatric & Adolescent Medicine, ran an editorial cautioning against such policy setting, along with the article.

  1. What or who are the communities that support abstinence only approaches? Why do you think the authors do not mention who these mysterious communities are? Would you like to see at least some citations to other studies here?

Political organizations that receive funding for running abstince-only programs support these approaches.  They are not mentioned in the editorial because it is designed to sway public opinion toward their cause.  Of course, citations are always ideal.

  1. Why did the national press run wild with this story?

The press sensationalized this story because it goes against popular opinion, and they have an agenda to push.

  1. Did they run with it responsibly? 

You would imply there’s such a thing as a responsible press?  There might have been at one point in time.  No longer.  No, they did not run with it responsibly.  To do so, they would have had to reveal the flaws in the study, which they did not do.

  1. What role should librarians play in helping their constituents develop research literacy skills?

Librarians can assist in evaluating resources, and provide instruction on doing so.  I can’t imagine this being done on an individual basis very often.  Classes might provide a better opportunity, with examples like this one, to teach the subtleties of evaluating research.

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