Sexual and Gender Diverse Adolescents and the Failures of Traditional Education in Public Education: Post #2

* Second part of the term paper titled "Sexual and Gender Diverse Adolescents and the Failures of Traditional Education in Public Education." This post covers the Literature Review portion of the paper.

Literature Review

There has been much discussion and disagreement about how the subject of sexual education should be taught in schools and what information should be provided in those classes. This discussion has included parents and schools as well as local, state, and federal governments and influence has flowed both ways. These conversations tend to revolve around concerns about government involvement in family life and sexual education, parental control of the information taught, moral values that might be included in sexual education, and what constitutes age appropriate sexual behavior. (Shtarkshall et al., 2007) The history of sexual education, which recently has enjoyed a increase in research and publications, illuminates a wide variety of curricula and the ways and means of teaching them. (Blout, 2016) It appears that the only consistency in the teaching of sexual education is the controversy and the zeal of the advocates and reformers that are drawn to it.

Over the last few decades, there has been much research has focused on whether different methods of sexual education have been ‘successful’ in terms of stated goals and the desires of the community. However, even here there is disagreement as to what the goals of sexual education programs are: whether to promote safe sexual behaviors in the events of the initiation of sexual experience, prevent negative consequences of sexual behavior such as sexually transmitted disease and pregnancy, or to restrict any sexual behaviors by individuals before marriage for moral or social reasons. It is also difficult to determine whether curricula or outcomes of sexual education are successful because its difficult to collate data across diverse studies. New research provides data that can be used for changing current programs and making them more efficient and successful for students. As it is generally accepted that public schools are the one institution in our society that is regularly attended by most young people, it is schools that have the widest opportunity and responsibility for teaching and addressing sexual risk taking behaviors. (Kirby et al., 1994; Silva, 2002) While limited sexual education has been available to young people for decades, “the AIDS epidemic would change the way many people viewed sexual education; the question was no longer whether schools would teach sexual education; it was what they would teach, and how, and to what end.” (Zimmerman, 2015)

For the purposes of clarity throughout this review, I would like to clearly define a few terms that will be used going forward:

Abstinence-only sexual education is typically defined as curricula that tell learners that they should wait to participate in sexual intimacy until they are married. (Kirby et al., 1994) These programs may also contain extra lessons on self esteem, communication, decision making, life planning, and cooperative learning. (Denny et al., 2002) To receive federal funding, these programs must also comply with Section 510 A-H of Title V which includes: an exclusive purpose to teach the social, psychological and health gains that are achieved through sexual abstinence, that abstinence is the expected standards for all students and the only certain way to avoid STD’s and pregnancy (Kohler et al., 2008), that a mutually faithful monogamous relationship in the context of marriage is the expected social standard and that sexual activity outside of marriage is likely to have harmful consequences for the student, potential children, and society. It must teach students how to reject sexual advances, how alcohol and drug use increase vulnerability to sexual advances, and the importance of attaining self sufficiency before engaging in sexual activity. (Rubenstein, 2017) Federal law also states that programs that use federal funds can not teach about contraceptives except to emphasis failure rates. (Jeffries et al., 2010)

Comprehensive sexual education (CSE) is defined as programming that seeks to postpone early sexual involvement, but also discusses both abstinence and contraception (the different methods available, instructions for use, etc.) as well as HIV/AIDS prevention. Some comprehensive programming also teaches other pertinent topics: human development and puberty, reproductive anatomy and health, pregnancy and prenatal care, consent, development of positive relationships, decision making, communication and interpersonal skills, and intimacy. (Kirby et al., 1994) Also, this type of sexual education may, if allowed by law, discuss sexual assault, sexual orientation, other sexual behaviors, and gender identity. (Jeffries et al., 2010)

