Youth Risk Behavior Survey

According to the 2015 Youth Risk Behavior Survey 41.2% of teens in the United States reported ever having sexual intercourse and 30.1% had been sexually active in the 3 months prior to the survey (CDC, 2015). Teen pregnancy and sexually transmitted infections (STIs) are leading public health problem in the United States (Office of Disease Prevention and Health Promotion, 2017). While it is known that abstinence is the only 100% effective way to prevent these potential problems, over 40% of students are not practicing abstinence; and studies show that abstinence only education (AOE) programs are not effective in reducing sexual risk-taking behaviors (Society for Adolescent Health and Medicine, 2017). Comprehensive sexual education (CSE) teaches medically accurate and age appropriate information about abstinence and contraceptives, but also addresses the psychosocial, emotional, physical and mental aspects of sexuality (SIECUS, 2009). CSE programs show the most promise in helping reduce risky sexual behaviors (Advocate for Youth, 2012).

Sexual health education in United States (U.S.) schools has changed significantly over the past 50 years as a direct result of federal and state legislation and funding. Starting in the 1960’s, in response to the sexual revolution, federal legislation on sexual health education became more progressive. In 1966 the U.S. Department of Education, to address the growing issue of teen pregnancy, funded 645 agencies throughout the U.S. to develop sexual health education programs. While there were no stipulations on the type of sexual health education required, CSE that emphasized birth control was included in many of the curricula. In 1971, President Nixon supported the implementation of CSE in all public schools, emphasizing sex as a healthy part of life, and giving students access to the information required to make informed healthy sexual decisions (Huber & Firmin, 2014).

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The promotion and expansion of CSE was halted in the 1980’s in response to the AIDs epidemic and a push from the religious right (Huber & Firmin, 2014). Legislation was enacted encouraging states to discard CSE and adopt abstinence only education (AOE) (Carr & Packham, 2017). In 1981 the Adolescent Family Life Act was passed with a primary goal to promote chastity and self-discipline; in 1996 the welfare reform law enacted Title V of the Social Security Act that provided grants to states that adopted AOE and its tenets (Lerner and Hawkins, 2016). In order to receive a grant, the curricula needed to cover the eight points of abstinence only education (Table 1). The grants grew substantially between 1996 and 2006, with many states adopting abstinence programs to obtain federal funding. It is estimated that over 2 billion dollars has been spent on AOE in the United States (Donovan, 2017). This trend continued until 2010 when President Obama cut funding to AOE and increased funding to programs that supported CSE (Kaiser Foundation, 2002, Weiser & Miller, 2010). According to Lerner and Hawkins (2016), there are still more federal funding opportunities available to AOE programming than to CSE.


Table 1

Sec. 501(b) of the Social Security Act 8 points that define “abstinence education”

  • Has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity
  • Teaches abstinence from sexual activity outside marriage as the expected standard for all school age children
  • Teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems
  • Teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity
  • Teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects
  • Teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society
  • Teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances
  • Teaches the importance of attaining self-sufficiency before engaging in sexual activity


While the United States government was promoting AOE in schools, leading health and educational organizations were taking a stance for CSE (WHO, 1993). The United Nations Educational, Scientific and Cultural Organization (UNESCO) and the World Health Organization (WHO) view CSE as a human right, with the objective to provide accurate, realistic information and life skills in a nonjudgmental way to help adolescents make informed decisions. Information should be free of stigma and reviewed regularly for inaccuracies (UNESCO, 2015, WHO, 2010). The CDC (2014), recommends comprehensive education delivered by trained instructors that provide information on the benefits of abstinence, but also discusses 16 critical sexual health topics including communication, HIV and STI transmission risks, contraceptives, decision making skills, and the efficacy of condoms (Table 2). The Society for Adolescent Health and Medicine (SAHM) (2017), released a position paper addressing the problems with AOE, recommending it be abandoned due to the lack of evidence of efficacy. Failures identified by SAHM: not meeting the needs of youth in sexual minority, being in violation of the sexual and reproductive rights of youth, and the negative impact of the programs misinformation. The purpose of this review is to examine why U.S. government officials are promoting AOE when leading health and educational organizations are promoting CSE.