One of the most important and easily quantifiable reasons that successful sexual education is needed can be seen in the recent statistics released for 2015 from the Centers of Disease Control. In that year, a total of 229,715 babies were born to women between the ages 15–19 years, for a birth rate of 22.3 per 1,000 women in this age group. In the same year, young adults (aged 13-24) accounted for an estimated 22% of all new HIV diagnoses in the United States. Half of the nearly 20 million new STDs reported each year were diagnosed in individuals between 15 to 24 years of age. (CDC, Sexual 2017) While 2015 shows birth rates for American teenagers at a record low with evidence suggesting the declines are due to abstinence and consistent contraception use, the teen pregnancy rate in the United States is still substantially higher than in other western industrialized nations, and racial/ethnic and geographic disparities in teen birth rates persist. (CDC, Teen 2017; Stanger-Hall and Hall, 2011)

Because we as a society have determined that pregnancy and sexually transmitted diseases are unfavorable outcomes for adolescents, research identifying distinguishing characteristics in effective sexual education programs- whether comprehensive or abstinence-only- is key. According to Kirby et al., effective programs used social learning theories such as social cognitive theory, social inoculation theory, and cognitive behavioral theory, etc. as a foundation for program development and included a narrow focus on reducing sexual risk-taking behaviors that may lead to STD’s or unintended pregnancy. (1994) According to Jeffries et al., more than 140 national scientific organizations acknowledge that CSE can effectively meet adolescents’ sexual needs. Their conclusions are based upon numerous findings that CSE effectively promotes abstinence and may delay sexual debut, reduce sexual frequency, reduce the number of lifetime sexual partners, reduce the risk of STD transmission, and increase the likelihood of consistent contraceptive use. (2010) Silva, who analyzed the success rates of several studies, found that some studies believe that more parental involvement in teaching sexual behavior may have contributed to higher abstinence rates; however, she acknowledges that parents who were willing and able to participate in these programs may differ in important demographic or lifestyle characteristics from those who did not participate, possibly skewing the data collected. (2002) Through research based on a national analysis of all state data available, Stanger-Hall and Hall show that abstinence-only education doesn't reduce, and likely increases teen pregnancy rates, while comprehensive sexual education that included abstinence as a desired behavior was correlated with the lowest teen pregnancy rates across states. (2011) However, all of these studies have some limitations which make for a shaky foundation when creating new programs and protocols for more effective sexual education. As suggested by Silva, research in sex education could be greatly improved if more efforts were directed to test interventions utilizing random controlled trials, measuring intervening variables variables and a more careful and detailed reporting of the results. (2002)

One clear oversight in both abstinence-only and many comprehensive sexual education programs is the recognition and teaching of sexual diversity. Very little research has been completed with a view to understanding how to recognize and teach individuals who claim a sexuality other than heterosexuality and students who report any form of sexuality other than heterosexuality are removed from studies to keep the results consistent for the majority population studied. For example, Kohler et al. specify in their research that “Individuals reporting sexual orientation other than heterosexual were also excluded as programs do not address same-sex behaviors.” (2008) Denny and Young state that in their questionnaires that sexual intercourse is defined as “ the male’s penis is in the female’s vagina” while Weed and his group of researchers measured data based on “virgin students who went on to have vaginal sexual intercourse.” (2006; 2008) Valenti writes that educators in abstinence-only sexual education are mandated to define the term ‘marriage’ as only “a legal union between one man and one women as a husband and wife” and the word ‘spouse’ as only “a person of the opposite sex who is a husband or wife” (Valenti, 2009) Luker notes in her book that she restricted herself to heterosexuality discussions “as the public discussion itself did.” (2006) Blount states that same sex desire and gender nonconformity have been so strenuously and consistently rooted out of sexual education curricula that the need for rigorous scholarship and additions to sex education protocols is significant. (2016)