Anorexia Nervosa: Abnormally Low Body Weight And Fear Of Gaining Weight

“”Anorexia Nervosa is an eating disorder that has abnormally low body weight and fear of gaining weight. People with anorexia care about what others think of them. Society plays a key role to people who have anorexia because; they put very thin people on the cover of magazines and advertisement. This causes individuals with anorexia to feel, un-pretty, rejected, and fat. This is all based on what the media puts out to the world. (works cited: 1). “”People with anorexia tend to show tend to show compulsive behaviors, may have may become obsessed with food, and often show behaviors consistent with other addictions in their efforts to overly control their food intake and weight. (works cited: # 2).

Some physical symptoms of anorexia nervosa include the following; thin appearance, fatigue, insomnia, dizziness or fainting, bluish discoloration of the fingers, hair falling out or thinning, low blood pressure, dehydration, etc. Emotional and Behavioral symptoms include the following; frequently skipping meals or refusing to eat, have eating schedules like spitting food out after chewing, lying about how much they’ve eaten, social withdrawal, binging foods, etc. (works cited: #1).

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Julie will need to get a referral from her primary care provider to see a psychologist. She will also need to see a psychiatrist to get her mind in a healthy state. Julie will also need to see a nutritionist to get an evaluation and a healthy meal plan. The psychiatrist can then determine how to best treat Julie. It is recommended that Julie seeks therapy as well as her family. Because Julie has severe anorexia nervosa, she will need to be admitted into a hospital so that she can be monitored daily. Because of Julie’s condition, she will have to eat small amounts of foods that have high energy density. 1200 calories would be the starting point for Julie. Julie will have to get fed through a feeding tube because of her weight. As Julie becomes more comfortable with eating, she should gradually increase energy intake. (Works Cited: 1,2,3,4,5).

Outpatients should be weighed weekly and inpatients daily. Weight gain of 1 to 3 pounds is safe for an anorexia nervosa patient. Healthy weight gain is the main focus of treatment for anorexia patients.. Treatment can take up to a few months to seven or several years. If Julie participates and following the orders given to her by her care team, she should be able to recover almost fully in one year. “”Because of the plethora list of complications anorexia causes, one may need frequent monitoring of vital signs, hydration level, and electrolytes, as well as related physical conditions. Severe cases of anorexia require hospitalization and a feeding tube. (works cited #4). Julie and her family must monitor Julie’s vital signs, electrolytes, and hydration level. Julie and her family must keep up with her diet plan, and other treatments. (works cited #5).

Anorexia has the highest mortality rate of 6% among psychiatric conditions. Suicide is one of the causes of death in people with anorexia. Most patients who die with anorexia nervosa, die from medical complications such as an imbalance of electrolytes, and cardiac arrest. Early diagnosis of anorexia can improve the prognosis. It is estimated that 20% of people with anorexia remain chronically ill from the condition. Many people will require ongoing treatment for anorexia for several months up to a lifetime. The longer the disease goes on, the longer the treatment. (works cited #5).

Works Cited

1.) The Clinic, M. (2018, February 20). Anorexia nervosa. Retrieved from

2.) Anorexia Nervosa Signs, Symptoms, Tips & Treatment. (n.d.). Retrieved from

3.) Whitney, E. (2017). Chapter 9 Weight Management: Overweight, Obesity, & Underweight. In Understanding Nutrition (15th ed., pp. 253-256). United States, LA: Cengage.

4.) Epocrates, E. (2018, June 7). Anorexia Nervosa: Practice Essentials, Background, Pathophysiology. Retrieved from

5.) Clinic, M. (2018, February 20). Anorexia nervosa. Retrieved from

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