This oversight in the acknowledgment and instruction of sexual diversity has come at a high cost to LGBTQI students and young adults. Among young people (aged 13-24) diagnosed with HIV in 2015, 81% were gay and bisexual males. (CDC, Sexual 2017) Data provided from the 2015 National Youth Risk Behavior Survey of surveyed LGBT students states that these students are at an increased risk of being threatened, bullied, or injured on school property or online. LGBT students are also at an increased risk of sexual and physical dating violence, and rape. (no author, LGBT…2017) These students are more likely to have problems with depression and are four times more likely to commit suicide than heterosexual youth. (Frieden et al., 2015) Eight states- Alabama, Arizona, Louisiana, Mississippi, Oklahoma, South Carolina, Texas, and Utah- limit what teachers can say about homosexuality and some of these states require inaccurate information to be shared with students. (Segal, 2017) For instance, Alabama education law requires that sex education programs emphasize that homosexuality is not a lifestyle acceptable to the general public, that homosexual conduct is a criminal offense under the laws of the state, and prevents educators from mentioning “that some methods of sex are safe methods for homosexual sex.” (Rubenstein, 2017) Hess notes that if some abstinence-only providers mention homosexuality, it is mentioned as a lifestyle with shocking negative consequences that can only be solved by marrying someone of the opposite gender. (2010) Therefore, students who do not identify as heterosexual may not find any mention of sexual diversity in their taught curriculum and, if it is mentioned, only negative or possibly inaccurate information is provided. It is important to note that until recently, same sex marriage was not an available option for homosexual individuals, effectively telling these students that they must remain celibate throughout their life span. While the legal union of marriage is now open to either heterosexual or homosexual relationships, many sexual education programs still teach that if you are homosexual, you must remain abstinent unless you marry a partner of the opposite sex. (Hess, 2010) Lastly, teachers who identify as LGBTQI fall in the minority and it can still be a challenge for a teacher that is known to identify as other than heterosexual to keep a teaching job. This discrimination suggests to students that their sexuality can affect future employment unless closeted. (Jennings, 2005; Jackson, 2007)

Another significant problem with specific abstinence-only curricula is how these lessons are taught: metaphors used, abstinence decisions as absolutes, etc. Most abstinence-only curricula do not discuss consent or sexual assault, but do use metaphors that imply that sexual activity degrades the female body. (Valenti, 2009) These metaphors include licked cupcakes or chocolate, sharing cups of spit, chewed up gum, old and worn out shoes, a piece of tape, a rose with no petals, etc. (Rubenstein, 2017) When these metaphors are used or demonstrated to students, many students who have been victims of sexual assault see themselves as broken, dirty, or worthless. These metaphors increase feelings of shame, anger, and embarrassment in victims-- most of whom are women. (Valenti, 2009) Another drawback to using these metaphors is that the use of them can diminish the self worth of individuals who choose to have sex and make them more vulnerable to other health conditions such as depression, eating disorders, etc.

Therefore, it is vitally important that research is conducted and programs tailored to use successful strategies for teaching sexual education to students. An abbreviated listing of sexual education laws per state was compiled by the Guttmacher Foundation in early 2017 which found only 13 states require that the information taught in sexual education protocols must be medically accurate, only eight states require the teaching should be ‘culturally appropriate and unbiased’, and only two states require that sexual education teachings cannot promote religion. (no author, Sex 2017) According to Blount, no program will be successful until the curricula recognize young people as sexual beings, a viewpoint that defies many community assumptions about the sexual innocence of youth. He also states that researchers need to recognize or acknowledge the sexuality of adults who work with adolescents instead of the current standard of assumed asexuality or sexual purity of school workers as a class. (2016) It should also be a given that teachers’ beliefs about the content of sexual education curricula may influence what they teach their students despite what is specifically in the curriculum itself. (Jeffries et al., 2010) Zimmerman suggests that no program will be successful if, at its core, the goals are to control sexuality by fear. (2015) As there is so little consensus on what to teach, how to teach it, when to teach it and what aspects of programs are the most successful, it is vital to encourage further research and scholarship into the matter.

A Spontaneous End to a Day....

So, I didn't go to sleep last night until long after 11pm. I have no really good excuse as I was feeling pretty pooped! However, I decided after work to do some errands and spontaneously decided to pick up the food waiting at the church for a struggling member and head over for a visit. I think these spontaneous decisions sometimes turn out to be some of the most significant choices that I make at certain periods of time in my life. I end up not doing everything that I 'should' – the house is not clean, my bed in not made and I haven't read my scriptures in a few days... but I find that I can look back on the things accomplished, feel satisfied and even find that some of my thoughts and future plans can change to the better. I awoke this morning in a much better frame of mind than I have been in a week.

Two things that were unplanned yesterday is that I did head down to see a member friend and ended up sitting for a few hours and just chatting. I consider this sweet sister my friend and yet I have been so busy over the last few years I haven't really kept up with or spent much time with her. Sitting in a glider with her on her porch– one of my favorite kinds of chairs and a kind I haven't sat in since the divorce- I sat and listened and I talked too. I feel like we both understand each other and what is going on in our lives and hearts much better then we did. I had even left the phone in the car so I didn't notice anyone call or leave emails for me or CPR or anything else until I left around 8:45 pm. I drove away knowing that my commitment of service for this sister had ended and that I have no real service commitments now... and yet I feel a renewed purpose to try and pay more attention not only to her but to others and even in my exhaustion and relief I feel an energy and a motivation to spend more of my energy and resources towards that. I hope I find myself more willing to squeeze in visits like these with people. (Earlier in the week I was invited and circumstances made possible a visit to a family at church whose house I have never been to and to see them outside of church and activities and it was pretty neat too... another spontaneous get together. Maybe that is a lesson I should keep in mind- that I enjoy visiting and joining other people, but it is easier and more enjoyable when it is not planned so I do not have the opportunity to worry or fret about it.)

When I left her house and pointed the car down the road towards home, I received a call from my ex husband and we ended up talking until almost 10:30. We talked about many things and what was fascinating about our chat is that it is the longest call/ conversation we have had since the divorce and it was also the most open and honest one in a long time that didn't get a bit angry and hurtful by either of us by the end of it. We chatted about Bug and then chatted about diets and 'cheating days' and health. After a bit we moved into what I considered more troublesome territory and we talked about Kate Kelly and her recent excommunication and John Dehlin and his appointment this Sunday and the church and gender inequality and modesty rhetoric and sexual assault and power... not a surprise the conversation took a while ;) I talked about what all of this means to me and he talked about the new things that he had learned on the internet and we both found surprises in each other. He was surprised about some of my knowledge on gender and race issues in the church and I was surprised that he had truly taken the time to try and look into all of it instead of just reading an article or two. It felt like he figured I couldn't know some of the flaws in church culture and even past actions and still be a member of the church- in his defense, I can understand that opinion and have had troubles sometimes dealing with those particular problems. We were able to express our thoughts and feelings about a lot of it and learned a bit about some of our actions in regards to church and people in it while we were married. I think that was a great opportunity in an of itself. Trying to turn our relationship into a strong friendship is something that I have been working towards- the better we get along and communicate, the better for Bug after all.... and when the call was over I lay in bed surrounded by slightly annoyed but purring cats. (Didn't I know that it was past bedtime!?! :D ) I thought about the conversation between us and just how amazing and unique it really was. I certainly have a bit to think about over the next few days and weeks in between patients and other work.

So my mind is more hopeful and optimistic today. I am tired but doing OK. Feeling more settled with the world right now and able to see the longer perspective more easily. Life is full of suffering and disappointment, but it is the small choices and the ways we look can really bring out the small joys around and in us. We just have to look for them. :)

Rape, Assault, and the Damage to Individuals and our Society

So, over the last few weeks, we have covered the basic ideas of what trauma and torture are, an understanding of how it affects the individual victims by causing PTSD and other medical problems, and how if affects and changes the actions of family members, friends, and caregivers. So it seems only fitting that this week we look at some of the most common trauma in our society as well as how it changes and impacts our society as well. Some of the most common forms of violence and trauma in American society is physical and sexual assault. Some studies show that the United States has the highest rate of homicide than any other first world nation (approximately 8.3 per 100,000 people) with the exception of the Bahamas and Ecuador. (Isn't that pretty interesting that our country holds itself up as a Superpower and the 'police' of the world, but we as a nation cause just as much harm to each other as we do to other countries... maybe even more. Something to think about when looking at American culture and what we like or want to change about it.) While homicide is at the extreme end of the spectrum of violence, physical assault is much more common place and studies show that a considerable percentage of our population have experienced physical assault at least once in their lives. Adolescents and adults are most likely to be assaulted and both African American and Hispanic populations have higher rates of assault/ homicide over other racial groups.

There are a few subtle and clear paths to see the effects of both physical and sexual assault of the individuals in our society... and therefore, the society as a whole. Studies show that people who have either been victims of crime or family members of the former tend to behave and think differently in a few aspects of their life. Some numbers mentioned in the text express this trend:

1. 36% of family members that have experienced criminal homicide become more careful about their personal safety.

2. 74.7% of people who have had experience with alcohol related vehicular death also admit to taking extra precautions to protect themselves from crime.

3. 11.7% of victims choose to begin carrying a gun

Another number mentioned was that 94% of emergency room visits in 1994 where the patient was seen for violence related injuries, the injuries were attained as part of an assault. In general, women tend to fear being a victim of crime more than men and so they restrict many aspects of their lives and their behavior based on that fear... but most members of our society have some fear of being a victim at some point in their lives and that is a tragic statement in and of itself. Victims of assault (whether physical or sexual) are more likely to develop and have problems with chronic health conditions such as pain, gastrointestinal disorders, headaches as well as other complaints. Other concerns are that these individuals receive more medical care overall, have non normal sexual function, and challenges with somatic symptoms that as twice as frequent as the general population.... as well as bulimia and low body weight. They are less likely to see their health in a favorable light, are more likely to engage in unhealthy behaviors such as smoking and substance abuse and see a future ahead of them that is bleak and devoid of good things. In fact, rape and physical assault victims as associated with the highest levels of PTSD among women when compared with other civilian traumas.

One paradox that I see in our society is that as a rule, the victims of crime are seen as a part of the crime and some blame is attached to them. If a women is raped, it is because of her clothing, her choice to have a drink, her choice of friends, whether she 'fought' hard enough, etc.... I think that we tend to perpetuate this ideal because it helps each of us to 'feel' safer- we don't wear those clothes, etc.... but it is also so embedded into our culture as a way of controlling people – mostly women and minorities- that we don’t even realize that we are doing it. One of the pharmacists that I worked with at one point said that a teenager who was killed was entirely to blame for her own death as she made the choice to go see someone she had only known online and she must have been stupid as well. I was horrified by the statement and nothing I could say to her would change her opinion. However, I think that the textbook worded the thoughts that I was feeling best:

“Predatory assailants, not victims, cause assaults, irrespective of any risk factors the victims might possess.”

“...Studies show that all victim's behaviors are of lesser significance than offender characteristics in determining the outcome of sexual assault...”

It feel pretty conflicting to realize not only how common rape and assault are in our communities, county and the world overall, but to also learn how much these acts cause such long term harm not only to the individuals affected but also to our society as a whole was pretty challenging for me. I hear the terms rape culture and see the way people of both genders react when talking about cases of rape or sexual assault. But to see a brief view of the ripples that these acts are causing across the society I live in is staggering. Even if all assaults both sexual and physical ended today and never happened again in America... it would be generations (if ever) before our society recovered because of the damage caused in the past. I wonder how many of my reactions are involuntary based on my past. I wonder how as people modify their actions and behaviors that we model for the future generations, if we can ever really lose those behaviors.

What are your thoughts?

Sexual Assault and Rape : The Differences Between Perception and Culture

I was challenged to look at both the ideas of rape and sexual assault and what the differences between these two horrible acts might be. At the time, I felt like there can be many differences that would also depend on the environment and mentality of the perpetrator. So here are my thoughts on the issue after my research this week.

Sexual assault can be generally defined as unwanted or inappropriate contact towards anther person that is seen or regarded as sexual in nature. Rape is a form of sexual assault in which a person forcibly or without permission penetrates the victim's body with anything; whether its parts of their body, other objects whether small or large, etc.... and it is still considered rape if the penetration is without consent to any opening of the body...even those that are not necessarily considered sexual orifices. So a person can be sexually assaulted, but not raped in some cases (physically, that is)... but a person who has been raped has also been sexually assaulted. With few exceptions, sexual assault and rape are usually crimes against women and tend to be based on power and dominance instead of love or perceived sexual needs. These behaviors are acts of violence, not acts of equality or caring. While these definitions are easy to understand, they do not also tend to convey the emotional or mental violence that is also inflicted when the physical crime is perpetrated. For many, just the act of reporting the crime or talking about it causes them to feel the 'act' again even though they are safe in the present time. Other challenges that come with the sexual assault/ rape for the victim is dealing with the emotions from the perpetrator that are expressed.

When thought about in these terms and also understanding the general patriarchy of most societies in the world, we can easily see how sexual assault and rape can be used not only to hurt one person but as weapon to cause harm to many people and even a community or society at large. In war, the raping of women is an act that not only causes harm to the victim, but is also an act of revenge and defiance against her husband, her 'protector, her community... and even of her culture and race. While there is much disagreement and debate about Thomas Jefferson and Sally Hemings, his black slave / mistress and whether she could or could not consent in their sexual relationship, few will argue that Mr. Jefferson was in a position of power over her and her family which could limit how much she really was able to consent to their relationship. And few would be willing to disagree with the idea that Mrs. Hemings was picked because she was black and the relationship most likely wouldn't have happened at all if she had been a purely white female. Other ways that rape is used against a culture/race is to attempt to change it genetically- if many of the men are killed and the women are raped or forced into longer term relationships with their assailants, the children born of such unions are usually

considered members of the dominant group and not part of the culture of the child's mother. It is easy to see looking at the past history of many groups of people how this tactic has been successfully used to not only change, but also decimate communities and cultures. (And on an amusing and side note.... isn't it interesting about the use of pure-blood and mud-blood in the Harry Potter books to denote positive or negative connotations... and these were on consensual births! Something to think about in relation to how each of us looks at those of mixed race heritage or bi-racial couples. :) Finally, one of the best ways to defeat your enemy isn't just to kill them, but to truly win you must also demoralize them and mentally defeat them.... to convince them that they are worthless or have lost something that can not be reattained. And that is what makes rape so effective a weapon in so many instances.

There is another way to look at sexual assault and rape and that is through the lens of the culture, society and the people living in it. The definitions I have given for the most part belong to the culture I live in: a first world country. There are some ways these definitions change when we look at the way other societies perceive women as well as girls and even marriage. In some cultures, girls are married at very young ages and that is not only culturally acceptable but encouraged and facilitated by the child's parents. In this country, we have made it very challenging for any female under eighteen to get married – even if they want to! In some areas of the world, girls are married between the ages of 10-12 on average... and sometimes as young as eight! These girls have not chosen this marriage and it is usually facilitated by the girls parents to a man at usually at least a decade older than the young girl. (In September, an article came out about the death of an eight year old girl named Rawan who had died due to internal bleeding caused by the consummation of her marriage to her much older husband. This marriage took place in Yemen). To myself and I suspect for many people I know, this act would be considered rape- whether the young lady had died or not. In this culture, the relationship was acceptable and not considered rape... or could be described as 'tolerable rape' (a rape that is culturally acceptable and sanctioned.) In my culture sitting alone with a man on a park bench is acceptable and even encouraged to get to know each other... in others, that can be considered sexual compromising and the young lady is 'ruined'. It really does have a lot to do with the society in which you live.

What are your thoughts on any of the issues that I brought up in this post? Do you have differing views on how culture defines sexual assault?